INTRAVENOUS INSERTION

SN: I’d like you to tell me about the different types of Intravenous catheters (IVs).

CI: There are basically three different types for maintenance fluids, antibiotics and medication, and blood.

SN: Are there any pre-assessment measures to take into account?

CI: Yes. Before we start an IV, we have to consider the patient’s condition and medical history. For example, mastectomy, a recent surgical site or the presence of contractures or paralysis in an extremity may affect choice of the intraveinous site.

SN: What about the supplies?

CI: We need to have gloves and an IV start kit that includes a tourniquet, tape, gauze, cleansing solution and transparent dressing. And also, saline flush, extension tubing and saline lock.

SN: Ok. You said that there are three types of IVs. But are there any specifications to this?

CI: This is a good question here. Actually, you always need to consider the size of the angiocatheters (angiocath), which are color-coded and diameter-based.

SN: I don’t seem to get it. Can you be more specific please?

CI: Sure. Most often, it’s that a 22-gage angiocath is chosen if the patient is receiving maintenance fluids, or antibiotics and medication. However, if the patient is going to receive blood or go to surgery, an 18-gage angiocath is required.

SN: Ok. Now that we’ve determined the types of IV and the different supplies, what’s the next step?

CI: You need to inform the patient in order to get their informed consent, depending on what procedure you’re performing. And in the case of a hospitalized patient, you’ll check the ID band to verify the name, date of birth and medical record number. All the same, you have to ask them for their name and date of birth for identity vigilance.

SN: Having done this, I guess we’ll proceed by starting the IV.

CI: Before that you need to explain to the patient what you’re up to, that is, for example, that they’re going to receive an IV for maintenance fluids, antibiotics, medication or blood.

SN: Then, for sure, we’ll start the IV.

CI: Yes. So, we open all of the materials maintaining a septic technique, and have a garbage can close by to decrease clutter. Then we connect the pieces and avoid touching the ends. And we flush the saline lock and the extension tubing upwards to prevent air bolus. Next, we prepare the angiocath by releasing the catheter from the needle to help in insertion, which is done by a slight twist of the catheter. At this stage, it would be good to reassure the patient.

SN: As I know, I think we need to consider the patient’s age, body size, condition and level of physical activity, size and location of vein for the IV.

CI: Exactly. Ideally, we select the most distal, largest and appropriate vein to accommodate the infusion. This is especially important if the patient is receiving a long-term IV therapy.