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INTRAVENOUS  THERAPY
IV Statistics   85% of all    hospitalized    patients have some    type of IV therapy   118 million IV    catheters ins...
COMPLICATIONS
PHLEBITIS Inflammation    of the vein  wall—precursor to sepsis What causes phlebitis?   IV left in too long   Cannula...
PreventionsChoose vein appropriately     Location     Size     Soft, spongy,      resilient     No pain or      tender...
INFILTRATION Leaking of nonvesicant fluid into tissues surrounding the vein Check   IV site every two hours Complicatio...
EXTRAVASATION   Inadvertent administration of vesicant drug into    surrounding tissues          Calcium          Magne...
INFECTION Cellulitis: An acute, spreading, bacterial  infection below the surface of the skin  characterized by redness (...
INFECTION   > 200,000 infections per year   More than 60,000 patients die annually    from bloodstream infections caused...
Causes   Poor insertion site   Squad starts   Unsterile start   IV left in too long—    change q 96 hours!   Hub cont...
Cellulitis
Prevention Hand washing Sterile technique Catheter size Insertion site Site inspection every two hours Encourage pat...
Patient’s Worst Nightmare!!!!
Other sites to avoid include:• veins below a previous I.V. infiltration• veins below a phlebitic area• sclerosed or thromb...
Muscle Man IV!
STARTING AN IV   Talk with patient   Gather equipment   Set up fluid and tubing on pump   Check patient order and ID b...
1.   Apply tourniquet 5-6 inches above insertion site2.   Never leave tourniquet on longer than one minute3.   Then Remove...
STARTING AN IV (CONT.)   Open equipment and connect flush to J-    loop   Loosen caps of IV and J-loop but leave in    p...
1. Put   on Gloves!!!
STARTING AN IV (CONT.)   Immobilize vein   Position needle 10-15 degree angle over    site   Insert cannula bevel up  ...
Advance cannula while holding stylet            stationary      Release tourniquet!!
Stabilize the hub of the canula22. Withdraw stylet while putting pressure on           vein above injection site
Stabilize the hub of the canulaApply pressure above                      while inserting the tubinginsertion site to slow ...
It may get messy sometimes, but with experience             this will be minimized
•    Flush with saline to clear tubing and insure IV has not infiltrated.3.   Stabilize tubing with tape to prevent IV fro...
Leave the end of the hubof the canula outside the dressing so that tubing can be changed without removing the dressing.1. ...
27.   Date, time and initial site and tubing
STARTING AN IV (CONT.)3.   Document!
What is wrongwith this picture?
Dartmouth
Power Port
CONTINUOUS INFUSION: SECURING THE NEEDLEWhen starting a continuous infusion, you must secure the right-angle, non-coringne...
http://www.youtube.com/watch?v=tfQbbCx6xFU&feature=relatedhttp://www.youtube.com/watch?v=ZcCWTEsEqPg&feature=related   App...
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
40088847 intravenous-therapy
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40088847 intravenous-therapy

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40088847 intravenous-therapy

