Module 3 Peripheral Intravenous

Purpose of IV Therapy

Maintain daily fluid and electrolyte balance, replace fluid and electrolyte losses, correct fluid and electrolyte imbalances, and provide access to venous system for medication administration

IV Therapy Absorption Characteristics

Absorption into bloodstream is immediate with rapid onset; medications have immediate physiological response

Peripheral IV (PIV)

Most common type of IV for short-term therapy; accesses superficial veins of hand and forearm for IV fluids, medications, and blood products

14 Gauge (Magenta) IV Catheter

Used for trauma patients requiring large volume resuscitation

16 Gauge (Gray) IV Catheter

Used for major surgery, large volume infusions, and unstable patients

18 Gauge (Green) IV Catheter

Used for large volume infusions, multiple or rapid transfusions

20 Gauge (Pink) IV Catheter

Used for medications, hydration, and transfusions; most common general purpose size

22 Gauge (Blue) IV Catheter

Used for small veins, common for short-term access; usually cannot administer blood products

24 Gauge (Yellow) IV Catheter

Used for fragile small veins and pediatric population; last resort for adults

Primary IV Lines

Continuous primary infusion that may have intermittent secondary infusions; can be bolus of fluid or intermittent; administered via pump or gravity; additives run slowly over time

Venipuncture Technique

Position patient comfortably, dilate vein by pumping fist with hand lower than heart or stroking downward, cleanse with chlorhexidine and allow to dry, stabilize vein, insert with bevel up

Intermittent Venous Access Device (IVAD)

Also called saline lock; provides intermittent access to venous system without continuous fluid infusion

IV Site Monitoring Frequency

Monitor every 1 hour for dressing integrity and intake and output

Phlebitis

Inflammation of vein due to mechanical trauma from needle or catheter or chemical trauma from solution

Phlebitis Scale

0 = no symptoms, 1 = erythema and possible pain, 2 = erythema, edema, and pain, 3 = erythema, edema, pain, streak formation, and palpable venous cord, 4 = symptoms of grade 3 with palpable venous cord >1 inch and purulent drainage

Phlebitis Treatment

Remove catheter, restart IV away from phlebitis site, apply warm compresses, document phlebitis and treatment, monitor site to ensure healing

Infiltration

Leakage of non-vesicant IV fluid into surrounding tissue causing swelling and discomfort

Infiltration Scale

0 = no symptoms, 1 = edema

Infiltration Treatment

Apply warm compresses for hypotonic solutions or cool compresses for isotonic or hypertonic solutions, elevate extremity, remove catheter and restart elsewhere, document infiltrate and treatment

Extravasation

Leakage of a vesicant medication into surrounding tissue; any amount of vesicant infiltration is considered an extravasation

Vesicant Medications

Any medication that can cause blistering, severe tissue injury, or tissue necrosis; examples include chemotherapeutic agents (vincristine, vinblastine), catecholamines (dopamine, epinephrine, norepinephrine, levophed), and other medications (gentamycin, mannitol)

Extravasation Treatment STOP Method

STOP infusion, Remove IV, Clean the site, Notify physician, Notify pharmacy for antidote

Sepsis from IV Therapy

Life-threatening complication of infection that can progress from puncture wound; chemicals released to fight infection trigger systemic inflammation causing multiple organ damage

Sepsis Symptoms

Fever, difficulty breathing, low blood pressure, fast heart rate, and mental confusion

Sepsis Treatment

Antibiotics and intravenous fluids

Absorption Speed Hierarchy

IV is fastest, IM is fast, SC and ID are slowest routes of medication absorption

IV Medication Conversion Formula

Ordered dose divided by available concentration equals volume to administer; example: 0.125 mg ÷ 0.25 mg/mL = 0.5 mL

Chlorhexidine IV Site Preparation

Antiseptic used to cleanse IV insertion site; must be allowed to dry completely before venipuncture for maximum effectiveness

IV Catheter Bevel Position

Bevel should be facing up during insertion to facilitate smooth entry through skin and into vein