Name: iv site selection for peripheral catheters
Uploaded: 2023-04-30T06:49:33.000Z
Duration: 11 min 39 s
Channel: JoVE

1. PIV 置入的一般注意事项（在病房内与患者一同进行评估）。
<ol>
	<li>首次进入患者病房时，应用肥皂和温水洗手，并用力摩擦至少 20 秒。若双手无明显污物，可使用手部消毒剂，但仍需用力摩擦。</li>
	<li>在床旁计算机上登录患者的电子健康记录，查看患者关于外周静脉导管（PIV）置入的医嘱。审查患者病史中可能存在的置管期间出血风险因素，如出血性疾病、抗凝治疗及血小板计数偏低等情况。获取患者对该操作的知情同意。</li>
	<li>使用两个独立的身份识别信息核对患者身份：患者的姓名和病历号。不得将患者所在房间号或床号作为身份识别依据。</li>
	<li>与患者沟通其对外周静脉导管（PIV）置入的偏好，例如需要避免的静脉、已知血液循环较差的部位，以及是否存在任何瘘管（如动静脉瘘）。</li>
	<li>向患者说明外周静脉导管（PIV）置入的操作过程，并解答患者的任何疑问或顾虑。同时，应讨论与 PIV 相关并发症的体征和症状，例如静脉穿刺部位肿胀、穿刺区域周围发红、输液或冲管时疼痛，以及静脉穿刺部位液体渗漏等。</li>
</ol>
2. 离开病房并按照步骤1.1中的说明洗手
3. 准备静脉留置针插入所需的用品。
<ol>
	<li>选择适合输液治疗类型及预期治疗时长的最小规格套管针。
	<ol>
		<li>给药和输注静脉液体应使用小口径导管，而输血或大量液体输注时可使用较大口径导管。请查阅医院关于导管长度和规格的相应规定。小口径套管针可在导管周围维持血流，使血液持续接触内皮细胞，从而通过降低渗出/外渗和静脉炎的风险，保持静脉通路通畅。</li>
	</ol>
	</li>
	<li>准备一套静脉穿刺包。或者，准备以下物品：一块 2 x 2 无菌纱布；透明半透性闭合敷料；静脉延长管；无针接头；预充式生理盐水冲管注射器；止血带；70% 酒精棉片或含氯己定的消毒棉签；薄膜制备垫；1 英寸透明透剖胶带；静脉导管粘性固定装置；标签；吸水垫；以及两副清洁无乳胶手套。建议准备粘性绷带，以备穿刺静脉失败时使用。除粘性绷带外，可能还需准备重复穿刺所需的备用耗材。由于氯己定具有长效抗菌特性，被美国疾病控制与预防中心（CDC）推荐使用。</li>
</ol>
4. 置入PIV的准备工作。
<ol>
	<li>返回患者床旁，进入房间后按照步骤 1.1 的描述洗手。</li>
	<li>向患者解释操作过程，并将患者置于舒适体位。调整病床高度，以维持护士操作时的人体工学姿势，减少背部劳损。确保照明充足。</li>
	<li>将所需物品放置在床头柜或床上桌等触手可及的位置。</li>
	<li>准备静脉输液延长管。
	<ol>
		<li>采用无菌技术打开静脉无针接头，将预充生理盐水的冲洗注射器连接到无针接头的雌端，特别注意保持装置两端的无菌状态。</li>
		<li>将注射器和无针接头移至非惯用手，夹在中指与无名指之间。</li>
		<li>采用无菌技术打开静脉延长管。用非惯用手的拇指和食指取下延长管雌端的保护帽，同时用惯用手持握延长管。</li>
		<li>采用无菌技术将静脉延长管的雌端连接到静脉穿刺针装置的雄端。</li>
		<li>用非惯用手握住延长管，使带帽的雄端朝上指向天花板。轻推生理盐水注射器活塞，冲洗无针接头和延长管，直至排尽所有空气，并可见少量盐水滴出。</li>
		<li>将已冲洗好的无针接头和延长管放置在触手可及处，保持生理盐水冲洗注射器连接在延长装置上。</li>
	</ol>
	</li>
	<li>准备静脉穿刺所需的其余物品。
	<ol>
		<li>从导管包装中取出透明闭合敷料。撕去背衬，使粘性面朝上，并放置在易于取用的位置。</li>
		<li>取出两条长约 4 cm 的透明胶带，放置在易于取用的位置。</li>
		<li>完全打开 2×2 无菌纱布、氯己定、静脉导管固定贴膜和创可贴的包装，保持其处于无菌包装内并置于易于取用的位置。</li>
	</ol>
	</li>
	<li>佩戴清洁的非无菌手套。</li>
	<li>选择外周静脉（PIV）穿刺部位。
	<ol>
		<li>目视检查患者双臂，寻找适合穿刺的静脉。优先选择头静脉、贵要静脉、肘正中静脉以及手背静脉。</li>
	</ol>
	</li>
	<li>在上臂距离穿刺部位约 10–15 cm 处绑扎止血带。确保止血带不过紧，且止血带远端的脉搏仍可触及。</li>
	<li>触诊选定的穿刺部位，评估是否存在静脉硬化、硬结、渗出、静脉炎、瘀斑或静脉瓣区域（静脉瓣触感为静脉内的隆起）。若所选静脉柔软且无并发症，可暂时松开止血带，准备进行静脉穿刺。</li>
