PPT Template for IV Insertion and Removal Overview

PPT Template for IV Insertion and Removal

Overview • Review of knowledge and skills required for peripheral IV access • Supplemental period of structured on-thejob training and competency evaluation for each individual is required in order to successfully apply this knowledge in a clinical setting

Learning Objectives • Identify legal and policy considerations in regard to IV placement • Define the proper technique and procedure for PIV insertion and removal • Identify appropriate intravenous access sites

Learning Objectives • Demonstrate the ability to properly insert a PIV • Demonstrate the ability to properly remove a PIV • Recognize complications that can occur with IV insertions • Demonstrate appropriate documentation of PIV insertion and removal

Definitions • Peripheral Intravenous (PIV) Catheter: A short (less than or equal to 7. 5 cm) intravenous catheter inserted into a peripheral vein. A PIV permits short-term access of the venous system for intermittent or continuous infusion therapy. • Infiltration: Inadvertent administration of a non-vesicant medication or solution into the surrounding tissue. Signs and symptoms can include skin blanching, edema, skin cool to touch, and/or pain.

Definitions • Extravasation: Inadvertent infiltration of vesicant medications or solution into surrounding tissue • Extension Set: Tubing (approximately 15 cm in length) attached to the PIV cannula at time of insertion

Legal/Policy Considerations • Laws concerning medication administration vary by state • Most hospitals also have institutional policies regarding who may insert IV’s and/or administer medication (including ultrasound enhancing agents (UEA) and saline contrast • Starting PIVs requires hospital approval, knowledge of sterile technique and venous anatomy, and awareness of associated risks

Legal/Policy Considerations • For non-nursing staff, many hospitals have IV courses and a certification process • Participation in this course does not completely prepare you to insert/remove PIVs • A competency–based program must also be completed at your facility

Overview of Venous Anatomy • Use appropriate graphics/resources here

Potential Complications of IV Insertion • • • Infection Infiltration Extravasation Phlebitis Hematoma/bruising

Typical Required Supplies • • • Gloves Tourniquet Alcohol wipe Sterile Gauze 20 or 22 gauge angiocatheter • Lidocaine for anesthesia if indicated • Tape or transparent dressing • Sterile Saline • Syringe (fill syringe with saline) • Heparin lock or extension set (prime extension set with saline) • Band-Aid

Typical IV Supplies

Prepare Patient • Identify patient and obtain consent according to institutional policy • Obtain relevant medical history/allergies • Ask patient if they have had prior problems with or contraindications for IV starts

Contraindications for IV Placement • Below site of existing phlebitis • In arm with dialysis access • On side of mastectomy or axillary node dissection • Lumpectomy not a contraindication

Special Considerations • Obese patients • Elderly • Rolling veins

Prepare Patient • Explain procedure according to institutional policy, allowing time for questions • Place patient in a supine position • HAND HYGIENE

Hand Hygiene • Cleanse hands per institutional policy, with attention to space in between fingers and nail beds • Cleanse before AND after IV insertion • Wet hands and apply soap or use antimicrobial cleanser

Potential for Infection • During the use of intravenous devices, micro-organisms may enter the blood stream and cause • • • Local/systemic infections Prolonged hospitalization Increased morbidity/mortality • Risk of infection can be minimized by appropriate universal infection prevention measures

Hand Hygiene Centers for Disease Control (CDC) • Recommendations • • Observe proper hand-hygiene procedures by either washing hands with conventional antiseptic -containing soap and water or with waterless alcohol-based gels or foams before and after palpating insertion sites Use of gloves DOES NOT obviate the need for hand hygiene

Hand Washing Tips • • Scrub per institutional policy Rinse hands from the fingertips to wrist Dry your hands with paper towel Don gloves

Choice of Site • Site influences risk for catheter-related infections and phlebitis • Lower extremity sites have higher rate of infection • Hand veins have lower risk than do veins on the wrist or upper arm • Veins typically considered for PIV placement are those found on dorsal and ventral surfaces of the upper extremity, including the metacarpal, cephalic, and basilic veins

IV Insertion Video • Optional videos may be inserted here

Inspect Arm • Inspect and palpate inner aspects of both arms. Avoid areas of bruising, recent IV sites, or scarring • Identify appropriate site • Start with distal sites and move centrally as needed

Place Tourniquet • Place tourniquet about 3 inches above antecubital fossa or 3 -5 inches above more distal site • Should be snug enough to occlude venous flow • Tourniquet should be placed so you will need only one hand to release it

Vein Selection • Palpate for appropriate vein (straight, long, soft and bouncy) • Tips • • • Ask patient to open and close fist Lower arm below level of heart Warm compress to assist vasodilatation

IV Placement • After identification of site, prepare site • Cleanse area with alcohol or povidoneiodine swab, in a circular motion, starting from the center and working out

IV Placement • Re-apply tourniquet • Prepare catheter for insertion • Use thumb to hold skin taut just below catheter insertion site (helps to stabilize the vein) • Puncture skin and insert catheter with the bevel up at approximately a 30 degree angle

IV Placement • Insert with a smooth steady motion • Level to a 15 -20 degree angle • Observe for blood in the flash back chamber of the catheter • While holding the stylet still, gently push the catheter into the vein • It should go in smoothly and easily • If it does not, do not force it

IV Placement • Release the tourniquet • Remove needle from angiocatheter while placing digital pressure on accessed vein above insertion site (at the end of the cannula) • Immediately dispose of needle in appropriate sharps container

IV Placement • Flush catheter with saline to assure it is patent • Secure catheter with tape or transparent dressing • Place heparin lock, three-way stopcock or extension set on hub of catheter

Site Care • Minimize contamination risk by wiping access port with appropriate antiseptic and accessing the ports only with sterile devices • Cap all stopcocks when not in use with new sterile caps

Unsuccessful Attempts • Remove angiocatheter and apply pressure to venipuncture site • General rule: If you are unsuccessful after two attempts, ask for help

IV removal • Remove tape while securely holding the catheter and skin • Place gauze over IV site and remove catheter • Dispose of catheter in approved container

IV removal • Apply pressure until bleeding stops (about 1 minute) • Apply sterile dressing or band-aid • Provide patient with post-procedure instructions • Documentation per institutional policy

Typical Documentation • • Patient education/consent Date/time Ordering physician Responsible individual Location of IV access/catheter size Complications or inability to obtain access Patient status post-procedure

Summary • Legal/policy considerations • Venous anatomy • Pre-procedure • • • Supplies Patient education/consent Hand hygiene

Summary • Procedure • • Identify site Perform venipuncture • Post-procedure • • • Remove IV Assess and dress site Evaluate for complications Hand hygiene Documentation