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Peripheral Intravenous Access

Assess indications and explain procedure to patient/family. A specific surgical consent is not generally obtained.

Indications:

·         Access to the peripheral circulation for blood sampling.

·         Administration of medication, fluids or nutrition.

Contraindications:

1.       Absolute thrombosis

2.       Phlebitis or cutaneous infection

3.       Relative ipsilateral to mastectomy, dialysis shunts, or distal to an area or trauma         

Equipment:

1.       Alcohol swab

2.       Tourniquet

3.       Appropriate size catheter

4.       Tape or occlusive dressing

5.       Filled IV bag and tubing or Heparin trap

6.       Anesthetic and topical (EMLA cream) or local (1% Lidocaine, 1cc SQ)     [OPTIONAL]

Procedure:

1.       Site selection will depend on many factors including:  Patient comfort, accessibility, urgency of IV access, intended use and patient age.  In general, more distal sites should be selected first.  This allows use of a more proximal site if initial attempt is unsuccessful.  Acceptable sites include:  dorsal hand, forearm, antecubital (higher likelihood of position related flow obstruction), foot, lower leg and scalp in children.

2.       Apply a tourniquet proximal under tension.

3.       Consider venous dilation; active or passive pumping of an extremity, warm compress or gravity.  Some advocate a small amount of nitroglycerin ointment.

4.       Clean skin with alcohol swab.

5.       Apply anesthetic.

6.       Stabilize skin by taught traction distally with the non-dominant hand.

7.       Puncture skin at a 30º angle, bevel up, just over or parallel to the vein.  Once blood is seen in the flash chamber, the catheter is advanced over the needle.

8.       Remove needle, connect IV tubing or Heparin trap.

9.       Apply tape or dressing.  Additional dressing or tape may be used to prevent removal.


Complications: Prevention and Management


Complication:

Prevention:

Management:

Bruising and hematoma:

Appropriate technique and catheter size.

Apply direct pressure.

Infection:

Aseptic technique.

(No acute)

 

Fluid extravasation:

Assure appropriate catheter function with saline prior to administering medications.

Removal of catheter.

Thrombosis:

Adequate fluid administration or Heparin flush.

Remove catheter.

Obstructed IV lines:

Adequate fluid administration or Heparin flush.

Aspirate blood if possible, discard, and flush with saline.  If unable to aspirate remove catheter.

Embolism:

Prevent air mixture with fluids;, do not allow IV bags to run dry.

Disconnect catheter and allow fluid to fill tubing or aspirate air from a nearby port using a needle