	<li>将吸水垫置于选定穿刺部位的手臂下方。</li>
	<li>准备套管针（带针套管导管）。
	<ol>
		<li>从包装中取出套管针，取下导管帽，将其夹在非惯用手的无名指与中指之间。检查导管和针头是否存在异常。</li>
		<li>部分套管针因灭菌工艺而存在张力。可小心地将导管座顺时针旋转后再回至原位，以释放张力，确保进入静脉后能顺利推进。</li>
		<li>重新盖上套管针帽，将其放置在易于取用的位置。脱去手套并丢弃至垃圾桶中。</li>
	</ol>
	</li>
</ol>
5. PIV 置入操作步骤。
<ol>
	<li>按照步骤 1.1 所述洗手，并重新戴上清洁手套。</li>
	<li>按照步骤 4.8 所述重新应用止血带。</li>
	<li>轻拍选定的穿刺部位 2-3 次，以扩张静脉。</li>
	<li>使用氯己定棉签以来回摩擦的方式对穿刺部位消毒 30 秒。待穿刺部位完全干燥。干燥有助于实现完全的杀菌作用，而带有摩擦的擦拭可使消毒剂渗透至表皮层的裂纹和缝隙中。</li>
	<li>用非惯用手握住套管针，取下保护帽，然后将套管针转移至惯用手。</li>
	<li>用非惯用手绷紧皮肤，并在穿刺点下方 4-5 cm 处固定静脉，注意避免污染穿刺点。</li>
	<li>将套管针夹在拇指与中指之间，针尖斜面朝上，与皮肤呈 15-20° 角，直接刺入静脉正上方的皮肤，直至观察到回血。</li>
	<li>略微降低套管针的角度，再向前推进几毫米，确保套管尖端已完全进入静脉内。</li>
	<li>用食指将套管座完全推入静脉，同时保持针芯稳定不动。</li>
	<li>用惯用手固定针芯和套管，用非惯用手松开止血带。用非惯用手的食指压迫穿刺点上方的静脉，以减少拔针后的出血。</li>
	<li>将针芯从套管中取出，并启动针头安全装置（如配备）。将针芯放置在床旁桌上或床边支架上。</li>
	<li>迅速取用预先充满生理盐水的静脉延长管。取下其雄性接头端的保护帽，插入套管座中。</li>
	<li>用非惯用手固定静脉延长管，用惯用手轻轻推动预充式生理盐水注射器的活塞，冲洗静脉通路以确认通畅性。
	<ol>
		<li>冲洗外周静脉导管（PIV）时，观察穿刺部位是否有肿胀、发红或渗漏。询问患者在冲洗过程中是否感到疼痛。若上述异常均未出现，应牢固地将静脉延长管旋紧至套管座上。冲洗 PIV 时出现口腔内的冷感或咸味均属正常现象。</li>
		<li>用惯用手再次缓慢冲洗 PIV，同时关闭静脉延长管上的夹钳。取下预充式生理盐水冲洗器，弃置于床旁桌或床边支架上。</li>
	</ol>
	</li>
</ol>
6. 使用敷料固定 PIV。
<ol>
	<li>取出隔离液包装，打开包装，在穿刺部位周围1 cm处均匀涂抹一层薄薄的隔离液。</li>
	<li>取用粘性静脉输液固定装置，移除背衬，将粘性面朝下贴于皮肤上，并置于导管座正下方。根据所用装置的制造商说明，用力按压（或滑动）固定装置，使其牢固固定在导管座上。</li>
	<li>取用半透性闭合透明敷料，将穿刺点置于敷料中央，平整贴合于皮肤并覆盖导管座。挤压导管座周围的敷料，使其与粘性层粘牢，从而固定导管座。若无固定装置，可取一块2×2无菌敷料，先对折一次，再对折一次，形成一个约1 cm见方的小块。将此敷料轻轻置于外周静脉导管座与延长管连接处下方，以防止导管座对皮肤造成压迫损伤。</li>
	<li>取一段透明透剖胶带，将粘性面朝上，抬起静脉延长管，将胶带置于导管座和2×2敷料下方。将胶带两端以对角线方向折叠，穿过导管座上方并覆盖在透明闭合敷料上，形成一个“V”形（人字形）固定。注意确保穿刺部位仍可通过透明敷料清晰观察。或者，也可将胶带两端垂直向上折叠并覆盖在闭合敷料上，形成“U”形，以将静脉导管固定于闭合敷料上。</li>
	<li>将静脉延长管弯成一个“U”形环，开口朝上，位置高于穿刺点，确保穿刺部位仍可通过透明闭合敷料清晰可见。</li>
	<li>取第二段透明胶带，横向覆盖在静脉延长管上。将胶带牢固粘贴于皮肤和闭合敷料上，再次确认穿刺部位可通过透明敷料清晰观察。穿刺部位应始终保持可见，以便日后评估导管通畅性。</li>
</ol>
7. 取出标签，填写插入时间与日期，并附上您的姓名缩写。根据医院的规程和程序，可能需要补充更多信息。将标签贴在闭塞性敷料上。
8. 收集所有包装材料和无针预充式生理盐水注射器，并将其丢弃至垃圾桶中。将套管针内的针芯丢弃至锐器容器中。
9. 回顾第1.5步中所述静脉输液或药物给药过程中并发症的体征和症状。
10. 按照步骤 1.1 中所述方法，脱下手套并丢弃至垃圾桶中，然后洗手
11. 在离开患者病房前，将PIV置入信息记录于患者的电子健康档案中。

