Intravenous Lines: Difference between revisions

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== Peripheral IV (PIV) ==
== Peripheral IV (PIV) ==
[[File:Peripheral IV.JPG|thumb|379x379px|PIV]]
[[File:Peripheral IV.JPG|thumb|379x379px|PIV]]
Overview:
'''Overview:'''
* Common and preferred method for short-term therapy (< 6 days)
* Common and preferred method for short-term therapy (< 6 days)
* A short intravenous catheter is inserted by percutaneous venipuncture into a peripheral vein  
* A short intravenous catheter is inserted by percutaneous venipuncture into a peripheral vein  
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* Upper extremities are the preferred sites for insertion  
* Upper extremities are the preferred sites for insertion  
* Usually attached to IV extension tubing with a positive pressure cap
* Usually attached to IV extension tubing with a positive pressure cap
Complications:
'''Complications:'''
* Chemical and mechanical complications include phlebitis, infiltration, extravasation, hemorrhage, and local infection.
* Chemical and mechanical complications include phlebitis, infiltration, extravasation, hemorrhage, and local infection.
* Systemic complications include pulmonary edema, air embolism, catheter embolism, and catheter-related bloodstream infection.
* Systemic complications include pulmonary edema, air embolism, catheter embolism, and catheter-related bloodstream infection.
Safety Considerations:
'''Safety Considerations:'''
* Increased risk of systemic complications in cardiac and renal patients as well as pediatric patients, neonates, and the elderly
* Increased risk of systemic complications in cardiac and renal patients as well as pediatric patients, neonates, and the elderly


== Central Venous Catheter (CVC) ==
== Central Venous Catheter (CVC) ==
Overview:
'''Overview:'''
* Also known as a central line or central venous access device
* Also known as a central line or central venous access device
* Inserted into a large vein in the central circulation system (guided by ultrasound)
* Inserted into a large vein in the central circulation system (guided by ultrasound)
* Tip of catheter terminates in the superior vena cava leading to an area just above the right atrium
* Tip of catheter terminates in the superior vena cava leading to an area just above the right atrium
* Can remain in place for more than a year
*[[File:Central Venous Catheter.jpg|thumb|373x373px|CVC with 3 lumens]]Can remain in place for more than a year
Sub-types:
'''Sub-types:'''
* Peripherally inserted central catheter (PICC)
* Peripherally inserted central catheter (PICC)
* Subcutaneous or tunneled central venous catheter ("Hickman", "Broviac", "Groshong")
* Subcutaneous or tunneled central venous catheter ("Hickman", "Broviac", "Groshong")
* Implanted central venous catheter (ICVC, or port-a-cath)
* Implanted central venous catheter (ICVC, or port-a-cath)
Commonly seen in patients who:
'''Commonly seen in patients who:'''
* require antineoplastic medications
* require antineoplastic medications
* are seriously/chronically ill
* are seriously/chronically ill
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* require medications with a pH greater than 9 or less than 5 OR osmolality of greater than 600mOsm/L
* require medications with a pH greater than 9 or less than 5 OR osmolality of greater than 600mOsm/L
* have poor vasculature
* have poor vasculature
* have had multiple PIV insertions/attempts
* have had multiple PIV insertions/attempt
Safety Considerations:
'''Complications:'''
* Heightened risk for developing a nosocomial infection (need strict adherence to aseptic technique)
* Assessment should include :
** type of CVC and insertion date
** dressing is dry and intact
** lines and sutures are secure
** insertion site is free from redness, pain, or swelling
** positive pressure cap is attached securely
** IV fluids are running through IV pump
** number of lumens and type of fluid running through each lumen
** vital signs
** respiratory/cardiovascular examination to check for signs and symptoms of fluid overload
Complications:  
* pulmonary edema
* pulmonary edema
* mechanical complications
* mechanical complications
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* damage to CVC line
* damage to CVC line
* Catheter migration
* Catheter migration
 
'''Safety Considerations:'''
* Heightened risk for developing a nosocomial infection (need strict adherence to aseptic technique)
== Administration Equipment <ref name=":1" /> ==
== Administration Equipment <ref name=":1" /> ==


