Domer and Kevin R. Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. Due to its inherently invasive nature, intravenous IV therapy is associated with a number of potential complications, many of which are directly relevant to patient safety PS. PIV-related morbidity may be due to mechanical or nonmechanical factors. The most frequent nonmechanical peripheral venous catheterization adverse events PVCAEs include insertion site pain, phlebitis, hematoma formation, and infusate extravasation.
Those admitted to intensive care units ICUs are five to ten times more Intravenous insertion hand washing to acquire nosocomial infections than other hospital patients. A verification has been sent to. Insertion of PIV by a trained specialist may Intravejous help reduce the risk of occlusion [ 37 ]. Prevention and treatment : The diagnosis of acute fluid overload requires immediate medical attention and treatment. Risk factors associated with unintentional arterial PIV placement include morbid obesity, dark skin, lack of patient cooperation, significant hypotension, and lack of vigilance . Cannulation A maximum of two attempts at cannulation by any Rici naked healthcare worker should be made in order to avoid multiple unsuccessful attempts, causing unnecessary trauma to the patient and limiting future vascular access. Pulmonary edema : Pulmonary edema or fluid overload is caused by excess fluid accumulation Honduras adult escort reviews the lungs, due to excessive fluid in the circulatory system [ 90 ]. Scrupulous aseptic and sterile technique during placement and maintenance of these sites will prevent hajd complications. Local and systemic complications of peripheral Intravenous insertion hand washing catheter. Treatment: Apply gauze to the site until the bleeding stops, then apply a sterile transparent dressing.
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An estimated 2. Measures that help prevent infiltration include: Securing the catheter and tubing well with tape. The use of disposable tourniquets may increase reliability if incorporated into the packs; there is also evidence that reusable tourniquets are associated with the risk of infection[ 1415 ]. No single issue was seen across all organisations, suggesting that each organisation has resolved some issues. These findings are also consistent with the results revealed by Tucker et al 5 and Elms and Chumley. Measures that help prevent formation of hematomas Intravenous insertion hand washing Ensuring that the catheter and tubing are securely anchored. D Doctors and advanced clinical practitioners. VD co-ordinated data collection, conducted interviews and performed data washung. Hands on learning prepare medical students for clinical rotations while decreasing anxiety. Site Washingg performed by Departments studied Cannulation Intravenous insertion hand washing used A Nurses, doctors and medical assistants. Login Register. Competing interests The authors Intravenlus that they have no competing interests.
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- Nursing faculty teaching medical students a module in clinical skills is a relatively new trend.
- I ntravenous Cannula Insertion is one important clinical procedure that requires skills and practice.
- Many patients in the medical and surgical wards will have some form of Intravenous Therapy.
- Intravenous cannulation is undertaken in a high proportion of hospitalised patients.
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An unexpected error occurred. Add to Favorites Embed Share Translate text to:. The purpose of peripheral intravenous catheter PIV insertion is to infuse medications, perform intravenous IV fluid therapy, or inject radioactive tracers for special examination procedures. Placing a PIV is an invasive procedure and requires the use of an aseptic, no-touch technique. Common IV venipuncture sites are the arms and hands in adults and the feet in children.
According to the Intravenous Nurses Society INS , the feet should be avoided in the adult population because of the risk of thrombophlebitis. Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident CVA , dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible.
The cephalic vein has been associated with nerve damage when used for IV placements. The most distal site available on the hand or arm is preferred so that future venipuncture sites may be used if infiltration or extravasation occurs.
This video will demonstrate the insertion of a PIV, including the preparation and attachment of an IV extension set. Although a PIV securement device is used here to stabilize the IV catheter, according to INS recommendations, some facilities may not elect to purchase these devices, and the alternate chevron or U-shaped taping method may also be used.
Nursing Skills. Peripheral Intravenous Catheter Insertion. General PIV placement considerations review in the room, with the patient. Leave the patient room and wash your hands, following the instructions in step 1. Retrieve the label and add the time and date of insertion, along with your initials.
