IVs and CVADS

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Specializes in NICU, Labor and Deliver, ED.

Hi again! Back at it for the third year, this one is the beginning of the true test, I believe. We go to medsurg 1 clinicals next week. Very excited!

Anyway, I'm here today to ask about IVs. We're just learning about them in a medsurg fashion...and I think I may be over thinking some things. So these questions are pretty basic, but feel free to elaborate as much info as you want. I'm looking for info anywhere I can get it!

So, the chapter we're in has a section about CVADs, which I understand to be access points to the central vascular system via a log tube inserted from a point on either your periphery or neck site, which extends either halfway (midline) up your central line, or all the way to the SVC. Although, my teacher informs that she has rarely seen a midline (other than someone who didn't bring enough tubing, and only made it half way, when it was supposed to be to the SVC). So, I feel okay about that...but what about just the little IVs that we get or give in the hand or AC (antecubital)? Are those just not in the umbrella of CVAD? Are they technically called something else?

When I figure this out, I know I'm going to feel silly, but I can't help but ask. She stated that you don't take blood from a peripherally inserted catheter, and I know that when I donate blood, there isn't a tube going from my AC to my SVC...so I guess the CVAD includes only IVs that go into or halfway to the SVC?

When someone is admitted or treated in the hospital, they usually get an IV, but its not a CVAD, right?? It's just a little guy in the hand or AC (or somewhere else)...yes? So, is this portion ONLY about the ones that go into your SVC?

I'm sorry, this probably became crazy about 1/3 of the way thru...but I'm really trying to figure this out on my own. My problem is, this chapter only talks about CVAD, and there doesn't seem to be another chapter with IV info...so....are these all of them?

Ugh, sorry :(

Thank you all!! If this doesn't make any sense, just give me your overview on IVs and maybe it'll be answered in there.

Thanks,

Sophie

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Specializes in NICU, Labor and Deliver, ED.

Yeah, I think I feel even more silly than when I posted this....There are two types, peripheral IV access, like in the AC, where you could do a saline lock, or run a midline cath thru and for short term, and type two is CVAD/CVC. And ALL of those go into the SVC and are long term. Yes? So then, why did she say you can't draw blood from a periph? That's how we donate blood...and I feel like thats how blood samples are taken in the hosp and other places...

Still would love any info on IVs. Maybe some indications of which to use, things to watch out for, contraindications for either, etc.

Thanks again,

Sophie

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You can draw blood from a PIV. I have no idea why she said you can't. It's not your first resource of blood but if they have awful veins and you can't get it with a butterfly you'll wanna try through that IV. Be sure to flush before (with about 5 cc) (Waste about 6 cc). (Draw your blood)(Flush AGAIN). Don't forget that last step. (If they have NS running than you can just let the primary flush it really up to you). If you forget to flush you're gonna clot the line. I hope this information is right, I'm a new grad. But seriously PLEASE RELAX. I've learned more in my first weeks of being a working RN than in all nursing school! Breathe breathe breathe and keep asking questions, you are NOT silly. You are intelligent for seeking help AND letting us know what you think.

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Specializes in Vascular Access.

First of all, there are many different types of IV catheters.. The kind of catheters which LPN's in most states and most RN's are familiar inserting are your IV catheters which are less then 3 inches in length. They may be put in the hand, forearm, ACF too.

However, those that are 3-8 inches in length are called Midlines. Midline may dwell in place in the absence of complications for up to a month.

The are used quite extensively in some regions of the country. The tip of this catheter stops around the shoulder, or before the axillary vein.

Those that are said to be Central catheters are those whose tip is in the SVC. This is the only acceptable tip placement for a central line. (Unless it is placed in the groin and then it would terminate in the IVC). There are four types of central lines: PICC, PORT, Non-tunneled and Tunneled lines. There are many different name brands under each category, but it is where the tip ends up which determines its type.

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Specializes in Surgical Intensive Care.

To keep it simple, only draw back from a PIV or Midline initially after insertion. Otherwise, these cannot be used for blood draws. You can draw blood from a PICC or Port as long as you follow the protocol for flushing, wasting, and then flushing after. Usually, Flush with 20mL, draw back and waste 10mL then drawback for the lab draw, then flush with 10mL after collection and use heparin if the PICC requires Hep lock. If IV maintenance fluids are infusing and you know you have a nurse draw coming up, Stop the infusion for 10-15 minutes prior to drawing back. If not, this can cause inaccurate results due to dilution of total blood.

