CPL Flashcards

Peripheral IV (most common)

• • Inserted by a RN

• • Small catheter and short in length

• • In peripheral vein

• • Short term

Peripheral Inserted Center Catheter (PICC)

• • Inserted by a certified RN

• • Via a peripheral arm large vein that extends through the venous system into the superior vena cava

• • In place for weeks to months

Central Venous Line (CVL)

• • Intensive settings (ICU, Surgery)

• • Directly into subclavian, internal, or external jugular veins

Why is caring for the IV site important?

• • Prevent what?

• • Infection

• • Phlebitis, infiltration, extravasation

• • Promote patient comfort

Caring for the IV Site

• Step 1: Assess the IV site for any redness, swelling, irritation, discharge, pain or discoloration.

• Step 2: Palpate the surrounding area to check for pain, temperature and edema

• • Step 3: Check Patency

  • • By ensuring that any continuous infusion fluids are actually running.

  • • Check for the correct ORDERED IV fluid rate

  • • Check that it is the correct ORDERED fluid

  • • **If no fluids are running: Flush the IV and ensure it flushes easily and with no pain/discomfort.

• • Step 4: 

  • Ensure that the dressing is clean, dry and properly secured. Replace the dressing if needed.

• Step 5: What if there are complications?

  • • Remove the existing IV catheter

  • • Insert a new IV catheter (with orders) in a NEW location

  • • Notify the provider for severe IV complications

  • • Replace the IV tubing according to facility protocol

  • • Ensure there are no kinks/obstructions in tubing

Phlebitis

• “Inflammation of the vein”

• • Warm Skin

• • Redness

Infiltration

• • IV fluids or IV Medications that have “leaked” into the surrounding tissues

• • Cool Skin

• • Can quickly lead to hematoma

Extravasation

• • Damaging MEDICATIONS that have leaked into surrounding tissues

• • Warm, red and PAINFUL skin

• • While rare…it can lead to limb loss

What medicines can cause extravasation?

• • Levophed (norepinephrine)

• • MANY chemotherapy drugs!!

• • Acyclovir (antiviral)

Discontinuing IV Site

• 1. Hand hygiene

• 2. Don clean gloves

• 3. Clamp the IV tubing (if fluids are running)

• 4. Remove the tape and dressing while holding the IV catheter

• 5. Apply a sterile gauze over the site without putting pressure on vein

• 6. Using the opposite hand withdraw the catheter by pulling straight back

• 7. Apply pressure until bleeding stops

• 8. Examine the site

• 9. Apply tape over the gauze

• 10.Check the catheter for intactness

• 11. Dispose of catheter

Assessing the IV and equipment:

• • Assess the IV site, tubing, and the pump (if used) every 1-2 hours starting on initial patient rounds or if the patient complains of pain/tenderness or the pump alarms

• • Change IV catheter per agency policy or for redness, swelling, pain, etc

• • Verify that the correct solution is infusing and at the correct rate. Solution should be <24 hours old

• • Ensure that the tubing is labeled with date/time. If not, prepare to change it during your shift

• • Ensure that the tubing is not kinked, laying on the floor, or laying underneath the patient

• • Ensure that the pump is plugged in and the extension cord is not a tripping hazard

• • Ensure that the pump alarms are not silenced

• • Change the IV site per agency guidelines or if complications develop

Frequency of IV Tubing Changes (check your agency policy):

• • All tubing must be change using aseptic technique

• • If possible, coordinate IV tubing changes with IV solution changes (i.e., change the entire system instead of tubing one day, and then new IV solution a few hours later). Decreases the risk of infection.

• • Every 72-96 hours for primary, continuous IV infusions

• • Every 24 hours for secondary set tubing

• • Every 24 hours for total parenteral nutrition infusions with fat emulsions

• • Sooner than the above recommended times if the tubing becomes disconnected or contaminated

• • Immediately if cloudiness or precipitate is seen in the IV solution or tubing

• • If the IV tubing is not labeled with time/date initiated

• • Blood tubing is changed between each unit of blood or every 4 hours whichever comes first

Tube occlusion

• • May occur if the tubing is kinked or bent. Tubing may become kinked if caught under the patient or on equipment, such as beds and bed rails.

Vein spasms

• • Irritating or chilled fluids may cause a reflex action that causes the vein to go into spasm at or near the intravenous infusion site.

• • Bring to room temperature prior to infusion.

Height of the fluid container

• The IV tubing drip chamber should be approximately 3 feet above IV insertion site for gravity infusions

Location/position of IV cannula

• • If the cannula is located in an area of flexion (bend of an arm), the IV flow may be interrupted when the patient moves around.

• • To avoid this issue, replace IV cannula or place the patient on a wrist or arm board (if replacement is not an option)

Needle or cannula gauge/diameter

• The smaller the needle or cannula, the slower the fluid will flow.

Accidental touching/bumping of the control clamp or raising arm above heart

• • Instruct the patient not to touch the roller clamp and to take care not to bump the clamp, as this may accidentally change the flow rate.

• • Instruct patient to keep hand/arm below heart level; an elevated hand/arm will slow or stop an infusion running by gravity.

Circulatory overload 

• • Distended neck veins

• • Increased BP and HR

• • SOB and decreased SpO2

• • Crackles in lungs

• • Edema

• • Confusion

• • Seizures

• • Cardiac arrythmias

  • • Stop the infusion and raise HOB

  • • Obtain VS and SpO2

  • • Notify the HCP

  • • Adjust the IV rate

  • • Administer O2 and diuretics and other medications as indicated

  • • Monitor I&O and electrolytes

  • • Document

Infiltration and Extravasation 

• • Pallor

• • Swelling

• • Cool skin temperature

• • Leaking or damp dressing

• • Slowed rate of infusion

  • • Stop the infusion and remove the IV catheter. Vesicants (i.e., chemotherapy) require actions per specific protocols

  • • Notify HCP for infusions with KCL, vasoconstrictors, or other potential vesicants

  • • Elevate the extremity

  • • Apply or warm or cold compress depending on the type of solution

  • • Restart the infusion proximal to the site or a different extremity

  • • Monitor old site closely for s/s of tissue damage and document

Phlebitis 

• • Edema

• • Throbbing, burning, or pain at insertion site

• • Warm skin temperature

• • Erythema or a red line up the vein

• • Slowed rate of infusion

  • • Stop the infusion and remove the IV catheter

  • • Elevate the extremity

  • • Apply warm compresses 3-4/day

  • • Restart the infusion proximal to the site or a different extremity

  • • Monitor old site closely for s/s infection and Document

Local Infection 

• • Throbbing, burning, or pain at insertion site

• • Warm skin temperature

• • Erythema or a red line up the vein

• • Possible purulent drainage

  • • Notify HCP and culture drainage (if ordered)

  • • Cleanse site with alcohol before removing the IV catheter. Save it for possible culture.

  • • Restart the IV proximal to the site or a different extremity

    • • Monitor old site closely and document

Air Embolism

• • Sudden onset of SOB, chest pain, hypotension, tachycardia, decreased LOC

  • • Clamp the IV tubing to prevent more air

  • • Place on left side with HOB up

  • • Call for emergency support

Bleeding at the IV insertion site 

• • Continued oozing at the insertion site

  • • Assess if IV catheter is still within the vein

  • • Apply clean sterile dressing or 2x2 gauze to absorb blood. Change as needed