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By the end of this lecture, students shall:
discuss the patient assessment required before
determining the need for IV cannulationidentify potential intravenous cannulation sites
determine cannula type and size
take precautions which must be undertaken wheninserting an intravenous cannula
know the theoretical and practical skills required to
perform intravenous cannulation
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participate in IV cannulation skills stations
demonstrating appropriate techniques and
environmental safety precautionsrecognize strategies to minimise IV cannulation
complications
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Intravenous infusion
(IV) is the installation of a
large amount of fluid
and/or electrolytes, or
nutrient substances into a
vein.
Venipuncture It is sterile technique that
permits insertion of aneedle or a catheter into avein .
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Two liters of water per day are generally sufficient
for adults
90-95% of patients in the hospital receive sometype of intravenous therapy.
It is based on a written doctors order
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Maintain & replace
body stores of water,
electrolytes, vitamins,
proteins, fat & calories
when patient or client
cannot maintain an
adequate intake bymouth
Provide nutrition while
resting the GI Tract
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Restore acid-base
balance
Restore volume ofblood components
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Provide avenue for the
administration of
medication
Administer diagnostic
reagents
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Diagnostic
Venous Blood Testing
Contrast Enhanced
Imaging
Therapeutic
Fluid Resuscitation
Medication Administration
Blood Product Transfusion
Parenteral Nutrition
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Administration of irritant
fluids or drugs through
peripheral access (i.e.highly concentrated, high
osmolarity solutions)
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Advantageused when patient
cannot take oral
medication
permits accurate dose
acts instantly
absorbed quickly by
the body
DisadvantageCarries risk like
bleeding, infiltration,
infection, and allergic
reactions
Limits patient activities
Costly costs more
than any other drug
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Physicians
Dentists
Nurses
Midwives
Pharmacists
Other licensed
health care
professionals
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The IV nurses are
registered nurses
committed to ensure the
safety of all patients
receiving IV therapy
An IV therapy nurse shallbe proficient and
competent in all clinical
aspects of the IV Therapy
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An IV therapy nurse shallperform procedures that
include but not limited to the ff:
Carry out MDs prescription forIV therapy
Perform peripheral
venipuncture (except insertion
of subclavian and cut-down
catheter)
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Prepare, initiate, monitor
and terminate IV therapy
Administer Blood and blood
components as prescribed
Determine solution and
medication incompatibilities
Change IV site, tubing and
dressings, according to IV
therapy standards
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Establish flow rates of solutions,
medications, blood and blood
components as prescribed by
the MDNursing management of
patients receiving IV therapy
and peripheral/central and
parenteral nutrition in various
set-ups (hospitals/home/others)
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Adherence to established
infection control practices
Observation and assessmentof all adverse reaction related
to IV therapy and initiation of
appropriate nursing
interventions
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Appropriate documentation
relevant to the preparation,
administration andtermination of all forms of
IV Therapy
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An IV therapy nurse
shall posses verbal
and writtencommunication
skills in translating
ideas and facts topatients, health
care members and
others
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An IV therapy nurse
have the responsibility
of educating patients
and significant others
on pertinent aspects of
IV therapy
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Continuing education
and staff development
are vital to professionaladvancement. In this
regard, the IV therapy
nurse actively participate
and share knowledge
with other disciplines.
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Legal therapeutic
prescription of a licensed
MD
Thorough knowledge of
the vascular system
Recognition of holistic
approach to patient care
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Individual profession
accountability
Networking and
linkages with external
environment
Collaboration with
members of health
team
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Assessment
Diagnosis
PlanningImplementation
Evaluation
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Sec. 27 (a) Art. V of R.A. 7164:
WHEREAS The Philippine
Nursing Act of 1991 providesthat intravenous injection is
within the scope of nursing and
that, in the administration of
intravenous injections, specialtraining shall be required
according to protocol
established.
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1. Obtain/Check
Doctors order
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Patients name
Type and amount of solution
Flow rate
Type, dose and frequency of
drugs
Others affecting the
procedures
MDs signature
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2. Select the
appropriate
equipment
3 Types of IV Systems
1. Luer Lock injection w/ J-loop2. IV fluid or medication on an
infusion pump
3. IV fluid Gravity Flow infusions
using the macro/microdrip or
Y type tubing
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This device maintainspatent venous access in
patients receiving IV
therapy regularly or
intermittently
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To transfuse accurate dosages
To deliver very large or small
amount of fluid accuratelyTo minimize risk for fluid
overload
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Emergency fluid
resuscitation
Short term medication
infusionBlood and blood products
Colloid administration
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Protective cap
Spike
Medication port
Drip chamber
Tubing
Nozzle/ thumbwheel/roller
clamp/ regulator
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Rubber medication port/ y-port
Luer connector/ connector
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Whats
wrongwith this
picture?
