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24.02.2014
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Peripheral venous access, or intravenous (IV) access, is commonly used to administer fluids, medications, or blood. IV therapy is one of the fastest routes of providing medication, and is the most effective means of providing fluids during periods of dehydration or hemodynamic instability.
The following contraindications all relate to the site chosen rather than the procedure itself. 14 - 16g - large (painful) catheters reserved for situations where volume resuscitation is needed or anticipated. Butterfly Catheters are generally used only in pediatrics and for very short-term venous access, as they tend to perforate veins easily and are more prone to infection.


Safety IV catheter systems are increasingly used to reduce needle stick injuries by encasing the entire needle within a guard. Upper extremities are generally preferred to lower as they are more convenient for staff and patient and pose lesser risk of infection, phlebitis and deep vein thrombosis. If the IV is being placed to resuscitate a patient, veins within the antecubital fossa (the inside of the elbow) should be considered, given their relatively bigger size. Prepare normal saline lock by cleaning the port with an alcohol swab and priming it with sterile normal saline flush solution. Using your non-dominant hand, hold the patient’s extremity and gently pull the skin taught over the vein.
Push the needle into the vein until you feel a pop and blood appears in the flash chamber of the IV Cannula. Attach the primed Normal Saline lock and flush it with 1-3 mls of Normal saline flush solution using the positive pressure technique (the saline injected via a syringe at the same time as the syringe is being removed). Spider veins (too small) - Dilate veins with warm moist washcloth, gentle tapping, hanging over side of bed (the arm). IV won’t run - Make sure cannula in vein, tourniquet is off, drip valve is open, IV solution bag is elevated.
Air in IV Line - Wind IV tubing around tightly around barrel of a pen, pushing air back into IV bag Or Aspirate air using needle and syringe in the distal injection port. Extravasation Necrosis - occurs secondary to extravasation of hypertonic solutions (D50W, 10 % CaCl, TPN, etc), toxic substances (chemotherapy, contrast dye) or vasoactive substances (epinephrine, dopamine).
Irritative Phlebitis - recognized by erythema at the site and possibly along the path of the vein.


Infectious Thrombophlebitis - sometimes difficult to distinguish from irritative phlebitis - look for erythema and tenderness proximally along the vein; may be associated with fever.
Feel free to use and share this material as widely as possible, according to our Creative Commons license. C'est en 2009 que Google l'aura enfin fait graduer a titre de service pret a etre utiliser. Using the safety IV catheter insert the needle bevel upwards, parallel to the skin surface. While holding the needle stationary, advance the cannula into the vein by placing the forefinger of your dominate hand, or the thumb of your non dominate hand, against the push-off tab. Start as far distal on the arm as possible - if you miss you can try more proximally without getting leaks from previous sites. If you choose to use local anaesthesia, raise a small intradermal weal of Xylocaine over the site. If necrosis occurs, discontinue the infusion immediately and consult the pharmacy - some of these substances have specific treatments to reduce the risk of tissue necrosis.



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