Understanding Intravenous Therapy
Many patients require intravenous therapy (IV therapy) and thus the methods used by medical professionals to put in IV lines in patients with poor veins, are extremely important, in order to avoid unnecessary trauma to the patient and the risk of infection.
What is intravenous therapy?
"Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein." (1)
Many hospitals have special IV teams, with medical personnel trained in advanced skills for intravenous therapy. Even for them, there may be times, when it appears almost impossible to establish an IV line, in a patient who has poor veins.
What are veins?
"In the circulatory system, veins (from the Latin vena) are the blood vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood." (2)
What is a poor vein?
When a patient becomes dehydrated, his or her peripheral veins may collapse. At times, in the sick or the elderly, these veins may become very fragile. In infants and children, veins can be very tiny and sometimes, almost impossible to find. Veins used too frequently for medication administration, may no longer be appropriate for intravenous therapy. Sometimes, patients just do not have good veins at all and thus they are said to have poor veins.
It may take a well-trained doctor or nurse to find an appropriate vein, that will function for ongoing intravenous therapy. The veins most commonly used for intravenous therapy are the veins that are located in the arms and hands or legs and feet. Starting intravenous lines properly, requires practice. Every patient scenario is unique and his or her veins can be different. Medical personnel may use various techniques for starting intravenous lines, depending upon how and where they train. Some doctors and nurses may find it easier than others.
A doctor prescribes intravenous therapy for his or her patient. He or she advises the registered nurse of the appropriate intravenous treatment, which generally consists of the administration of fluids, electrolytes and/or medication. The location of the IV line is important. Being aware of which vein to use, as well as which vein is the most appropriate to use for a patient, is also important. Sometimes the veins in one part of the body are better suited for some kinds of intravenous therapy, than the veins in another part of the body.
The following questions must be taken into consideration.
How long will the patient receive intravenous therapy? What fluid or medication has the doctor prescribed? What is the volume of the IV infusion going to be? Is an IV treatment prescribed as a single administration of medication or will it be ongoing therapy, over a period of days? Is the size of the needle appropriate for the size of the vein or for the medication?
The nurse should have the IV equipment ready, prior to searching or probing for any veins. Normally, there can only be three attempts by one medical person to establish an IV line. If the attempts are not successful, it is generally advisable to seek the assistance of another medical person with more experience or expertise, in order to prevent unnecessary trauma to the patient.
Veins are blue in appearance and may be openly visible on a patient's hand or a foot. Palpation of an area may help to locate a deeper vein or one that is more appropriate, for instance, on the inner aspect of the elbow. Lowering an arm or hand will cause the blood to flow downward and the vein will become more evident. Applying a warm, moist towel over the area, may help as well. Using a rubber tourniquet on a limb, is usually sufficient to cause the vein to bulge enough to insert a needle for an intravenous line. One must always use caution regarding the length of time that a tourniquet is allowed to restrict blood flow in a limb.
With infants and children or others who may be frightened, it is important to have another person present when the IV is being started. Encourage a parent or other health care professional to assist by holding, positioning and helping the patient to understand what is happening. It should not be a frightening experience for him or her. Having the patient look away or occupying the patient's attention in another way, may make it easier for him or her. The pain experienced should be minimal.
Sometimes, massaging the area, milking the vein or tapping on the vein gently, will cause it to become more prominent. Fully extending an arm will bring the vein forward on the inner aspect of the elbow. Proper skin preparation is always important to prevent infection. Once the needle is in the vein, dark red, venous blood should be evident. Immediately start the flow of intravenous fluid, to keep the vein open. Place tape over the needle to prevent it from slipping out of the vein. Appropriate pressure applied on the IV insertion site, will any prevent unnecessary bleeding. An IV line, held in place by tape or an appropriate bandage, is not likely to fall out.
Calculating the drip flow correctly and maintaining it continually, is important to prevent having to restart the IV. Good observation skills are vital. Always record the location of the intravenous line and document any problems encountered.
Care, concern and compassion are always vital aspects of nursing care in respect to intravenous therapy, because IVs can be painful for patents. An intravenous line can give them a feeling of helplessness. Encouraging the patient to walk about with the use of an IV pole, is generally a good idea.
Be aware that the administration of some medications can be painful, even if does not cause pain initially. An IV not inserted correctly, can cause unnecessary swelling, particularly when the IV goes interstitial. There may be excessive bleeding or bruising. At times, the IV may not flow at all. The use of an ice pack will help to reduce swelling. The use of a splint or correct positioning of a hand or arm can be beneficial in terms of keeping an IV running. At times, restraints may be necessary to prevent a patient from pulling out an IV. Constant monitoring and maintaining an accurate record regarding the patient's IV therapy are always important. An intravenous line should not be allowed to run dry.
Make certain that the patient receives proper age, orientation and education appropriate directives and instructions regarding his or her IV. He or she should be encouraged not touch or attempt to remove the intravenous line and should report any evidence of blood backing up in the tubing, bleeding around the IV site or any excessive bruising.
Many patients take pride in helping to monitor their intravenous lines. So should intravenous team members, who are able to establish and maintain effective intravenous lines, particularly in patients with poor veins.