使用套管针经静脉穿刺置入外周静脉导管（PIV）进行输液治疗是一种无菌、非接触式操作。在静脉穿刺前，务必向患者说明操作过程及可能发生的并发症。应告知患者整个流程以及置管时可能产生的疼痛感。此外，许多患者错误地认为静脉穿刺后针头仍留在血管内。需重点强调，仅柔软且具弹性的导管部分保留在静脉中，患者可自由活动肢体，不会造成额外损伤。
任何输液过程中均可能发生外渗和渗出等并发症。应指导患者了解渗出和外渗的体征与症状，并指出疼痛可能是并发症最早出现的征兆之一。在穿刺前应准备好备用物品，以防因初次穿刺位置不准确而在操作过程中需要再次进行静脉穿刺。美国静脉输液护理学会（INS）建议，每名医务人员最多只能进行两次静脉穿刺尝试，之后必须请求其他人员协助。放置外周静脉导管（PIV）时常见的错误包括：使用抗菌溶液清洁后触碰穿刺部位，从而污染了穿刺点；另一个常见错误是氯己定溶液未充分干燥，这可能导致抗菌效果降低以及粘附力不足。在置管过程中应避免将针头从导管中拔出后再重新插入，此举可能增加针头刺穿导管或导致导管断裂并留于静脉内的风险。INS会定期对静脉导管置入操作规程进行研究和修订，因此每位护士都应定期查阅其...

