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IV access to a patient provides us with one of the
most direct routes for patient treatment.
Fluid and medications can be immediately introduced into
the body through the circulatory system when
performed correctly.
And it can be one of the safest,
most effective methods.
An important point to remember is making sure you prepare all
the necessary equipment and supplies before you begin.
Sharps container, tape or another securing device for
securing the IV, antiseptic swabs per your local protocol,
gauze pads, site dressings, a latex-free tourniquet,
appropriate-size catheters--
of course based on your patient's needs--
and a Band-Aid.
Your preparation in advance will help you achieve a safe
and sterile intravenous catheterization.
Select the appropriate IV solution, double-checking the
expiration date, color, and clarity.
Administration sets generally come in two sizes, 60- and
10-drop sets.
The appropriate size is determined on your protocols
and patient's medical condition.
To open your solution, tear the outer packaging at the
precut slit on either end of the bag.
Recheck the clarity of the solution and expiration date.
Whenever possible, the IV bag should be hung in a vertical
position with the tail ports extended downward to
facilitate the preparation.
Open the appropriate administration set based on
the patient's condition.
Be certain that the end caps remain in place to preserve
the sterile field of the administration set.
Uncoil the tubing in preparation for
spiking the IV bag.
And if adjunct devices, such as extensions, are to be used,
it should be opened and attached to the administration
set at this time.
Move the flow-control clamp to the closed position and place
it in a convenient location.
Grasp the IV port just above the plastic tab, and with the
other hand pull the plastic tab from the port, being
careful to maintain sterility of the port itself.
Remove the protective cap from the IV tubing spike and insert
the IV tubing spike into the IV port by pushing with a
twisting motion until the spike punctures
the seal of the port.
Squeeze the drip chamber to fill it approximately half
full of fluid.
Open the flow-control clamp and allow the IV fluid to
completely fill the line.
It's often necessary to invert or flick the med ports to
remove larger air bubbles.
Once the line is completely filled with fluid, close the
flow clamp and place the primed line in
position for use.
A second method for spiking an IV bag consists of inverting
the bag so the tail ports extend upward.
Grasp the IV port just below the plastic tab, and with the
other hand pull the plastic tab from the port.
Remove the protective cap from the IV tubing spike and insert
the IV tubing spike into the IV port by pushing and
twisting the spike until it punctures
the seal of the port.
Invert and hang the bag so it's in an upright position.
Squeeze the drip chamber to fill it approximately half
full of fluid.
Selecting a venipuncture area usually involves the hand,
wrist, forearm, or antecubital space.
Inspect it for contraindications for
venipuncture.
Applying a venous tourniquet may help facilitate finding
the appropriate site.
When selecting a vein for cannulation, it may help to
reapply the venous tourniquet approximately four to eight
inches above the selected area.
Cleanse the intended venipuncture site with a
suitable antiseptic swab in an outward motion for at least
two inches.
Allow the alcohol to dry for 30 seconds for bacteria to be
killed and to minimize the discomfort to the patient.
Based on the intent of the IV and the size of the vein
selected, choose an appropriate-size IV catheter.
Remove the catheter from its packaging and
the protective sheath.
Remember to be careful to maintain the sterility of the
needle and the catheter.
And visually inspect the end for any defects, such as
burred edges.
As an optional step, slightly twist the catheter to ensure
the catheter moves freely on the needle.
Grasp the patient's extremity near the area where the IV
will be started, using your non-dominant hand, in order to
stabilize the vein.
This may be accomplished by either pulling traction
distally or holding the extremity circumferentially so
the area is taut.
Ensure that the bevel of the needle is facing upward in
relation to the patient's skin.
While continuing to apply traction to the skin, quickly
but carefully enter the skin with the needle.
A pop may be felt as the needle enters the vein.
In this alternate view, the flash chamber fills with blood
when the needle enters the vein.
Slowly advance the catheter along the needle until the hub
meets the patient's skin.
Palpate the end of the catheter beneath the patient's
skin and occlude the vein with direct pressure.
Attach IV tubing to the catheter hub, making sure not
to push the catheter further in or pull it out.
After releasing the tourniquet, open the IV flow
clamp and observe the flow of fluid into the drip chamber.
With the IV running and before securing the IV in place,
inspect the venipuncture site for signs of infiltration.
If an IV cannot be made to flow properly or infiltration
is observed, discontinue the IV immediately.
