An intravenous (IV) drip is a very common but vital tool in modern medicine. It allows doctors to deliver fluids, blood products and drugs directly into the patient's blood system via a small tube. This type of therapy is highly absorbent and allows for precise dosage control, which is crucial in many medical procedures. In addition, fluids can be given to treat dehydration, blood to counteract bleeding and antibiotic therapies. Although everyone can learn how to insert an IV, alone medical and nursing staff are authorized to do so. Read on to learn more.
Steps
Part 1 of 3: Preparation
Step 1. Prepare everything you need
Even if having everything you need for an IV is not such a complicated procedure, it is always necessary to have a basic level of preparation and take all the necessary precautions in the medical field. Before starting, you must have all the tools and all the material you need at hand, plus everything that will come into contact with the patient, especially the needle, must be sterile. To insert an intravenous drip you need:
- Sterile disposable gloves
- Catheter of appropriate diameter for the type of needle (usually a 14-25 gauge)
- IV bag
- Non-latex tourniquet
- Sterile bandage or dressing
- Gauze
- Disinfectant wipes
- Medical adhesive tape
- Container for sharp and stinging waste
- Sterile mat or crossbar (on which to place all your tools and have them at hand)
Step 2. Introduce yourself to the patient
An important part of the procedure is to introduce yourself to the patient and explain what is about to happen. Talking to the sufferer and sharing basic information with him allows you to put him at ease and prevent any of your actions from frightening or surprising him. In this way, moreover, you will obtain the consent to proceed. Once this is done, ask the patient to lie down or sit in the place where the drip will be given.
- When patients are nervous, the veins are a little contracted. This phenomenon is called vasoconstriction and makes it difficult to insert a needle; it therefore becomes important to try to relax the patient.
- You can ask the patient if, in the past, he or she has ever had a problem with drips. If the answer is yes, you can ask where on his body it is easier to insert the needle.
Step 3. Prepare the tubing for the drip
First attach the bag to the IV pole, fill the tubing with saline and check for air bubbles. If necessary, clamp it so that the solution does not drip onto the floor. Make sure you get rid of any bubbles by tapping and squeezing the tube.
- Injecting air bubbles into the patient's bloodstream could cause a serious condition called embolism.
- One technique that allows you to easily remove bubbles from the tube is to unroll it completely along its entire length and slide the roller valve to the dropper chamber. Next, slip the tube into the pouch with the pointed end and pinch the dropper chamber. Open the valve and release the tube, the fluid should flow throughout the tube without making bubbles.
Step 4. Choose a catheter with the correct diameter for the type of IV
Usually those for intravenous are fixed to a needle which is in turn inserted into a vein. Once inserted into the vein, the catheter is left in place to have an available access. This instrument is available in different calibers called gauges. The smaller the gauge number, the larger the diameter and the faster the drug is injected into the bloodstream. However, large catheters are more painful to insert, so it is essential not to use one that is oversized for the purpose.
Generally, a 14-25 gauge catheter is required for drips. Try to use a larger (thinner) gauge catheter for children and the elderly, but rely on a smaller gauge catheter if a smaller gauge is needed. rapid transfusion
Step 5. Put on sterile gloves
Inserting an IV means introducing foreign material directly into the bloodstream. To avoid the risk of dangerous infections, it is vital to wash your hands and dry them with clean paper towels before starting. Next you must wear sterile gloves before handling the instruments and touching the patient. If at any stage of the procedure the gloves lose sterility, take them off and put on another pair - prevention is better than cure. Follow the instructions listed here to know when to change gloves during medical procedures:
- Before touching the patient
- Before aseptic / hygienic procedures (such as IV medications)
- After procedures at risk of contamination with body fluids
- After touching the patient
- After touching the patient's surroundings
- Before moving to another patient
Step 6. Look for the most noticeable veins
Now you need to find the place to insert the needle into the patient's body. In most cases the veins on the inside of the forearms are easy to access, or those on the inside of the elbow and on the back of the hand although, theoretically, any visible vein can be considered suitable for inserting an IV drip. (even those of the feet that are often used in pediatrics). If the patient is known to have difficult-to-reach veins, ask him where the IVs are normally inserted. Remember that, although they are clearly visible, there are some veins where you don't have to insert an IV. These are:
- Where the IV interferes with surgical access
- In the same place where an IV is already present (or has recently been removed)
- In areas with obvious signs of infection (redness, swelling, skin irritation, etc.)
- In the limb corresponding to the side of the mastectomy or vascular implant (could cause complications)
Step 7. Apply the tourniquet
To swell your chosen vein and thus see it better, place the tourniquet over the entry point. For example, if you are going to insert the needle into the classic crook of the elbow, put the lace on the arm, above the elbow.
- Do not tie it too tightly as it causes bruising, especially in older people. It should be snug but not so tight that you can't fit a finger under it.
- Let the limb dangle towards the floor as you put on the lace; the vein will become even more evident as blood flow to the area increases.
Step 8. Palpate the vein if necessary
If you are having trouble locating a suitable vein, you can feel the patient's skin in the area where you intend to insert the needle. Align a finger according to the direction of the blood vessel and then press on the skin. You should feel the vein walls "push back" your finger. Continue in this way for about 20-30 seconds, the vein should become noticeably larger.
Part 2 of 3: Access a Vein
Step 1. Disinfect the insertion site
Open a clean disinfectant wipe (or use a similar disinfection system) and apply it to the skin where you will insert the needle. Rub gently making sure the entire area is wet with alcohol. This kills the bacteria and minimizes the risk of infection.