外周静脉导管置入

来源：Madeline Lassche，MSNEd，注册护士，Katie Baraki，MSN，注册护士，犹他大学护理学院，犹他州
外周静脉导管（PIV）置入的目的是输注药物、实施静脉（IV）液体治疗，或注射放射性示踪剂以进行特殊检查操作。置入PIV是一种侵入性操作，需要采用无菌、非接触技术。
成人常见的静脉穿刺部位是手臂和手部，而儿童则常选择足部。根据静脉输液护理学会（INS）的建议，应避免在成人足部进行穿刺，因为存在血栓性静脉炎的风险。在选择穿刺部位时，应仔细评估是否存在禁忌证，例如疼痛、伤口、血液循环不良、既往脑血管意外（CVA）、透析用动静脉瘘或同侧乳房切除术史。应尽量避免在肘正中静脉以及腕部区域的头静脉进行穿刺，因为头静脉穿刺与神经损伤相关。首选手部或手臂上最远端的可用穿刺部位，以便在发生渗出或外渗时，仍可保留近端部位用于后续穿刺。
本视频将演示外周静脉导管（PIV）的置入过程，包括静脉延长管套件的准备与连接。尽管本例中使用了PIV固定装置以稳定静脉导管，但根据美国静脉输液护理学会（INS）的建议，部分医疗机构可能选择不采购此类装置，而采用替代的V形或U形胶带固定方法。

来源：马德琳·拉舍（Madeline Lassche），护理学硕士教育学位，注册护士，及凯蒂·巴拉基（Katie Baraki），护理学硕士，注册护士，犹他大学护理学院，犹他州  
外周静脉导管的目的……