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Determine the following:
Purpose of infusion
Type of infusion
Size and condition of the patients vein
Duration of treatment
Condition of patient
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G26 - neonates
G24 - children/elderly/medical/post op surgical
patients
G22 - children/medical/post op surgical patients
G20 - adult/medical/ post op surgical patients
G18 - surgical patients/ BT
G16 - trauma patients
G14 - trauma patients
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Types of IVcannula
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Parts of IV
Cannula
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with smaller gauges (e.g.
14 ga) representing largerdiameters than larger
gauges (e.g. 20 ga).
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should always be
maintained to protect
the patient, the personperforming the
procedure, and other
individuals involved in
all aspects of care
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Consider Patients:
Medical history
Age
Body sizeWeight
Conditions of vein and skin
Type of fluid/medicationDuration of therapy
Skill at venipuncture
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Ease of access
Use of the non-
dominant extremity
Avoiding joint areas
Avoiding use of the
lower extremities
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Hand Veins Arm Veins
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Foot Veins Jugular Vein
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A vein thats suitable for
venipuncture should
feel round, firm, elastic,
and engorgednothard, bumpy, or flat.
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Successful cannulation
of a peripheral vein
requires proper site
selection, as well asknowledge of the gross
anatomy of a vein.
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Flexed areas
Extensive scars
HematomaInfiltration of
phlebitis site
FistulaSkin disease
Reminder:
If the patients chosen IVsite is hairy, dont
shave the area, instead,
clip/cut the hair.
The IV site and IV tubing
is good for 72 hours
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Dehydration/Hypovolemia
Chronic illness with venous scarring from frequent
IV accessIV drug use with venous scarring
Obesity
Significant edemaTortuous, fragile vessels due to advanced age
Thin vessel walls due to age, steroid use, certain
disease conditions
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3 Fluid Types:
Isotonic
Hypotonic
Hypertonic
REMINDER:
A bottle (1000ml or
500ml) of IVF is good
for 24 hours only. If notconsumed, discard and
hook a new IVF
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Crystalloid
Clear IV Fluid
Colloid
Murky
Dark Fluid
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Same osmolarity as
serum
Remain inside
intravascular
For hypotensive /
HypovolemiaRisk for overload
Examples:
PNSS - Plain Normal Saline
Solution or 0.9 % NaCl
Solution (green)
D5W (5% dextrose in
water) (red)
PLRS - Plain LactatedRingers Solution
(dark blue)
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Less osmolarity than
serum
Causes swelling of the
cells
For dehydration
For hyperglycemia
May cause increasedICP and cardiovascular
collapse
Examples:
Distilled water
0.18% NaCl0.45% NaCl (half
strength normal saline)
0.33% NaCl ( one third
strength normal saline)
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Higher osmolarity
than serum
Shrinking of cellsFor BP stabilization,
increase urine
output, reduce
edema
Examples:Blood products
Albumin
D5NSS (5% Dextrose in normalsaline solution)
D5 in 0.45% NaCl ( 5% Dextrose
in half strength normal saline)
D5LR (5% Dextrose in LactatedRinger's Solution)
D10W ( 10% Dextrose in water)
D50W50 (50% Dextrose in 50
ml of water)
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Hypertonicsolution
No fluid
movement
Fluid
movementinto veins
Fluid
movement
out of veins
Isotonic
solution
Hypotonic
solution
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STARTING
AN IV
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1. Apply tourniquet 5-6
inches above insertion
site
2. Never leave tourniqueton longer than one
minute
3. Then Remove tourniquet
and prepare equipment
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4. Open equipment and connect
flush to J-loop
5. Loosen caps of IV and J-loop
but leave in place for sterility.(They should just slide off when you pickup the device).
