Basic Intravenous Therapy Vein Anatomy and Physiology

Basic Intravenous Therapy

Vein Anatomy and Physiology

• Veins are unlike arteries in that they are 1)superficial, 2) display dark red blood at skin surface and 3) have no pulsation

• Vein Anatomy

• - Tunica Adventitia

• - Tunica Media

• - Tunica Intima

• - Valves

Tunica Adventitia the outer layer of the vessel

• Connective tissue

• Contains the arteries and veins supplying blood to vessel wall

Tunica Media the middle layer of the vessel

• Contains nerve endings and muscle fibers

• The vasoconstrictive response occurs at this layer

Tunica Intima the inner layer of the vessel

Valves present in MOST veins

• Prevent backflow and pooling

• More in lower extremities and longer vessels

• Vein dilates at valve attachment

Veins of the Upper Extremities

Veins of the Upper Extremities

• Cephalic (Intern’s Vein)

• -Starts at radial aspect of wrist

• -Access anywhere along entire length (BEWARE of radial artery/nerve)

• Medial Cephalic (“On ramp” to Cephalic Vein)

• -Joins the Cephalic below the elbow bend

• -Accepts larger gauge catheters, but may be a difficult angle to hit and maintain

Veins of the Upper Extremities

• Basilic

• - Originates from the ulner side of the metacarpal veins and runs along the medial aspect of the arm. It is often overlooked becauses of its location on the “back” of the arm, but flexing the elbow/bending the arm brings this vein into view

• Medial Basilic

• - Empties into the Basilic vein running parallel to tendons, so it is not always well defined. Accepts larger gauge catheters.

• - BEWARE of Brachial Artery/Nerve

Purposes of IV Therapy

• To provide parenteral nutrition

• To provide avenue for dialysis/apheresis

• To transfuse blood products

• To provide avenue for hemodynamic monitoring

• To provide avenue for diagnostic testing

• To administer fluids and medications with the ability to rapidly/accurately change blood concentration levels by either continuous, intermittent or IV push method.

Starting a Peripheral IV

• Finding a vein can be challenging

• - Go by “feel”, not by sight. Good veins are bouncy to the touch, but are not always visible.
• - Use warm compresses and allow the arm to hang dependently to fill veins.
• - A BP cuff inflated to 10mmHg below the known systolic pressure creates the perfect tourniquet. Arterial flow continues with maximum venous constriction.
• - If the patient is NOT allergic to latex, using a latex tourniquet may provide better venous congestion
• - Avoid areas of joint flexion
• - Start distally and use the shortest length/smallest gauge access device that will properly administer the prescribed therapy
• (BE AWARE: Blood flow in the lower forearm and hand is 95ml/min)

IV Start Pain Management

• One of the most frequent contributors to patient dissatisfaction is painful phlebotomy and IV starts

• Use 25-27g insulin syringe to create a wheal similar to a TB skin test on top of or just to side of vein with 0.1 -0.2 ml normal saline or 1% xylocaine without epinephrine

• Topical anesthesia cream (ie EMLA) may be applied to children>37 weeks gestation 1 hr. prior to stick. It might be a good idea to anesthetize a couple of sites

• Have the patient close their fist (NO PUMPING) prior to stick

• Make sure the skin surface cleansing agent (alcohol/chlorhexidine) is dry prior to stick. Drawing this into the vein may stimulate the vasoconstrictive action of the tunica media layer

Flushing Peripheral IV’s

Dressing/Bag Changes

Central Venous Catheters

Central Venous Catheter Sites

CVC Care/Maintenance

CVC Care/Maintenance

Site Care

Infiltration/Extravasation

Phlebitis/Thrombophlebitis

Cellulitis

Septicemia/Pulmonary Edema/ Embolism

Vascular access device will not flush/can’t draw blood

• Vascular access device will not flush/can’t draw blood

• - Evaluate for kink in tubing or catheter tip against vein wall.

• Vascular access device (VAD) leaking when flushed

• - Verify that hub access cap is connected correctly

• Patient complains of pain while VAD being flushed

• - Assess for infiltration

• VAD broken

• - PICC’s may be repaired. All other devices must be replaced

• Call IV therapy team member for any concerns or questions.

Policy notes

IV Medication Administration

IV Medication Administration

Infusion Nurses Society (INS)

• Infusion Nurses Society (INS)

• Professional Organization that sets the standards of care for clinicians practicing in the field of infusion therapy.
• Standards set by INS are reflected in our policies and procedures related to infusion therapy for health care providers.
• In a court of law, the standards set by the INS are used to assess the infusion clinician’s performance.