INTRAVENOUS CATHETERIZATION

Transcription

1 ONTARIO BASE HOSPITAL GROUP INTRAVENOUS CATHETERIZATION PART Ontario Base Hospital Group p. 1 of 42

2 INTRAVENOUS CATHETERIZATION AUTHORS Mike Muir AEMCA, ACP, BHSc Paramedic Program Manager Grey-Bruce-Huron Paramedic Base Hospital Grey Bruce Health Services, Owen Sound Kevin McNab AEMCA, ACP Quality Assurance Manager Huron County EMS REVIEWERS Lori Smith AEMCA, ACP, RN Waterloo-Wellington-Dufferin Base Hospital Rob Theriault EMCA, RCT(Adv.), CCP(F) Peel Region Base Hospital Updated December 2006 Angela Schotsman AEMCA, ACP Hamilton Base Hospital Slide production & animation by Rob Theriault 2007 Ontario Base Hospital Group p. 2 of 42

3 START AT THE BEGINNING PREPARING IV EQUIPMENT IDENTIFYING VEINS SELECTING AN IV SITE IV PROCEDURE COMPLICATIONS OF IV THERAPY FACTORS AFFECTING IV FLOW SALINE LOCK BLOOD TUBING BURETROL PEDIATRIC VASCULAR ACCESS WHEN NOT TO START AN IV SHARP SMART p. 3 of 42

4 STARTING AN I.V USE ASEPTIC TECHNIQUE NO EXCEPTIONS p. 4 of 42

5 STARTING AN I.V BE SAFE WITH SHARPS NO EXCEPTIONS p. 5 of 42

6 Preparing IV Equipment p. 6 of 42

7 Equipment to to start start an an IV IV gloves (plus other PPE PPE as as needed) IV IV bag bag IV IV tubing tourniquet IV IV catheter alcohol swab 2 x 2 dressing transparent dressing strips of of tape tape (3-4) long long sharps container p. 7 of 42

8 then attempt proximal IV attempts: start at a distal site p. 8 of 42

9 Veins of the Hand 1. Digital Dorsal veins 2. Dorsal Metacarpal veins 3. Dorsal venous network 4. Cephalic vein 5. Basilic vein Veins of the Forearm 1. Cephalic vein 2. Median Cubital vein 3. Accessory Cephalic vein 4. Basilic vein 5. Cephalic vein 6. Median antebrachial vein p. 9 of 42

10 Selecting I.V. site - tourniquet on vein anatomy, size of vein valves (stay away from) movement pulsation hardness presence of shunts sites with infection previously used sites (injured, sclerotic) reason for I.V (T.K.V.O, fluid therapy, medication) again, attempt access in a distal to proximal fashion p. 10 of 42

11 Preparation of the vein (s) place arm in dependant position (below the heart) tourniquet to block venous return warm skin flexion arm and hand gentle palpation / tapping p. 11 of 42

12 Tourniquet application and getting veins up p. 12 of 42

13 I.V procedure MENU patient communication site selection assemble equipment (gloves) tourniquet applied cleanse site check catheter for integrity stabilize vein puncture with bevel up observe for flashback in chamber advance catheter 2mm further (drop angle) pull stylet 1-2mm back advance catheter at shallow angle release tourniquet apply transparent dressing place 2x2 under hub connect I.V site assess patency and regulate drip rate secure I.V tubing and site label site with size of catheter, time, date, initials, length of catheter communicate with partner p. 13 of 42

14 Cleaning Site p. 14 of 42

15 Catheterization p. 15 of 42

16 Attaching I.V Set p. 16 of 42

17 Complications of IV Therapy: Local/Systemic Potential complications infiltration, extravasation - local infection - local or systemic fluid overload - systemic catheter/air embolism - systemic speed shock (cold fluid into core) - systemic phlebitis (chemical, mechanical) - local vasospasm - local p. 17 of 42

18 Possible complications Infiltration accumulation of fluid (I.V. or blood, or medication) in tissue S&S: white, puffy, hard, cool, pain, treatment: discontinue I.V., restart I.V. away from site, chart the incident, including what was done to treat it (e.g. cold pack) p. 18 of 42 Extravasation I.V fluid is fluid is flowing into surrounding tissue instead of vein because vein wall is punctured, broken or catheter is outside of vein

19 Infection Infection at insertion site cause: contaminated site or equipment S&S: swelling and tenderness at site IV access is never so urgent that aseptic technique can be bypassed Systemic infection (Sepsis) due to invasion of bacteria, virus, or fungus into bloodstream onset 1-2 days post I.V, fever, chills, shaking, malaise, tachycardia, hypotension cause: use of contaminated equipment or solutions, contamination at site of venipuncture p. 19 of 42

20 Infection p. 20 of 42

21 PHLEBITIS NOT USUALLY SEEN IN SHORT TERM I.V THERAPY INFLAMATION OF VEIN WITH/WITHOUT CLOT FORMATION MENU Mechanical occurs due to motion and pressure of catheter on the endothelial wall Causes catheter too large for vein, movement of catheter within the vein Chemical occurs when an irritating solution is introduced with a catheter that is too large for the vein the relative occlusion of blood flow prevents adequate hemodilution of the solution p. 28 of 42

