There are situations when a patient with a serious illness requires constant injections and intravenous infusions. In case of emergency care for bad veins, resuscitation can be delayed, so doctors resort to a procedure such as peripheral vein catheterization. What is this manipulation, for what purpose is it carried out and are there possible complications? The answers to these questions are presented in the article.
Catheterization procedure
This is a method that involves the placement of a peripheral catheter to provide access to the bloodstream. A peripheral venous catheter (PVC) is a device designed to be inserted into a vein and provides access to vessels for the fastest possible infusion.
This procedure has become almost routine for doctors, more than 500 catheters are installed in patients during the year. The emergence of quality systems increases the amount of catheterization of peripheral veins compared to the central blood vessels. According to studies, intravenous therapy is much more convenient ifuse peripheral vessels.
Catheters are central and peripheral. If the first type is installed only by a doctor, then a catheter with a needle for catheterization of peripheral veins can be installed by a nurse.
Pros and cons of the technique
The procedure has its advantages and disadvantages. If we talk about the pros, then they are:
- Provides quick access to the patient's vein, which allows you to instantly provide assistance if necessary or to administer the drug without any problems.
- After the catheter is inserted, there is no need to puncture the vein each time for the drip of the drug.
- The procedure does not affect the patient's mobility in any way: after the catheter is inserted, the patient can move his hand without restrictions.
- Medical staff saves their time, which has to be spent on intravenous drug administration. And the patient will not have to experience pain every time during injections.
But do not forget about the existing shortcomings:
- The peripheral venous catheter cannot be placed indefinitely. 3 days maximum, after which it must be removed.
- Although minimal, there is a risk of complications after catheter placement. It all depends on the experience of the he alth worker in establishing such systems.
Peripheral venous catheterization system - indications for installation
It happens when in an emergency it is necessary to provide assistance to the victim, and access to the bloodthe channel is impossible due to shock, low blood pressure or stuck together veins. In this case, the injection of the drug directly into the blood is required. That's when the puncture and catheterization of the peripheral vein is necessary.
Sometimes you have to access the bloodstream through the femoral vein. This is often necessary if cardiopulmonary resuscitation is required. Doctors can work in parallel and not interfere with each other. Peripheral vein catheterization is also required in the following cases:
- Emergency fluid therapy in an ambulance. After hospitalization, doctors do not have to waste precious time, and you can immediately begin medical procedures.
- Patients requiring frequent intravenous administration of drugs in large volumes also need a catheter.
- Surgical patients require intravenous infusions as they may need urgent surgery.
- Administration of intravenous anesthesia during surgery.
- Install a catheter for women in labor if there is a risk of problems during labor with access to the veins.
- If frequent venous blood sampling for testing is required.
- Multiple blood transfusions.
- Peripheral venous catheterization is also performed if the patient needs parenteral nutrition.
- Requires support or correction of fluid and electrolyte balance.
- Peripheral venous catheterizationmay be a preliminary procedure before the placement of a central catheter.
As you can see, there is an extensive list of indications for the procedure, but contraindications must also be taken into account.
When is venous catheterization not indicated?
There are practically no contraindications that would categorically prohibit the procedure. But there are some nuances that do not allow catheterization of this particular vein or in this area.
1. Preferred central venous access if:
- the introduction of drugs irritates the vascular wall (most often this phenomenon is observed when infusing solutions with high osmolarity);
- requires a large volume of blood transfusion;
- superficial veins are not visible or palpable even after a tourniquet has been applied.
2. It is necessary to choose another site for the introduction of the catheter if there are inflammatory processes on the skin or thrombophlebitis in a certain area.
It can be said that venous catheterization with a peripheral catheter is possible in almost all patients. The choice of place is carried out according to individual indications.
What is needed to insert a catheter?
Peripheral vein kit includes the following instruments:
- Tray, but always sterile.
- Trash can.
- Syringe with heparinized solution.
- Cotton balls and sterile wipes.
- Patch or adhesive bandage.
- Medical alcohol.
- Catheter. Must be selectedappropriate size based on patient age and placement.
- Connecting tube.
