Intravenous (IV) lines are vascular access devices used to gain venous access to a patient, giving the health care team the ability to administer medications and fluids. There are many types of IV lines, with Peripheral IVs (PIVs) being the most common. Because there are potential complications associated with any vascular access device, both proper insertion techniques, as well as care and maintenance of the IV line, are extremely important. Vascular Wellness advocates for a complete assessment of not only the access site but also the infusion equipment attached to the patients, including the tubing and delivery mechanism. Read to learn more about how to assess an IV and how our Vascular Access clinicians follow this practice regularly and educate clients on best practices.
What are IVs Used For?
IVs are flexible tubes or catheters that are placed inside a vein and used by healthcare providers to administer solutions directly into the bloodstream. IV lines are most commonly placed in the upper extremities, but in certain patient populations, the lower extremities and even the neck may be used. Almost every patient in a hospital will receive an IV (many life-saving medications are administered intravenously), and some patients in outpatient settings may have them, too. In most situations, IVs are used to administer fluids, medications, parenteral nutrition therapy, contrast agents for imaging studies, and blood products. In some circumstances, blood samples may be drawn through IVs.
What are the Different Types of IVs?
Different types of IVs exist due to the variability of the patient and the use case. The type of IV or vascular access device used depends on many criteria, including a patient’s unique situation, therapy required, length of time a device needs to stay in place, and medical history. Vascular access devices used in patient care include traditional peripheral IVs (PIVs), Midlines (a type of longer peripheral IV in the upper arm) and central venous catheters (CVCs). Central venous catheters, like peripheral IVs, come in many different sizes and lengths. All correctly placed CVCs have one thing in common: when correctly placed, they end either very close to, or just inside of the heart. This allows for maximal dilution of the administered therapy due to the large amount of blood flow at that location. CVCs include PICCs (Peripherally Inserted Central Catheters); Acutely placed CVCs (in a variety of anatomical locations), Tunneled catheters, and implanted ports. Some CVCs serve very specific purposes like dialysis catheters, or for Extracorporeal Membrane Oxygenation (ECMO).
Read more about each type of IV and how each is used on our VASCULAR ACCESS PATIENT EDUCATION PAGE
How to Assess the Area Around the IV Site
It is very important to wash your hands with an approved method and to wear gloves before handling a vascular access device. Proper hand hygiene guidelines can be found here: CDC – Clean Hands
Assessing the area around the IV Site or insertion site is one of the most important factors in the care and maintenance of an IV. The clinician should assess for redness or abnormal skin color, swelling, bruising, or if the patient reports tenderness or pain. The skin around the insertion site should also approximate the temperature of the surrounding skin.
After assessing the skin, clinicians should observe the dressing and the device itself. Correctly maintained dressings will appear clean, dry, and intact. This means the IV site is not damp or moist, the area of skin under the clear dressing is not soiled or discolored, and the edges of the dressing are well-adhered to the skin. The catheter lumens (internal channels) not being used should be clamped and the device should be free of kinks that could affect performance.
In addition to regularly assessing the IV and the area around it, clinicians should change dressings and perform routine flushing per facility policy to ensure the IV line is working properly, and to minimize infection risk.
How to Assess the Patency of an IV
Full patency, in the context of an IV, refers to both the ability to flush the device without resistance and the free flow of blood return upon aspiration. Assessing the patency of an IV requires confirmation of these uses as applicable. The current IV Therapy Standards of Practice require blood return on all central lines, but not on all PIVs. Nevertheless, lack of blood return on a PIV requires more caution on the part of the clinician prior to use. IVs should be flushed routinely to ensure the line stays patent. While flushing, clinicians should assess resistance to the flush and palpate a couple of inches distal to the IV site to feel for any signs of infiltration (leakage of a medication or solution from the catheter into the surrounding tissues instead of the vein). Although patients may report various sensations during flushing, pain is not expected and would indicate a complication with the IV.
How to Assess an IV with a Continuous Infusion
If clinically prudent, vascular access devices with continuous infusion will also benefit from routine flushing and, of course, require regular assessment. The infusion rate of the medication should also be checked for accuracy, and all tubing should be assessed for proper dates and connections.
Image showing how to assess an IV, assuring proper dates and connections
How to Care for an IV or Vascular Access Device?
Care for an IV or vascular access device is critical for it to continue to perform as needed. All hospitalized patients require regular bathing to reduce infection risks. Patients with CVC’s will benefit from a special bath with Chlorhexidine Gluconate (CHG). CHG bath products have been shown to reduce the chance of infection for patients with CVCs in place. The patient’s skin may temporarily feel a little dry or itchy after the bath, and lotion can be applied if that occurs. Patients who are discharged with a vascular access device in place should arrange to have CHG wipes at home. Dressing changes are as directed, which is typically once per week; however, if the dressing becomes wet, dislodged, or soiled, patients should notify their nurse, provider, or home health agency right away.
PROVIDERS:
Learn more about vascular access device assessment, and infection prevention and control measures by visiting our PROVIDER PAGE
PATIENTS:
Learn more about important guidelines and helpful tips for IV and vascular access device care and maintenance by visiting our PATIENT PAGE
Vascular Access Training Solutions
We bring training for IV Care and Maintenance and other vascular access topics straight to your healthcare setting and location. Learn more about Vascular Wellness Education & Training…
How does Vascular Wellness Support the Care and Maintenance of IV Lines?
Vascular Wellness does not just place IV lines but we also support the care and maintenance of IV lines. Vascular Wellness’ Vascular Access Specialists ensure proper vascular access device selection, insertion, care and maintenance of all types of IV lines through every aspect of our work, and we educate others on proper procedures. Our clinicians are Vascular Access Board Certified (VA-BC) and undergo extensive training, precepting and semiannual skill verification to ensure we provide expert services. We only use the highest quality, hospital preferred supplies and follow all industry guidelines, enabling us to support a 0% infection rate on all standard and advanced vascular access device placements. We also partner with hospital clients to perform routine assessments, care and maintenance of all the IVs we’ve placed, and help them with infection control measures and more.
In addition, we offer several training courses, including the Care and Maintenance of vascular access lines. This course is taught by VA-BC nurse clinicians who regularly place vascular access lines, and train and precept nurses. Vascular Wellness provides all the equipment and supplies required and the training can take place a Vascular Wellness location or in the client’s own healthcare setting. The course covers multiple aspects of the care and maintenance of IV lines, including minimizing infection risk, performing dressing changes, troubleshooting line complications, and more.
IV line placement or insertion is a very common procedure performed both inside and outside of the hospital setting. Proper care and maintenance of these lines is extremely important, and regular assessment is crucial to preventing complications and infections. Our Vascular Access nurse clinicians always follow best practices to ensure IVs stay clean, dry, intact, and patent. Vascular Wellness also partners with clients through education and performing these important tasks where needed, and offers courses on this subject and others that are taught by Vascular Access Board Certified nurse clinicians.
Click below to learn about the Central Line Care and Maintenance course from Vascular Wellness:
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Want to learn more about how we assess an IV? Read our Vascular Access Patient Cases below…
Vascular Access Patient Cases:
Clinical Cases from the Front Lines of Vascular Access Care
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.