6. Cleanse skin with alcohol
solution in back & forth
motion X 30 seconds
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7. Allow to dry for 30 seconds
8. Put on Gloves!!!
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9. Immobilize vein
10. Position needle 10-15 degree
angle over site11. Insert cannula bevel up
12. Watch for blood backflow
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13. Advance cannula
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14. Advance cannula while holding stylet stationary
15. Release tourniquet!!
Stabilize the hub of the canula
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16.Withdraw stylet while putting pressure on veinabove injection site
Stabilize the hub of the canula
Stabilize the hub of the canula
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17. Insert tubing or prn adaptor
Apply pressure aboveinsertion site to slowbleeding
Stabilize the hub of the canulawhile inserting the tubing
Saline flush is already attached and tubingflushed and ready
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18. Flush with saline to clear tubing and insure IV has notinfiltrated.
19. Stabilize tubing with tape to prevent IV from pulling
out while applying the sterile dressing.
Leave the end of the hub of
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Leave the end of the hub ofthe canula outside thedressing so that tubing can bechanged without removing the
dressing.
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21. Date, time and initial site and tubing
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Local Complications:
Hematoma
ThrombosisPhlebitis
Infiltration/
Extravasation
Local infection
Allergic reactions
Systemic Complications:
Venous spasm
Speed shockSepticemia
Air embolism
Circulatory overloadCatheter embolism
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formations resulting
from the infiltration
of blood into the
tissues at the
venipuncture site
Causes:nicking the vein during
an unsuccessful
venipuncture attemptdiscontinuing the I.V.
cannula or needle
without pressure
applying a tourniquet
too tightly above a
previously attempted
venipuncture site
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discoloration of the skin,
site swelling and discomfort
inability to advance the
cannula all the way into the
vein during insertion,
resistance to positive
pressure during the lickflushing procedure
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Choose vein appropriately Location
Size
Soft, spongy, resilient
No pain or tenderness or rednesswith injection
Release torniquet as soon asinsertion is achieved
Remove IV
Check for bleeding
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Inflammation of the vein
wallprecursor to sepsis
What causes phlebitis?
IV left in too long
Cannula too large
Vein in poor conditionAcidic solution or high
osmolality
Infusion rate too fast
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Redness
Puffy area
Hard vein on
palpation
Increase bodytemperature
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Choose vein appropriately
Removed IV
Cold then Warm compress
Elevate site
Notify MD
Restart at large vein or use small
gauge cannula
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Leaking ofnonvesicant fluid
into tissues
surrounding the
vein
Cause : Cannuladislodgement or
perforation of wall
of vein
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Complications: Nerve compression
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coolness of skin around
site
taut skin
dependent edema
absence of blood
backflow
pinkish blood returninfusion rate slows but
the fluid continues to
infuse
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Inadvertent administration of vesicantdrug into surrounding tissues
Calcium
Magnesium
Phenergan
Potassium chloride
Antibiotics
Chemotherapy drugs
Vasopressors(Dopamine,epinephrine)
Dextrose > 10%
Lorazepam
Dilantin
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Mild
Extravasation
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Moderate
Extravasation
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complaints of pain or burning
swelling proximal to or distal
to the IV site
Puffiness limbskin tightness at the
venipuncture site
blanching and coolness of the
skin
slow or stopped infusion
damp or wet dressing
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Stop infusion immediately
Determine treatment prior to removal ofcatheter
Administer prescribed antidoteimmediately
Elevate extremity
Apply ice for 20 min q 4 hrs when indicated
Notify MDDont use same extremity for subsequentIV catheter placement if possible
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> 200,000 infections
per year
More than 60,000
patients die annuallyfrom bloodstream
infections caused by
intravenous therapy
Cost is so expensive
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Cellulitis:
An acute, spreading,
bacterial infection
below the surface of
the skin characterized
by redness
(erythema), warmth,swelling, and pain.
Sepsis:
clinical symptoms of
systemic illness, such
as fever, chills,
malaise, hypotension,
and mental status
changes.
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Poor insertion site
Squad starts
Unsterile startIV left too long
Hub contamination
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Cellulitis
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Check IV site every two hours
Removed IV & restart new site
Warm compress & elevate limbs
Check for pulse & numbness
Notify MD
May start Antibiotic as
prescribed
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If air is introduced into thevascular system, it may
accumulate and cause
complications such asblockage of the right side of
the vascular system (i.e.
venous) leading to outflow
obstruction of the right
ventricle and pulmonary
arteries.
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5 ml / kg of air is needed toproduce an "air lock" of the
right ventricle and
pulmonary artery, circulatorycollapse has been reported
with as little as 20cc of air.
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impaired gas exchangeHypotension
circulatory collapse
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all tubing should be flushed
prior to utilization.
all connections must be tightfluid bags should not be
allowed to completely empty
before replacement.
patient should be placed in a
left lateral recumbent
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