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47584698 Principals of i v Acess Dr Arish

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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_vein
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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


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