More information may be needed based upon hospital protocols and procedures. Place the label on the occlusive dressing. Gather all packaging and the needleless prefilled saline syringe and discard them in a trash receptacle. Discard the over-the-needle stylet in a sharps container. Review the signs and symptoms of complications in IV fluid therapy or medication administration, as described in step 1. Remove and discard the gloves in a trash receptacle and wash your hands, as described in step 1.
Document the PIV insertion in the patient electronic health record before leaving the patient room. The placement of a peripheral intravenous catheter is a frequently performed nursing procedure. Peripheral venous access is necessary for many aspects of patient care, including the infusion of medications, fluids, dyes, and radioactive tracers. In this video, we will demonstrate the aseptic "no-touch" technique for insertion of a peripheral intravenous, or PIV, catheter, with the attachment of an IV extension set.
The most common sites for the placement of a PIV catheter are the arms and hands in adults, and the feet in children. The feet should be avoided in adults because of the risk of thrombophlebitis.
Also, the median cubital vein and cephalic vein in the wrist should be avoided when possible due to the risk of nerve damage. Always use the most distal site possible, so that more proximal sites are still available in the case of infiltration or extravasation.
Other considerations when choosing a site include pain, presence of wounds, decreased circulation, previous cerebrovascular accident, dialysis fistulas, or mastectomy. The first step, upon entering the patient's room, is to wash your hands with soap and warm water for 20 seconds, or use sanitizer with vigorous friction if the hands are not visibly soiled.
Next, at the bedside computer, review the patient's electronic health record and the order for PIV insertion. Also review the patient's history for the risk of bleeding complications, such as bleeding disorders, anticoagulant therapy, and low platelet count. Then, explain the procedure to the patient, emphasizing that only the soft, flexible catheter will remain in their vein after the venipuncture, allowing them to move the limb freely, and obtain their consent for the procedure.
It is important to verify the patient's identity using two independent identifiers, such as the patient's name and medical record number.
Do not utilize the patient's room or bed number as identifiers. Next, place the patient in a comfortable position and adjust the bed height to maintain an ergonomic nursing position and decrease back strain. Also, ensure that the lighting is adequate and that a bedside stand or over-the-bed table is clear for use. For supply preparation, exit the patient's room and wash your hands again, as previously described.
Now gather the necessary supplies, which might be available as an IV insertion kit. The list of needed supplies includes a tourniquet, absorbent pad, chlorhexidine swabs, 2 pairs of latex-free gloves, appropriate size over-the-needle catheter, IV needleless connector, prefilled saline flush syringe, IV extension tubing, barrier solution, IV adhesive securement device, transparent occlusive dressing, transpore tape, 2 x 2 sterile gauze, and adhesive bandage.
Choose the smallest size over-the-needle catheter suitable for the intravenous therapy being delivered and the expected length of therapy, in accordance with the policies of the institution. Duplicate supplies, for repeated IV attempts, may be needed.
Return to the patient's room. Place all of the supplies on the bedside stand, and wash your hands again. Now, open the prefilled syringe and hold it between your non-dominant middle and ring fingers.
Next, using aseptic technique, open the extension tubing. Hold the tubing in your dominant hand and remove the cap from the male end using your non-dominant thumb and forefinger. Then, attach the female end of the extension tubing to the male end of the syringe. Subsequently, hold the extension tubing with the capped male end pointing towards the ceiling. Now push the syringe plunger to prime the needleless connector and extension tubing until all air has been removed and a few drops of saline have been expressed from the end.
Then place the primed needleless connector with extension tubing and attached syringe down on the table, within reach.
Now, remove the backing from the transparent occlusive dressing and place it sticky-side-up, within reach. Next, remove four strips of tape from the transpore tape roll and open the gauze, chlorhexidine packaging, IV adhesive securement device, and adhesive bandage packaging.
