輸液と末梢静脈ラインを中止

Peripheral intravenous catheters may be discontinued at any time for a number of reasons. The common reasons to discontinue IV fluids are: the patient’s fluid volume has returned to baseline; the patient is being discharged from the facility; the IV catheter needs to be replaced; or the IV site has become unfavorable due to infection, infiltration, extravasation, or phlebitis.

This video will illustrate the approach to discontinue intravenous fluid administration as well as peripheral intravenous catheters.

The first step upon entering a patient’s room is to perform proper hand hygiene. At the bedside computer, log into and review the patient’s electronic medical record. Be sure to be aware of the patient’s fluid volume status. This includes intake and output total volumes and serum laboratory results, assessment of the vital signs, skin turgor and mucus membranes, and the patient’s ability to maintain adequate oral fluid intake. Additionally, review the MAR to note the current medication orders and determine if there is a continued need for IV access and medication administration. Also, be sure to review the patient’s history for the risk of bleeding complications, such as bleeding disorders, anticoagulant therapy, and low platelet count.

Next, ensure you review the removal procedure with patient and address any questions the patient may have. Additionally, it is important to verify the patient’s identity using 2 independent identifiers, such as the patient’s name and medical record number. Remember, never utilize the patient’s room or bed number as identifiers.

Assess the patient’s IV site for any redness, swelling, or bruising, as this can be indicative of irritation, inflammation, infection, or a formation of a thrombus. Next, gently palpate the area around the IV site to assess for tenderness and swelling. Additionally, palpate the same area on the other limb with your other hand to see if there is any difference in skin temperature, texture, or swelling, as increased temperature may indicate inflammation or infection, while decreased temperature and bogginess may suggest an infiltration.

Next, at the bedside computer, record all procedures and assessments in the patient’s EMR, as well as any abnormal findings. Leave the patient’s room to gather the supplies to remove the IV catheter and wash your hands upon exiting, as previously described. Enter the clean holding room to gather the supplies needed to remove the IV. Obtain two sterile 2 x 2 gauze packages and tape or a non-adhesive self-adhering wrap, based on the patient’s preference.

Return to the patient’s room, place the supplies on the bedside table that is on the same side as the patient’s IV, and perform hand hygiene.

Now, while holding the IV tubing in your dominant hand, use your other hand to slide the clamp toward the narrow end to occlude the tubing and prevent backflow. If an IV pump is being used, hold the “channel off” button on the IV pump to shut off the machine. Next, disconnect the IV tubing from the patient and dispose of the fluid bag and tubing in the appropriate disposal receptacle based on the facility’s policy.

Now, open two 2 x 2 sterile gauze packages and leave them on their sterile packing on the bedside table to ensure no contamination. Wash your hands and put on clean gloves. While holding the skin taut near the dressing removal site with your non-dominant hand, gently peel up one corner of the transparent dressing, toward the catheter and away from the patient.

Next, remove and discard the gloves, wash your hands, and don a new pair of gloves before proceeding. Now, grasp the IV catheter near its hub with your dominant hand, fold one gauze in half, and hold it gently over the IV insertion site with your non-dominant hand. Next, pull the catheter out along the line of the vein and away from the patient.

With your non-dominant hand, apply firm pressure to the gauze over the insertion site for 1 to 3 minutes, or until bleeding stops. Then, with your dominant hand, fold the remaining clean gauze in half, remove the soiled gauze, and then place the clean gauze over the insertion site. Subsequently, secure the clean gauze to the insertion site with tape or a non-adhesive self-adhering dressing. Monitor the IV site for bleeding and instruct the patient to apply pressure to the site if it begins to bleed again.

Assess the removed catheter to determine if it is intact. The catheter should not be shortened and should have a clean edge to the catheter tip. Next, dispose of the catheter and soiled gauze into the appropriate disposal receptacle, remove and discard your gloves, and wash your hands thoroughly. Lastly, document the discontinuation of the IV fluids and the removal of the catheter in the patient’s EHR. It is important to include the patient’s response to the peripheral intravenous catheter removal and any abnormal findings.

“While discontinuation of intravenous fluids and removal of a peripheral intravenous catheter appears to be a straight-forward process, the nurse should ensure an adequate preparation and assessment prior to the procedure and monitor the patient closely afterwards.”

“Note if the patient’s history indicates increased risk of bleeding following the peripheral line removal, including bleeding disorders, anticoagulant therapy, and low platelet counts. Redness can indicate irritation, inflammation, infection, or formation of a thrombus. Bruising at the insertion site could be a sign of a hematoma, which may cause a damage to the surrounding tissues.”

“When removing the IV catheter, the catheter should not be shortened and should have a clean edge to the catheter tip.”

“Common mistakes when discontinuing a peripheral IV include not acquiring appropriate supplies, neglecting to stop fluid administration prior to the procedure, and failure to monitor the insertion site for complications following the catheter removal.”

You’ve just watched JoVE’s discontinuation of IV fluids and peripheral IV site. You should now understand the supplies needed and the process of terminating IV fluids and removing an IV site from a patient. As always, thanks for watching!