The document outlines the procedure for intracath insertion performed by Meghavarsha Lakra, a first year MSc Nursing student, under the supervision of Shubhangi Malavade. It provides the objectives, materials, steps, and rationale for properly inserting an intracath into a patient's vein based on aseptic technique and safety principles. The demonstration was conducted for second year BSc Nursing students on March 11, 2020 in the classroom and foundation laboratory.
The document outlines the procedure for intracath insertion performed by Meghavarsha Lakra, a first year MSc Nursing student, under the supervision of Shubhangi Malavade. It provides the objectives, materials, steps, and rationale for properly inserting an intracath into a patient's vein based on aseptic technique and safety principles. The demonstration was conducted for second year BSc Nursing students on March 11, 2020 in the classroom and foundation laboratory.
The document outlines the procedure for intracath insertion performed by Meghavarsha Lakra, a first year MSc Nursing student, under the supervision of Shubhangi Malavade. It provides the objectives, materials, steps, and rationale for properly inserting an intracath into a patient's vein based on aseptic technique and safety principles. The demonstration was conducted for second year BSc Nursing students on March 11, 2020 in the classroom and foundation laboratory.
The document outlines the procedure for intracath insertion performed by Meghavarsha Lakra, a first year MSc Nursing student, under the supervision of Shubhangi Malavade. It provides the objectives, materials, steps, and rationale for properly inserting an intracath into a patient's vein based on aseptic technique and safety principles. The demonstration was conducted for second year BSc Nursing students on March 11, 2020 in the classroom and foundation laboratory.
PRACTICE TEACHING DEMONSTRATION ON INTRACATH INSERTION
SUBMITTED TO SUBMITTED BY Mrs. Shubhangi Malavade Meghavarsha Lakra Lecturer First year MSc. Nursing
DATE OF SUBMISSION 11/03/2020 INTRACATH INSERTION
NAME OF THE STUDENT : MEGHAVARSHA LAKRA
NAME OF THE GUIDE : Mrs. SHUBHANGI MALAVADE
SUBJECT : MEDICAL-SURGICAL NURSING
UNIT : IX
DATE : 11/03/2020
TIME : 45 min
VENUE : CLASSROOM, FOUNDATION
LABORATORY
CLASS TAUGHT : 2nd YEAR B.Sc NURSING
METHOD OF TEACHING : LECTURE CUM DEMONSTRATION
AUDIO-VISUAL AIDS : CHARTS, FLASH CARDS, HANDOUT
PREVIOUS KNOWLEDGE : THE GROUP WILL HAVE PREVIOUS
KNOWLEDGE ABOUT ANATOMICAL SITES OF VEIN. INTRACATH INSERTION
GENERAL OBJECTIVE :
At the end of the procedure demonstration, students will have an in depth
knowledge about intracath insertion, and will be able to apply this knowledge in clinical field.
SPECIFIC OBJECTIVE :
At the end of the procedure demonstration, students will be able to :
1. Define intracath insertion.
2. Explain the purposes for intracath insertion.
3. Explain the anatomical sites for intracath insertion.
4. Classify the sizes of intracath to be inserted.
5. State the scientific principles of intracath insertion.
6. Enlist the indications and contra-indications of intracath insertion.
7. List down the articles required for intracath insertion.
8. Demonstrate and explain procedure of intracath insertion with rationale.
9. Ennumerate the complications of intracath insertion.
INTRACATH INSERTION
DEFINITION The process of puncturing a vein, with a needle, using aseptic technique.
PURPOSES 1. To administer fluids intravenously. 2. To administer bolus medication for investigations or treatment. 3. To draw blood specimen. 4. To administer total parenteral nutrition. 5. To administer blood and blood products.
ANATOMICAL SITES FOR INTRACATH INSERTION
Signs of a good vein.
1. Bouncy 6. Has a large lumen 2. Soft 7. Well supported 3. Above previous sites 8. Straight 4. Refills when depressed 9. Easily palpable 5. Visible Veins to avoid Thrombosed / sclerosed / fibrosed Inflamed / bruised Thin / Fragile Mobile Near bony prominences Areas or sites of infection, oedema or phlebitis Have undergone multiple previous punctures Do not use if patient has IV fluid in situ
SIZES OF INTRAVENOUS CATHETERS
Catheter-over-needle device for the cannulation of peripheral blood vessels.
