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An IV catheter is usually inserted to deliver fluids and medications when a patient is unable to receive them orally. IV therapy is used to replace fluids, such as blood and blood products, lost through injury and surgery, or as part of therapy for certain medical conditions. Antibiotics and pain relieving medications are also common uses for IV administration. Medications can be administered continuously or intermittently as determined by the patient's medical condition and IV therapy can assist with the supporting the nutritional status of the patient such as the infusion of total parental nutrition (TPN). Up to 80% of hospital admissions can receive some form of intravenous therapy (IV) during their stay.

 

Types of catheter sites include:

 

Peripheral Vein Catheter (PVC)

The most common site for insertion of a IV catheter is the veins in the arm (peripheral veins). This type of IV therapy usually stays in place for two to three days, before either being removed or moved to a different site.

 

Central Venous Catheter (CVC)

--> In situations where the patient requires longer treatment with an IV a catheter will be inserted into a larger vein, usually one near the shoulder (subclavian vein) or neck (jugular vein). These types of catheters extend into the tip of the heart (superior vena cave) to allow more direct and faster access to the bloodstream in the administration of medication and fluids and can remain in place for up to seven days.

Central venous catheters that are required to remain in place for several weeks can be implanted (tunnelled) under the skin positioned in a large vein with the ideal catheter exiting the skin on the patient's chest.

 

Peripherally Inserted Central Catheter (PICC)

Longer-term central vein catheters can also be inserted into the large vein in the front of the elbow, the cubital fossa, which then extends up into the superior vena cava. This type of catheter is referred to as a peripherally inserted central catheter, or PICC and can stay in the same vein for several weeks. PICCs are the most common form of IV therapy for home care patients.

PICC catheters are commonly used in the hospital setting (acute care) such as intensive care units and critical care, but are also widely used in the home nursing environment and are usually indicated for patients who will require long-term therapy (several weeks to months).

PICC catheters allow for self-administration, due to their ease of use, and a wide range medication delivery, providing many advantages to the patient and caregivers as treatment in their own environment allows the patient to have a higher degree of control over their care.

PICCs also offer a cost-effective alternative to hospital based care.

 

Complications
Certain complications can arise from the insertion of an IV catheter:

  • Inflammation of the vein (phlebitis) - related to several factors, one of which is the stabilisation of the catheter in the vein. Phlebitis can occur simultaneously with a blood clot in the vein (thrombophlebitis). A blood clot in the vein without swelling (thrombosis) can cause the IV to slow or stop affecting the infusion of fluid or medication.
  • Infection of the IV catheter is problematic to because the skin's normal protective barrier has been breached allowing the entry of bacteria directly into the vein. Most catheter-related infections are sourced from either the patient's own skin bacteria or from the hands of a caregiver. Where there is movement of the catheter inside the vein the fluid, which is being transfused, can leak into the surrounding skin causing swelling or a skin tightening around the insertion site (infiltration). This tends to occur more frequently with peripheral IV therapy. Additionally, medications can also be inadvertently administered into the surrounding skin with certain medications causing skin blistering.

 

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Treatment

Catheter Securement
Stabilisation of the both peripheral and central catheters is important to reduce mobilisation of the catheter within the vein and avoid known complications. Sterile tape, sutures, or a sterile transparent dressing can be used for peripheral insertion sites. Central insertions, both short-term percutaneous and long-term catheters can be sutured or have a catheter securement device attached and covered with sterile transparent dressing.


Regular Site Inspection

Current guidelines recommend regular visual inspection or palpation through an intact dressing of the catheter insertion site to allow for early detection of complications. An IV dressing should be to provide continuous visual inspection of the site.


Ensure a Dry Site
A key objective of a preserving an IV site is ensuring a dry entry site. An intravenous site dressing must be able to stabilise a catheter inside the vein to prevent trauma to the skin at the catheter insertion site and the vein. It must aim to prevent external contamination of the insertion site from patient's skin bacteria and from bacteria on the hands of caregivers handling the catheter.

A dry catheter site will reduce the risk of bacteria accumulating on the skin around the catheter entry site (skin colonisation) and infection. This requires eliminating the moisture accumulation under the dressing - a waterproof dressing is important to allow the patient to continue normal daily activities.

Reduce Number of Changes

In addition, and in combination with the above criteria, the dressing should reduce the number of dressing changes to minimise interference with the catheter site and allow easy application and removal of the catheter dressing.

 

 

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Product Selection


IV3000* Moisture Responsive Catheter Dressings

 

 

 

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Related Links

INSERT: Intravenous Access Network - http://www.ivteam.com/

 

Infusion Nurses Society - www.ins1.org

 

League of Intravenous Therapy Education (LITE) - www.lite.org

 

Canadian Intravenous Nurses Association - www.cina.ca

 

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