The reason we have phlebotomy draw blood for patients with a midline or PIV is because of how we use those small, short catheters. Being for meds, the small vessel size, etc.

The only time we use blood draws from PICC in addition to having phlebotomy draw blood is when there is a chance of CLABSI (central line associated bloodstream infection) or a PICC cannot be drawn back due to clotting or rejection.

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Specializes in NICU, Labor and Deliver, ED.

Thank you Studentofhealing!! That was really great information, and I sincerely appreciate the pep talk :)

2 more years and I'm sure I'll be just exactly where you are!

Thanks again :)

Sophie

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Specializes in NICU, Labor and Deliver, ED.

IVRUS, thats incredibly helpful. The way the book and class powerpoint were written didn't make it seem that the tunneled and others were types of CVA. They seemed like they were options for either the PICC, Central or Port.

Thanks!!

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Specializes in NICU, Labor and Deliver, ED.

Speasa204,

Thank you very much. This was simple, and laid out very plainly, step by step, I always like that. But the one I'm accustomed to for blood donation, or quick blood samples with the phlebotomist is a peripheral IV, yes? And when someone is having fluids in an emergency or short term fashion, that isn't a PICC, right? Its a periph IV as well? And PICC, CVA, Tunneled, Port, etc, those are all in a more long-term fashion for fluids, possibly, but also for other things, whereas the periph IV would be for quick/short term fluid, or IV push meds, although again short term or quick (emergency type situation)...but never a long term item like fluid maintenance, TPN, etc. Please correct if I am wrong in any way! I'm just trying to summarize what I think I've learned from you lovely folks, my prof and the book.

Anyone else feel free to chime in to correct anything!

Thank you all again, immensely,

Sophie

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Specializes in L&D, infusion, urology.
Speasa204,

Thank you very much. This was simple, and laid out very plainly, step by step, I always like that. But the one I'm accustomed to for blood donation, or quick blood samples with the phlebotomist is a peripheral IV, yes? No, those are different. For blood donation, the cath is usually a needle, rather than a flexible plastic catheter the way a typical PIV is. For phlebotomy, a straight needle is used. As stated above, you should only draw labs from a peripheral IV (PIV) during initial insertion. Otherwise, the sample is compromised.

And when someone is having fluids in an emergency or short term fashion, that isn't a PICC, right?) Its a periph IV as well? In an emergency, there often isn't time for a PICC. You may do IO (intraosseous) or PIV (or more than one PIV), but PICC takes time, ultrasound, etc. Youtube intraosseous infusion. It is very interesting!

And PICC, CVA, Tunneled, Port, etc, those are all in a more long-term fashion for fluids, possib Yes, these would be used more for long term stuff, frequent fliers with horrible veins, people receiving caustic medications (chemo, Vanco, etc).

but also for other things, whereas the periph IV would be for quick/short term fluid, or IV push meds, although again short term or quick (emergency type situation)...but never a long term item like fluid maintenance, TPN, etc. Please correct if I am wrong in any way! I'm just trying to summarize what I think I've learned from you lovely folks, my prof and the book. Most facilities have policies about how long a PIV may stay in. At the most, 72 hours.

A friendly heads up, you may want to keep your real name (including your screen name) off any public website, especially once you're a nurse. It's important to protect your identity! You cna change your screen name in your account settings.

Anyone else feel free to chime in to correct anything!

Thank you all again, immensely,

Hope that helps! :)

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Specializes in Vascular Access.

"Stop the infusion for 10-15 minutes prior to drawing back. If not, this can cause inaccurate results due to dilution of total blood."

???? Whoa... No need to stop an infusion for that long. You are risking clotting the IV catheter. ONE minute is all you need to clear the vessel if its tip is centrally located.

Also, many organizations allow short term peripherals to dwell for extended periods of time, and some keep them in till they go bad. Our policy is changing them q 96 and prn.

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Specializes in NICU, Labor and Deliver, ED.

This was all incredibly helpful! Thank you again. And great advice about the name, I think I'll change it now

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Specializes in NICU, Labor and Deliver, ED.

That was all incredibly helpful! Breaking out my comments like that really made it clear what you meant. And thanks for the tip about the name, I changed it right away.

Thanks again!!

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