- Tourniquet and sterile medical gloves.
- Bandage.
- Scissors.
- "Hydrogen peroxide".
Having everything you need to install a catheter also requires organizing space for comfortable work. There must be good lighting. You need to remove everything superfluous from the table. The nurse must be in a gown and cap. The patient must be informed in advance about the procedure and have an idea about it.
Peripheral vein catheterization - algorithm
The procedure for inserting a catheter requires the following steps:
- Medical staff prepares for catheterization: hands are thoroughly washed, treated with an antiseptic solution and dried.
- Preparing the patient for the procedure. If required, remove the hair in the area for better hold.
- Assemble the peripheral vein catheterization kit, check its integrity and shelf life. The nurse must also ensure that the correct patient is in front of her.
- Provide lighting for good visibility, prepare a waste tray and help the patient to a comfortable position.
- Choose a catheter according to the size of the blood vessel, the age of the patient, the characteristics of the cannula and the frequency of intravenous infusions. Open package.
- The skin area where the puncture will be performed must be degreased and treatedantiseptic solution.
- Above the catheter insertion site, apply a tourniquet and ask the patient to work with a fist.
- Take the catheter with your right hand, remove the protective cap, fix the vein with your thumb and forefinger and insert the needle at an angle of 5-15°.
- Pull back the piston. If blood begins to flow into the syringe, it means that the needle has entered a vein.
- Pass the catheter 0.5 cm further down the vein, holding the wings.
- Fix the stylet needle and while advancing the catheter, remove it from the guide needle.
- Remove tourniquet.
- Press the vein, finally remove the guide needle and send it to the waste container.
- Examine the insertion site for redness, swelling.
- Clamp the vein and disconnect the syringe.
- Clean the site of catheter insertion with an antiseptic solution and apply a sterile dressing or bandage.
- Enter the date and time of catheterization, system size in a special journal.
If the technique of peripheral vein catheterization is followed, then, as a rule, complications do not occur. But don't rule them out either.
Complications of catheterization
Most often, complications of peripheral vein catheterization are provoked by the inexperience of the medical staff who performs this procedure. An important role is played by compliance with all stages of the introduction of the catheter. If the algorithm is not followed, then complications cannot be avoided.
Negative consequences can be divided into two groups:
- Generalcomplications.
- Local.
Let's consider each type in more detail. Local unwanted side effects include:
- Hematoma. It can be formed due to the leakage of blood from the vessel and its accumulation in the area of the installed catheter. This usually occurs if an unsuccessful puncture of the vein was made at the time of insertion or removal of the catheter.
- Venous thrombosis develops against the background of the formation of a blood clot in the vessel. Most often, this complication is provoked by a mismatch between the size of the catheter and the vein, as well as improper care after the procedure.
- Infiltration is observed when the injected drugs do not enter the blood vessel, but under the skin. The complication is serious, because the intake of hypertonic, alkaline solutions or cytostatics can provoke tissue death. Early detection of this complication will help avoid more serious consequences.
- Phlebitis. It develops due to mechanical, chemical irritation or infection, which happens when hygienic requirements and sterility of the procedure are not observed. Thrombophlebitis may develop, signs are redness and soreness in the area of the installed catheter. Later, the temperature rises, pus may be observed when the catheter is removed.
Common complications include:
- Thromboembolism. Diagnosed when a blood clot on a catheter or in a vein breaks off and travels to the heart with blood flow.
- Air embolismmay develop during intravenous therapy, but as a rule, if a system for catheterization of peripheral veins is used, the risk of development is significantly reduced due to the presence of positive venous pressure.
- Very rare, but catheter rupture is possible.
Medical staff must be prepared to deal with any complications after catheter insertion, and precautions must be taken to prevent them.
Prevent complications
Of course, the outcome of the procedure cannot be 100% predicted, because the body of each patient is individual. But doctors should do everything possible to reduce the risk of unwanted consequences if peripheral venous catheterization is performed. How to avoid complications? To this question, a competent specialist will always give the necessary advice to young doctors:
- Do not choose subtle vessels for the procedure.
