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Diagnostic purposesTherapeutic purposes
Maintain patency of theintravenous access
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1.Replace fluids, electrolytes, calories,nutrition
2.Fluid and electrolyte balance
3.Acid-base balance4.provide fluid, electrolytes, calories ornutrition to maintain homeostasis
5.transfuse blood and blood products6.administer medications
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Use distal veinsof the arm first Use the clients non dominant armwhenever possible Select a vein that is:Easily palpated and feels softand full
Naturally splinted by bone
Large enoughto allow adequate circulation around the catheter
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Avoidusing veins that are1. In areas of flexion
2. Highly visible, because they tend to rollawayfrom the needle
3. veins below a previous I.V. infiltration
4. veins below a phlebitic area
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5. Sclerosed or thrombosed veins
6. AREAS of skin inflammation, disease, bruising, or
breakdown
7 An arm affected by a radical mastectomy, edema,blood clot, or infection
8 An arm with an arteriovenous shunt or fistula.
9. In a surgically compromised or injured
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For adults, vein in the hand and arm arecommonly used
For infants, veins in the scalp and dorsalfoot are often used
Larger veins are preferred for infusions thatneed to be given rapidlyand for solutionsthat could be irritating. (e.g., medications )
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8. Apply tourniquet 5-6 inches above insertion site
9. Never leave tourniquet on longer than oneminute
10. Then Remove tourniquet and prepare equipment
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11. Cleanse skin with ANTSEPTIC SOLUTION
12. Allow to dry for 30 seconds
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13. Put on gloves!!!!
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14.Immobilize vein15.Position needle 10-15 degree angle over site
16. Insert cannula.
17. Watch for blood backflow18.Advance cannula
19.Only try twicebefore calling for help
STARTING AN IV (CONT.)
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Advance cannula while holding styletstationary
Release tourniquet!!
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22. Withdraw stylet while putting pressure on
vein above injection site
Stabilize the hub of the canula
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23. Insert tubing or prn adaptor
Apply pressure aboveinsertion site to slow
bleeding
Stabilize the hub of the canulawhile inserting the tubing
Saline flush is already attached andtubing flushed and ready
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It may get messy sometimes, but with experiencethis will be minimized
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24. Flush with saline to clear tubing and insure IV has not infiltrated.
25. Stabilize tubing with tape to prevent IV from pulling out whileapplying the sterile dressing.
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27. Date, time and initial site and tubing
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28.
Document!
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Leaking of nonvesicant fluid intotissues surrounding the vein
Check IV site every two hours
ComplicationsNerve compression requiringfasciotomy
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INFILTRATION
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Administration of vesicant drug intosurrounding tissues
Calcium Magnesium Phenergan Potassium chloride Antibiotics Chemotherapy drugs Vasopressors (Dopamine, epinephrine) Dextrose > 10% Lorazepam
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Cellulitis: An acute, spreading, bacterialinfection below the surface of the skincharacterized 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 lifethreatening.
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Poor insertion site
Unsterile insertion
of I.V line
IV left in too longchangeq 96 hours Hub contamination
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Hand washing Sterile technique
Proper Catheter size
Proper Insertion site
Site inspection every two hours
Encourage patient to report any discomfort
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Central venous catheter/line
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A central venous catheter is a catheterplaced into a large vein in the neck (internal jugular veinor external jugularvein) Chest (subclavian vein) Groin (femoral vein).
http://en.wikipedia.org/wiki/External_jugular_veinhttp://en.wikipedia.org/wiki/External_jugular_veinhttp://en.wikipedia.org/wiki/Internal_jugular_veinhttp://en.wikipedia.org/wiki/External_jugular_veinhttp://en.wikipedia.org/wiki/External_jugular_veinhttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Femoral_veinhttp://en.wikipedia.org/wiki/Femoral_veinhttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/External_jugular_veinhttp://en.wikipedia.org/wiki/External_jugular_veinhttp://en.wikipedia.org/wiki/Internal_jugular_vein8/13/2019 47584698 Principals of i v Acess Dr Arish
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IT IS USED FOR medication or fluids blood tests (specifically the "mixed venous oxygen
saturation"), cardiovascular measurements such as the centralvenous pressure.
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Monitoring of the central venous pressure(CVP) Long-term Intravenous antibiotics Long-term Parenteral feeding Long-term pain medications
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Chemotherapy plasmapheresis Dialysis Frequent blood draws when Peripheral venous access is impossible persistent requirement for intravenous access
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Mal-position of the CVP catheter Pneumothorax/hemothorax/hydrothorax Infection Air embolism hemorrhage arrhythmias
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Venous cutdownis an emergency procedurein which the vein is exposed surgically andthen a cannula is inserted into the vein underdirect vision. It is used to get vascular access
in trauma and hypovolemic shock patientswhen peripheral cannulation is difficult orimpossible. The saphenous vein is commonlyused, but antecubital and femoral vesselsarealso suitable.
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Cellulitis hematoma
Phlebitis
perforation of the posterior wall of the vein
venous thrombosis
damage to the saphenous nerve
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THANKS