末梢静脈カテーテル挿入
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Q1: Why should the feet be avoided for peripheral intravenous catheter placement in adults?
The feet should be avoided in adults because of the risk of thrombophlebitis, a serious vein inflammation. In contrast, feet are preferred sites for children. Site selection requires careful assessment of contraindications including wounds, decreased circulation, previous cerebrovascular accident, dialysis fistulas, or mastectomy on the same side.
Q2: What is the aseptic no-touch technique for peripheral intravenous catheter insertion?
The aseptic no-touch technique is a sterile procedure that minimizes contamination during PIV placement. Key steps include hand hygiene, using chlorhexidine to scrub the insertion site for 30 seconds, allowing it to dry completely for antimicrobial activity, and avoiding touching the venipuncture site after cleaning. Common mistakes include contaminating the site after antiseptic preparation or not allowing chlorhexidine adequate drying time.
Q3: What supplies are needed for peripheral intravenous catheter insertion?
Essential supplies include a tourniquet, absorbent pad, chlorhexidine swabs, latex-free gloves, an appropriately sized over-the-needle catheter, IV needleless connector, prefilled saline flush syringe, IV extension tubing, barrier solution, IV adhesive securement device, transparent occlusive dressing, transpore tape, sterile gauze, and adhesive bandage. Duplicate supplies may be needed for repeated IV attempts.
Q4: How should the insertion site be prepared before venipuncture?
Apply a tourniquet 10-15 cm proximal to the chosen site without obliterating distal pulses. Tap the site to vasodilate the vein. Scrub with chlorhexidine for 30 seconds, ensuring penetration into skin cracks and fissures. Allow chlorhexidine to dry completely to enable full antimicrobial activity and proper adhesive function before proceeding with needle insertion.
Q5: What angle and technique should be used to insert the over-the-needle catheter?
Hold the catheter with the bevel up and pierce the skin at a 15-20 degree angle directly over the vein. Advance until blood flashback is visible, then drop the angle slightly and advance a few millimeters to ensure the tip enters the vein. Advance the catheter hub fully while holding the needle steady, then remove the stylet and engage the safety device if available.
Q6: How is the peripheral intravenous line secured and dressed after insertion?
Apply barrier solution 1 cm around the insertion site. Place a twice-folded gauze under the catheter hub to prevent skin pressure. Cover with a transparent occlusive dressing and secure the hub with an adhesive IV securement device. Loop the IV extension tubing in a U-shape and secure with tape. Attach a label with insertion time, date, and initials, ensuring the site remains visible for future evaluation.
Q7: Why is priming the IV extension set and needleless connector important before insertion?
Priming removes all air from the extension tubing and needleless connector by pushing saline through until a few drops are expressed. This prevents air from entering the patient's vein during catheter flushing. After insertion, flush the line with normal saline to ensure patency while observing for swelling, redness, or leaking, and ask the patient about discomfort. Afterward, you may proceed with preparing and administering intermittent intravenous medications with an infusion pump or other IV therapies.