NRSG 302 Week 5

What is a PVAD

Peripheral venous access device

Inserted into a peripheral vein and are most commonly used for IV access for fluid therapy, medication and blood administration

How long can a PVAD be left in?

Can remain in situ as long as it is needed, patent and free of complications

Best practice is not to resite just to resite

How many mL NS is needed to saline lock?

3 mL

How many mL Ns is needed after meds, PPN, blood draws and transfusions?

10 mL

What should you inspect the IV site for?

Pain, blanching, erythema, induration, fluid leak, purulent drainage, tenderness

How often should an IV be checked

Q1h with infusion or q shift without

How often are dressing changes required for IVs

Q7D and PRN

Why do we access veins instead of arteries?

Low pressure, less blood loss, less muscle (more shallow)

What are vesicants?

Solutions/drugs which destroy tissue if the IV goes interstitial

Hypertonic

Greater concentration of solutes than blood plasma

Causes cells to shrink and water moves into vascular space

Useful for treatment of hypovolemia and hyponatremia

What to watch for with hypertonic fluids

Volume overload or pulmonary edema

Examples of hypertonic fluids

3% NS, D51/2NS, D5LR, D10W

Isotonic

Same concentration of solutes as blood plasma, ideal fluid replacement for volume deficiency

Does not change the volume of a cell

Examples of isotonic

NS, RL, D5W

Hypotonic

Causes the cell to swell

Lesser concentration of dissolved solutes than blood, causes movement of water from vascular system into tissue

Gauges and colours of IVs

Yellow = 24

Blue = 22

Pink = 20

Green = 18

Grey = 16

When is a 24g used

Babies, fragile veins or short 1 time infusion as an outpatient

When is a 22g used

Allows for good flow of infusate, as well as small enough for most veins to have good flow around the catheter to dilute infusate

When is a 20g used

Preferred for blood to decrease damage to cells, preferred for CT contrast under pressure (inserted at ACF)

When is an 18g used

Rapid infusions/traumas

When is a 16g used

Mass/rapid infusions

Most people do not have big enough veins for this, replace ASAP

Does every new IV need a new bag and line?

Yes

What to include in documentations for IV initiation

Site, gauge, number of attempts, flush, insertion, dressing, site assessment, patient tolerance

Catheter embolism

As a result of catheter fracture, breaks off into bloodstream

S/S of catheter embolism

Catheter dysfunction, leaking at insertion site, localized pain, swelling, palpitation, arrhythmias, dyspnea, cough, thoracic pain

Phlebitis scale 0

0 - no symptoms

Phlebitis scale 1

Erythema at access site with or without pain

Phlebitis scale 2

Pain at access site with erythema or edema

Phlebitis scale 3

Pain at the access site with erythema or edema and streak formation with palpable venous cord

Phlebitis scale 4

Pain at the access site with erythema or edema, streak formation, palpable venous cord > 2.54 cm in length, purulent drainage

Infiltration scale 0

No symptoms

Infiltration scale 1

Skin blanched, edema > 1in in any direction, cool to touch with or without pain

Infiltration scale 2

Skin blanched, edema > 1-6in in any direction, cool to touch with or without pain

Infiltration scale 3

Skin blanched, translucent, gross edema > 6in in any direction, cool to touch, mild to moderate pain and possible numbness

Infiltration scale 4

Skin blanched, translucent, skin tight, leaking, discoloured, bruised, swollen, gross edema > 6in in any direction, deep pitting tissue edema, circulatory impairment, mod to severe pain, infiltration of any amount of blood product, irritant or vesicant