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Principles and Management

Principles and Management. Intravenous Lines. 1. Aims . To discuss Peripheral Venous Lines Indications Complications Planning Good Clinical Practice. 2. Aims (Cont). Central Venous Lines Indications Catheter choice Types Complications of insertion Problems

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Principles and Management

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  1. Principles and Management Intravenous Lines 1

  2. Aims To discuss Peripheral Venous Lines Indications Complications Planning Good Clinical Practice 2

  3. Aims (Cont) Central Venous Lines Indications Catheter choice Types Complications of insertion Problems Golden Rules in IV Therapy Summary 3

  4. Peripheral Venous Lines 80% of Hospitalised patients receive Intravenous therapy at some point during their admission. Peripheral venous cannulation is the commonest method used for IV therapy They are not devoid of complications leading to increased mortality and morbidity, increased hospital stay and significant costs 4

  5. Indications for Peripheral Venous Lines Intravenous fluid administration Correction of electrolyte imbalance Administration of blood and blood products Drug administration Prophylactic before procedures/surgery Prophylactic in unstable patients 5

  6. Complications Local: > Position /site 44% > Phlebitis 44% > Infiltration and Extravasation 23% > IV running too slow 42% > Patient interference 41% > IV running too fast 38% 6

  7. Complications Systemic: Circulatory overload Pharmaceutical problems Embolism Allergic reactions 7

  8. Planning Is the key to ensuring this procedure is safe and effective for the patient. 3 distinct areas to consider: > The Patient > The Equipment > The Environment 8

  9. Good Clinical Practice Obtain informed verbal consent Explain the procedure to the patient Patient allergies ANTT to reduce the risk of local and systemic infections Care of lines* (RCN 2010) Know national and local guidelines/policies 9

  10. Good Clinical Practice Use of appropriate cleansing agent – Clinelle wipes for hubs/access ports (Chloroprep for skin cleansing) Regular monitoring of vital signs VIP score Regular monitoring of access device insertion site Duration of access device use Removal of access devices Documentation 10

  11. 11

  12. Central Venous Lines A CVC is an indwelling catheter threaded into the central venous circulation; the tip will always be in either: - Superior Vena Cava - Right Atrium - Inferior Vena Cava (femoral approach) 12

  13. Indications for Central Venous Lines Administration of irritant drugs/solutions and nutrition. Monitoring of CVP in acute situations Monitoring of Cardiac output Obtaining venous access when peripheral route fails or long term access 13

  14. Catheter choice The type of central line used will depend upon the reason for insertion and the length of time the line is likely to stay in situ. Preferable to use catheters with the minimum number of lumens Use catheters impregnated with antimicrobials (with caution) Ultrasound guided positioning (NICE 2002) 14

  15. Types of Central Venous Catheters Short-term Venous Catheters Peripherally Inserted Central Catheters (PICC) Tunnelled Catheters Implanted Venous Access Ports 15

  16. PICC Line 16

  17. Tunnelled catheter 17

  18. Implanted venous access portsPort-A-cath 18

  19. Complications of insertion Incorrect positioning of catheter Haematoma Haemorrhage Arterial puncture Pneumothorax* Cardiac arrythmias 19

  20. Complications Perforation (R. atrium, Pulmonary artery) Local and systemic sepsis: Colonised catheter Exit site infection/Tunnel infection Catheter related blood stream infection can be serious with substantial and directly attributable mortality/morbidity (10-35%) 20

  21. Complications (cont) Damaged catheter Catheter related thrombosis SVC syndrome (Clot occlusion of blood flow in SVC) Pinch off syndrome (rib compression of catheter) Air emboli Removal of catheter 21

  22. Golden Rules of IV therapy Plan as much as possible Know national/local guidelines/policies Know how to care for venous access device and how to remove safely. Know how to use the equipment Know how to prepare drugs/solutions Know the risks/complications Obtain verbal informed consent whenever possible 22

  23. Golden rules of IV therapy Use ANTT Avoid unnecessary manipulation of lines/giving sets/pumps Label lines, sites clearly Regularly examine infusions while they are running Monitor patients’ vital signs Maintain good documentation Know when to seek help and from whom 23

  24. Any Questions ? 24

  25. Summary Have discussed Peripheral Venous Lines & specific care Planning Good Clinical Practice Central Venous Lines & specific care Golden Rules in IV Therapy 25

  26. References www.cs.cmu.edu/~pausch/news/PICCline.jpg www.codybuker.com/.../uploads/2010/02/PICC.gif www.vascularphysicians.com/images/tunneled_ca www.ivteam.com/.../uploads/2008/08/hick.jpg NICE (2002) Guidance on the use of ultrasound locating devices for placing central venous catheters Guidance No 49 RCN (2010) Standards for infusion therapy. The RCN IV Therapy Forum 3rd ed. 26

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