Catheterization of peripheral veins: advantages and disadvantages of the technique

There are times when patients with severe illness require constant injections and intravenous infusions. In case of emergency help with bad veins, you can be late with resuscitation, so doctors resort to such procedure as catheterization of peripheral veins. What is this manipulation, for what purpose is it conducted and are possible complications? The answers to these questions are presented in the article.

Catheterization Procedure This is a method that involves the establishment of a peripheral catheter to provide access to the bloodstream. A catheter for peripheral veins( IVC) is a device intended for insertion into a vein and providing access to vessels for the fastest infusion.

This procedure for doctors has become almost ordinary, during the year, patients are installed more than 500 catheters. The appearance of qualitative systems increases the number of catheterization of peripheral veins in comparison with the central blood vessels. According to studies, intravenous therapy is much more convenient if you use peripheral vessels.

Catheters are central and peripheral. If the first species is installed only by a doctor, then a catheter on the needle for catheterization of peripheral veins can be installed by the nurse.

Pros and Cons of the

Method The procedure has its advantages and disadvantages. If you talk about the pros, they are as follows:

• Provides quick access to the patient's vein, which allows you to instantly help if necessary or without problems to introduce a drug.
• After insertion of the catheter, there is no need to do a vein puncture every time to drip the medication.
• The procedure does not affect the patient's mobility: after installation of the catheter, the patient can perform hand movements without restrictions.
• Medical personnel save their time, which has to be wasted with intravenous administration of the drug. And the patient will not have to experience painful sensations every time during injections.

But do not forget about the shortcomings:

• Catheter for peripheral veins can not be installed for an indefinite period. Maximum 3 days, after which it is necessary to extract it.
• Although minimal, there is a risk of complications after catheter placement. Everything depends on the experience of the medical worker in establishing such systems.

System for catheterization of peripheral veins - indications for installation

It happens that when an emergency needs to be given to the victim, and access to the bloodstream is impossible due to shock, low blood pressure or stuck together veins. In this case, the administration of the drug directly into the blood is required. That's when the puncture and catheterization of the peripheral vein is needed.

Sometimes it is necessary to access the bloodstream through the femoral vein. Often there is such a need, if it is required to conduct cardiopulmonary resuscitation. Doctors can work in parallel and do not interfere with each other. Catheterization of peripheral veins is also necessary in the following cases:

• Emergency infusion therapy in an ambulance. After hospitalization, doctors do not have to waste precious time, and you can immediately begin treatment procedures.
• Patients requiring frequent intravenous administration of drugs in large volumes without a catheter also can not do.
• Patients from the surgical department require intravenous infusions, as urgent surgical intervention may be necessary.
• Introduction of intravenous anesthesia during surgery.
• Place a catheter for women in labor if there is a risk of problems during labor with access to the veins.
• If you need frequent venous blood sampling for tests.
• Multiple blood transfusions.
• Peripheral veins can also be catheterized if parenteral nutrition is required.
• Support or correction of water-electrolyte balance is required.
• Peripheral venous catheterization may be a preliminary procedure before establishing a central catheter.

As you can see, has an extensive list of indications for the procedure, but it is necessary to take into account contraindications.

When is vein catheterization not shown?

There are practically no contraindications that would categorically prohibit the procedure. But there are some nuances that do not allow the catheterization of this particular vein or on this site.

1. It is advisable to prefer central venous access if:

• administration of medications irritates the vascular wall( most often this phenomenon is observed when infusion of solutions with large osmolarity);
• requires the transfusion of large amounts of blood;
• superficial veins are not visible and not palpated even after application of the tourniquet.

2. You must select another site for insertion of the catheter if there are inflammatory processes on the skin or thrombophlebitis in a certain area.

It can be said that catheterization of veins by a peripheral catheter is possible in practically all patients. The choice of location is based on individual indications.

What is needed to install a catheter?

Peripheral vein catheter kit includes the following tools:

• Tray, but necessarily sterile.
• Waste container.
• Syringe with heparinized solution.
• Cotton balls and sterile wipes.
• Plaster or adhesive bandage.
• Medical alcohol.
• Catheter. Necessary size is chosen taking into account the age of the patient and the place of installation.
• Connector tube.
• Harness and sterile medical gloves.
• Bandage.
• Scissors.
• "Peroxide of hydrogen".

