Peripheral IV Insertion and Care; Catheter Selection
In 2011 the INS, Infusion Nurse Society released their latest “Infusion Nursing Standards of Practice”
Many changes in recommendations of how we care for infusion patients were made in this publication. Remember it is the INS standards that we are held accountable to in a court of law; therefore it is imperative that we are familiar with and follow these standards. We will begin a mini blog series to review the current standards of infusion therapy, to keep you knowledgeable in your practices of infusion therapy.
Let’s review the latest recommendations for peripheral IV therapy in adults and how it relates to what type of peripheral device should be selected for your infusion patient.
Consider the Therapy Orders
The nurse should select the catheter, peripheral or central line, based on the type of therapy that is prescribed, properties of the infusate or solution, length of treatment (short peripheral therapies are usually for less than 1 week), vascular integrity of the patient, as well as the resources to care and maintain the access device should be considered.
Know The Ph, Osmolality, And Phlebogenic Properties of the Infusate Ordered
Remember that many infusion therapies are not appropriate for peripheral administration. Many times the physical properties of a particular solution or medication are inappropriate for peripheral infusion. The criteria for peripheral administration is; no infusion of continuous vesicant s, no infusion of parenteral nutrition via a peripheral catheter, infusates with a pH of less than 5 or greater than 9, or an osmolality of greater than 600 should not be administered through a peripheral. For a list of infusates not appropriate to administer via a peripheral IV, please see Pedagogy’s list of Phlebogenic Medications. This list is available as a printable reference; click on the title to view. The pharmacist is a great resource any time an infusate is in question as to whether or not it is appropriate for peripheral administration. Should your infusate fall outside of the appropriate administration parameters, it is time to consider an alternative to a peripheral IV catheter for the infusion.
Choose The Smallest Gauge And Shortest Catheter Possible
For therapies requiring peripheral access, the device should be the shortest length and smallest gauge needed to accommodate and manage the prescribed therapy. Steel winged devices (butterflies) should be limited to short term or single-dose administrations of fluids or medications.
In my early days of infusion practice, and admittedly this was over 25 years ago, it was common practice to reach for the largest catheter possible when starting an IV for any reason. Many an infusion nurse prided themselves in the ability to insert an 18 gauge catheter into any patient. In these “ancient” times, the school of thought was that the larger catheters allowed for a greater flow of infusate and prevented phlebitis and other complications. For blood and blood product infusions, we never chose a catheter less than 18 gauge. We now know through studies and evidence that the practice of using larger bore catheters actually cause irritation of the veins intima and the current recommendations are to use the smallest and shortest catheter necessary to achieve the infusion. Evidence also proves that even blood and blood products do not require such large bore cannulas and may be infused through catheters as small as 24 gauge; this is taking into account that the patient does not need a rapid infusion of blood in the case of hemorrhage or other emergent situation.
Always Use a Safety Engineered Device
Healthcare professionals should always use safety devices and be familiar with the proper procedures for use of the safety device as recommended by the manufacturer. There are many products to choose from on the market today, with each offering specific advantages and disadvantages. Many products require the healthcare professional to perform a series of steps to activate the engineered safety mechanism of the insertion device, these are known as active safety devices. Some manufactures have engineered IV catheters that “automatically” activate the safety mechanism without the operator having to manually perform any steps, these are known as passive safety devices. It is my personal preference to employ the use of passive devices, as I have personally observed in my experiences, that many nurses are not familiar with the manufacturer’s recommendations on the activation procedures of their particular IV catheter. Needle sticks continue to occur due to non-adherence to the proper procedures of “active” safety devices.
Are you Ready to Insert a Peripheral IV?
With all these criteria in mind, is the solution or medication that has been ordered for your patient suitable for a peripheral infusion? If so, let’s get ready to insert that catheter. We will review insertion criteria and standards in a upcoming blog, so stay tuned!
Capra Dalton, Registered Nurse, has more than 28 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant. As the CEO, Capra is responsible for all operational aspects of Pedagogy, including education course content, author recruitment, and management. She is a member of the National Nurses in Business Association and received her nursing education from Lamar University in Beaumont, Texas. Capra has an avid interest in holistic healing, nutrition, herbs, and alternative therapies for the treatment of disease in humans as well as animals. She and her husband, Patrick, live on a ranch near Tyler, Texas.