copyright © 2006 by mosby, inc. all rights reserved. chapter 11 intravenous cannulation

Copyright © 2006 by Mosby, Inc. All rights reserved.

Chapter 11Chapter 11Intravenous CannulationIntravenous Cannulation


ObjectivesObjectives

Define the term Define the term intravenous cannulationintravenous cannulation

Recall the indications and contraindications of Recall the indications and contraindications of intravenous cannulationintravenous cannulation

Identify the equipment used to perform intravenous Identify the equipment used to perform intravenous cannulationcannulation

Select preferred solutions for use in management of Select preferred solutions for use in management of trauma and medical emergenciestrauma and medical emergencies



Recall the recommended ratio of IV replacement to Recall the recommended ratio of IV replacement to blood loss in patients experiencing hypovolemic blood loss in patients experiencing hypovolemic shockshock

Describe the methods used to determine the proper Describe the methods used to determine the proper IV flow rateIV flow rate

List the advantages, disadvantages, and List the advantages, disadvantages, and complications associated with the use of peripheral complications associated with the use of peripheral veinsveins



Identify the veins that are commonly used for Identify the veins that are commonly used for peripheral intravenous cannulationperipheral intravenous cannulation

Recall the steps used to perform peripheral Recall the steps used to perform peripheral intravenous cannulationintravenous cannulation

Use problem-solving skills with IV lifelines that are not Use problem-solving skills with IV lifelines that are not functioning properly to determine the cause and functioning properly to determine the cause and correct the problemcorrect the problem



List complications associated with IV therapyList complications associated with IV therapy

Demonstrate the steps for discontinuing an IV Demonstrate the steps for discontinuing an IV lifelinelifeline


IntroductionIntroduction

Intravenous cannulationIntravenous cannulation Placement of a catheter in a veinPlacement of a catheter in a vein Administer blood, fluids, medicationsAdminister blood, fluids, medications Obtain blood specimensObtain blood specimens


IntroductionIntroduction

Intravenous cannulationIntravenous cannulation IndicationsIndications

• Cardiac diseaseCardiac disease• HypoglycemiaHypoglycemia• SeizuresSeizures• Shock Shock • Precautionary measurePrecautionary measure

ContraindicationsContraindications• Sclerotic veinsSclerotic veins• Burned extremitiesBurned extremities• Critical patientsCritical patients


Body Substance Isolation PrecautionsBody Substance Isolation Precautions

When performing IV therapyWhen performing IV therapy

Hepatitis B virus (HBV)Hepatitis B virus (HBV)

Human immunodeficiency virus (HIV)Human immunodeficiency virus (HIV)


Body Substance Isolation PrecautionsBody Substance Isolation Precautions

GlovesGloves

Barrier protectionsBarrier protections

Proper disposalProper disposal


IV CannulationIV Cannulation——EquipmentEquipment

IV solutionIV solution Administration setAdministration set Extension setExtension set Needles/cathetersNeedles/catheters TourniquetTourniquet Protective glovesProtective gloves Gown and gogglesGown and goggles

TapeTape Antibiotic swabs/ointmentAntibiotic swabs/ointment Gauze dressingsGauze dressings 10ml-35mL syringes10ml-35mL syringes Vacutainer holderVacutainer holder Assorted blood collection Assorted blood collection

tubestubes Padded arm boardsPadded arm boards


EquipmentEquipment

Intravenous solutionsIntravenous solutions 25 – 1000 mL25 – 1000 mL Clear plastic bagClear plastic bag Two portsTwo ports


EquipmentEquipment

Colloids and crystalloidsColloids and crystalloids Normal saline and Normal saline and

lactated Ringer’slactated Ringer’s 3 L IV crystalloid/1 L 3 L IV crystalloid/1 L

blood lost (3:1)blood lost (3:1)


EquipmentEquipment

Administration setAdministration set Piercing spikePiercing spike Drip chamberDrip chamber Flow clampFlow clamp Drug administration portDrug administration port Connector endConnector end


EquipmentEquipment

Microdrip chamberMicrodrip chamber Precise amountsPrecise amounts


EquipmentEquipment

Macrodrip chamberMacrodrip chamber Large amountsLarge amounts


EquipmentEquipment

IV flow ratesIV flow rates Medical emergenciesMedical emergencies

• ““To keep open” (TKO)To keep open” (TKO)

• Precautionary measurePrecautionary measure

• Administer medicationsAdminister medications


EquipmentEquipment

IV flow ratesIV flow rates Trauma Trauma

• Patient’s responsePatient’s response PulsePulse B/PB/P Capillary refill <6 y/oCapillary refill <6 y/o Cerebral functionCerebral function

• Severe hypovolemic patientSevere hypovolemic patient

• Wide open rateWide open rate

• 2-3 L limit2-3 L limit

• 3-4 times normal flow3-4 times normal flow


EquipmentEquipment

Volutrol chamber Volutrol chamber Specific amountsSpecific amounts Pediatric infusionsPediatric infusions


EquipmentEquipment

Over-the-needle catheterOver-the-needle catheter Through-the-needle catheterThrough-the-needle catheter


EquipmentEquipment

Hollow needle (butterfly Hollow needle (butterfly type)type)


EquipmentEquipment

IV catheter with attached syringeIV catheter with attached syringe


Differences Between Arteries and VeinsDifferences Between Arteries and Veins


Sites for Peripheral Venous CannulationSites for Peripheral Venous Cannulation

Sites used in routine Sites used in routine situationssituations


Sites for Peripheral Venous CannulationSites for Peripheral Venous Cannulation——Other SitesOther Sites