The presence of everything necessary for the installation of the catheter also requires the organization of space for comfortable work. There must be good lighting. You need to remove all the extra from the table. A nurse should be in a dressing gown and a hat. The patient should be informed in advance about the procedure and have an idea about it.

Catheterization of the peripheral vein -

algorithm The procedure for insertion of the catheter requires the following steps:

1. The medical staff are preparing for the catheterization: hands are thoroughly washed, treated with an antiseptic solution and dried.
2. Preparation of the patient for the procedure. If required, you need to remove the hair in the area for better fixation.
3. Assemble kit for peripheral vein catheterization, check its integrity and shelf life. The nurse must also make sure that she is the patient in front of her.
4. Provide lighting for good visibility, prepare a waste tray and help the patient to take a comfortable position.
5. Choose a catheter, taking into account the size of the blood vessel, the age of the patient, the characteristics of the cannula and the frequency of intravenous infusions. Open the package.
6. The area of ​​the skin where the puncture will be performed should be degreased and treated with an antiseptic solution.
7. Place a tourniquet above the insertion site and ask the patient to operate the cam.
8. Take the catheter with your right hand, remove the protective cap, fix the vein with your thumb and index finger and insert the needle at an angle of 5-15 °.
9. Pull off the piston. If blood began to flow into the syringe, then the needle hit the vein.
10. Carry the catheter farther along the vein by 0.5 cm, holding it by the wings.
11. Fix the needle-stylet and push the catheter to remove it from the needle-guide.
12. Remove the harness.
13. Press the vein, finally remove the needle and guide into the waste container.
14. Inspect the insertion site for redness, swelling.
15. Press the vein and disconnect the syringe.
16. Place the insertion site with an antiseptic solution and apply a sterile bandage or patch.
17. Enter the date and time of catheterization, the size of the system in a special journal.

If the technique of catheterization of the peripheral vein is observed, then, as a rule, complications do not arise. But to exclude them is also not worth it.

Complications of catheterization

The most common complications of peripheral vein catheterization are provoked by the inexperience of medical personnel who conduct this procedure. Compliance with all stages of the introduction of the catheter plays an important role. If the algorithm is not followed, complications can not be avoided.

Negative consequences can be divided into two groups:

1. General complications.
2. Local.

Consider each species in more detail. The local undesirable side effects include:

• Hematoma. It can be formed due to leakage of blood from the vessel and its accumulation in the area of ​​the established catheter. This usually occurs if an unsuccessful vein puncture was performed at the time the catheter was inserted or removed.
• Vein thrombosis develops on the background of the formation of a blood clot in the vessel. Most often, such a 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 are not delivered to the blood vessel, but under the skin. The complication is serious, because the intake of hypertonic, alkaline solutions or cytostatics can provoke tissue death. Identification at an early stage of this complication will avoid more serious consequences.
• Phlebitis. Develops due to mechanical, chemical irritation or infection, which occurs when non-compliance with hygiene requirements and the sterility of the procedure. Thrombophlebitis may develop, the signs are redness and soreness in the area of ​​the established catheter. Later, the temperature rises, there may be a discharge of pus when the catheter is removed.

Common complications include:

1. Thromboembolism. It is diagnosed if a blood clot on the catheter or in the vein comes off and with the blood flow goes to the heart.
2. Air embolism may develop during intravenous therapy, but as a rule, if a system is used for the catheterization of peripheral veins, the risk of developing is significantly reduced by the presence of a positive venous pressure.
3. Very rarely, but a catheter can be detached.

Medical personnel should be prepared to cope with any complications after insertion of the catheter, and preventive measures must be taken to prevent them.

