Intravenous Tubing and Dressi... Health Article

Definition

Intravenous (IV) infusion is the process whereby fluids, medications, blood products, and nutritional substances are administered into a vein by means of an intravascular device. The most commonly used device is the short peripheral venous catheter, which is usually inserted into the veins of the forearm or hand. IV fluids are supplied in plastic bags and delivered via an administration set, i.e., tubing. The fluid to be infused and the flow rate are prescribed by a physician or nurse practitioner.

Purpose

IV infusion is a method of fluid replacement used most often to maintain fluid and electrolyte balance, or to correct fluid volume deficits after excessive loss of body fluids, or in patients unable to take sufficient volumes by mouth. Many medications are also given by IV infusion and it is used for prolonged nutritional support of patients with gastrointestinal dysfunction.

Precautions

The insertion of an IV access device creates an open wound and the continued presence of the catheter within the wound keeps it "open," which provides easy access for opportunistic bacteria. These bacteria may be present on a patient's skin or may come from touch contamination by a practitioner. Technically, the administration of IV solutions takes place within a "closed-system," but the delivery system usually has a number of connections, which may allow entry of bacteria. Strict adherence to handwashing and aseptic technique must always be followed while obtaining venous access and the equipment must be handled carefully to prevent contamination. Before using any materials, the practitioner must ensure that all packaging is intact prior to opening, that expiration dates have not passed, and that there are no visible signs of contamination. The site at which a catheter is placed has been shown to influence the subsequent risk of catheter-related infections; and in adults, hand vein insertions have a lower risk of problems than do upper arm or wrist vein insertions. Similarly, there is a greater risk with insertions in the legs than the arms, but the choice of a site may be limited by patient factors, e.g., preexisting catheters, anatomic deformity, present illness, or trauma. The practitioner must also be aware of any patient allergies to latex, iodine, or other substances. For

KEY TERMS

Catheter—A hollow tube that is flexible and used for withdraw or introduce fluids into the body.

Dehydration—A condition that results from a loss of water in the body.

Intravascular—Within a vessel, as a blood vessel.

Semipermeable—Permitting passage of only certain molecules.

Peripheral—That portion of the body that is outside the main region, as arms or legs.

Povidone—A synthetic polymer used as a dispersing and suspending agent as in povidone-iodine, a topical anti-infective agent.

selection of catheters, the Centers for Disease Control (CDC) recommend the use of a Teflon catheter, a polyurethane catheter, or a steel needle. The choice depends on the intended purpose, duration of use, and known complications. Transparent, semipermeable, polyurethane dressings reliably secure the site, permit continuous visual inspection of it, allow patients to bathe or shower without saturating the dressing, and require less frequent changes than standard gauze and tape dressings. Research has shown no clinically important differences between the two with regard to rate of infection or occurrence of inflammation.

Description

The initial insertion of a catheter with transparent dressing or sterile gauze should be labeled as to the time and date of insertion in an obvious location near the site(e.g. on dressing or on the bed) and the IV administration set should likewise be labeled as to time and date of hanging. CDC recommendations for care and management of peripheral venous catheter sites, IV administration sets, and dressing changes include the following:

• Hands must be washed before and after palpating, inserting, replacing, or changing dressing.
• The catheter site must be visually inspected and palpated for redness, tenderness, or warmth (phlebitis) daily.
• Sites must be replaced and rotated every 48–72 hours to minimize risk of phlebitis. Catheters inserted under emergency conditions must be replaced with new catheters within 24 hours due to possible break-in aseptic technique. Heparin locks must be replaced within 96 hours. Catheters with signs of phlebitis should be removed immediately or as soon as its use is no longer clinically indicated. Do not routinely apply topical antimicrobial ointment to site.
• When the catheter is removed or replaced, the site dressing should be replaced. The dressing should also be replaced when it becomes damp, loosened, or soiled. Dressings are changed more frequently for patients that sweat. Avoid touching the site when dressing is replaced.
• The IV tubing, including piggyback tubing and stopcocks, is replaced no more frequently than at 72-hour intervals, unless clinically indicated. Tubing used to infuse blood, blood products, or lipid emulsions is replaced within 24 hours of initiation.
• Injection ports are cleaned with 70% alcohol or povidone-iodine before accessing the system. Heparin locks require a routine flush with normal saline solution, unless they are used to obtain blood specimens, in which case a dilute heparin (10 units/ml) flush solution should be used.