Procedure for PerformingProcedure for PerformingIV CannulationIV Cannulation

Insert spiked piercing Insert spiked piercing into IV baginto IV bag

Drip chamber filled to Drip chamber filled to half wayhalf way


Procedure for Performing Procedure for Performing IV CannulationIV Cannulation

Place tourniquetPlace tourniquet

Make slip knotMake slip knot



Complete band placementComplete band placement

Cleanse siteCleanse site



Pull skin tautPull skin taut——needle needle bevel facing upbevel facing up

Penetrate at juncturePenetrate at juncture



Enter vein from either top Enter vein from either top or sideor side

Watch for blood flashbackWatch for blood flashback



Advance needleAdvance needle

Slide catheterSlide catheter



Remove needleRemove needle

Draw blood sampleDraw blood sample



Release tourniquetRelease tourniquet

Connect IVConnect IV



Secure in placeSecure in place

Commercial deviceCommercial device



Proper disposal of used Proper disposal of used needleneedle



Documentation Documentation Date/time Date/time Type/amountType/amount Device usedDevice used SiteSite Number of attemptsNumber of attempts Flow rateFlow rate Adverse reactionsAdverse reactions Name of EMT-IName of EMT-I



Common puncture sites that use an arm boardCommon puncture sites that use an arm board



ComplicationsComplications PainPain Catheter shearCatheter shear Circulatory overloadCirculatory overload Cannulation of an arteryCannulation of an artery Hematoma or infiltrationHematoma or infiltration Local infectionLocal infection Air embolismAir embolism Pyrogenic reactionPyrogenic reaction


Drawing BloodDrawing Blood

EquipmentEquipment


Discontinuing the IV LifelineDiscontinuing the IV Lifeline

EquipmentEquipment Protective glovesProtective gloves Sterile gauze padsSterile gauze pads Adhesive bandageAdhesive bandage

Close control valveClose control valve

Carefully untape and remove dressingCarefully untape and remove dressing


Discontinuing the IV LifelineDiscontinuing the IV Lifeline

Stabilize tissue with dressingStabilize tissue with dressing

Withdraw catheterWithdraw catheter

Cover puncture site with dressing and tapeCover puncture site with dressing and tape


External Jugular Vein CannulationExternal Jugular Vein Cannulation


Elderly PatientsElderly Patients


SummarySummary

IV cannulation is used for administering IV cannulation is used for administering blood, fluids, or medications into circulatory blood, fluids, or medications into circulatory system and for obtaining blood samplessystem and for obtaining blood samples

IV placement should never delay patient IV placement should never delay patient transporttransport

Normal saline and lactated Ringer's solution Normal saline and lactated Ringer's solution are recommended for prehospital therapy; are recommended for prehospital therapy; they are isotonic crystalloid solutionsthey are isotonic crystalloid solutions


SummarySummary

Crystalloid solutions diffuse out of circulatory system Crystalloid solutions diffuse out of circulatory system quickly; at least 3 L must be administered for every quickly; at least 3 L must be administered for every liter of blood lostliter of blood lost

Two most common administration sets are micro Two most common administration sets are micro (delivers 60 drops/mL) and macro (delivers 10 to 20 (delivers 60 drops/mL) and macro (delivers 10 to 20 drops/mL)drops/mL)

Plastic over-the-needle catheters are most commonly Plastic over-the-needle catheters are most commonly used because they can be better anchored and used because they can be better anchored and permit freer patient movementpermit freer patient movement


SummarySummary

In noncritical patients, use distal veins on dorsal In noncritical patients, use distal veins on dorsal aspect of hand as IV sitesaspect of hand as IV sites

During cardiac arrest, preferred sites are veins of During cardiac arrest, preferred sites are veins of antecubital fossaantecubital fossa

Difficult cannulation can occur in obese persons, Difficult cannulation can occur in obese persons, during shock and cardiac arrest, in chronic mainline during shock and cardiac arrest, in chronic mainline drug users, in elderly patients with "fragile" or "rolling drug users, in elderly patients with "fragile" or "rolling veins," and in small childrenveins," and in small children


SummarySummary

When selecting equipment for IV therapy, ensure When selecting equipment for IV therapy, ensure fluid is clear, not outdated, and bag has no leaksfluid is clear, not outdated, and bag has no leaks

Employ infection control procedures when Employ infection control procedures when assembling administration set, cannulating vein, and assembling administration set, cannulating vein, and attaching IV tubing to catheterattaching IV tubing to catheter

Discard needles appropriatelyDiscard needles appropriately


SummarySummary

Release tourniquet once IV is connected to catheterRelease tourniquet once IV is connected to catheter

Carefully monitor patient for signs of improvement Carefully monitor patient for signs of improvement and for signs of circulatory overloadand for signs of circulatory overload

Some complications of IV therapy are pain, catheter Some complications of IV therapy are pain, catheter shear, circulatory overload, cannulation of artery, shear, circulatory overload, cannulation of artery, infiltration/hematoma, local infection, and air infiltration/hematoma, local infection, and air embolismembolism


Questions?Questions?

copyright © 2006 by mosby, inc. all rights reserved. chapter 11 intravenous cannulation

Documents

intravenous cannulation

iv lifeline slide

problem slide

term intravenous cannulation

iv crystalloid1

equipment administration

equipment colloids

use of peripheral veins