Preventing the development of complications

Of course, the outcome of the procedure can not be predicted for 100%, because the body of each patient is individual. But doctors should do everything possible to reduce the risk of unwanted consequences if the peripheral veins are catheterized. How to avoid complications? To this question, a competent specialist will always give the necessary advice to young doctors:

1. Do not choose low-visibility vessels for the procedure.
2. You can prevent the formation of a hematoma if you press your fingers with the place where the catheter was installed and hold for 3-4 minutes.
3. Thrombosis is prevented by the right choice of catheter size. 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 the skin area above the putative catheter with heparin ointments( Lyoton is suitable).
4. To avoid infiltration, it is necessary to use a turnstile to stabilize the catheter( especially if it is installed in the place of folding of the arm or leg).
5. To prevent phlebitis during the installation of the catheter, it is necessary to carefully observe the rules of antiseptic, use as far as possible high quality instruments. The administration of drugs should be carried out slowly, always following the instructions for breeding. For prevention, it is recommended to change the vein to install a catheter if a repeat procedure is required.
6. It is undesirable to place PVC on the lower extremities, this increases the risk of developing blood clots. After stopping the infusion due to the fault of the clot formation on the catheter, it is worthwhile to extract and install a new one.
7. Air embolism is prevented by complete removal of air from the infusion system before connecting it to the catheter. All parts must also be sealed together.

These important guidelines will help avoid many complications if catheterization of the cubital and other peripheral veins is performed.

Catheter care procedure

If the PVK installation procedure was successful, this does not mean that you can forget about the catheter. Proper care is important to notice the appearance of the earliest symptoms of developing complications.

Care rules are as follows:

1. Every day the nurse must inspect the place where the PVC is installed. If dirt is found, they are immediately removed.
2. When handling the catheter and the infusion system, aseptic rules must be followed.
3. The catheter needs to be changed after 2-3 days. If blood products are used for transfusion, then every day.
4. To wash the catheters, an isotonic solution of sodium chloride should be used.
5. When connecting the catheter, do not touch the equipment.
6. All manipulations should be carried out in sterile gloves.
7. Regularly change plugs and do not reuse them.
8. After the administration of medications, the catheter should be washed with saline solution.
9. Change fixing bandage as necessary.
10. Do not use scissors during manipulations with the catheter.
11. To prevent thrombophlebitis after puncture above the site of insertion of the catheter, the skin site is treated with thrombolytic ointments and gels.

Adherence to all care recommendations will allow timely detection of problems or completely avoid negative consequences.

Features of catheterization in children

Catheterization of peripheral veins in toddlers has its own characteristics, taking into account the age of the patients. The child needs to be prepared. The temperature in the procedural room should be comfortable( if necessary, you need to install a heater to avoid a stressful reaction to the cold).It is not recommended to perform the procedure immediately after eating.

Catheterization of peripheral veins in newborns is carried out according to the following algorithm:

1. A blood vessel is selected to establish a catheter. In children it is preferable to use vessels on the back of the hand, on the forearm, on the head, foot, in the elbow or in the ankle.
2. The selected site needs to be warmed up.
3. Apply the tow and tighten until the ripple stops at the periphery.
4. Treat the skin with an antiseptic compound.
5. Connect the syringe to the catheter and the adapter, check the permeability using saline solution.
6. Disconnect the syringe.
7. Catheter on the needle for the catheterization of peripheral veins to take the index and thumbs and hold for the "wings".
8. Press the vessel with your finger and needle to pierce the skin just below the puncture site.
9. The needle is inserted into the vein until blood appears in the cannula when the guide is pulled.
10. Remove the wire. Do not allow the needle to move further - this may damage the opposite wall of the vessel.
11. Catheter Install as far as possible and remove tourniquet.
12. Connect the adapter and syringe and introduce a small amount of saline to ensure the catheter is positioned correctly.
13. Secure the catheter so that the child can not damage the system.

The procedure for installing PVC in children can bring a lot of problems. If in adult patients this is almost an ordinary procedure, then in babies it can turn into a small surgical intervention. Often for a young doctor, catheterization in children becomes an impossible task.

The procedure for catheterization is sometimes the only way to effectively treat a patient. If a physician approaches the procedure and prepares it with knowledge of the case, then complications do not arise. The medical personnel will not have to deliver unpleasant sensations and puncture the vein every time before the introduction of an intravenous medication. In addition, it is often the installation of PVK that can provide the necessary assistance urgently to save the patient's life.