22 Phlebitis p. 21 of 42

23 Hematoma p. 22 of 42

24 Infiltration p. 23 of 42

25 Tissue Sloughing p. 24 of 42

26 Fluid Overload causes: excess fluid administration, renal failure, cardiac failure S&S: headache, hypertension, coughing, dyspnea, pulmonary edema, restlessness, JVD treatment: slow I.V to TKVO, oxygen, elevate head document and notify receiving hospital p. 25 of 42

27 Air Embolism Air Embolism air inadvertently enters the vasculature and heads through the right side of the heart to the pulmonary circuit and blocks a pulmonary vessel 10 ml air can seriously harm or kill a patient Signs & Symptoms MENU clear chest (or wheezing), coughing, sudden onset of SOB, chest pain, dizziness tests ABGs, lung scan, pulmonary angiogram Treatment administer O 2 2,, put put pt. pt. in in sitting position, IVC IVC filter filter Or Or -- place pt. pt. on on left left side side with with head down trapping air air in in right right atrium report to to hospital staff staff stat stat and and document incident p. 26 of 42

28 CATHETER EMBOLISM Catheter Embolism piece of catheter breaks off entering blood stream will travel to right side of heart and most likely will become lodged in pulmonary capillary bed causing signs and symptoms of a pulmonary embolism tests: CXR risk of PE, CVA, MI DON T RE-THREAD THE NEEDLE THROUGH THE CATHETER WHEN YOU MISS ON INITIAL ATTEMPT(S) p. 27 of 42

29 Factors that affect flow catheter against valve catheter too large for vein vasospasm kinked tube I.V bag too low- i.e. height of bag elevated arm thrombosis flexion tourniquet inadvertently left on amount of fluid in bag low line taped to tight - circulation restricted p. 29 of 42

30 Saline Lock allows for venous access without I.V fluid set attached used for patients that need extricated if only medications needed: good alternative (e.g. seizure patient) prevents fluid overload Limitations can be time consuming catheter can become occluded p. 30 of 42

31 Equipment for for saline lock lock cc cc syringe NaHCL cc cc nebule/vial lock device (prn (prn adaptor) tourniquet IV IV catheter alcohol swab 2 x 2 dressing transparent dressing strips of of tape tape (3-4) long long sharps container p. 31 of 42

32 Blood Tubing if anticipated that patient will need blood administration, it is recommended that one line be started using blood tubing will not be primary I.V line due to time needed for preparation 2 nd I.V. access alternative p. 32 of 42

33 p. 33 of 42

34 Buretrol MENU used for Dopamine administration and intravenous therapy for children chamber holds 150 ml and is measured in 1 ml increments may or may not be used locally Priming a Buretrol ensure all protective caps in place (top valve open) close all roller clamps fill cylinder with 30 ml of fluid use OSCAR method Open clamp Squeeze drip chamber Close And Release prime rest of line fill cylinder to 100 ml piggy back dopamine into another line p. 34 of 42

35 BURETROL Note: Note: Some Some Base Base Hospitals Hospitals allow allow for for a a ml ml bag bag of of NS NS with with microdrip microdrip tubing tubing for for pediatric pediatric patients patients rather rather than than a a Buretrol Buretrol p. 35 of 42

36 Pediatrics Vascular Access preferred site is the largest most accessible vein (arm, leg, hand, foot, scalp) access is difficult as veins collapse during shock and arrest may be necessary to attempt a blind insertion based upon prediction of anatomic location of vein 2 person job immobilize site with board and cling beware of fluid overload use Buretrol or 250 cc bag with microdrip tubing if volume replacement needed use macro set Note: Note: Some Some Base Base Hospitals Hospitals allow allow for for a a ml ml bag bag of of NS NS with with microdrip microdrip tubing tubing for for pediatric pediatric patients patients rather rather than than a a Buretrol Buretrol p. 36 of 42

37 When not to start an I.V. when transport is a higher priority when you think the hospital may want one AV fistula avoid same arm!! Arterio-venous shunt in a hemodialysis patient Starting an IV on the same arm will jeopardize hemodialysis treatment Mastectomy avoid same arm Lymph nodes in the arm on the same side may have been removed as part of the cancer treatment if IV fluid goes interstitial, it won t reabsorb well p. 37 of 42

38 Fistulas and Shunts hemodialysis access in arm for patients with chronic renal failure limited life span, limited number of sites, preserve each site as long as possible fistula identifiable by palpating for a thrill over site once again DO NOT TAKE BLOOD PRESSURE OR PERFORM VENIPUNCTURE ON ARM WITH FISTULA p. 38 of 42

39 BE SHARPS-SMART p. 39 of 42

40 Sharps and needlestick injuries What to do if you have an injury NOTIFY SUPERVISOR IMMEDIATELY COMPLETE INCIDENT REPORT AND DOCUMENTATION COMPLETE ACR DOCUMENTATION (if appropriate) SEEK MEDICAL ATTENTION p. 40 of 42

41 NEEDLESTICK POLICY Ask for local policy BASE HOSPITAL MEDICAL DIRECTIVES Ask for local Standing Orders / Medical Directives p. 41 of 42

42 ONTARIO BASE HOSPITAL GROUP MENU Well Done! OBHG Education Sub Committee Self-directed Education Program p. 42 of 42