The next step is to choose an insertion site. Visibly inspect both arms for suitable veins. The cephalic, basilic, median cubital, and dorsal hand veins are preferred. Apply a tourniquet around the arm, cm proximal to the chosen insertion site. The tourniquet should not be so tight as to obliterate the distal pulses. Assess the chosen vein with the tourniquet in place.
If it is soft and free of complications such as sclerosis, bruising, phlebitis, or infiltrates, temporarily remove the tourniquet and place an absorbent pad under the arm.
Before proceeding, perform hand hygiene again. Now, take the over-the-needle catheter from the packaging, remove the cap, and place it between the ring and middle fingers of the non-dominant hand.
Check the catheter and needle for irregularities, such as bends, nicks, or hooks. Move the catheter hub clockwise, and then back to the original position to break any suction tension remaining from the sterilization process. This will allow for smooth advancement of the catheter. Replace the catheter cap and set the over-the-needle catheter within easy reach.
Now you are ready to proceed with catheter insertion. Wash your hands again and don clean gloves. Re-apply the tourniquet to the patient's arm and tap the chosen insertion site several times to vasodilate the vein.
Use the chlorhexidine swab to scrub the insertion site back and forth for 30 seconds, ensuring that the anti-microbial penetrates any cracks and fissures in the skin. Then allow the chlorhexidine to dry completely-this will enable complete microbicidal activity. Next, remove the cap from the over-the-needle catheter and hold the catheter in your dominant hand. Then, using your non-dominant hand, stretch the skin taught and stabilize the vein cm below the insertion site, taking care not to contaminate the point of insertion.
Advance until a flashback of blood is visible. Then, drop the angle of the catheter a few degrees and advance it with the needle a few millimeters to ensure that the tip has passed into the vein. Next, using the dominant index finger, advance the hub of the catheter fully into the vein while holding the needle steady. Then release the tourniquet with your non-dominant hand and occlude the vein to help reduce bleeding after needle removal. Remove the stylet needle from the catheter, engaging the needle safety device, if available, and place the needle down on the bedside table.
Quickly remove the cap and insert the male end of the pre-primed IV extension set into the catheter hub. Now, while stabilizing the IV extension set, depress the plunger of the syringe and flush the IV with normal saline to ensure patency. Observe for swelling, redness, or leaking at the IV site and ask the patient if they feel any discomfort during this process. It is not unusual for the patient to notice a cold sensation or a salty taste in the mouth.
If there are no adverse reactions, then flush the PIV again slowly, while engaging the clamp located on the IV extension set to prevent the blood from backing up into the tubing. Then remove the syringe and place it on the bedside table. The next step is to apply the dressings. First open the barrier solution packaging and spread a light film of barrier solution 1 cm away from and around the insertion site.
Now, place a twice-folded 2 x 2 gauze under the hub of the PIV to prevent pressure on the underlying skin. Subsequently, place the semi-permeable occlusive transparent dressing over the insertion site and catheter and squeeze to anchor the hub in place. Then remove the backing from the adhesive IV securement device and place the sticky side against the skin directly under the catheter hub to secure the catheter hub to this device. Now, loop the IV extension tubing in a U-shape, pointing up past the insertion site and secure it with tape to the skin and the occlusive dressing.
Advance the needle until you observe blood at the back of the cannula. Although nurses were aware that their hand-washing rates were being observed, they did not know who was doing the observations. Open in a separate window. Department of Health: High Impact Interventions. Doctors and advanced clinical practitioners. Probl Hig Epidemiol. All incidents related to unavailability of cannulae, tourniquets and sharps bins.
Intravenous insertion hand washing. Indications
Nosocomial or hospital-acquired infections cost several billion dollars and cause more deaths annually per year than road accidents.