外周静脉导管置入是一种常见的护理操作。外周静脉通路对于患者护理的多个方面至关重要，包括药物、液体、造影剂和放射性示踪剂的输注。在本视频中，我们将演示外周静脉留置导管（PIV）的无菌“非接触”置入技术，并连接静脉延长管装置。成人外周静脉留置针最常见的置管部位是手臂和手部，儿童则为足部。成人应避免在足部置管，因为存在血栓性静脉炎的风险。此外，由于可能造成神经损伤，应尽量避免使用腕部的肘正中静脉和头静脉。应始终选择最远端的穿刺部位，以便在发生渗出或外渗时，近端部位仍可使用。选择穿刺部位时还需考虑其他因素，包括疼痛、伤口存在、循环不良、既往脑血管意外、透析用动静脉瘘或乳房切除术史。进入患者病房后的第一步，是用肥皂和温水洗手20秒，或者如果双手没有明显污物，可使用消毒剂并用力摩擦进行手部消毒。接下来，在床旁计算机上查看患者的电子健康记录以及外周静脉置管医嘱。同时，回顾患者是否存在出血并发症的风险，例如出血性疾病、抗凝治疗以及血小板计数偏低等情况。然后向患者解释操作过程，强调静脉穿刺后仅柔软且具弹性的导管会保留在静脉内，患者仍可自由活动肢体，并取得患者对该操作的知情同意。必须使用两个独立的标识符（如患者的姓名和病历号）来确认患者身份。不得使用患者所在的房间号或床号作为标识符。接下来，将患者置于舒适体位，并调节床的高度，以维持符合人体工学的护理姿势，减少背部劳损。同时，确保照明充足，并清空床旁桌或床上桌，以便使用。准备用物时，离开患者病房并再次按前述方法洗手。然后收集所需的物品，这些物品可能以静脉穿刺套件的形式提供。所需物品清单包括止血带、吸水垫、氯己定棉片、两副无乳胶手套、合适尺寸的套管针、静脉无针接头、预充生理盐水冲洗注射器、静脉延长管、屏障溶液、静脉导管固定胶带、透明闭合敷料、透析胶带、2 cm × 2 cm 无菌纱布以及粘性绷带。根据医疗机构的政策，选择适合所实施静脉治疗类型及预期治疗时长的最小规格套管针导管。可能需要准备重复静脉穿刺所需的备用耗材。返回患者病房。将所有物品放在床边桌上，再次洗手。然后，打开预充式注射器，用非惯用手的中指和无名指夹住注射器。接下来，采用无菌技术打开延长管。用惯用手握住延长管，用非惯用手的拇指和食指取下延长管雄性端的保护帽。随后，将延长管的雌性端连接到注射器的雄性端。随后，握住延长管，使带有帽端的雄性接头朝向天花板。推动注射器活塞，对无针连接器和延长管进行预冲，直至排尽所有空气，并有少量生理盐水从末端滴出。然后将已预冲的无针连接器连同延长管及连接的注射器放置在触手可及的桌面上。现在，取下透明闭合敷料的背衬，将粘性面朝上放置在便于取用的位置。接着，从透皮胶带卷上取下四段胶带，并打开纱布、氯己定包装、静脉导管固定装置以及创可贴的包装。下一步是选择穿刺部位。目视检查双臂，寻找合适的静脉。优先选择头静脉、贵要静脉、肘正中静脉以及手背静脉。在距离选定穿刺部位近端10-15 cm处的上臂绑扎止血带。止血带的松紧应适中，不应紧到阻断远端脉搏。在扎好止血带的情况下评估所选静脉。如果静脉柔软且无硬化、瘀斑、静脉炎或渗出等并发症，可暂时松开止血带，并在手臂下方放置一块吸水垫。操作前再次进行手部卫生。现在，从包装中取出套管针导管，取下保护帽，用非惯用手的无名指和中指夹住导管。