Intravenous Therapy

Intravenous Therapy
HAFIZ AHMAD KHATTACK

SKILL L AB TECHNOLOGIST INS - KMU
Peripheral Intravenous Cannulation
Intravenous therapy:
It is the infusion of fluids into a vein. The therapeutic goal is to maintenance,
replacement, treatment, diagnosing, monitoring, palliation or combination of
all.
Venipuncture / IV Cannulation:
“Peripheral intravenous cannula is a procedure in which the patient skin is
punctured with a needle to allow insertion of temporary plastic tube into a
vein.”
(Morris and Tay, 2008)
Anatomy and Physiology of vein
Blood vessels have three layers:
Tunica intima
(Inner most epithelia tissue)
Tunica Media
(Elastic smooth muscles fibrous and
nerves supply)
Tunica externa
(Outer coat)
Veins of the Upper Extremities
Veins of the Hands and Foot
External Jugular Vein
It is the last choice if IV line
Indications of Peripheral IV
-To maintain or replace body stores of water, electrolytes, vitamins, proteins,
fats and calories in patients who cannot maintain an adequate intake by mouth.
-To administer safe and effective, continuous or intermittent infusions of
medications.
-To restore volume of blood components.
-To administer blood and blood products
-To obtain blood samples for lab tests.
-Administration of total parenteral nutrition (TPN).
-To administer a bolus preparation or IV push medication such as in CPR
Contraindications of Peripheral IV
- Oral medications can be given effectively.
- IM medications can be given effectively.
- Patient is sensitive or allergic to IV equipment.
- Coagulation disorders (unless IV is needed to treat the condition).
- Peripheral access is not preferred for long term IV therapy, e.g., chemotherapy
Which veins to be avoid?
-Thrombosed // fibrosed -Do not use arm on the side of the
mastectomy because of impaired blood
-Inflamed / bruised flow through lymphatic system.
-Hard or Thin / -Have undergone multiple previous
-Near bony prominences, painful punctures
-Areas or sites of infection, edema or -Avoid sites that are easily moved or
phlebitis bumped.
-In the lower extremities (unless none -Avoid areas of joint flexion and veins
else available) close to arteries and deep underlying
tissues.
-Do not use an arm with a fistula.
Which gauge of cannula?
Cannula color code & gauge Specific indications
16 and 14 gauge (orange and gray)  Used in high risk surgical procedure
 Large volume replacement
 Requires a large vein
18 gauge (Green)  Used in trauma, blood transfusion and for CT scan
with dye (requires large vein)
20 gauge (Pink)  Fluids maintenance e:g NPO patients
 Most commonly for IV drugs and infusions
 Suitable for non-emergent blood transfusion
22 gauge (blue)  Older adults and IV fluid maintenance
 Suitable for slow speed infusions
 Chemotherapy patients
24 gauge (yellow)  Used in pediatrics / elderly adults or difficult vein
Complications:
Infiltration:
It is a condition in which a non-vesicant
solution or medication enters the
surrounding subcutaneous tissue.
Complications:
Extravasation:
It is similar to infiltration, with an
inadvertent administration of vesicant
solution or medication into the
surrounding tissue, e.g
chemotherapeutic agents, dopamine,
calcium preparation can lead to blister,
inflammation and necrosis of tissue.
Complications:
Phlebitis:
Inflammation of a vein related to a
chemical or mechanical irritation or
both.
Thrombophlebitis
It refers to the presence of a clot plus
inflammation in the vein.
Complications:
Cellulites
Warm, red and often tender skin
surrounding the site of cannula
insertion; pus is rarely detectable.
IV Cannulation
1.) Selection of vein 2.) Wash hands, apply latex 3.) Clean the area and apply
gloves, select appropriate tourniquet at least 10 cm above from
vein site of insertion and recheck the vein
IV Cannulation
4.) Open wings of cannula, 5.) Remove its cap, place 6.) Ensure that the bevel is
ensure that cannula slides upright, unsheathe needle and upward Insert the needle at 10
smoothly try to 30 degree
IV Cannulation
7.) Observe for flush back and 8.) Pull the stylet and insert 9.) Give pressure with the help of
blood is seen in the hub, cannula, released the thumb, Removed stylet, apply gauze,
withdraw needle tourniquet screw on cap and place it
IV Cannulation
◦ 10.) Flush cannula with 3 – 5 cc 11.) Tag (Date, Time, Gauge,
0.9% Normal saline or Distal Initial) the cannula and Collect
water and secure cannula by all your sharps needles etc.
applying zinc or paper tap and discard it in danger box
Documentation
Mention Date & time
Site and size of cannula
Mention your Initials
Review date (cannula should be in situ no longer than 72 hours without
appropriate risk assessment.)
Note: some hospitals have pre-printed forms to record cannula event

Remember:
Dispose of your gloves and equipment in the clinical waste bin,
ensure the patient is comfortable and thank them.
Once you pass IV cannula, you should to flush it according to your
hospital policy to check for patency.
If there is any resistance or causes pain or you noticed any localized
swelling; immediately stop flushing, removed cannula and maintain
IV line again.
RIGHTS of drug administration
Right patient Check the name on the physician’s order and the patient’s file. Use two
identifiers. Ask patient to identify herself/himself.
Right drug Check the medication label and check the written order.
Right dose Check the order. Confirm the appropriateness of the dose using patient file
written orders. Always calculate the dose again whenever you are
administering high alert drugs or if need calculating.
Right time Double check that you are administering drugs on right time and ensure that
when the last dose was given.
Right route Again, check the order and appropriateness of the rout order. Confirm that
the patient can take or receive the medication by the ordered rout.
Right Document administration after giving the ordered medication. Chart the
documentation time, rout and any other specific information as necessary.
Thank You

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Intravenous Therapy

HAFIZ AHMAD KHATTACK

Note: some hospitals have pre-printed forms to record cannula event

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