Latest Likes For IVRUS

IVRUS 17,830 Views

Joined: Dec 16, '04; Posts: 1,089 (42% Liked) ; Likes: 1,063

Sorted By Last Like Received (Max 500)
  • Apr 25

    Quote from Ironprostate
    you metioned that small catherter is more preferred for irritating medication. But when it comes to ChemoTheraphy, does it go same? As far as Im concerened, The first route of CTx is central line like Chemoport or Hickman Cath. or C-line. But sometime, CTx medication was injected via peripehral line. And at that time, facility regulations are that never given the CTx via peripehral line smaller than 22G. hmm.. I was told that bigger size cathterter prevent vein from chance of extravasation. So what rational is beneath this?. thank you for your kindness.
    As Wuzzie said appropriately, it is all about blood flow. You always want to choose the smallest IV catheter to do the job, all-the-while allowing for adequate blood flow around said IV catheter. Ideally, I do not like my IV catheters to take up more than 33% of the vein, but sometimes I don't get what I want!! Bigger IV catheters cause more damage to the smooth inner lining of the blood vessel, the Tunica Intima. This damage starts the process of phlebitis and thrombosis. But, another factor one must also consider is the pH of the medication or solution and the Osmolarity. INS standards state that the pH should NOT be extreme and the Osmolarity should NOT be greater than 900, or one does too much damage to the vein, if it is via short peripheral IV catheter. Now if any one of the four Central IV catheters is in place, than any osmolarity or pH works as the blood flow in the central vein (SVC) is approx 10 times greater than that that is in the arms.

  • Apr 25

    Quote from Ironprostate
    you metioned that small catherter is more preferred for irritating medication. But when it comes to ChemoTheraphy, does it go same? As far as Im concerened, The first route of CTx is central line like Chemoport or Hickman Cath. or C-line. But sometime, CTx medication was injected via peripehral line. And at that time, facility regulations are that never given the CTx via peripehral line smaller than 22G. hmm.. I was told that bigger size cathterter prevent vein from chance of extravasation. So what rational is beneath this?. thank you for your kindness.
    As Wuzzie said appropriately, it is all about blood flow. You always want to choose the smallest IV catheter to do the job, all-the-while allowing for adequate blood flow around said IV catheter. Ideally, I do not like my IV catheters to take up more than 33% of the vein, but sometimes I don't get what I want!! Bigger IV catheters cause more damage to the smooth inner lining of the blood vessel, the Tunica Intima. This damage starts the process of phlebitis and thrombosis. But, another factor one must also consider is the pH of the medication or solution and the Osmolarity. INS standards state that the pH should NOT be extreme and the Osmolarity should NOT be greater than 900, or one does too much damage to the vein, if it is via short peripheral IV catheter. Now if any one of the four Central IV catheters is in place, than any osmolarity or pH works as the blood flow in the central vein (SVC) is approx 10 times greater than that that is in the arms.

  • Apr 25

    Quote from Ironprostate
    you metioned that small catherter is more preferred for irritating medication. But when it comes to ChemoTheraphy, does it go same? As far as Im concerened, The first route of CTx is central line like Chemoport or Hickman Cath. or C-line. But sometime, CTx medication was injected via peripehral line. And at that time, facility regulations are that never given the CTx via peripehral line smaller than 22G. hmm.. I was told that bigger size cathterter prevent vein from chance of extravasation. So what rational is beneath this?. thank you for your kindness.
    As Wuzzie said appropriately, it is all about blood flow. You always want to choose the smallest IV catheter to do the job, all-the-while allowing for adequate blood flow around said IV catheter. Ideally, I do not like my IV catheters to take up more than 33% of the vein, but sometimes I don't get what I want!! Bigger IV catheters cause more damage to the smooth inner lining of the blood vessel, the Tunica Intima. This damage starts the process of phlebitis and thrombosis. But, another factor one must also consider is the pH of the medication or solution and the Osmolarity. INS standards state that the pH should NOT be extreme and the Osmolarity should NOT be greater than 900, or one does too much damage to the vein, if it is via short peripheral IV catheter. Now if any one of the four Central IV catheters is in place, than any osmolarity or pH works as the blood flow in the central vein (SVC) is approx 10 times greater than that that is in the arms.

