Nurses from time to time will be required to perform tasks that demand mastery of a technical equipment procedure. To deliver a programmed regimen of medication, when a patient is a hard stick, to prevent repeated needle stick trauma and injuries to the epidermis, an intra venuous line is used. The vein inside the hand or arm is located and mapped.
An ideal site for connection of the vein to the external delivery device is located. This is where the vein will be connected to an attached ( or hung) intra-venuous line. Thus liquid medication can be set up to line-drip into the body via a plastic catheter.
After this site is located, the first attempt is executed. The procedure to install the exterior I.V. (catheter) is begun by setting up surgical drapes for infection control. Masks, gowns, and gloves should be worn. The internal vein location is sited on-screen using live EKG or radiographic video photography. This internal site is evaluated for positive and consistent blood flow and the successful circulation of the medication.
This attribute of vein quality is needed for best distribution of the treatment material throughout the corpus. If the ideal site cannot be mapped, the procedure should be rescheduled.
The vein physically is reached via needle treated with Lidocaine. After a few moments a burn and a mild pain will be felt. Pre-medication against patient discomfort should be anticipated. The catheter ligation is then performed. If the venal connection is not successful a repeated attempt may be made as long as site integrity is maintained. The ultimate site must be clean and free from lesions or irritation.
The catheterization must now take place. Usually I.V. lines are put in during in-patient visits to or in a hospital radiography lab. But specialty nurses are now licensed to do this as part of a mobile health services arrangement. The plan of care adapts to include I.V. therapy.
After images of the vein assist the surgeon, nurse, or technician in mapping the best external route from a vein, then the vein is connected to the epidermis via an exterior cannula and channels of plastic or vinyl tubing. The patient may require a PICC line, a Heplock, or a formal intra venuous line catherization.
The infusion of catheterization for Hep lock, I.V., and PICC line devices requires formal technical training. Physicians and other providers learn the I.V. technique, sterile procedure etiquette, and the immediate I.V. environmental infection control. The administration of an I.V. and the facility policies must be followed to the letter for site hygiene, optimum infection control, and medical treatment etiquette.
I.V. administration is a critical nursing skill that can save many lives.. Focus on anatomy and needle stick skill sets is critical. Student nurses should petition for radiography internships if they are interested in I.V. catheterization as a career.
The site injection procedure is done via E.K.G. placement or radiology X-ray. Siting should be done by a nurse that knows or has become familiar with the patient.
The efficient I V. nurse will appraise how infusions will alter the patient’s daily routine. Minute details can affect placement success. Discussion of the patient’s daily routine is essential.
Will the patient eat before or after the medication? Will the rolling I.V. rack allow for bathroom access? Which arm or hand is best for the siting? How dies the patient sleep? Viability of the overall catherization effort for intra venuous infusion must be evaluated with respect to specific patients.
How old is the patient? How well can they manage to sit and be still and maintain drip flow? Have they managed an I.V. before? Are they in a skilled nursing or long term care facility? Do they thrash around uncontrollably during slumber? Patients can do damage to themselves or the I.V. line while moving during sleep.
Do they take a sleeping pill at night that limits control of the arm with the I.V. in it? How alert and ambulatory is the patient?Exploring these issues can ward off problems necessitating repeating the procedure. Conversation with the patient and issuing verbal prompts during the procedure can help I.V. line patients feel more in control.
All these factors can play a major role in the successful siting of an intra venous catheter device.
The epidermis is very sensitive to the strong adhesives used in the catheter site securement. Nurses should be careful not to strip the skin at the site. Attention should be paid to any allergies or past problems with bandages, metals, or tape. If the adhesives used in the I.V. siting cause an irritation, the dressing can come loose, the skin can over-adhere, or a site lesion cause an infection to spring from access to the vein.
Before scheduling the I.V. procedure, the patient’s chart and medical history must be reviewed. Sensitivity to the prescribed medication and success with previous regimens if intra venuous therapy should be evaluated. Upon efficient administration of a midline catheter or intravenuous line, repeated inspection and evaluation of the site should ensue. Then caretaking literature should be available for distribution, to the chart or to patient or resident.
If the veins have become occluded or blocked, the effort to site the catheter may need to be redone. The cost of these procedures to be repeated may be oppressive, not to mention the inconvenience, expense, and interruption of the ordered I.V. treatment.
There is some debate as to whether or not EKG or radiography siting procedure is preferable at the commencement of the ligation order. Hospital or facility policy must govern whether or not mobile services can be used in place of stationary institutional surgery centers. Specialty licensed and specially qualified nurses and technical personnel must be staffed for all of the above procedures.
Nurses should constantly monitor the catheter midline site for redness, stiffness, swelling and unusual pressure around the line-in. Remove and re-apply the sterile dressing as needed. Prevent loss of sterile I.V. conditions by using iodine or alcohol to clean residues or backflow from the insertion lesion.
When changing the adhesive tapes and cleaning the I.V. site cap, inspect the site area for unconventional blood spotting, movement of the line too far in or out of the I.V. site, or stained or fouled adhesive material next to the skin.
Always make sure to wash the hands in warm soapy water before contact with the site area and dressing materials. Allow adequate time for refrigerated material to come to room temperature. Check tags and labels upon fresh presentation of pharmaceuticals to the I.V stand, inside the patient room or clinic area.
Nurses and intra venuous medication administrators should always flush the line clean and make sure fouled tubing is removed from the site attachment immediately. Saline flushing schedules should be found on the patient’s chart or in the endorsement sheet. Counter signatures should reviewed for dressing and taping checks. I.D. tags and site condition checks should be conducted before the next I.V treatment.
Never flush against resistance. Review the infuaing catheter to adjust flow pressure. Advise the patient to notify nurses or caregivers to administrate prescribed anti-nausea medication if symptoms present.
Report unusually distressed wound sites to a charge nurse or physician for further instructions. Patients, nurses, and caregivers should be watchful for side effects throughout the duration of the I.V. administration. Upon successful completion of the I.V. treatment, nurses can refer back to the prescribing physician for further orders.