1. The catheter fits snugly over the needle and has a tapered end to prevent fraying of the catheter tip during insertion. 2. The needle has a clear hub to visualize the “flashback” of blood that occurs when the tip of the needle enters the lumen of a blood vessel. 3. Safety needle guard automatically covers the needle's sharp bevel after withdrawal of needle from the hub, minimizing the risk of needle stick injuries.
INDICATIONS 1. Fluid and electrolyte replacement 2. Administration of medicines 3. Administration of blood/blood products 4. Administration of Total Parenteral Nutrition 5. Haemodynamic monitoring 6. Blood sampling
CONTRAINDICATIONS 1. An arterio-venous fistula in the extremity. 2. Mastectomy on the same side of the arm/ a surgically compromised extremity 3. Presence of phlebitis, infiltration or sclerosis. ARTICLES USED A Clean Tray Containing 1. Sterile needle/ angiocath/ butterfly needle of appropriate size. 2. Sterile cotton swabs in a bowl with antiseptic/ alcohol pads. 3. Tourniquet. 4. Tapes for fixing catheter/ needle. 5. Syringe of required size for blood draws (optional). 6. Specimen bottle (optional). 7. Syringe loaded with medicine (optional). 8. Infusion made ready for administration. 9. Towel/mackintosh for protecting linen. 10. Gloves. 11. IV pole. 12. Kidney tray/ paper bag.
SCIENTIFIC PRINCIPLES Principle of anatomy and physiology – The anatomical sites for intracath insertion should be known very well, so that we do not cause pain to the client. Principle of microbiology - Microorganisms enter the body through an open skin break. Hand washing and gloves to be worn to prevent spread of infection. A clean antiseptic swabs to be used to disinfect the site. Principle of safety – Patient to be given supine position. Follow all the rights of the patient. Principle of psychology – Prior explanation of the procedure to the client ensures good co- operation and reduces anxiety. Privacy to be provided.
PROCEDURE
Nursing action Rationale
1. Check physician's order and nursing Ensures that right procedure is being done for care plan. right patient.
2. Identify client.
3. Explain procedure to patient that there Reduces anxiety and ensures client cooperation. will be a slight discomfort initially. If required, demonstrate procedure on a doll for children. 4. Make sure that clothing can be removed Prevents dislodgment of needle. over IV tubing if needed. Provide client with a gown if necessary.
5. Wash hands. Prevents transfer of microorganisms.
6. Select venipuncture site. Unless It is difficult to initiate and maintain IV access
contraindicated select the nondominant if using sclerotic veins. Joint flexion increases arm of the client. Look for veins that risk of irritation of vein walls by the catheter. are relatively straight. Consider the catheter length so that the wrist/elbow will be away from the catheter tip.
7. Dilate the vein
a. Place extremity in a dependant Gravity slows venous return and distends the position (lower than heart). vein. Distending the vein makes insertion of needle easy. b. Apply a tourniquet firmly about 15 Obstructing arterial flow inhibits venous filling, to 20cm (6 to 8inches) above the If a radial pulse is felt, arterial flow is not vein puncture site, explain that obstructed. tourniquet will feel tight. The tourniquet must be tight enough to obstruct venous flow but not tight enough to obstruct arterial supply. c. If the vein is not sufficiently dilated, This action helps in filling the vein. massage/stroke the vein distal to the site in the direction of venous flow towards the heart. d. Encourage the client to clench and Contracting the muscle compresses the distal unclench the fist. veins, forcing blood along the veins and distending them. e. Lightly tap the vein. Tapping the vein may distend it. f. If all the above steps fail, remove Heat dilates superficial blood vessels causing the tourniquet and apply heat to the them to fill. entire extremity for 10 to 15 minutes.
8. Don clean gloves. Prevents nurses from exposure to blood.
9. Clean venipuncture site
a. Clean with antiseptic swab from This movement carries microorganisms away center outward in circular motion from site of entry. for several inches. b. Permit solution to dry on the skin. Povidone iodine should be in contact with skin for at least one minute to be effective. 10. Insert the needle/ catheter. a. Use nondominant hand to pull the This stabilizes the vein and makes skin taut for skin taut below the entry site. needle entry. b. Hold catheter/needle at a 15 to 30 Holding the needle at 15 to 30 degree reduces degree angle with and bevel up, the risk of counter puncture. insert the catheter through the skin and into vein in one thrust the vein. A Sudden lack of resistance is felt as needle enters the vein. c. Once blood is seen in the lumen or Reducing the angle of catheter lowers the risk when a lack of resistance is felt, of counter puncture. reduce the angle of catheter till it is almost parallel to the skin and advance the needle and catheter approximately 0.5 to 2 cm. Remove the needle slowly while inserting the cannula inside the vein. When fully inside, loosen tourniquet. d. Remove needle from inside the angiocath completely and attach syringe with medication/syringe for blood draws/IV infusion tube as required.