If the IV is observed to flow properly, using a gauze pad as
necessary, wipe away any fluid or blood that may be present
in order to dry the site sufficiently
that tape will adhere.
Secure the IV and the IV tubing in place.
Cover the insertion site with a sterile dressing or
commercially available device.
Many taping methods and commercial securing devices
are available, but follow your local protocols.
Adjust the flow rate by closing the flow clamp or
other flow-metering devices to the appropriate setting.
And continue to monitor the patient for signs of fluid
overload, other complications resulting from the IV,
maintain the appropriate flow rate, and watch for
infiltration.
Some protocols may require you to initial and date the IV
cannulation.
Selecting a venipuncture area usually involves the hand,
wrist, forearm, or antecubital space.
Inspect it for contraindications for
venipuncture.
Applying a venous tourniquet may help facilitate finding an
appropriate site.
When selecting a vein for cannulation, it may help to
reapply the venous tourniquet approximately four to eight
inches above the selected area.
Cleanse the intended venipuncture site with a
suitable antiseptic swab in an outward motion for at least
two inches.
Allow the alcohol to dry for 30 seconds for bacteria to be
killed and to minimize discomfort of the insertion.
Based on the intent of the IV and the size of the vein
selected, choose an appropriate-size IV catheter.
Remove the catheter from its packaging
and protective sheath.
As an optional step, slightly twist the catheter to ensure
the catheter moves freely on the needle.
Hold traction distally or circumferentially
so the area is taut.
Ensure that the bevel of the needle is facing upward in
relation to the patient's skin.
While continuing to hold and apply traction to the skin,
quickly but carefully enter the skin with the needle.
A pop may be felt as the needle enters the vein.
The flash chamber should fill with blood when
entering the vein.
But remember, patients with poor perfusion and small
catheters will be slower to show a flash.
Slowly advance a catheter along the needle until the hub
of the needle meets the patient's skin.
Palpate the end of the catheter beneath the patient's
skin and occlude the vein with direct pressure.
For blood draws, leave the tourniquet in place.
Apply the vacutainer to the catheter hub and use the
flanges on the container to facilitate pressure when
inserting blood tubes.
Secure the vacutainer while switching blood tubes.
And after each blood tube is drawn, gently mix the two.
However, follow your local protocols on blood draws.
After releasing the tourniquet, palpate the end of
the catheter beneath the patient's skin and occlude the
vein just proximal to the end of the
catheter with direct pressure.
With your free hand, remove the protective cap from the
end of the IV tubing and attach it to the catheter hub,
making sure not to push the catheter further
in or pull it out.
Open the IV flow clamp and observe the flow of fluid into
the drip chamber.
If the IV does not flow, ensure the tourniquet has been
released and carefully adjust the catheter while observing
the drip chamber, since the tip may be occluded by a valve
or the side of the vein.
With the IV running, and before securing the IV
catheter in place, inspect the venipuncture site for signs of
infiltration.
If the IV is observed to flow properly, wipe away any fluid
or blood so that tape will adhere sufficiently.
Secure the IV and the IV tubing in place.
Cover the insertion site with a sterile dressing or
commercially available device.
There are many taping methods and commercially securing
devices available, so follow your local protocols.
Adjust the flow rate to the appropriate setting and
continue to monitor the patient for signs of fluid
overload or other complications
resulting from the IV.
Select and inspect the IV solution.
Open the outer packaging by tearing the precut slit at
either end of the bag.
Check for clarity and the expiration date.
Shut off the flow clamp on the nearly empty IV bag to prevent
air from entering the IV tubing as the solution bag is
being changed.
Invert the empty bag to prevent any remaining fluid
from running out.
Then remove the IV tubing spike from the bag, using
extreme care to ensure the IV tubing spike does not touch
anything to contaminate the sterile field.
Follow the methods previously described to puncture the new
solution bag.
Discard the used solution bag after noting the approximate
amount of fluid remaining, if any.
Finally, re-establish the IV flow rate.
When discontinuing an IV, we should first close the flow
clamp of the IV administration set.
Gently remove the tape and/or securing device to expose the
venipuncture site.
Cover the venipuncture site with a gauze square and apply
gentle pressure as you remove the IV catheter.
Inspect the catheter to ensure it's complete, noting any
abnormalities.
Affix an adhesive bandage that will continue to apply
pressure until the bleeding has stopped.
And as always, properly dispose of all materials and
monitor the venipuncture site for further bleeding.