When compared to the crash fatality data, hospitalized patients are 2. Of the estimated two million nosocomial infections, approximately , are classified as catheter-associated infections CAIs , with 50, categorized by CDC surveillance criteria as catheter-associated bacteremias CABs The majority of these infections are associated with central intravenous catheters. This percentage is derived from hospitalized patient data comparing those who have intravenous catheters that complicate and die compared to similar patients who do not have intravenous catheters but complicate and die.
Patients admitted to hospitals today are sicker and experience shorter lengths of stay. Those admitted to intensive care units ICUs are five to ten times more likely to acquire nosocomial infections than other hospital patients. Epidemics are defined as rates of disease or events significantly higher than the usual frequency while endemic rates reflect the usual frequency of disease or events. Colonization occurs when microorganisms are present and multiplying but are not invading the tissue or causing damage.
Complicating hospitalized patients' risks for catheter-associated infections, Pelletier reported that patients with coexisting infections are more likely to have catheter-related infections or bacteremia than patients without coexisting infections even when no differences were found in APACHE II scores, white blood counts WBC , length of hospital stay, time from admission to fever, time from fever to treatment, normalization of WBC, days of antibiotics, defervescence diminishing or disappearance of a fever , gender, presence of comorbidities, colonization while in the ICU, or mortality rate.
It also has been reported that an increased risk for catheter-associated infections occurs in patients who have pneumonia and urinary tract coexisting infections. Although the CDC only recognizes catheter-related bloodstream infections with bacteremia and labels those infections without bactermia as colonization, Pelletier indicated that perhaps the definition of catheter-associated infections should be expanded to include those bloodstream infections that are without the presence of systemic illness and not explained as a result of another infectious source.
Most intravenous catheter infections result from either catheter seeding occurring during catheter placement extraluminal or during manipulation of hubs or catheter junctions during use intraluminal.
For critically ill patients bacteremia is the leading cause of nosocomial infections. Contributing to the seriousness of nosocomial infections, especially in ICUs, is the increasing incidence of infections caused by antibiotic-resistant pathogens and specifically Staphylococcus aureus and Enterococcus. For example, more than half of the catheter-associated bloodstream infections in the US are caused by the gram-positive organism staphylococci.
Weinstein 29 identified three main sources of bacteria responsible for IV-associated infections: the air, the skin, and the blood. Although the number of microbes per cubic foot of air varies, depending on the particular area of the hospital involved, contamination can occur when infection is present and bacteria escape in the form of bodily discharge onto clothing, bedding, and dressings. Airborne contaminates settle on injection ports. Intravenous tubing may be inadvertently contaminated when allowed to drape onto the floor or placed next to the patient in a bed where urine and fecal incontinence could contaminate access ports or tubing exterior.
Healthcare workers' HCWs hands may become contaminated while bathing or cleaning the patient or during manipulation of dressings or devices. Subsequent manipulation of intravenous tubing and access ports without prior hand washing may inadvertently contaminate access sites along the intravenous system, on the IV drip rate regulator, or on IV sites during dressing changes.
Airborne microorganisms in patient areas and utility rooms may find their way to IV fluids and equipment via breaches in aseptic technique. A particle microns in size is equivalent to 0. To prevent intravenous tubing contamination, the HCW should cover and contain drainage from infected wounds, avoid excessive movement of linens, and keep all intravenous tubing off the floor.
Capping intravenous sites for intermittent infusion preserves IV access when patients no longer need continuous infusions but still need intermittent IV access.
New caps should be used each time a new IV catheter is inserted. Although no textbooks or articles were found that cited exactly how many punctures an IV cap can tolerate safely before the integrity is impaired and should be changed, the safest guideline is to check with the manufacturer of the product for guidance and incorporate the information into the agency IV policy for your specific equipment. Intuitively, the larger the needle or needleless access device and the more frequently accessed, the more likely the integrity of the cap will become impaired.
Although several studies are dated, they are and continue to form the rationale used by the Intravenous Nurses Society INS to support the gold standard of intravenous skin prepping prior to IV catheter insertion.
