Intravenous access setting and maintainance

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Cannulation of the venous system may be required:

  • For the administration of drugs.
  • For the intravenous infusion of fluids.
  • For transfusion of blood products.
  • For parenteral feeding when alternative routes are unsuitable.
  • Access is also required for measurement of central venous pressure.

Choice of Vein

The choice of vein depends:

  1. On the individual requirement for each patient.
  2. On the patency of veins.

In general, it is advantageous to use veins on the dorsum of hand or on the forearm for isotonic fluids & central veins for irritant fluids.

Whenever possible, the most peripheral vein should be used first in order to preserve central veins for subsequent use.

For rapid infusion three sites are available:

  • Subclavian vein.
  • Jugular vein.
  • Basilic vein.

Use of the cephalic vein in the upper arm or long saphenous vein anterior to medial malleolus is not recommended because of the tendency of these veins to become thrombosed and because of immobility imposed by an infusion in the leg.

 

Percutaneous Puncture of Vein

TYPES OF IV NEEDLES.

  • Butterfly
  • Venous cannula
  • Drum cartridge catheter

 

Procedure of Maintenance of Intravenous Catheter:

 

Select and prepare the site carefully before vene puncture.  Hold the cannula firmly with three-point grip.  Advance the cannula through the skin and puncture the vein.  Venepuncture is indicated by entry of blood into the flashback chamber. Change the grip and advance the cannula into the vein, withdraw the needle completely avoiding spillage by pressing a finger on the vein above the cannula tip.  Connect the infusion line or seal off the cannula with luer lock plug.  If there is no immediate use, then cannula should be flushed with saline or heparinised saline.  Secure the cannula; protect the puncture site with a dressing.  Good fixation is important to prevent mechanical irritation.