检查导管和针头是否存在异常，例如弯曲、缺口或钩状变形。顺时针旋转导管接头，再转回原位，以解除灭菌过程中可能残留的负压吸附力。这一步有助于导管顺利推进。重新盖上导管保护帽，并将套管针导管放置在便于取用的位置。现在，您已准备好进行导管插入操作。再次洗手并戴上清洁手套。重新将止血带绑在患者的上臂，并反复轻拍选定的穿刺部位数次，以扩张血管。使用氯己定棉签来回擦拭穿刺部位30秒，确保抗菌剂渗入皮肤的任何裂纹和缝隙中。然后让氯己定完全干燥——这将实现彻底的杀菌作用。接下来，取下套管针导管的帽盖，用你的优势手握住导管。然后，用非优势手绷紧皮肤，并在穿刺点下方 4-5 cm 处固定静脉，注意避免污染穿刺部位。现在，用主手的拇指和中指夹住套管针，针尖斜面朝上，与皮肤呈15-20°角，在静脉正上方穿刺皮肤。推进针头直至看到回血。随后，将导管角度略微降低几度，再向前推进几毫米，以确保导管尖端已进入静脉。接下来，用主手的食指将导管座完全推入静脉，同时固定针头不动。然后，用非主手松开止血带，并压迫静脉，以减少拔针后的出血。从导管中取出导丝针，如有安全装置，应启动针头安全装置，并将针头放置在床旁桌上。迅速取下保护帽，将预冲好的静脉延长管的雄性接头插入导管接口。接着，在固定静脉延长管的同时，按压注射器的活塞，用生理盐水冲洗静脉通路，以确认其通畅性。观察静脉穿刺部位是否有肿胀、发红或渗漏，并询问患者在此过程中是否感到任何不适。患者可能会感觉到局部冷感或口中出现咸味，这是常见现象。若无不良反应，则再次缓慢冲洗外周静脉导管，同时关闭静脉延长管上的夹子，防止血液反流至管路中。然后取下注射器，将其放置在床旁桌上。下一步是敷料的使用。首先打开隔离液包装，将一层薄薄的隔离液涂抹在穿刺部位周围及距离穿刺点约1 cm的区域。接着，将一块对折两次的2 × 2纱布垫于外周静脉导管（PIV）连接端下方，以防止对下方皮肤造成压迫。随后，将半透性闭合透明敷料覆盖在穿刺部位及导管上，并轻轻按压以固定导管连接端。然后，撕下粘性静脉固定装置的背衬，将粘性面直接贴于导管连接端下方的皮肤上，从而将导管连接端牢固固定于该装置上。现在，将静脉延长管以向上的 U 形绕环，使其位于穿刺点上方，并用胶带将其固定在皮肤和闭合敷料上。同时，在闭合敷料上粘贴标签，注明穿刺的时间和日期、您的姓名缩写，以及医疗机构要求的其他信息。确保穿刺部位保持可见，以便后续评估。接下来，将所有包装材料和预充式注射器丢弃至医疗垃圾桶中，并将套管内穿刺针芯弃置于锐器盒中。最后，在离开患者病房前，将外周静脉导管置入操作记录于患者的电子健康档案中。“使用套管针进行外周静脉导管置入以实施输液治疗是一种无菌非接触操作。”PIV 置管过程中常见的错误包括使用消毒剂清洁后触碰穿刺部位，从而污染了穿刺点。另一个常见错误是未给予氯己定足够的干燥时间，这可能导致抗菌作用减弱以及粘附效果不充分。在置管过程中应避免拔出和重新插入导管内的针头，因为这可能增加针头刺穿导管，甚至导致导管断裂并留于静脉内的风险。美国输液护理学会定期对静脉导管置入操作规程进行研究和修订，每位护士都应定期参考该指南。您刚刚观看了JoVE关于使用静脉延长管进行外周静脉导管插入的视频。您应该已经了解了该常见操作所需的物品及其无菌不接触技术。一如既往，感谢您的观看！