11. Tape the catheter using 3 strips of Prevents dislodgement of needle.
adhesive tapes. a. Place one strip with sticky side up under the catheter hub. b. Fold over each side so that sticky sides are a skin. c. Place second strip sticky side down over catheter hub_ d. Place 3rd strip sticky side down over catheter hub/ infusion tubing.
12. Dress and label the venipuncture site as
per agency policy. a. Place a sterile gauze piece with povidone/ iodine over the venipuncture site. Apply pad over the site. Apply occlusive dressing over site. b. Label the dressing with date, time of insertion, Size of needle used, catheter used and initials.
13. Remove gloves and wash hands. Reduces risk of infection.
POSSIBLE COMPLICATIONS 1. Direct access to a patient's vascular system so provides a potential route for entry of micro-organisms into that system. 2. Cause serious infection if they are allowed to enter and proliferate in the IV cannula, insertion site, or IV fluid.
IV-Site Infection: Does not produce much
(if any) pus or inflammation at the IV site. This is the most common cannula-related infection.
Cellulites: Warm, red and often tender
skin surrounding the site of cannula insertion; pus is rarely detectable.
Infiltration or tissuing: Occurs when the
infusion (fluid) leaks into the surrounding tissue. It is important to detect early as tissue necrosis could occur – re-site cannula immediately
Thrombolism / thrombophlebitis: occur
when a small clot becomes detached from the sheath of the cannula or the vessel wall – prevention is the greatest form of defence. Flush cannula regularly and consider re-siting the cannula if in prolonged use.
Extravasation: Accidental administration
of IV drugs into then surrounding tissue, because the needle has punctured the vein and the infusion goes directly into the arm tissue. The leakage of high osmolarity solutions or chemotherapy agents can result in significant tissue destruction, and significant complications.
Bruising: Commonly results from failed
IV placement -particularly in the elderly and those on anticoagulant therapy.
Air embolism: Occurs when air enters the infusion line, although this is very rare it is best if we consider the preventive measures – Make sure all lines are well primed prior to use and connections are secure.
Haematoma: Occurs when blood leaks
out of the infusion site. The common cause of this is using cannula that are not tapered at the distal end. It will also occur if on insertion the cannula has penetrated through the other side of the vessel wall – apply pressure to the site for approximately 4 minutes and elevate the limb.
Phlebitis: It is common in IV therapy and can be caused in many ways. It is inflammation of
a vein (redness and pain at the infusion site). Prevention can be using aseptic insertion techniques, choosing the smallest gauge cannula possible for the prescribed treatment, secure the cannula properly to prevent movement and carry out regular checks of the infusion site. SUMMARY A plastic tube, usually attached to a puncturing needle, inserted into a blood vessel for infusion, injection, or pressure monitoring. Catheters are made of synthetic polymers (polyurethane and silicone) that are chemically inert, biocompatible, and resistant to chemical and thermal degradation. Peripheral vascular catheters (arterial and venous), central venous catheters, and pulmonary artery catheters are mostly made of polyurethane, peripherally inserted central venous catheters (PICCs) are mostly made of silicone.
CONCLUSION The procedure demonstration on the topic Intracath insrertion was given to the second year BSc nursing students. The students will be able to use it in the clinical field. The objectives of the demonstration was covered during the presentation.
REFERANCES Book : 1. Annamma Jacob, “Clinical nursing procedures - The art of nursing practice”, 3rd edition, Jaypee publication, Page no.- 242 to 245. 2. B.T. Basavanthappa, “Fundamentals of nursing”, 2nd edition, Jaypee publication, Page no. – 491 to 495. 3. PR Ashalata, “Textbook of anatomy and physiology”, 4th edition, Jaypee publication, page no. – 383 to 431 - 567 to 574
