iv procedure requirements

1. SETTING UP PROCEDURE
FOR IV DRIPS
By:-
Dr Prashant Bellad

2. AIM
 “The aim of intravenous management is for safe, effective delivery of
treatment without discomfort or tissue damage and without
compromising venous access, especially if long term therapy is
proposed.”

3. Types of IV access
 Peripheral venous access
 Central venous access
 Peripherally inserted central catheter(PICC Lines)

4. Indications
 Fluids and electrolyte replacement.
 Administration of medicines.
 Administration of blood/blood products.
 Administration of total parenteral nutrition.
 Hemodynamic monitoring, blood sampling for lab analysis.

5. Advantages
 Immediate effect
 Control over the rate of administration
 In patients who cannot tolerate drugs/fluids orally.
 Some drugs which cannot be absorbed by any other route.
 Pain and irritation is avoided with some substances compared when
given via SC/IM

6. Types of IV cannula/catheter
 Over-the-needle catheter
 Hollow-needle-catheter
(butterfly/scalp vein set)
 Plastic catheter inserted through a hollow needle
(disposable)

7. Types of IV cannula

8. IV administration sets
 Drip-
 Macro drip:- 10 drops=1 ml
indication- for administering large
amounts of fluid.
 Micro drip :- 60 drops= 1 ml
indication- for restricting and limited amount of fluid
transfusion
 Blood tubing:- has filter to prevent passage of clots
 Electromechanical pump tubing- specific for each pump
 IV extension tubing- for dialysis/ blood donation

9. Pre requisite
 MISE-EN-PLACE (laying out of all expected essential equipment)
 Patient positioning
 Prediction of difficult access like dehydration, venous scarring, IV drug
use with venous scarring, obesity, oedema, varicose veins, fragile and
small veins.

10. Essential equipment
 Each tray contains
o Non sterile gloves
o IV cannula(appropriate size)
o Tourniquet
o Dressing to secure cannula
o Alcohol swabs
o Saline flush and sterile syringe/fluid to administered
o Bio Medical waste Bin-white(for sharp item).

11. Identification of a suitable vein
 Bouncy
 Soft
 Above previous injected site
 Refills when depress
 Visible
 Large lumen
 Straight
 Easily palpable

12. Which veins to avoid
 Inflamed
 Thin/fragile
 Mobile
 Near bony prominence
 Near sites of oedema of phlebitis
 Multiple previously punctured veins
• Wrist, legs, feet or ankles
• Veins below a previous IV infiltration
• Vein below a phlebitic area
• Sclerosed or thrombosed veins

13. Procedure
Pre-requisite
 Check and verify the physician’s orders.
 Gather all essential equipment.
 Explain the procedure and take consent of patient.
 Provide privacy.
 Check vital signs.
 Adjust the height of bed for comfortable working/ restrain hand in case
of children.
 Select a non dominant arm.
 Call for assistance if required

14. Procedure-Contd..
 Wash hands with antiseptic soap.
 Wear gloves
 Apply tourniquet above insertion site
 Disinfect the selected site with alcohol swab and allow it to dry
 Strictly adhere to aseptic technique while inserting cannula
 Inspect the cannula before insertion to ensure that needle is fully
inserted into the plastic cannula and the tip is not damaged
 Do not touch shaft or tip

15. Procedure-Contd..
 Ensure that the bevel of the cannula is facing upwards(facilitates the
piercing of the skin by the bevel).
 Hold the cannula in your dominant hand, stretch the skin over the vein
with your non-dominant hand9do not re palpate the vein).
 Insert the needle at an angle of 15-30 degree to the skin, observe for
blood in the flashback chamber
 Partially withdraw the needle and advance the cannula.
 Release the tourniquet.
 Remove the needle and attach white lock cap.

16. Procedure-Contd..
 Secure cannula with clean adhesive tape.
 Flush the cannula with normal saline(to ensure patency and
accessibility.
 Cover the intravenous line and surrounding area with sterile transparent
dressing.
 Immobilise if required with well padded splint(in children).
 Remove gloves and dispose in dustbin.
 Perform hand wash.

17. complications
 Immediate-
 improper application/ not in the vein.
 Kinking of the catheter.
 Arterial placement
 Air embolism.
 Infection-
 Thrombophlebitis
 Cellulitis
 Thromboembolism
 Bruising/Haematoma

18. Vein finder Fluid warmer

19. Phlebotomy
 Phlebotomy is the process of making a puncture in a vein with a
cannula, for the purpose of drawing blood from the patient's arm
typically. The procedure itself is known as a venepuncture.

20. Central venous line catheter

21. Venous cut down procedure