== Assessment<ref name=":1" /> ==
* type of CVC and insertion date
* dressing is dry and intact
* lines and sutures are secure
* insertion site is free from redness, pain, or swelling
* positive pressure cap is attached securely
* IV fluids are running through IV pump
* number of lumens and type of fluid running through each lumen
* vital signs
* respiratory/cardiovascular examination to check for signs and symptoms of fluid overload
== References  ==
== References  ==


<references />
<references />
[[Category:Acute Care]]
[[Category:Acute Care]]

Revision as of 04:28, 18 April 2019

Original Editor - Jin Yoo Top Contributors - Jin Yoo and Kim Jackson  

Introduction [1][edit | edit source]

In the acute care setting, intravenous (IV) lines have varied functions:

  1. to infuse fluids, nutrients, electrolytes, and medication
  2. to obtain venous blood samples
  3. to insert catheters into the central circulatory system

Common areas of placement are in the forearm or back of the hand.

Types of Venous Access [2][edit | edit source]

Peripheral IV (PIV)[edit | edit source]

PIV

Overview:

  • Common and preferred method for short-term therapy (< 6 days)
  • A short intravenous catheter is inserted by percutaneous venipuncture into a peripheral vein
  • Held in place with a sterile transparent dressing to keep site sterile and prevent accidental dislodgement
  • Upper extremities are the preferred sites for insertion
  • Usually attached to IV extension tubing with a positive pressure cap

Complications:

  • Chemical and mechanical complications include phlebitis, infiltration, extravasation, hemorrhage, and local infection.
  • Systemic complications include pulmonary edema, air embolism, catheter embolism, and catheter-related bloodstream infection.

Safety Considerations:

  • Increased risk of systemic complications in cardiac and renal patients as well as pediatric patients, neonates, and the elderly

Central Venous Catheter (CVC)[edit | edit source]

Overview:

  • Also known as a central line or central venous access device
  • Inserted into a large vein in the central circulation system (guided by ultrasound)
  • Tip of catheter terminates in the superior vena cava leading to an area just above the right atrium
  • CVC with 3 lumens
    Can remain in place for more than a year

Sub-types:

  • Peripherally inserted central catheter (PICC)
  • Subcutaneous or tunneled central venous catheter ("Hickman", "Broviac", "Groshong")
  • Implanted central venous catheter (ICVC, or port-a-cath)

Commonly seen in patients who:

  • require antineoplastic medications
  • are seriously/chronically ill
  • require vesicant/irritant medications
  • require toxic medications/multiple medications
  • require central venous pressure monitoring
  • require long-term venous access/dialysis
  • require total parenteral nutrition
  • require medications with a pH greater than 9 or less than 5 OR osmolality of greater than 600mOsm/L
  • have poor vasculature
  • have had multiple PIV insertions/attempt

Complications:

  • pulmonary edema
  • mechanical complications
  • catheter-related bloodstream infection
  • infection at insertion site
  • air embolism
  • occlusion of CVC (mechanical or thrombus)
  • damage to CVC line
  • Catheter migration

Safety Considerations:

  • Heightened risk for developing a nosocomial infection (need strict adherence to aseptic technique)

Administration Equipment [2][edit | edit source]

Assessment[2][edit | edit source]

  • type of CVC and insertion date
  • dressing is dry and intact
  • lines and sutures are secure
  • insertion site is free from redness, pain, or swelling
  • positive pressure cap is attached securely
  • IV fluids are running through IV pump
  • number of lumens and type of fluid running through each lumen
  • vital signs
  • respiratory/cardiovascular examination to check for signs and symptoms of fluid overload

References[edit | edit source]

  1. Dutton M. Introduction to Physical Therapy and Patient Skills. New York: McGraw Hill; 2014.
  2. 2.0 2.1 2.2 Doyle GR, McCutcheon. Clinical Procedures for Safer Patient Care. Victoria, BC: BC Campus; 2015 Available from: https://opentextbc.ca/clinicalskills/ [Accessed 18th April 2019].