Colonization rapidly increases with duration of hospital stay. Staphylococcus epidermidis , Staphylococcus aureus , and gram-negative bacilli such as Klebsiella , Enterobacter , Serratia and enterococci intestinal flora are ubiquitous on the skin of hospitalized patients. Abrams reported that anaerobic bacteria occurs aerobic in the bowel.
While antibiotic resistant organisms such as vancomycin-resistant enterococcus VRE and methicillin-resistant Staphylococcus aureus MRSA can be spread by direct contact, effective handwashing by healthcare workers has been proven to be successful in interrupting transmission. Most organisms are not visible to the human eye. Iodophor preparations require at least a minimum second contact time and INS standard recommends two-minute drying time in order for the agent's properties to become activated.
In , Maki reported that the use of chlorhexidine in skin preparation and IV dressing changes was associated with the lowest incidence of catheter-related infections and catheter related bacteremia. Intravenous sites can become seeded when organisms from distant infection sites are transported to the access port or adhere to the catheters, as discussed above.
Removal is recommended when catheters are implicated in catheter-associated infections. Healthcare workers must inspect each container of intravenous solution carefully, holding it against a light and dark background examining for cracks, defects, turbidity, and particulate matter.
Always label infusates with the date, time, and your initials when hung. For example, dextrose is slightly acidic pH 4. Intravenous medications that are widely dissimilar in pH values are unlikely to be compatible in solution.
New technology currently being tested for catheter-related infections include antibiotic and antiseptic-coated catheters, antiseptic hubs, disinfecting caps, and flushing solutions. Each organization should have established policies and procedures for the placement of intravenous catheters. At a minimum, healthcare professionals should have a comprehensive understanding of anatomy and physiology, vascular assessment techniques, and insertion techniques appropriate to the specific device.
The catheter should always be inspected for product integrity prior to insertion. Cannulation A maximum of two attempts at cannulation by any one healthcare worker should be made in order to avoid multiple unsuccessful attempts, causing unnecessary trauma to the patient and limiting future vascular access. Catheters placed in an emergency situation where aseptic technique potentially has been compromised should be replaced as quickly as possible and definitely within 24 hours.
IV catheter and skin junction sites should be assessed for potential complications redness, tenderness, pus, warmth, and edema at established intervals by hospital policy. Intravenous therapy continues to be the most frequent medical procedure hospitalized patients will experience.
Scrupulous aseptic and sterile technique during placement and maintenance of these sites will prevent catheter-associated complications. Patients who are in intensive care units and who develop pneumonia and urinary tract infections, are at increased risk for intravenous catheter-associated infections. Furthermore, the increased use of antibiotics creates a patient care environment where antibiotic resistance emerges. Following INS standards for intravenous therapy will decrease the risk of catheter-associated infections and will improve patient outcomes.
For a complete list of references and tables, visit www. How do public health officials know if there is a disease outbreak and where that outbreak has occurred? During the Zika virus outbreak of , public health officials scrambled to contain the epidemic and curb the pathogen's devastating effects on pregnant women. At the same time, scientists around the globe tried to understand the genetics of this mysterious virus.
Artificial intelligence could become a busy infection preventionist IP 's best friend and should be embraced where feasible to help reduce the burdens associated with traditional surveillance methodologies. Influenza causes an estimated 3, to 50, deaths per year in the U. Timely and representative data can help local, state, and national public health officials monitor and respond to outbreaks of seasonal influenza.
Skip to main content. June 1, Sources of Organisms in Catheter-Associated Infections Epidemics are defined as rates of disease or events significantly higher than the usual frequency while endemic rates reflect the usual frequency of disease or events. Blood-related Infections Intravenous sites can become seeded when organisms from distant infection sites are transported to the access port or adhere to the catheters, as discussed above.
For a complete list of references click here. December 4, By Kelly M. Pyrek Artificial intelligence could become a busy infection preventionist IP 's best friend and should be embraced where feasible to help reduce the burdens associated with traditional surveillance methodologies.