peripheral-intravenous-catheter-insertion

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Peripheral Intravenous Catheter Insertion

外周静脉导管插入

iv site selection for peripheral catheters

Peripheral intravenous catheter insertion uses a careful site check before the catheter is placed. A peripheral IV, or PIV, is used to give medications, provide IV fluid therapy, or inject radioactive tracers for special examination procedures. Because it is an invasive procedure, it requires an aseptic, no-touch technique.

Choosing the right venipuncture site is an important part of the process. In adults, common IV sites are the arms and hands. In children, the feet are also common, but the feet should be avoided in adults because of the risk of thrombophlebitis, which is inflammation of a vein with clotting.

Each possible site should be assessed for contraindications, or reasons not to use it. These include pain, wounds, decreased circulation, a previous cerebral vascular accident, dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible, and the cephalic vein has been associated with nerve damage when used for IV placement.

The most distal site available on the hand or arm is preferred. This helps preserve other venipuncture sites if infiltration or extravasation occurs. The procedure also includes preparing and attaching an IV extension set. A securement device may be used to stabilize the catheter, although some facilities use chevron or U-shaped tape instead.

IV Site Selection for Peripheral Catheters

iv-site-selection-for-peripheral-catheters

safety checks and ten rights of medication administration

safety-checks-ten-rights-medication-administration

Medication Safety Checks Before Drug Pickup

Medication safety checks are an important part of safe medication administration. Nurses use the Ten Rights of medication administration to reduce the risk of medication errors and improve patient safety. These rights include the right patient, right medication, right dose, right time, right route, right documentation, right education, right to refuse, right assessment, and right evaluation. The acquisition phase of medication administration focuses on retrieving the medication. This process...

preparing and administering oral tablet and liquid medications

preparing-and-administering-oral-tablet-and-liquid-medications

Oral Medication Safety: Tablets and Liquids

Oral medication safety includes preparing and giving tablets and liquid medicines by mouth. Oral preparations are a common route used by providers and are usually swallowed with fluid. After swallowing, they are absorbed through the gastrointestinal tract. Oral medications come in solid forms and liquid forms. Solid forms include tablets, capsules, caplets, and enteric-coated tablets. Liquid forms include syrups, elixirs, spirits, and suspensions. Most oral medicines have a slower onset of...

preparing and administering topical medications

preparing-and-administering-topical-medications

Safe Skin, Eye, and Ear Medication Use

Topical medications are applied directly to body surfaces such as the skin and the mucous membranes of the eyes, ears, nose, vagina, and rectum. Common forms include creams, ointments, lotions, patches, and aerosol sprays. Some topical drugs are also transdermal, meaning they are placed on the skin to create a slow, controlled, systemic effect throughout the body. Transdermal absorption can change if the application site has lesions, burns, or skin breakdown. Many transdermal medications are...

preparing and administering inhaled medications

preparing-and-administering-inhaled-medications

Using a Metered-Dose Inhaler Properly

Inhaled medications are used to treat conditions that affect the bronchi and bronchioles in the lungs. These airways can be involved in acute conditions, such as acute bronchitis, pneumonia, tuberculosis, pulmonary edema, and acute respiratory distress syndrome. They can also be involved in chronic conditions, including COPD, asthma, chronic bronchitis, emphysema, cystic fibrosis, lung cancer, and pneumoconiosis. These medicines help open airways, reduce airway inflammation, and improve...

preparing and administering subcutaneous medications

preparing-and-administering-subcutaneous-medications

Subcutaneous Injection Setup and Safety

Subcutaneous medication administration places a small dose of medicine just below the skin. This route is used for medications that need to be absorbed more slowly than by an intravenous route. It is also chosen for some drugs that may be broken down by the acidic environment of the gastrointestinal tract if taken by mouth. Common subcutaneous medications include anticoagulants such as heparin or enoxaparin. Epinephrine for allergic reactions, insulin, and some immunizations can also be given...

preparing and administering intramuscular injections

preparing-and-administering-intramuscular-injections

Selecting Sites for Intramuscular Injections

Intramuscular injections place medication deep into muscle tissue. Because muscle has a rich blood supply, this route can move medication into the body quickly and can handle relatively large volumes. Skeletal muscle also has fewer pain-sensing nerves than subcutaneous tissue, which can make it a better choice for irritating drugs such as chlorpromazine. IM injections are often used when a patient cannot take medicine by mouth or is not cooperative. Common examples include antibiotics,...

preparing and administering enteric tube medications

preparing-and-administering-enteric-tube-medications

Checking Enteric Tube Placement Before Meds

Enteric tube medications require a careful check of tube placement before each dose. An enteric tube is a tube inserted through the nose or mouth and passed into the stomach or intestines. These tubes may be used for stomach decompression, enteric feeding, or giving medications and oral contrast. Enteric tubes are used when a patient has trouble swallowing, has a neurological condition, or has another condition that raises aspiration risk. They are also used when a patient cannot take enough...

peripheral intravenous catheter insertion

Peripheral intravenous catheter insertion uses a careful site check before the catheter is placed. A peripheral IV, or PIV, is used to give medications, provide IV fluid therapy, or inject radioactive tracers for special examination procedures. Because it is an invasive procedure, it requires an aseptic, no-touch technique. Choosing the right venipuncture site is an important part of the process. In adults, common IV sites are the arms and hands. In children, the feet are also common, but the...

