IV devices

You will choose the type of device based on clients condition, type of fluid being infused and anticipated length of treatment.

Over the needle catheters ( angiocaths)

A polyurethane or teflon catheter is threaded over metal needle. You pierce the skin and vein with needle, advance the catheter into vein and retract needle.

Ideal for brief therapy. CANNOT give highly irritating or hyperosmolar solutions thru this device bc it will cause severe damage to vein.

Butterfly needle ( wing- tipped catheter)

A short, beveled metal needle with flexible plastic flaps attached to the shaft. You can pink flaps to help insert needle, but after insertion, flatten wings and tape them on skin to prevent dislodgement during infusion process.

Only used for single dose administration or drawing blood and should not be left in place because the inflexible metal needle remains in the vein, a butterfly needle is more likely to infiltrate than a plastic catheter.

Midline peripheral catheter

Midline (VAD) is a flexible IV catheter typically inserted into ante cubital fossa and then advanced into the larger vessels of the upper arm for greater hemodilution. Can be used for longer period of time than a shorter, over the needle catheter. Recommended for 5-14 days. CANNOT administer highly osmolar and irritating solutions through it.

Central venous access devices

A central venous access device (CVAD) is an intravenous line inserted into major vein. Typically, the subclavian or internal jugular vein is used, using surgical asepsis, a catheter is advanced from insertion site into the superior vena cava.

How to change a central line dressing

1). Obtain a sterile central line dressing kit and mask for you and patient.

2). Place pt in semi fowlers position and explain procedure. Ask pt to turn their head to opposite side from insertion side.

3). Put on mask and clean gloves. Carefully remove the old dressing.

4). Inspect site for signs and symptoms of infection and other complications.

5). Remove and discard your gloves. Set up sterile field and open dressing kit. Don sterile gloves, scrub insertion site and surrounding skin with an antiseptic swab. Then clean with chlorhexidine

6). Allow site to dry on its own.

7). Apply transparent dressing. And label name and date and time after dressing change.

Advantages of central lines

Can accommodate highly irritating and hyperosmolar solutions because the blood and solutions mix rapidly at infusion site.

Very easily accessible even in severe fluid depletion. Recommended for infusions with duration greater than 15 days. Nutrition can be given parentally. Phlebitis, extravasation, and infiltration are LESS LIKELY to occur with central lines. Central lines with extra ports allow you to withdraw blood from a port to use for lab results.

Disadvantages of central lines

Patient consent required. Placement is treated as minor surgical procedure and must be confirmed by radiography. Placement and dressing changes require strict sterile technique. Several possible risks( sepsis, air embolus, ventricular dysrhythmias, pneumothorax).increased risk for catheter related bloodstream infection and sepsis than peripheral sites.

Preventing central line- associated bloodstream infection stream infections

To help prevent these infections: encourage and teach patients to report any changes or new discomfort in their catheter site. Hand hygiene + gloves. full barrier precautions for insertion includes drapes for patient, head cover, mask and sterile gown and gloves. Chlorhexidine skin antisepsis. Optimal catheter site selection. Type of catheter to reduce the risk of catheter related infection, the catheter with the fewest number of ports and lumens needed to manage the patient is best. Daily review of lines.

Types of central venous catheters

Four types of CVAD: peripherally inserted central catheters, nontunneled CVCs, tunneled CVCs, and implanted ports.

Peripherally inserted central catheters ( PICCs)

Long, soft, flexible catheters inserted at the antecubital fossa through the basilica, or cephalic vein of the arm. The catheter is the advanced into the superior vena cava. A qualified provider performs the insertion. PICC lines are most commonly used for prolonged IV antibiotic therapy, parenteral nutrition, and chemotherapy. A PICC line is intended for intermediate-to-long-term use and does not need to be replaced unless the site appears infected or the catheter is no longer patent.

Non-tunneled CVCs are inserted by a qualified provider through the skin into the jugular, subclavian and occasionally, femoral veins. They are sutured in place. These may have numerous of lumens or ports. Intended for shorter use than a PICC line( less than 6 weeks and should not be routinely replaced). Nontunneled CVCs account for majority of centra, lime associated bloodstream infections (CLABSIs).

Tunneled central venous catheters.

Intended for long-term use. Inserted by surgeon through tunnel in the chest wall and then into jugular or subclavian vein. End of catheter comes out through the skin and is sutured in place, with the sutures . CVCs tunneled through the skin rather than through a vein and therefore have a lower risk of systemic infection.