IV Lecture

Editor's Notes

• #6: There are disadvantages:Time, skill to establish & maintainMobilityInfectionSevere reactionsAccidental removalHematoma, infiltration (medication or fluid enters the surrounding tissue), & phlebitis (inflammation of the vein).Opens a direct route to the cardiovascular system for microorgansisms. So very important to use aseptic techniques. Placing IV can be risky due to needle stick & exposure to blood borne pathogens (HIV, hepatitis B, Hepatitis C).
• #7: Steel needles not seen as much any more—butterfliesOver-the –needle what we useThrough-the-needle is were you have a inducer as in a PICC line
• #8: Most common IV sites in adults are the lower arm & hand (hand not ideal; movement, painful, & lots of valves)If possible use the non-dominant hand or armMedian cubital vein most commonly use for blood draws but not good for IV site due to this is a joint of flexion.Hand is easy quick access. Try to avoid the wrist in laboring mothers due to bending of the wrist to push. Sites must be rotated q48-72hrs depending on the facility.When placing a IV or changing sites the new site needs to be proximal, meaning above & closer to the point of attachment.
• #9: Subclavian vein—few structures near it, but can cause a pneumothorax (air in the pleural cavity cause clasping of the lung).Always get a chest x-ray to confirm placement.Jugular veins—are easily visualized but lie near major arteries. Pt drool & increase infection risk. Still chest x-ray after placement.Femoral vein—used in emergencies, or unable to place SC due to anatomy/dehydration. Increased risk of infection. No x-ray needed.Intraosseous IV—when unable to get access in emergency placed in the tibia long bone. Faster when pt is in a low flow perfusion state. Risks are fracture, pain, compartment syndrome, & infection. PICC—placed by a specially trained nurse. High risk for blood clots.
• #10: Veins are easy to see and palpate but tend to roll.With age arteries lumen size decreases & harden due to arteriosclerosis (thickening of vessel walls & accumulation of calcium causing vessels to become stiff) & atherosclerosis (accumulation of plaque inside the walls).Veins more fragile.Age also affects the ability to metabolize drugs.
• #11: Most accurate but still room for error. Roller clamps must count gtts per min to calculate gtts per hr. Volume-control device pg 72 in atlas.
• #12: Whole blood—is separated into red blood cells, plasma, & platelets. People rarely need whole blood transfusions.RBC’s—gives blood its color, transports O2, & carries CO2 to the lungs to be exhaled. Made in the bone marrow which is stimulated by the hormone erythropoietin from the kidneys. Transfusion of RBC’s is in the form of packed RBC’s, where most of the plasma & other cells have been removed. Plasma—infused in the form of FFP. Plasma can be frozen for up to a yr. Straw color contains clotting factors & proteins for clotting & antibodies. Platelets—also come from the bone marrow. There is only a small amount in whole blood, so it takes several donors to replace someone who needs platelets. Usually 6-10 pack.Volume expanders (common OR): NS, lactated Ringer’s (NS with some other chemicals), albumin, & hydroxyethyl starch (HES span). Used to prevent pt’s from going into shock from volume loss. Working on developing blood substitutes, still experimental. 18 gauge needle prefered. Can make due with a 20 & even 22 but your pushing it!
• #13: Typed—is A, B, AB, or O. Rh + or -. NS to flush, in case of a reaction. Clamp blood & open NS 3-4 hrs because of the risk for bacterial growth. No faster than 150ml/hr due to risk of circulatory overload resulting in HTN.
• #14: Most common. Piggybacks. Use port closest to the cannula.Solution, TPN, any gtt should be replaced q24hr. Make sure to do your I & O’s at least once per shift.
• #18: ClotAccumulation of air in the pleural space that can result in the collapsing of the lung. Inflammation of the veinAbnormal particle (air, clot, fat, tissue, foreign body) circulating in the blood that can travel & lodge itself in a vessel, thus occluding the vessel.Fluid escaping from the veins into the surrounding tissue. UnobstructedPuncture of a vein for medical purposesSame as extravasation except it is an accumulation, pulling of fluid in the tissue