assessing and flushing a peripheral intravenous line

assessing-and-flushing-a-peripheral-intravenous-line

Peripheral IV Care: Site Checks and Flushes

Peripheral IV care includes regular site checks and normal saline flushes to keep the catheter working properly. After peripheral intravenous access is started, the line should be assessed and maintained according to institutional policies and nursing standards of practice. Careful maintenance helps preserve patency, which means the IV remains open and usable. The insertion site and the tissue around it must be checked often for signs of complications. These can include infiltration,...

initiating maintenance iv fluids

Gravity Setup for Maintenance IV Fluids

Maintenance IV fluids help keep a patient's fluid and electrolyte balance steady during hospital care. Patients who cannot drink by mouth may need IV fluids with or without electrolytes to help prevent hypovolemia, dehydration, and electrolyte imbalance. Patients who are NPO, or nil per os, before surgery or a procedure with anesthesia also need hydration while they are not eating or drinking. After surgery or other procedures, IV fluids may be used to restore intravascular volume after blood...

preparing and administering iv push medications

preparing-and-administering-iv-push-medications

IV Push Medication Safety and Dosing

IV push medication safety and dosing are shown in this nursing demonstration. An intravenous, or IV, push is the rapid delivery of a small amount of medicine into a vein through a previously placed IV catheter. These medications often come in vials or ampules, which are used to draw the drug into a syringe before it is given. This method is chosen when a fast response is needed or when a medication cannot be taken by mouth. The transcript gives moderate or severe pain treatment as one common...

preparing and administering intermittent intravenous medications with an infusion pump

preparing-administering-intermittent-intravenous-medications-with-an

Infusion Pump Steps for Intermittent IV Meds

Intermittent IV medications are given by infusion pump to deliver a set volume over a specific time. These infusions may be primary, meaning they run alone, or secondary, meaning they run with another IV fluid such as maintenance fluids. Medications like IV antibiotics are common examples of this type of treatment. Infusion pumps help control the fluid rate and keep medication effects more predictable. They also help reduce nurse medication errors. High-volume IV medications, often in the 50-...

preparing and administering secondary intermittent intravenous medications

preparing-administering-secondary-intermittent-intravenous

Secondary IV Piggyback Medication Setup

Secondary IV piggyback medication setup is used to give small, controlled amounts of IV solution, usually 25 to 250 mL. These infusions run longer than IV push medications. That slower delivery can lower the risk of problems linked to rapid infusion, such as phlebitis and infiltration. In secondary IV therapy, the medication tubing connects to the primary macrobore IV tubing, so the secondary line is tied to the main infusion. The secondary bag is usually hung higher than the primary bag. This...

discontinuing intravenous fluids and a peripheral intravenous line

discontinuing-intravenous-fluids-and-a-peripheral-intravenous-line

When IV Fluids Can Be Stopped

Intravenous (IV) fluids and peripheral IV catheters can be stopped when they are no longer needed. A patient may no longer need IV fluid therapy after returning to euvolemia, which means normal body fluid volume. IV fluids may also be stopped when the patient can drink enough fluids by mouth or is being discharged from the hospital. Peripheral IV catheters, or PIVs, also need regular checks for safety. In adults, the Centers for Disease Control and Prevention recommends replacing a PIV every...

central venous access device dressing change

central-venous-access-device-dressing-change

Sterile Care for Central Line Dressings

Central line dressings must be changed with sterile care to help protect the line from infection. Central venous access devices, or CVADs, are large IV catheters that go into the central circulation. They are also called central lines or central catheters. These devices usually end in the superior vena cava, just outside the right atrium of the heart. Some may end in other large veins, including the aorta, inferior vena cava, brachiocephalic vein, pulmonary artery, internal iliac vein, or...

nursing skills

该收集显示药物准备和管理, 与视频突出重要的安全检查, 考虑因素, 剂量计算, 和常见的错误与用药管理不当有关。

Learn how peripheral IV site selection, aseptic technique, contraindications, and catheter securement help guide safe IV placement in adults and children.

IV Site Selection for Peripheral Catheters

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