  1. 1. INTRAVENOUS THERAPY
  2. 2. IV Statistics 85% of all hospitalized patients have some type of IV therapy 118 million IV catheters inserted yearly
  3. 3. COMPLICATIONS
  4. 4. PHLEBITIS Inflammation of the vein wall—precursor to sepsis What causes phlebitis?  IV left in too long  Cannula too large  Vein in poor condition  Acidic solution or high osmolality  Infusion rate too fast
  5. 5. PreventionsChoose vein appropriately  Location  Size  Soft, spongy, resilient  No pain or tenderness or redness with injection
  6. 6. INFILTRATION Leaking of nonvesicant fluid into tissues surrounding the vein Check IV site every two hours Complications  Nerve compression requiring fasciotomy
  7. 7. EXTRAVASATION Inadvertent administration of vesicant drug into surrounding tissues  Calcium  Magnesium  Phenergan  Potassium chloride  Antibiotics  Chemotherapy drugs  Vasopressors (Dopamine, epinephrine)  Dextrose > 10%  Lorazepam  Dilantin
  8. 8. INFECTION Cellulitis: An acute, spreading, bacterial infection below the surface of the skin characterized by redness (erythema), warmth, swelling, and pain. Usually localized. Sepsis: clinical symptoms of systemic illness, such as fever, chills, malaise, hypotension, and mental status changes. Sepsis can be life threatening.
  9. 9. INFECTION > 200,000 infections per year More than 60,000 patients die annually from bloodstream infections caused by intravenous therapy Cost for one patient is $56,000 Annual US total = $2.3 billion
  10. 10. Causes Poor insertion site Squad starts Unsterile start IV left in too long— change q 96 hours! Hub contamination
  11. 11. Cellulitis
  12. 12. Prevention Hand washing Sterile technique Catheter size Insertion site Site inspection every two hours Encourage patient to report any discomfort
  13. 13. Patient’s Worst Nightmare!!!!
  14. 14. Other sites to avoid include:• veins below a previous I.V. infiltration• veins below a phlebitic area• sclerosed or thrombosed veins• areas of skin inflammation, disease, bruising, or breakdown• an arm affected by a radical mastectomy, edema, blood clot, or infection• an arm with an arteriovenous shunt or fistula.
  15. 15. Muscle Man IV!
  16. 16. STARTING AN IV Talk with patient Gather equipment Set up fluid and tubing on pump Check patient order and ID band & allergies Wash your hands!! Select a vein Select a catheter size
  17. 17. 1. Apply tourniquet 5-6 inches above insertion site2. Never leave tourniquet on longer than one minute3. Then Remove tourniquet and prepare equipment
  18. 18. STARTING AN IV (CONT.) Open equipment and connect flush to J- loop Loosen caps of IV and J-loop but leave in place for sterility. (They should just slide off when you pick up the device). Cleanse skin with chlorhexidine gluconate solution in back & forth motion X 30 seconds Allow to dry for 30 seconds
  19. 19. 1. Put on Gloves!!!
  20. 20. STARTING AN IV (CONT.) Immobilize vein Position needle 10-15 degree angle over site Insert cannula bevel up Watch for blood backflow Advance cannula Only try twice before calling another RN to help
  21. 21. Advance cannula while holding stylet stationary Release tourniquet!!
  22. 22. Stabilize the hub of the canula22. Withdraw stylet while putting pressure on vein above injection site
  23. 23. Stabilize the hub of the canulaApply pressure above while inserting the tubinginsertion site to slow bleeding Saline flush is already attached and tubing flushed and ready 23. Insert tubing or prn adaptor
  24. 24. It may get messy sometimes, but with experience this will be minimized
  25. 25. • Flush with saline to clear tubing and insure IV has not infiltrated.3. Stabilize tubing with tape to prevent IV from pulling out while applying the sterile dressing.
  26. 26. Leave the end of the hubof the canula outside the dressing so that tubing can be changed without removing the dressing.1. Apply clear sterile dressing. Cover site and hub, not tubing
  27. 27. 27. Date, time and initial site and tubing
  28. 28. STARTING AN IV (CONT.)3. Document!
  29. 29. What is wrongwith this picture?
  30. 30. Dartmouth
  31. 31. Power Port
  32. 32. CONTINUOUS INFUSION: SECURING THE NEEDLEWhen starting a continuous infusion, you must secure the right-angle, non-coringneedle to the skin. If the needle hub is flush with the skin, apply a transparentsemipermeable dressing over the entire site. If the needle hub isn’t flush with theskin, place a folded sterile dressing under the hub, as shown. Then apply adhesiveskin closures across it. Secure the needle and tubing, using the chevron-taping technique with sterile tape.
  33. 33. http://www.youtube.com/watch?v=tfQbbCx6xFU&feature=relatedhttp://www.youtube.com/watch?v=ZcCWTEsEqPg&feature=related Apply a transparent semi-permeable dressing over the entire site. medisim@lww.com.

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