must follow OSHA standards ALWAYS!
which are the following
- hand washing before and after
- wear gloves
- no artificial nails
- never reuse a needle or catheter
- injection parts must be aseptically cleansed
- scrub the hand for 15 seconds
- swab caps required
- never leave any used or unused needles left unattended
tourniquet is used to cause what?
an increase pressure to make it easier to see the vein
always check allergies prior to what?
- to know which cleaning solution to use on the patient
- be sure to use appropriate solution for equipment
always let the skin dry prior to inserting the iV
however, you NEVER do what?
never blow- let it air dry to avoid getting germs onto skin
always make sure to have supplies ready prior to getting started
T/F
true
do you need to have an order to insert an iV?
yess
when checking your order, you check for what?
date/time to start the infusion, solution, route, dose, rate, and duration
is it easier to insert an iv into a calm or anxious patient?
into a clam patient, if they are anxious it causes vasoconstriction in the veins
blood should NEVER going into a gauge smaller than what?
20 gauge
the smaller the catheter, the easier...
the easier it slows
proper assessment to prevent complications
never put in on a limb alert arm or one that has a fistula
which veins are the preferred site?
metacarpal (hard)
which direction do you want to work towards ?
never work toward your fingers, always want to working and the catheter is going in the direction of your heart
- begin with distal veins and work your way up
- non-dominant arm preferred but NOT required
Dorsal digital veins (finger veins)
- small gauges
- support with board or tongue blade
metacarpal veins (hand vein)
considered primary IV site; first choice for site selection
cephalic vein (thumb side)
can accommodate large bone needles
basilic vein (pinky side)
- often used for PICC lines
- good choice for peripheral lines as well
do you put IV lines in diabetics feet?
NEVER put IV lines in diabetics feet!
does the DR. need to order a IV insertion in the lower extremities?
yes, you as the nurse cannot make the call
knowing how long to leave on a tourniquet is very important, why?
to avoid causing damage make that call!
do you want to insert an IV in a varicosed vein?
NOOOO, NEVER! can cause patient to bleed
pediatrics require what kind of tubing?
microdrop tubing and PUMPS ONLY!
older adults facts
- lower, slower infusions
- frequent lung assessment
- extra padding and securement to protect skin
in older adults that are receiving fluids, what do you want to assess?
check the lung sounds to assess for possible fluid overload
the bigger the number the smaller the catheter
factsss or false
facts
16 gauge
GRAY
traumas, emergencies, blood products
18 gauge
green
traumas, emergencies, blood products
20 gauge
pink
most commonly used
22 gauge
blue
smaller veins
24 gauge
yellow
pediatrics, elderly, very small veins
trouble visualizing idialating veins ?
have patient dangle their arm for several minutes
how long should a tourniquet stay on for?
no more than 2 minutes
where do you want to play the tourniquet ?
4-6 inches above insertion site
Cleansing Skin
center then outward 2-3 inches with chlorahexidine (chloraprep), or alcohol, or bedtime
- allow to dry
- check allergies
- don't touch after cleansing
performing venipuncture with IV catheter
- needle bevel up
- 15-30 degree angle
when you see a ''FLASH OF BLOOD" in the cannula, after inserting the IV needle, what do you do next?
advance the catheter 1/4-1/2 inches to ensure the needle is all the way in.
-flush line to be sure its patent; may also aspirate for blood
things to remember when inserting the IV catheter
- hold the stylet in place and remove the tourniquet
- THEN remove the stylet
- attach PRIMED extension set, aspirate for blood return then flush (assess for infiltration)
- apply transparent dressing to the site (secure the extension tubing with tape)
- label the IV site with date-time-gauge-initals
- document- including site,gauge,dressing,complications,attempts, did pt tolerate &how
why do you want to check for infiltration prior to giving any medications/ IVFS
- can aspirate for blood
- flush line
- check surrounding area of IV site
factsss about flushing an iv site
- flush every shift or every day- check policy
- 3-10 ml NS
- when flushing do NOT force if you meet resistance (do further assessment)
IV site dressings
- transparent dressings should be used in order to monitor the IV site closely (tegaderm)
- change dressing as per facility policy or Q 72 hours
- change PRN if soiled or loose
when discounting an IV catheter
- LPN IS ABLE TO PERFORM
- gloves needed
- stop IV infusion if applicable & detach from IV catheter
- loosen tape
- Hold IV site with a 2x2 gauze - DO NOT USE ALCOHOL- will prolong bleeding time
- pull catheter out while holding the gauze over the catheter site
- hold pressure x 1 minute
- apply dressing/band aid
- check site
- check for intact catheter after its removed, discard and document removal
- catheter are radiopaque-can be seen on x-ray