Step 2. Prepare the catheter for insertion
Remove it from its sterile packaging and check that it is intact and functional. Push it towards the flow control chamber to make sure it fits snugly. Rotate the center mandrel to make sure it is not tight on the needle. Take off the protective cap and check the needle, be very careful that it doesn't touch anything. If everything looks good to you, get ready to insert it.
Neither the needle nor the catheter should touch anything other than the patient's skin at the IV insertion point. Otherwise their sterility is compromised and infections could be triggered
Step 3. Insert the needle
With your non-dominant hand stabilize the patient's limb with gentle pressure, be careful not to directly touch the needle insertion area. With your dominant hand, grab the catheter and insert the needle (blunt side up) into the skin. Reduce the angle of insertion as it flows into the vein.
Look at the catheter flow control chamber to make sure there is blood. This means that the needle is in the vein. At this point you can insert it another centimeter into the blood vessel
Step 4. If the vein is missing, explain it to the patient and try again
Inserting a needle is a delicate art; sometimes even the most experienced doctors and nurses fail on the first try, especially if the patient has "difficult" veins. If you do not see blood in the catheter's control chamber, explain to the patient that you have not "caught the vein" and that you will need to try again. Try to be courteous, the process could be painful for the sufferer.
- If you fail again, apologize, remove the needle and catheter and try on a different limb with new material. Making several attempts at insertion on the same vein is quite painful and causes bruising.
- You could comfort the patient by explaining the possible reasons for failure and saying something like, "Sometimes it happens, it's nobody's fault. We should do it on the next try."
Step 5. Remove and discard the needle
Maintain pressure on the skin and pull the needle (needle only, not catheter) out of the patient's vein about 1 cm. Slowly slide the catheter into the vein without releasing the pressure on the skin. When it is perfectly in place, remove the tourniquet and secure the catheter with a sterile bandage or adhesive dressing (such as Tegaderm) applied to the central portion.
Be sure not to block the connections between the catheter and tubing with the bandage
Step 6. Remove the needle completely and connect the tubes
Maintain some pressure in the center of the catheter with your thumb and forefinger, so it doesn't move from its seat in the vein. With your other hand, pull out the needle (only that one). Throw it into the sharps and stinging waste container. At this point, remove the protective cap from the IV tube and insert it into the central part of the catheter. Secure it by screwing it in and locking it.
Step 7. Secure the IV
Finally, it secures the drip to the patient's skin. Place a piece of medical tape over the center of the catheter, loop the tube and secure the tube with a second piece of tape over the first. This operation reduces the traction that the tube exerts on the catheter, makes the procedure less troublesome for the patient and there is less risk of the drip coming out of the vein.
- Make sure there are no tangles on the tube, as they may interfere with the administration of the drug.
- Don't forget to put a label on the dressing with the date and time of the last listing.
Part 3 of 3: Check for an IV
Step 1. Check the flow of liquids in the IV
Open the roller valve and check that the drug is dripping into the dropper chamber. Verify that the fluid enters the vein by temporarily occluding the vein at a point distal to the access (by pressing on it). If the drip stops or slows and then starts again as soon as the pressure in the vein is released, then the drug reaches the bloodstream.
Step 2. Change dressing if needed
If the IV is left in for a long time, there is a greater risk of infection than temporary IVs. To minimize this risk, it is important to carefully remove the dressing, clean the insertion area and put on a new dressing. In general, the transparent dressings should be changed once a week while the white gauze more frequently, since they do not allow direct inspection of the area.
Don't forget to wash your hands and put on a new pair of gloves every time you touch the IV insertion area. This is especially important if you need to change the bandage, as multiple connections to the catheter increase the risk of infection
Step 3. Remove the IV safely
First close the roller valve to stop delivering the fluid. Gently remove the tape and bandage to expose the catheter and insertion site. Clean the area with a piece of gauze and apply gentle pressure to the area as you pull out the catheter. Inform the patient that they must keep the gauze on the area by applying pressure to stop the flow of blood.
You can secure the gauze at the puncture site with medical tape or a bandage. However, in most patients, the blood flow stops fairly quickly and no patch is needed
Step 4. Dispose of all needles properly
IV needles fall into the category of stinging and cutting medical devices and should be thrown into the appropriate bins immediately after use. Since needles can transfer very dangerous infectious agents and blood diseases from one individual to another, they should be handled with great care and should never be disposed of with normal trash, even if you are certain that the patient is perfectly healthy.
Step 5. Know what complications are associated with an IV
While this is a safe medical procedure, there are small but real chances of complications. It is important to recognize the symptoms in order to offer the best possible care to the patient and, if necessary, to be able to intervene in an emergency. Here are the most common complications and related symptoms:
- Infiltration: Fluid is not injected into a vein but into surrounding tissues. There is swelling and paleness of the skin at the insertion site. It can be a serious or minor complication, depending on the drug administered.
- Hematoma - Blood escapes from the vein and spreads to nearby tissues. It usually happens when the blood vessel walls are pricked by mistake. It is accompanied by pain, bruising and irritation. It clears up within several weeks.
- Embolism: Occurs when air is injected into a vein. It is often caused by bubbles in the IV tube. Children are particularly at risk. In severe cases it causes breathing problems, chest pain, cyanotic skin, drop in blood pressure and even heart attack.
- Thrombosis and endarteritis: Both are life-threatening events and are the result of an injection into the artery rather than a vein. They cause severe pain, compartment syndrome (high pressure on a muscle leading to a very painful "contracture" or a feeling that the muscle is "full"), gangrene, motor dysfunction and limb loss.
Advice
Record the procedure as you insert the drip. Keeping adequate records prevents unnecessary complaints and lawsuits
Warnings
- Always check your medical records to make sure there are no specific instructions to follow.
- Don't try to find a vein more than twice. If on the second attempt you can't find it to insert the needle, ask a colleague for help.
