Needle and syringe

The simplest form of intravenous access is a syringe with an attached hollow needle. The needle is inserted through the skin into a vein, and the contents of the syringe are injected through needle into the bloodstream. This is most easily done with an arm vein, especially one of the metacarpal veins. Usually it is necessary to use a tourniquet first to make the vein bulge; onceeedle is in place, it is common to draw back slightly on the syringe to see blood return, thus verifying that the needle is really in a vein; then the tourniquet is removed before injecting.

This is the most common method of intravenous drug use for illegal substances such as heroin, or in any case where a person must self-administer intravenous medication at home.so a convenient way to deliver laving medons in an emergency. However, in a controlled health-care setting, direct injection is rarely used since it only allows delivery This is the most common intravenous access method in both hospitals and paramedic services. A peripherane consists of a short catheter a few centimeters inserted through the skin into a peripheral vein. A peripheral vein is any vein that is not in the chest or abdomen. Arm and hand veins are typically used altb that can be connected to a syrinn intravenou line, or capped with a bung between treatments. The caliber of cannulas is commonly indicated in gauge, withbeing a very large cannula ed in resuscitation setting the smallest.Blood can be drawn from a peripheral necessary, but only if it is in a relatively large vein and only if the is newly inserted.

Originally, a peripherawas simply a needle that was taped in place and connected to tubing rather than to a syringe. , hospitals use a safer system in which the catheter is a flexible plastic tube that originally contains a needle to allow it to pierce the skin; the needle is then removed and discarded, while the soft catheter stays in the A peripheral cannot be left in the , because of the risk of insertion-site infection leading to cellulitis and bacteremia. Hospital policies usually dictate that every peripheral be replaced at a different location every three days to avoid this complication.

Central IV lines flow through a catheter with its tip within a larmedications that would be overly irritating to peripheral veins because of their concentration or chemical composition. These include some chemotherapy drugs and totnteral nutrition.

Medicationsin a single tube. Carers can measure central venous pressure and other physiological variables through the line.

Central lines also carry higher risks of bleeding, bacteremia, and gas embolism .There are several types of central, depending on the route thahecatheter takes from the outside of the body to the vein.

Peripherally inserted central catheter A line is inserteripheral vein, usually in the arm, and then carefully advanced upward until the catheter is in the superior vena cava or the right atrium. This is usually done by feel and estiion; an then verifies that the tip is in the right place.A may have two parallel compartments, each with its own external connector , or a single tube and connector single-lumen From the outside, a single-lumen resembles a peripheral , except that the tubing is slightly wider.

The insertion site must be covered by a larger sterile dressing than would be required for a peripheral due to the higher risk of infection if bacteria travel up the catheter. Howevpreading through the tream.The chief advantage of a over other types of central lines is that it is easy to insert, poses a relatively low risk of bleeding, is externally unobtrusive, and can be left in place for months to years for patients who require extended treatment. The chief disadvantage is that it must travel through a relatively small peripheral vein and is therefore limited in diameter, and also somewhat vulnerable to occlusion or damage from movement or squeezing of the arm.

Central venous lines

There are several types of cateters that take a more direct route into central veins. These are collectively called central venous lines.In the simplest type of central venous access, a catheter is inserted into a subclavian, internal jugular, or a femoral vein and advanced toward the heart until it reaches the superior vena cava or right atrium. Becall of these veins are larger than peripheral veins, central lines can deliver a higher volume of fluid and can have multiple lumens.

Another type of central line, called a Hickman line or Broviac ctheter, is inserted into the target vein and then "tunneled" under the skin to emerge a short distance away. This reduces the risk of infection, since bacter skin surface are not able to travel directly into the vein; these catheters are also made of materials that resist infection and clotting.

Implantable ports

A port often referred to by brand names such MediPort is a central venous line that not have an external connector; instead, it has a small reservoir implanted under the skin. Medication is administered intermittently by placing a small needle through the skin into the reservoir. Ports cause less inconvenience and have a lower risk of infection than , and are therefore commonly used for patients on long-term intermittent treatment.

Infusion equipment

A standard infusion set consists of a pre-filled, sterile container glass bottle, plastic bottle or plastic bag) of fluids with an attached drip chamber which allows the fluid to flow one drop at a time, making it easy to see the flow rate and also reducing air bubblesa long sterile tube with a clamp to regulate or stop the flow; a connector to attach to the access device; and connectors to allow "piggybacking" of another infusion set onto the same line, e.g., adding a dose of antibiotics to a continuous fluid drip.An infusion pump allows precise control over the flow rate and total amount delivered, but in cases where a change in the flow rate wouldhaerious consequences, or if pumps are not available, the drip is often left to flow simply by placing the bag above the level of the patient and using the clamp to regulate the rate; this is a gravity drip.A rapid infuser can be used if the patient requires a high flow rate and the IV access device is of a large enough diameter to accommodait. This is either an inflatable f placed around the fluid bag to force the fluid into the patient or a similar electrical device that may also heat the fluid being infused.

Intermittent infusion

Intermittent infusion is used when a patient requires medications only at certain times, and does not require additional fluid. It can use the same techniques as an intravenous drip, but after the complete dose of medicatio has been given, the tubing is disconnected from the access device. Some medications are also given by push, meaning that a syringe is connected to theaccess device and the medication is injected directly slowly, if it might irritate the vein or cause a too-rapid effect.

Risks of intravenous therapy

Intravenous therapy has many risks and should therefore only be performed by trained personnel under medical supervision, using proper equipme
InfectionAny break in the skin carries a risk of infection. Although IV insertion is a sterile procedure, skin-dwelling organisms such as Staphylococcus aureus or Candida albi enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment.Infection of IV sites is usually local, causing easily visible swelling, redness, anfever. If bacteria do not remain in one area but spread through the bloodstream, the infection is called septicemia and can be rapid and life-threatening. An infected central IV poses a higher risk of septicemia, as it can deliver bacteria directly into the centcirculat

Phlebitis

Phlebitis is irritation of a vein that is not caused by infection, but from the mere presence of a foreign body or the fluids or medication being given. Symptoms are swelling, pain, and redness around the vein. It does not necessarily mean the IV device must be removed; warmth, elevation of the affected limor a change in the rate of flow may resolve the symptoms. to frequent injections and recurring phlebitis, the peripheral veins of intravenous drug addicts, and of cancer patients undergoing chemotherapy, become hardend and difficult to access over time.

Infiltraton

This occurs when the tip of the IV catheter withdraws from the vein or pokes through the vein into surrounding tissue, or when the vein's wall becomes permeable and leaks fluid. It occurs frequently with peripheral IVs, andquires replacement of the IV at a different location. The symptoms of pain and swelling are temporary and not dangerous, unless a highly irritating medication was being given.

Fluid overload

This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema.

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