Iv Therapy Catheter And Site Selection

Front 1

Explain what an angiocath is.

Back 1

An angiocath is a flexible, hollow tube that stays in the vein once the needle is removed, it is the most comman peripheral infusion catheter.

Front 2

How do you know when you have successfully inserted an angiocath?

Back 2

You will recieve flas back (blood) when you are in the vein.

Front 3

Related to needles, the higher the number, the ______ the gage.

Back 3

The higher the number, the smaller the gage, ex. 24 is smaller than a 16.

Front 4

If a patient comes into the ER afer a tramatic accident, what is the gage of needle normally chosen? Why?

Back 4

18 gage is used for major surgery, trauma, rapid blood infusion.

Front 5

When would you use a 20 gage needle? 22?

Back 5

20 is used for blood product administration, minor surgeries, procedures, cardiac monitoring. 22 is appropriate for all transfusions except when high flow rates are required, you may administer blood in a 22, but it is not recommended.

Front 6

What gage needle is normally used in frail elderly patients, pediatrics, or patients with chronic diseases?

Back 6

A 24 gauge needle

Front 7

What is a "butterfly"? Why would you use one?

Back 7

A butterfly is a stainless steel needle with soft pliable wings with short extension tubing; used for blood draws, single doses, IV push meds, A disadvantage is that sometimes it requires an arm board, and there is an increase potential for infiltration.

Front 8

What are some physical anomalties that can effect perfusion of an IV?

Back 8

Presence of fatty tissue/swelling can effect the availability of a vein, pale/gray/cyanotic skin tone, cold, could indicate patient is at risk for poor perfusion. Dehydration and a loss of elastisity can cause difficulty in vein distention.

Front 9

If you note brusing, rashes, or bteaks in the skin where you were planning on initiating a peripheral IV, what should you do?

Back 9

Find another site, NEVER start an IV on a bruise, rash, or break in the skin!

Front 10

What types of conditions would cause you to question a site of an IV?

Back 10

Motor or sensory disfunction (do not start an IV on the only arm that a patient is able to use), CVA, Mastectomy (20+ years before the arm of a woman who has had a mastectomy can be used for an IV), a dialysis patient (the arm with a fistula CAN NOT be used for an IV), Also take into consideration, hand dominence, areas of flexion, pressure or location. Areas that are easily snagged are at an increased potential of cvath occlusion, dislodgment, or damage.

Front 11

Name and describle the 3 layers of the vein.

Back 11

Tunica intima~ inner layer, composed of flat epithelial cells, provides resistance to flowing blood, most damage takes place in this inner layer.

Tunica media~ middle layer, contains smooth and elastic tissue, sensative to pressure changes, used for vasoconstriction and vasodialation, temperature, and trauma. (shrinks when cold, dialates when warm).

Tunica adventitia~ Outer layer, made of connective tissue, supports the vein, used to maintain vasomotor tone, has the blood vessels to nourish the vein, provides vessel protection.

Front 12

What can damage the vein?

Back 12

Damage to the vein can be caused by rapid cannula advancement, advancing cannula with out holding traction on the skin, inserting a gauge that is too large of a cath for lumen of the vein, inserting cannula too close to joint flexion with out support of an arm board. Also, inadequate taping or skin prep (allowing organisms to invade), dirty or wet dressings, rapid infusion or quantities too large for vessel lumen to accommodate.

Front 13

Solution flows through tubing, cath and into veins as a result of a relationship between ________ and __________.

Back 13

Solution flows through tubing, cath and into veins as a result of a relationship between resistance and pressure. Resistance impedes flow, RESISTANCE INCREASES= FLOW RATE DECREASES.

slow flow rate means high resistance;
higher flow rate means lower resistance.

Front 14

What are some of the major resistors in fluid flow?

Back 14

Fluid viscosity: thicker and colder fluid is higher resistance;
Catheter length: long caths have slower infusion rates, long caths have decreased flow rate.

Front 15

Larger lumens allow for ______________ flow rate.

Back 15

Larger lumens allow for increased flow rate.

Front 16

What is the purpose of a valve?Why should you be aware of where the valves are located?

Back 16

Valves are semi-lunar folds that ensure one way blood flow back to the heart. Do not start an IV at the site of a valve; valves are visable as buldges and when a tourniquet is applied they ussually feel firmer.

Front 17

What are some comman veins in the hand? What are the advantages and disadvantages to using those veins?

Back 17

Metacarpal: dorsal aspect of the hand, easy to visualize and palpate, lowest site available; but difficult to stabalize, limits mobility, smaller than the forearm veins.

Digital veins~flow along lateral aspect of the fingers. Advantages, none, use only if nothing else is available. disadvantages: small diameter, limits patient's movement.

Front 18

Comman veins in the forearm, advantages and disadvantages?

Back 18

Basilic vein~ inner aspect of forearm (little finger side) from wrist to shoulder, advantages, easy to palpate and visulaize, disadvantages, location makes venipuncture more difficult.
Cephalic, along the radial bone, advantages, easy to visualize and palpate, disadvantages, valve present at junction.

Front 19

Where is the Median Cubital? What are the advantages and disadvantages?

Back 19

The median cubital joins the basilic vein slightly below antecubital fossa on medial aspect of forearm, advantages, easy to visualize and palpate, disadvantages, increased pain sensation with venipuncture.

Front 20

What are the factors of site selction?

Back 20

~length of therapy, patient age, skin consitency, vessel elasticity, fluid balance, muscle mass, catheter size, abiulity to visualize, palpate, and stabalize, dressing managment, fluid adminstration.

Front 21

How often should dressing changes be performed? IVs changed?

Back 21

Every 12 hours, unless needed more often. Every 48-72 hours.

Front 22

Why would a patient with heart disease effect a IV site? Diabetes? A patient with renal disease? Immunodificency?

Back 22

A patient with heart disease might have edema, increased chance of potential of venous spasm, causing vein collapse. Diabetes~ thicker veins, peripheral neuropathy. Renal disorders~may have shunts, limits sites for venipuncture, also, with chronic steriod use, skin and veins become fragile, have increased skin tears, bruising, and infliltration. Immunodeficency, signs of phlebitis may be delayed, response to infection slowed.

Front 23

How do you select a vein?

Back 23

Choose veins that are soft and supple, veins should be round, firm, and elastic, should not pulsate or feel knotty (if it pulsates, it is an artery!), start selection at lowest point!

Front 24

What should you avoid when selcting a vein?

Back 24

Avoid bifutcations, valves, bony prominences, areas of flexion, arms with loss of motor or sensory function, arms with AV fistulas, sides affected by CVA or mastectomy.

Front 25

What are the 5 major factors influencing site selection?

Back 25

1.) Type of solution
2.) Age and condition of veins
3.) Length of therapy
4.) Presence of disease
5.) Size of vein