IV CatheterizationVTHT 1491- Special Topics

Ms. Liddell

CTVT: Chapter 20 (pg: 607-610) VTDRG: Chapter 8 (pg: 349-351)

Learning Objectives

Describe the procedure for placement and care of a peripheral intravenous catheter

Describe the indications and procedure for placement and care of a jugular catheter

List requirements for monitoring of patients with intravenous catheters

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IV Catheterization Used for:

Temporary access for medications, fluid and electrolyte replacement therapy, or

transfusion of blood products

IV Catheterization

Catheter site selection depends on: Available vessels Condition of vessels Patient Expense Urgency of situation

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IV Catheterization

ComplicationsPhlebitisLocal cellulitisSepticemia Collapsed veins or hematomas rendering

veins unusable

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IV Catheterization Types Winged needle (butterfly) catheter

Plastic wings on needle shaft facilitate placement and taping (if needed)

Tubing extending from needle to syringe connector port allows maneuverability

Is for short-term useUsed for:

blood collection Administration of non-irritating

medications Moves out of vessel easily because of needle

IV Catheter Types Over-the-needle catheter

Used primarily for peripheral vein catheterization

Come in many different sizes (gauges) that coordinate (color) with needle sizes

Needlepoint extends beyond catheter tip for entry into vein

Once catheter is placed, needle is withdrawn from insertion site

MOST COMMON IV CATHETER USED

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IV Catheter Types Through-the-needle

Usually longer than over-the-needle catheters (8- to 12-inch) and are primarily used for jugular vein

Once catheter is placed, needle is withdrawn from insertion site and a needle guard is placed over needle

Protects needle from sticking animal and shearing catheter

IV Catheter Types Multi-lumen catheter

Have two to three separate lumens allowing simultaneous infusions at one catheter site

Placement is usually completed per- cutaneously with a guidewire

More expensive than other catheters

Used primarily in Jugular catheterization

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Peripheral Catheterization Sites Dogs and cats Cephalic, medial saphenous (cat) and

lateral saphenous (dog) 20-gauge, 22-gauge, and 25-gauge, 1- to

1.5-inch catheters

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Peripheral Vein Catheterization Supplies ClippersAntiseptic scrub and solutionsCatheterA syringe filled with flush

heparinized salineSaline

Injection cap or T-connectorTape and/or non-absorbable sutureBandage material

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Peripheral Vein Catheterization Procedure

Shave area of insertion site Surgical prep with antiseptic scrub and solutionAseptic technique is important to prevent infectionA relief hole may be made with a #11 blade or 20-

gauge needle to reduce frictionIndicated in severely dehydrated patients or

patients with tough skinOcclude vein proximal to insertion site with

tourniquet or an assistant

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Peripheral Vein Catheterization Procedure cont..

Grasp distal portion of leg and extend it to help immobilize the vein

With bevel up, insert catheter through skin or relief hole at approximately 15-degree angle

Advance catheter into vessel; when blood flashes in (hub), needle and catheter are advanced together as a unit for an additional 1-4 mm

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Peripheral Vein Catheterization Procedure cont..

Hold needle still and advance the catheter ONLY into vessel

Cap catheter with an injection cap or T-connector and flush catheter

Secure catheter with tape wrapped around hub of catheter and then around leg

Taping in of Peripheral Catheters

Taping techniques vary from person to persona and hospital to hospital

There is not one “right way” to tape a catheter in

Always remember to: Secure the catheter hub and injection port Never secure tape to tightly Be sure patients leg is dry prior to applying tape

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Jugular IV Catheterization Procedure

Site chosen is shaved and surgically prepped Wipe or spray with betadine solution, left to dry on 2-5 ml of lidocaine given ID over and above

insertion site Create sterile field by opening sterile gloves, and

laying opened catheter on gloves Other items are either placed on sterile field or in

cold sterilization tray Sterile gloves are worn

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Jugular IV Catheterization

Hold catheter in dominant hand—other gloved hand occludes jugular

Insert catheter into skin at approximately 45-degree angle, toward heart

Flash of blood in hub indicates vessel is hit, advance centimeter more

Hold needle still, sliding catheter into vessel; remove needle

Check to make sure vein is still catheterized by applying digital pressure

Attach a PRN or T-port and suture catheter into place

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Jugular IV Catheterization

Apply small amount of antibacterial ointment before placing wrap over catheter

Wrap neck or apply stents over catheters to stabilize them and to prevent them from getting rubbed out

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IV Catheter Maintenance

If any of these things occur, remove catheter and place a new one in a different location: Phlebitis Infection Thrombosis Leaking at insertion site by itself or during a flush Pain upon injection Any portion of the catheter is exposed

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IV Catheter Maintenance

If catheter site looks good, then clean with iodophor or chlorhexidine solution

Recommended not to leave a catheter in place longer than 72 hours

If bandage gets wet, reason should be identified and bandage changed

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IV Catheter Maintenance

If patient is chewing at bandage, reason should be investigated

Catheters not continuously used should be flushed with 4 U/ml of heparinized saline (1000 units/ 250 ml normal saline) every 4 hours

Bags of heparinized saline are discarded every 12-24 hours to minimize risk of contamination