- You can prevent the formation of a hematoma if you press your fingers on the place where the catheter was inserted and hold for 3-4 minutes.
- Thrombosis is prevented by proper catheter sizing. It is also important to consider the material from which the cannulas are made, for example, polyurethane, polytetrafluoroethylene are less thrombogenic. It is advisable to use a patch of skin over the proposed catheter with heparin ointments (Lyoton is suitable).
- To avoid infiltration, it is necessary to use a tourniquet to stabilize the catheter (especially if placed in the fold of the arm or leg).
- To prevent phlebitis during installationcatheter, it is necessary to carefully observe the rules of antisepsis, use high-quality devices whenever possible. The introduction of drugs should be carried out slowly, always in compliance with the instructions for breeding. For prevention, it is recommended to change the vein for catheter placement if a second procedure is required.
- It is undesirable to install PVCs on the lower extremities, this increases the risk of developing blood clots. After the infusion is stopped due to the formation of a clot on the catheter, it should be removed and a new one inserted.
- Air embolism is prevented by completely removing air from the infusion line before connecting it to the catheter. All parts must also be sealed together.
These important recommendations will help to avoid many complications when catheterization of the cubital and other peripheral veins is performed.
Catheter maintenance procedure
If the procedure for installing the PVK was successful, this does not mean that you can forget about the catheter. Proper care is important to notice the earliest symptoms of developing complications.
The rules of care are as follows:
- Every day, a nurse should inspect the place where the PVC is installed. If contamination is found, they are removed immediately.
- When manipulating the catheter and infusion set, asepsis must be followed.
- The catheter needs to be changed every 2-3 days. If blood products are used for transfusion, thenevery day.
- Isotonic sodium chloride should be used to flush catheters.
- When connecting the catheter, avoid touching the equipment.
- All manipulations should be carried out with sterile gloves.
- Change end caps regularly and do not reuse them.
- After drug administration, the catheter must be flushed with saline.
- Change the fixation bandage as needed.
- Do not use scissors while manipulating the catheter.
- To prevent thrombophlebitis after a puncture above the catheter insertion site, treat the skin area with thrombolytic ointments and gels.
Compliance with all care recommendations will allow you to detect problems in a timely manner or completely avoid negative consequences.
Features of catheterization in children
Catheterization of peripheral veins in children has its own characteristics, taking into account the age of patients. The child needs to be prepared. The temperature in the treatment room should be comfortable (if required, a heater should be installed to avoid a stress reaction to the cold). It is not recommended to perform the procedure immediately after eating.
Peripheral vein catheterization in newborns is performed according to the following algorithm:
- A blood vessel is selected to place the catheter. In babies, it is preferable to use vessels on the back of the hand, on the forearm, on the head, foot, elbow or ankle.
- The selected area needs to be warmed up.
- Apply a tourniquet and tighten until the pulsation stops at the periphery.
- Treat the skin with an antiseptic composition.
- Connect the syringe to the catheter and adapter, check the patency using saline.
- Disconnect syringe.
- Take the catheter on the needle for catheterization of peripheral veins with the index and thumb and hold by the "wings".
- Press the vessel with your finger and pierce the skin with a needle just below the puncture site.
- The needle is inserted into the vein until blood appears in the cannula when the guidewire is removed.
- Remove explorer. Do not allow the needle to move further - this may damage the opposite wall of the vessel.
- Insert the catheter as far as possible and remove the tourniquet.
- Connect adapter and syringe and inject a small amount of saline to ensure proper catheter placement.
- Secure the catheter so that the child cannot damage the system.
The procedure for installing PVCs in children can cause many problems. If in adult patients this is almost an ordinary procedure, then in children it can turn into a minor surgical intervention. Often, for a young doctor, catheterization in children becomes an impossible task.
The catheterization procedure is sometimes the only way to effectively treat a patient. If the doctor approaches the procedure and its preparation with knowledge of the matter, then there are no difficulties. Medical personnel do not have to each time before the introductionintravenous drug to give the patient discomfort and puncture the vein. In addition, it is often the installation of PVK that allows you to provide the necessary assistance urgently in order to save the patient's life.
