Lecture Outline • Types of intravenous access • Equipment for intravenous access • IV drug administration • Venous blood sampling • Intraosseous infusion Intravenous (IV) Access • Indications – Fluid and blood replacement – Drug administration – Obtaining venous blood specimens for lab analysis • Types – Peripheral venous access – Central venous access Intravenous (IV) Access • Contraindications – Patients with no indications for an IV – In an arm with an A-V fistula – Distal to a fractured bone site – Through skin damage with more than erythema or superficial abrasion. Peripheral IV Access Sites IV, IO, Blood Sample INTRAVENOUS FLUIDS Colloids • Colloids remain in the circulatory system for a long time. – Plasma protein fraction (plasmanate) – Salt poor albumin – Dextran – Hetastarch (hespan) Crystalloids • Primary out of hospital solutions – Isotonic solutions – Hypertonic solutions – Hypotonic solutions • Prehospital Solutions – Lactated Ringer’s – Normal saline solution – 5% dextrose in water Packaging of IV Fluids • Most packaged in soft plastic or vinyl bags. • Container provides important information: – Label lists fluid type and expiration date. – Medication administration port. – Administration set port. IV Solution Containers IV Solutions • Do not use any IV fluids after their expiration date, any fluids that appear cloudy, discolored, laced with particulate, or any fluid whose sealed packaging has been opened or tampered with. IV Administration Sets • Macrodrip – 10 to 20 gtts = 1 ml, for giving large amounts of fluid. • Microdrip – 60 gtts = 1 ml, for restricting amounts of fluid. • Blood tubing – Has a filter to prevent clots from blood products from entering the body. • Measured volume – Delivers specific volumes of fluids. IV Administration Sets • IV extension tubing – Extends original tubing. • Electromechanical pump tubing – Specific for each pump. • Miscellaneous – Some sets have a dial that can set the flow rates. Macrodrip and Microdrip Administration Sets Measured Volume Administration Set Intravenous Cannulas • Over the needle catheter • Hollow needle catheter • Plastic catheter inserted through a hollow needle Over the Needle Catheter Hollow Needle Catheter Catheter Inserted Through the Needle IV, IO, Blood Sample PERIPHERAL IV ACCESS Peripheral IV Access • Place the constricting band Peripheral IV Access • Cleanse the venipuncture site Peripheral IV Access • Insert the intravenous cannula into the vein Peripheral IV Access • Withdraw any blood samples needed Peripheral IV Access • Connect the IV tubing Peripheral IV Access • Secure the site Peripheral IV Access • Label the IV solution bag IV, IO, Blood Sample PERIPHERAL INTRAVENOUS ACCESS IN AN EXTERNAL JUGULAR VEIN External Jugular • Place the patient in a supine or Trendelenburg position External Jugular • Turn the patient’s head to the side opposite of access and cleanse the site External Jugular • Occlude venous return by placing a finger on the external jugular just above the clavicle External Jugular • Point the catheter at the medial third of the clavicle and insert it, bevel up, at a 10°– 30° angle External Jugular • Enter the jugular while withdrawing on the plunger of the attached syringe IV, IO, Blood Sample INTRAVENOUS ACCESS WITH A MEASURED VOLUME ADMINISTRATION SET Burette • Prepare the tubing Burette • Open the uppermost clamp and fill the burette chamber with approximately 20 ml of fluid Burette • Close the uppermost clamp and open the flow regulator Factors Affecting IV Flow Rates • Constricting band • Edema at puncture site • Cannula abutting the vein wall or valve • Administration set control valves • IV bag height • Completely filled drip chamber • Catheter patency IV Access Complications • Pain • Circulatory overload • Local infection • Thrombophlebitis • Pyrogenic reaction • Thrombus formation • Allergic reaction • Air embolism • Catheter shear • Necrosis • Inadvertent arterial puncture • Anticoagulants Changing an IV Bag or Bottle • Prepare the new bag or bottle. • Occlude the flow from depleted bag or bottle. • Remove spike from depleted bag or bottle. • Insert spike into the new IV bag or bottle. • Open the clamp to appropriate flow rate. IV, IO, Blood Sample INTRAVENOUS BOLUS ADMINISTRATION IV Medication Administration • Prepare the equipment IV Medication Administration • Prepare the medication IV Medication Administration • Check the label IV Medication Administration • Select and clean an administration port IV Medication Administration • Pinch the line IV Medication Administration • Administer the medication IV Medication Administration • Adjust the IV flow rate IV Medication Administration • Monitor the patient Saline Lock Infusion Pump Syringe Type Infusion Pump Discontinue • Remove any IV that will not flow or has fulfilled its need IV, IO, Blood Sample DRAWING BLOOD Indications • You should obtain venous blood in the following situations: – During peripheral access – When drug administration may be needed – Before drug administration Blood Tubes Blood Tubes Order # Tube Colour Collection Tube Purpose 1 Aerobic/Anaerobic Blood Cultures 2 Light Blue Sodium Citrate Tube sodium citrate as an anticoagulant - coagulation studies 3 Red Serum Tube contains no anticoagulant - serum for selected chemistry tests, clotted blood for immunohematology 4 Gold SST Gel Separator Tube contain a special gel that separates blood cells from serum, as well as particles to cause blood to clot quickly 5 Light Green PST Gel Separator Tube with Contains lithium heparin for plasma separation Heparin 6 Dark Green Heparin Tube contains sodium heparin - used for collection of heparinized plasma or whole blood for special tests 7 Lavender EDTA Tube EDTA as an anticoagulant - used for most hematological procedure 8 Grey Fluoride Tube contains potassium oxalate as an anticoagulant and sodium fluoride as a preservative - used to preserve glucose in whole blood and for some special chemistry tests Vacutainer and Luer Lock Obtaining a Blood Sample • Obtaining a blood sample with a 20 ml syringe Luer Sampling Needle IV, IO, Blood Sample INTEROSSEOUS INFUSION Intraosseous Infusion • A rigid needle is inserted into the cavity of a long bone. • Used for critical situations when a peripheral IV is unable to be obtained. • Initiate after 90 seconds or three unsuccessful IV attempts. Tibia IO Needle Placement • Pediatric and adult intraosseous needle placement sites. – Proximal humerus – Proximal tibia (most common) – Distal tibia – Sternum Intraosseous Needles EZ-IO System Illinois IO Needle Interosseous • Prepare the equipment • Select the appropriate site • Clean the site • Make the puncture Interosseous • Aspirate to confirm proper placement. Interosseous • Connect the IV fluid tubing Interosseous • Secure the needle appropriately • Adjust flow rate accordingly Complications • Fracture • Thrombophlebitis • Infiltration • Air embolism • Growth plate damage • Circulatory overload • Complete insertion • Allergic reaction • Pulmonary embolism • Infection Contraindications • Fracture to tibia or femur on side of access • Osteogenesis imperfecta – Congenital bone disease resulting in fragile bones • Osteoporosis • Establishment of a peripheral IV line IV, IO, Blood Sample INTRAOSSEOUS MEDICATION ADMINISTRATION Interosseous Medication Administration • Administer the medication • Monitor the patient for effects Summary • Types of intravenous access • Equipment for intravenous access • IV drug administration • Venous blood sampling • Intraosseous infusion