Intravenous Devices

 

II. Intravenous Devices
A. IV cannulas
1. Butterfly sets
a. The set is a wing-tip needle with a metal cannula, plastic or rubber wings, and a plastic catheter or hub.
b. The needle is 0.5 to 1.5 inches in length, with needle gauge sizes from 16 to 26.
c. Infiltration is more common with these devices.
d. The butterfly infusion set is used commonly in children and older clients, whose veins are likely to be small or fragile.
2. Plastic cannulas

a. Plastic cannulas may be an over-the-needle device or an in-needle catheter and are used primarily for short-term therapy.
b. The over-the-needle device is preferred for rapid infusion and is more comfortable for the client.
c. The in-needle catheter can cause catheter embolism if the tip of the cannula breaks.
B. IV gauges
1. The gauge refers to the diameter of the lumen of the needle or cannula.
2. The smaller the gauge number, the larger the diameter of the lumen; the larger the gauge number, the smaller the diameter of the lumen.
3. The size of the gauge used depends on the solution to be administered and the diameter of the available vein.
4. Large-diameter lumens (smaller gauge numbers) allow a higher fluid rate than smaller diameter lumens and allow
the administration of higher concentrations of solutions.
5. For rapid emergency fluid administration, blood products, or anesthetics, large-diameter lumen needles or
cannulas are used, such as a 14-, 16-, 18-, or 19-gauge.
6. For peripheral fat emulsion (lipids) infusions a 20- or 21-gauge lumen or cannula is used.
7. For standard IV fluid and clear liquid IV medications, a 22- or 24-gauge lumen or cannula is used.
8. If the client has very small veins, a 24- to 25-gauge lumen or cannula is used.
C. IV containers
1. Container may be glass or plastic.
2. Squeeze the plastic bag to ensure intactness and assess the glass bottle for any cracks before hanging.
Do not write on a plastic IV bag with a marking pen because the
ink may be absorbed through the plastic into the solution. Use a label and a
ballpoint pen for writing on the label, placing the label onto the bag.
D. IV tubingimage
FIGURE 
 Intravenous Devices
IV Tubing
1. IV tubing contains a spike end for the bag or bottle, drip chamber, roller clamp, Y site, and adapter end for attachment to the cannula or needle that is inserted into the client’s vein.
2. Shorter, secondary tubing is used for piggyback solutions, connecting them to the injection sites nearest to the drip chamber 
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3. Special tubing is used for medication that absorbs into plastic (check specific medication administration guidelines when administering IV medications).
4. Vented and nonvented tubing are available.
a. A vent allows air to enter the IV container as the fluid leaves.
b. A vented adapter can be used to add a vent to a nonvented IV tubing system.
c. Use nonvented tubing for flexible containers.
d. Use vented tubing for glass or rigid plastic containers to allow air to enter and displace the fluid as it
leaves; fluid will not flow from a rigid IV container unless it is vented.
Extension tubing can be added to an IV tubing set to provide
extra length to the tubing. Add extension tubing to the IV tubing set for
children, clients who are restless, or clients who have special mobility needs.
E. Drip chambers 
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1. Macrodrip chamber
a. The chamber is used if the solution is thick or is to be infused rapidly.
b. The drop factor varies from 10 to 20 drops (gtt)/mL, depending on the manufacturer.
c. Read the tubing package to determine how many drops per milliliter are delivered (drop factor).
2. Microdrip chamber
a. Normally, the chamber has a short vertical metal piece (stylet) where the drop forms.
b. The chamber delivers about 60 gtt/mL.
c. Read the tubing package to determine the drop factor (gtt/mL).
d. Microdrip chambers are used if fluid will be infused at a slow rate (less than 50 mL/hour) or if the solution contains potent medication that needs to be titrated, such as in a critical care setting or in pediatric clients.
F. Filters
1. Filters provide protection by preventing particles from entering the client’s veins.
2. They are used in IV lines to trap small particles such as undissolved substances, or medications that have precipitated in solution.
3. Assess the agency policy regarding the use of filters.
4. A 0.22-μm filter is used for most solutions; a 1.2-μm filter is used for solutions containing lipids or albumin; and a special filter is used for blood components.
5. Change filters every 24 to 72 hours (depending on agency policy) to prevent bacterial growth.
G. Needleless infusion devices
1. Needleless infusion devices include recessed needles, plastic cannulas, and one-way valves; these systems decrease the exposure to contaminated needles.
2. Do not administer parenteral nutrition or blood products through a one-way valve.
H. Intermittent infusion devices
1. Intermittent infusion devices are used when intravascular accessibility is desired for intermittent administration of medications by IV push or IV piggyback.
2. Patency is maintained by periodic flushing with normal saline solution (sodium chloride and normal
saline
are interchangeable names).
3. Depending on agency policy, when administering medication, flush with 1 to 2 mL of normal saline to
confirm placement of the IV cannula; administer the prescribed medication and
then flush the cannula again with 1 to 2 mL of normal saline to maintain patency.
I. Electronic IV infusion devices
1. IV infusion pumps control the amount of fluid infusing and should be used with central venous lines, arterial lines, solutions containing medication, and parenteral nutrition infusions. Most agencies use IV pumps for the infusion of any IV solution.
2. A syringe pump is used when a small volume of medication is administered; the syringe that contains the
medication and solution fits into a pump and is set to deliver the medication at a controlled rate.
3. Patient-controlled analgesia (PCA) is a device that allows the client to self-administer IV medication, such
as an analgesic; the client can administer bolus doses at set intervals and the
pump can be set to lock out bolus doses that are not within the preset time
frame to prevent overdose. The PCA regimen may include a basal rate of infusion
along with the demand dosing.

 

Check electronic IV infusion devices frequently. Although these
devices are electronic, this does not ensure that they are infusing solutions
and medications accurately.

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