Aims

1. To gain peripheral venous access in

order to:
• administer blood products, medications
nutritional components
2. To minimize the risk of complications
when
initiating IV therapy through:
• careful choice of IV site
• good insertion technique
• aseptic preparation of infusions
Key points

1. Only nurses who have been certified as

competent in the insertion of IV cannula will
perform this procedure.
2. Where the patient is less than 14 years of
the IV cannula will be inserted by a medical
practitioner. The exception will be in the
case
neonates where neonatal trained nurses
may insert an IV cannula if directed by a
medical officer.
3. In the case of two unsuccessful attempts at insertion, the
operator will seek the assistance of another experienced
nurse for one additional attempt. After a total three
unsuccessful attempts the assistance of a medical practitioner
will be sought.
Selection of Catheter Site
Choose a suitable vein. In adults, use long straight veins in an
upper extremity away from the joints for catheter insertion -
in preference to sites on the lower extremities. If possible
avoid veins in the dominant hand and use distal veins first.
Key points

1. Only nurses who have been certified as

competent in the insertion of IV cannula will
perform this procedure.
2. Where the patient is less than 14 years of
the IV cannula will be inserted by a medical
practitioner. The exception will be in the
case
neonates where neonatal trained nurses
may insert an IV cannula if directed by a
medical officer.
 1. Digital Dorsal veins
2. Dorsal Metacarpal veins
3. Dorsal venous network
4. Cephalic vein
5. Basilic vein

Veins of the Hand

Veins of the Forearm
1. Digital Dorsal veins
1. Cephalic vein
2. Dorsal Metacarpal
2. Median Cubital vein
veins
3. Accessory Cephalic Vein
3. Dorsal venous network
4. Basilic vein
4. Cephalic vein
5. Cephalic vein
5. Basilic vein
6. Median antebrachial vein
1. Check for the doctors order.
2. Identify the pt.
3. Wash hands prior to insertion.
6. Bring all the necessary materials @ pt. bed
sides.
7. Explain procedure to the patient.
8. Prepare IV infusion , open the seal of the IV
bottles and close the IV clamp. Spike the
infusate aseptically and fill the drip chamber to
at least half & prime the tubing prior to
insertion. Remove air bubbles if any & cover the
distal end of tubing.
9. Don gloves and select appropriate venipuncture
site.
10.Apply torniquet 2-6 inches above proposed
insertion site.
11.Disinfect the selected site with skin cotton balls
with alcohol and allow to dry. Do not touch the skin
with the fingers after preparation solution has been
applied and maintain aseptic technique while doing
the procedure remains the cornerstone of
prevention of cannula related infections.
12.Inspect the cannula before insertion to ensure that
the needle is fully inserted into the plastic cannula
and that the cannula tip is not damaged.
13. Ensure the bevel of the cannula is facing upwards
to facilitate piercing of the skin by the bevel.
14. Using the appropriate cannula, pierce the skin w/
needle positioned on a 15-30 degree angle. Insert
the needle and the cannula into the vein & apply
gentle traction on skin may stabilize the vein under
the skin.
15. Partially withdraw the needle and advance the
cannula.
16. Release the torniquet. Apply gentle pressure over
the vein just proximal to the entry site to prevent
blood flow. Remove the needle from within the
plastic catheter.
17. Quickly connect end of the infusing tubing to
the end cannula, secure connection and
regulate the IV fluids
18. Cover the intravenous and surrounding area
with a transparent dressing ensure that
insertion site and the area proximal to the
site
are visible for inspection purposes.
19. Make an IV tag and write the name of the pt,
type of IV fluids, incorporation if any, date and
time IV fluid was started.
20. Dispose of all sharps in the appropriate sharps
container, remove gloves and wash hands
Local Complication:
1. Phlebitis is irritation of a vein that is not caused by
infection, but from the mere presence of a foreign
body (the IV catheter) or the fluids or medication
being given. Symptoms are warmth, swelling, pain,
and redness around the vein. The IV device must be
removed and if necessary re-inserted into another
extremity.
To ease your patient's discomfort, apply warm packs.
Document your patient's condition and
interventions.
If indicated, insert a new catheter at a different
site, preferably on the opposite arm, using a
vein or a smaller device and restart
the infusion.
2. Thrombophlebitis is similar to phlebitis but a
thrombus (or clot) is in addition involved. As the
IV cannula stays inside your body, it may irritate
the vein leading the body to trigger its clotting
mechanisms. This occurs when the catheter
unintentionally enters the tissue surrounding the
blood vessel. In this case the IV fluid and
associated medications will go into the tissues
and
there will be a lump as an IV has been inserted
3. Infiltration - occurs when I.V. fluid leaks into
surrounding tissue. It's commonly caused by
improper placement or dislodgment of the
catheter. Patient movement may cause the
catheter to slip out or through the lumen of the
vessel. t is characterized by coolness and pallor
to the skin as well as local edema It is usually
not painful. It is treated by removing the
intravenous access device and elevating the
affected limb so that the collected fluids can
drain away. Infiltration is one of the most
common adverse effects of IV therapy and is
usually not serious ..
4. Hematoma is a collection of blood caused by
internal bleeding. This happens when the catheter
punctures through the vein and causes a
hematoma
5. Extravazation the leaking of vesicant drugs (such
as antineoplastics) into surrounding tissue, can
cause severe local tissue damage, resulting in
delayed healing, infection, tissue necrosis,
disfigurement, loss of function,
6. Infection -Any break in the skin carries a risk of
infection. Although IV insertion is a sterile
procedure, skin-dwelling organisms such as
candida albicans may enter through the insertion
site around the catheter, or bacteria may be
accidentally introduced inside the catheter from
contaminated equipment.
7. Venous Spasm - A sudden involuntary contraction of a vein or an
artery resulting in temporary cessation of blood flow through a
vessel.
Systemic Complication:
1. Septicemia: a febrile disease process that results from the presence
of microorganisms or their toxic products in the circulatory system.
2. Fluid overload & Pulmonary edema - caused by infusing excessive
amounts of isotonic or hypertonic crystalloid solutions to rapidly,
failure to monitor the IV infusion or too-rapid infusion of any fluid in a
patient compromised by cardiopulmonary or renal disease
3. Air embolism -Air entering the central vein, which is
quickly trapped in the blood as it flows forward.
Prevention is the key.
4. Shock - occurs when a foreign substance usually a
medication is rapidly introduced into the circulation
5. Catheter embolism - a piece of the catheter
off and travels through the vascular system.
Treatment : Discontinue IV, apply a tourniquet
above the site, take appropriate emergency
measures, inspect catheter for rough edges that
might indicate loss of fragments. Obtain order for
x-ray to determine if fragments are present.
 Thank you
for
listening
Prepared By:
emma a. valero,rn,rm,man.
clinical instructor
phcm