Chapter 8. Intravenous Therapy
8.3 Types of Venous Access
Safe and reliable venous access for infusions is a critical component of patient care in acute and community health settings. There are a variety of options available, and a venous access device must be selected based on the duration of IV therapy, type of medication or solution to be infused, and the needs of the patient. In practice it is important to understand the options of appropriate devices available.
This section will describe two types of venous access: peripheral IV access and central venous catheters. Besides observing the site for complications, accessing, flushing, and removal of IVADs, tunneled catheters, and catheters used for hemodialysis require specialized skill and they are not within the scope of this textbook.
Peripheral Venous Access Device—Short Cannula (PVAD-Short) a.k.a. Short Peripheral Catheter (SPC)
A PVAD-short cannula is a common, preferred method for short-term IV therapy in the hospital setting (see Figure 8.1). Principles of asepsis are followed during insertion. Sites are covered with dressings, which can be a sterile transparent semi-permeable dressing or a gauze dressing if the site is bleeding (RNAO, 2005/2008). Dressings serve to keep the site sterile and prevent accidental dislodgement (CDC, 2017). Upper extremities (hands and arms) are the preferred sites for insertion by a specially trained healthcare provider. If a lower extremity is used, remove the peripheral IV and re-site in the upper extremities as soon as possible (CDC, 2017; McCallum & Higgins, 2012). The hub of a short intravenous catheter should be attached to IV extension tubing with a needleless cap (Fraser Health Authority, 2014).
PVAD-shorts are used for infusions under six days and for solutions that are iso-osmotic or near iso-osmotic (CDC, 2017). They are easy to monitor and can be inserted at the bedside. CDC (2017) recommends that PVAD-shorts be replaced every 72 to 96 hours to prevent infection and phlebitis in adults. Other literature suggests that PVAD-short catheters be changed based on individual assessment of the site and not specific time frames (Gorski et al., 2012). Many agencies require additional training to initiate IV therapy, but the care and preparation of equipment, and the maintenance of an IV system, is the responsibility of the trained healthcare provider.
PVAD-short sites are prone to phlebitis and infection, and should be removed (CDC, 2017) as follows:
- Every 72 to 96 hours and p.r.n. Some literature challenges this firm timeline and suggests that sites should be assessed individually for decisions about removal (Gorski et al., 2012).
- As soon as the patient is stable and no longer requires IV fluid therapy
- As soon as the patient is stable following insertion of a cannula in an area of flexion
- Immediately if tenderness, swelling, redness, or purulent drainage occurs at the insertion site
- When the administration set is changed (IV tubing)
Midline Cath