Understanding intravenous therapy
Many patients require
intravenous (IV) therapy and thus, the methods used by medical professionals to
put in IV lines in patients with poor veins are important, in order to avoid
unnecessary trauma to the patient and the risk of infection.
What is intravenous therapy?
"Intravenous therapy or IV
therapy is the giving of liquid substances directly into a vein." (1)
Many hospitals have special IV
teams with medical personnel trained in advanced skills for intravenous
therapy. Even for them, there may be times when it appears almost impossible to
establish an IV line in a patient who has poor veins.
What are veins?
"In the circulatory
system, veins (from the Latin vena) are the blood vessels that carry blood
toward the heart. Most veins carry deoxygenated blood from the tissues back to
the heart; exceptions are the pulmonary and umbilical veins, both of which
carry oxygenated blood." (2)
What is a poor vein?
When a patient becomes
dehydrated, his or her peripheral veins may collapse. At times, in the sick or
the elderly, these veins may be fragile. In infants and children veins can be
tiny and sometimes, almost impossible to find. Veins used too frequently for
medication administration, may no longer be appropriate for intravenous
therapy. Sometimes, patients just do not have good veins and thus, are said to have
poor veins.
It may take a well-trained
doctor or nurse to find an appropriate vein that will function for ongoing
intravenous therapy.
The veins most commonly used for intravenous therapy are
the veins that are located in the arms and hands or legs and feet. Starting
intravenous lines properly requires practice. Every patient scenario is unique as
his or her veins can be different. Medical personnel may use various techniques
for starting intravenous lines, depending upon how and where they train. Some
doctors and nurses may find it easier to insert IVs than others do.
A doctor prescribes intravenous
therapy for his or her patient. He or she advises the registered nurse of the
appropriate intravenous treatment which consists of the administration of
fluids, electrolytes and/or medication.
The location of the IV line is
important. Being aware of which vein to use, as well as which vein is the most
appropriate to use for a patient, is also important. Sometimes the veins in one
part of the body are better suited for some kinds of intravenous therapy than
the veins in another part of the body.
The following questions must be
taken into consideration.
How long will the patient
receive intravenous therapy? What fluid or medication has the doctor
prescribed? What is the volume of the IV infusion going to be? Is an IV
treatment prescribed as a single administration of medication or will it be
ongoing therapy, over a period of days? Is the size of the needle appropriate
for the size of the vein and/or the medication?
The nurse should have the IV
equipment ready, prior to searching or probing for any veins. Normally, there
can only be three attempts by one medical person to establish an IV line. If
the attempts are not successful, it is advisable to seek the assistance of
another medical person who has more experience or expertise, in order to prevent
unnecessary trauma to the patient.
Veins are blue in appearance
and may be openly visible on a patient's hand or a foot. Palpation of an area
may help to locate a deeper vein or one that is more appropriate, for instance,
on the inner aspect of the elbow. Lowering an arm or hand will cause the blood
to flow downward and the vein will become more evident. Applying a warm, moist
towel over the area may help. Using a rubber tourniquet on a limb is sufficient
to cause the vein to bulge enough to insert a needle for an intravenous line.
One must always use caution regarding the length of time that a tourniquet is
allowed to restrict blood flow in a limb.
With infants and children or
others who may be frightened, it is important to have another person present
when the IV is started. Encourage a parent or other health care professional to
assist by holding, positioning and helping the patient to understand what is
happening. It should not be a frightening experience for him or her. Having the
patient look away or occupying the patient's attention in another way, may make
it easier for him or her. The pain experienced should be minimal.
Sometimes, massaging the area,
milking the vein or tapping on the vein gently, will cause it to become more
prominent. Fully extending an arm will bring the vein forward on the inner
aspect of the elbow.
Proper skin preparation is
always important to prevent infection.
Once the needle is in the vein,
dark red, venous blood should be evident. Immediately, start the flow of
intravenous fluid to keep the vein open. Place tape over the needle to prevent
it from slipping out of the vein. Appropriate pressure applied on the IV
insertion site, will any prevent unnecessary bleeding. An IV line, held in
place by tape or an appropriate bandage, is not likely to fall out.
Calculating the drip flow
correctly and maintaining it continually is important to prevent having to
restart the IV. Good observation skills are vital. Always record the location
of the intravenous line and document any problems encountered.
Care, concern and compassion
are always vital aspects of nursing care in respect to intravenous therapy, because IVs can be painful for patents. An intravenous line can give them a
feeling of helplessness. Encouraging the patient to walk about with the use of
an IV pole is a good idea.
Be aware that the
administration of some medications can be painful, even if does not cause pain
initially. An IV not inserted correctly can cause unnecessary swelling,
particularly when the IV goes interstitial. There may be excessive bleeding or
bruising. At times, the IV may not flow at all. The use of an ice pack will
help to reduce swelling.
The use of a splint or correct
positioning of a hand or arm can be beneficial in terms of keeping an IV
running. At times, restraints may be necessary to prevent a patient from
pulling out an IV.
Constant monitoring and
maintaining an accurate record regarding the patient's IV therapy are always
important. An intravenous line should not be allowed to run dry.
Make certain that the patient
receives proper age, orientation and education appropriate directives and
instructions regarding his or her IV. He or she should be encouraged not touch
or attempt to remove the intravenous line and should report any evidence of
blood backing up in the tubing, bleeding around the IV site or any excessive
bruising.
Many patients take pride in
helping to monitor their intravenous lines. So should intravenous team members
who are able to establish and maintain effective intravenous lines,
particularly in patients with poor veins.
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