  • Apr 25

    Quote from Ironprostate
    you metioned that small catherter is more preferred for irritating medication. But when it comes to ChemoTheraphy, does it go same? As far as Im concerened, The first route of CTx is central line like Chemoport or Hickman Cath. or C-line. But sometime, CTx medication was injected via peripehral line. And at that time, facility regulations are that never given the CTx via peripehral line smaller than 22G. hmm.. I was told that bigger size cathterter prevent vein from chance of extravasation. So what rational is beneath this?. thank you for your kindness.
    As Wuzzie said appropriately, it is all about blood flow. You always want to choose the smallest IV catheter to do the job, all-the-while allowing for adequate blood flow around said IV catheter. Ideally, I do not like my IV catheters to take up more than 33% of the vein, but sometimes I don't get what I want!! Bigger IV catheters cause more damage to the smooth inner lining of the blood vessel, the Tunica Intima. This damage starts the process of phlebitis and thrombosis. But, another factor one must also consider is the pH of the medication or solution and the Osmolarity. INS standards state that the pH should NOT be extreme and the Osmolarity should NOT be greater than 900, or one does too much damage to the vein, if it is via short peripheral IV catheter. Now if any one of the four Central IV catheters is in place, than any osmolarity or pH works as the blood flow in the central vein (SVC) is approx 10 times greater than that that is in the arms.

  • Apr 17

    The concept of a "virgin line" or not being able to give the drug the way you discussed is only applicable if the reason you are needing to switch sites is because of infection. If the first line became infected, yes everything is pitched, and a new set up should be established.

  • Apr 17

    Ivana, Usually the reason patients have two IV catheters in at once is either to administer incompatible meds or to use the other one if the first one fails. I would definitely move the medication to the patent line.

  • Apr 16

    Yes, but when a pharmacy tech draws up the medication, he/she will attach the empty vial to the syringe so that the pharmacist who does the final checking can sign off that it truly was the drug ordered. So that there is another check in the system.

  • Apr 16

    Yes, but when a pharmacy tech draws up the medication, he/she will attach the empty vial to the syringe so that the pharmacist who does the final checking can sign off that it truly was the drug ordered. So that there is another check in the system.

  • Mar 23

    The concept of a "virgin line" or not being able to give the drug the way you discussed is only applicable if the reason you are needing to switch sites is because of infection. If the first line became infected, yes everything is pitched, and a new set up should be established.

  • Mar 9

    Quote from MrsJt
    Thank you for your reply and encouragment! I am ready for a change. Just being off of nightshift I think will make a world of difference for me. I did not end up seeking counseling, but I have been confiding in a nursing buddy (someone I've known for yrs that I do not work with). I am extremely proud of myself for sticking it out. I have learned a lot on my unit, but I am just burnt out. My husband is being suppoortive in my choice to leave my unit. It is less hrs, so I am surprised by his encouragment. At this point, I think he just wants me to be happy and knows that this kind of opportunity doesn't come a long everyday. Keepimg ky fingers crossed everything goes well when I shadow next week!
    Well, IV therapy is the most invasive procedure we as nurses perform on a patient. Some take this too lightly. And, please remember, IV therapy is much, much more than "sticking" someone. I'd encourage you to do some research BEFORE you shadow: 1. Know the four types of Central Lines 2. Know where a central line must terminate before being able to call it a central line. 3. Know the difference between a short term peripheral IV and a midline. 4. Rationalize why a clinician should choose one IV catheter over another for placement. ( pH of drug, Osmolarity of drug, Length of therapy, age of patient, etc) ... these are a few food for thought tips.

  • Mar 7

    Quote from MunoRN
    If the PICC has clamps then that generally means it is a non-valved PICC, in which case you should be clamping before removing any device that leaves the lumen open, whether it's a displacement cap or syringe.

