Intravenous Therapy (Latex Allergy, Peripheral IV Site, Medication)

 

III. Latex Allergy
A. Assess the client for an allergy to latex.
B. IV supplies, including IV catheters, IV tubing, IV ports (particularly IV rubber injection ports), rubber
stoppers on multidose vials, and adhesive tape, may contain latex.
C. Latex-safe IV supplies need to be used for clients with a latex allergy.

D. A three-way stopcock, rather than a rubber injection port, needs to be used on plastic tubing.
E. See for additional information regarding latex allergy.
IV. Selection of a
Peripheral IV Site
A. Veins in the hand, forearm, and antecubital fossa are suitable sites 
FIGURE 14-4
Common intravenous sites. A, Inner arm. B, Dorsal surface of hand. 
B. Veins in the lower extremities (legs and feet) are not suitable for an adult client because of the risk of
thrombus formation and the possible pooling of medication in areas of decreased venous return 
BOX 14-1
Peripheral Intravenous
Sites to Avoid
 Edematous extremity
 An arm that is weak, traumatized, or
paralyzed
 The arm on the same side as a mastectomy
 An arm that has an arteriovenous fistula
or shunt for dialysis
 A skin area that is infected
C. Veins in the scalp and feet may be suitable sites for infants
D. Assess the veins of both arms closely before selecting a site.
E. Start the IV infusion distally
 to provide the option of proceeding up the extremity if the vein is ruptured or infiltration occurs; if infiltration
occurs from the antecubital vein, the lower veins in the same arm usually cannot be used for further puncture sites.
F. Determine the client’s dominant side, and select the opposite side for a venipuncture site.
G. Bending the elbow on the arm with an IV may easily obstruct the flow of solution, causing infiltration that could lead to thrombophlebitis.
H. Avoid checking the blood pressure on the arm receiving the IV infusion if possible.
I. Do not place restraints over the venipuncture site.
J. Use an armboard as needed when the venipuncture site is located in an area of flexion.
In an adult, the most frequently used sites for inserting an IV
cannula/needle are the veins of the forearm because the bones of the forearm
act as a natural support and splint.
V. Addition of Medication to an IV Solution
A. Assess for compatibility of medication and solution.
B. When adding medication to the IV bag, mix the bag end over end several times before hanging it to disperse
the medication.
C. Manufacturer-prepared IV medication systems are available; these systems are similar to a secondary IV
with medication or a piggyback system.
D. Ensure that the medication can be mixed in soft plastic because some medications absorb into the soft plastic
and should be mixed only in glass.
VI. Initiation and
Administration of IV Solutions
A. Check the IV solution against the health care provider’s (HCP’s) prescription for the type, amount,
percentage of solution, and rate of flow; follow the six rights for medication administration.
B. Assess the health status and medical disorders of the client and identify client conditions that
contraindicate use of a particular IV solution or IV equipment such as an
allergy to cleansing solution, adhesive materials, or latex.
C. Check client’s identification and explain the procedure to the client; assess client’s previous experience
with IV therapy and preference for insertion site.
D. Wash hands thoroughly before inserting an IV line and before working with an IV line; wear gloves.
E. Use sterile technique when inserting an IV line and when changing the dressing over the IV site.
F. Change the venipuncture site every 72 to 96 hours in accordance with Centers for Disease Control and
Prevention (CDC) recommendations and agency policy.
G. Change the IV dressing when the dressing is wet or contaminated, or as specified by the agency policy.
H. Change the IV tubing every 96 hours in accordance with CDC recommendations and agency policy or with change
of venipuncture site.
I. Do not let an IV bag or bottle of solution hang for more than 24 hours to diminish the potential for bacterial
contamination and possibly sepsis.
J. Do not allow the IV tubing to touch the floor to prevent potential bacterial contamination.
K. Before adding medications to solutions, swab access ports with 70% alcohol, an equally effective solution,
or as specified by the agency policy.

 

L. See Priority Nursing Actions for instructions on inserting an IV.

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