    There's no reason to be changing the cap however when drawing blood, the cap should not be changed more often than every 5-7 days. And there's also no reason to waste 10ml of the patient's blood, blood is valuable stuff, a waste of 2-3 times the lumen volume is sufficient and a larger (Power) lumen on a PICC is only 1.2 ml.
    How one flushes an IV catheter depends on the needleless cap on its end. Valved or non-valved, it doesn't matter. There are Negative, Neutral and Positive displacement devices. If your needleless cap is a Positive displacement cap, then you should NOT clamp the IV catheter before the removal of the syringe, but rather flush, remove the syringe and then after a few more seconds = CLAMP. Positive displacement caps "sense" the removal of the syringe and after its removed, it will force fluid out of the cap and through the IV catheter to prevent reflux of blood.
    Also, if one is doing blood draws through the needleless cap, it should be changed s/p. The blood drawn into the cap becomes a perfect medium for bacterial growth.

  • Mar 5

    Okay,
    My first thought after reviewing your answers is this:
    If the patient is up and down several times throughout the 2 hour infusion your rate will slow as he moves namely because you are utilizing a D-A-F, instead of a pump.
    Pumps have an accuracy of + or - 3 to 5% whereas DAF's can be 10-25% off... and as the person is up and ambulating, there is a resistance to flow inside the vein and the catheter.
    Using a pump aids in the correct deliver of a medication as it will continue with a preset PSI in it deliver of the medication. I understand the whole, "rental amounts" which some HHA dislike and therefore just want a cheap dial-a-flow... But please remember that this is a primary intermittent tubing and should be changed daily.
    The heaight of the container in relationship to the PICC insertion site is also a factor. Ideally, the bag should be about 36 inches above the VP site.
    So, I don't believe that your patient is doing anything wrong perse', but that his increased movement is slowing the rate.. So he may want to limit ambulation, or have it so a BSC is something that he can swivel onto while he is infusing. ( Keep alcohol foam by his chair so that he can "wash" s/p. )

  • Mar 5

    Well before anything can be assessed in this situation, I'd like to know a couple of things:
    1. Are they infusing via pump, or via gravity or an on-line-regulator like a dial-a-flow?
    2. What type of IV catheter does the patient have in?
    3. Is the catheter positional?
    4. Does the patient get up and move around when you are NOT there while infusing, vs. remaining stationary while you are there?
    5. What medication are you infusing?

  • Feb 22

    Okay,
    My first thought after reviewing your answers is this:
    If the patient is up and down several times throughout the 2 hour infusion your rate will slow as he moves namely because you are utilizing a D-A-F, instead of a pump.
    Pumps have an accuracy of + or - 3 to 5% whereas DAF's can be 10-25% off... and as the person is up and ambulating, there is a resistance to flow inside the vein and the catheter.
    Using a pump aids in the correct deliver of a medication as it will continue with a preset PSI in it deliver of the medication. I understand the whole, "rental amounts" which some HHA dislike and therefore just want a cheap dial-a-flow... But please remember that this is a primary intermittent tubing and should be changed daily.
    The heaight of the container in relationship to the PICC insertion site is also a factor. Ideally, the bag should be about 36 inches above the VP site.
    So, I don't believe that your patient is doing anything wrong perse', but that his increased movement is slowing the rate.. So he may want to limit ambulation, or have it so a BSC is something that he can swivel onto while he is infusing. ( Keep alcohol foam by his chair so that he can "wash" s/p. )

  • Feb 7

    Quote from morte
    actually, i was under the impression you shouldn't use a prefilled NS syringe....that if you put it down someone may confuse it with plain NS.....an unmarked 10 ml syringe would be the better choice, drawing up saline then med.....if the dilaudid is in prefilled syringes instead of vials there is a problem. there is no way i would do it you instructors way unless there was no other way to do it.....

    Why would you put it down???
    Once you draw up the medication.. GIVE IT.
    And whose to say that a 10cc syringe filled with NSS and dilaudid won't be confused for just saline as well... Therefore, DO NOT lay the syringe down.. You drew it up, now give it. If for some weird reason you must lay it down.. Label the syringe so there is NO confusion!


close