|Generally, an intravenous (IV) catheter must be placed before beginning IV therapy, although in some situations, medication may be injected directly into a vein using a needle and syringe. A catheter is a thin, hollow, plastic tube that is introduced through the skin into a vein. Several types of catheters are available. The choice depends on location of insertion and the length of time the catheter needs to remain in use.|
The technique for placing a catheter into a vein (venipuncture) varies, depending on the vein to be used (peripheral or central) and on the type of catheter. Before placing the catheter, the solution, tubing, and delivery system are prepared. The catheters most commonly used for a peripheral IV have a fine needle inside the catheter, which is necessary for puncturing the skin and vein during placement.
To insert a peripheral catheter, a tourniquet is placed above the insertion site, filling the vein with blood, making it easier to find and enter the vein. The site is cleansed with an antibacterial solution to prevent infection. A local anesthetic may be given just under the skin to ease any discomfort that may occur during insertion of the catheter. The catheter is inserted through the skin and into the vein. After entry, the catheter is gently threaded into the vein and the tourniquet removed. The needle used for introduction is removed, and the IV tubing that is connected to the solution is attached to the catheter, allowing the solution to drip into the vein. The catheter and tubing are securely taped in place.
Placement of a central catheter varies. Some types of central catheters used for long-term outpatient therapy (peripherally inserted central catheter, PICC lines) are placed by a physician or specially trained nurse. Central catheters may be placed in a large vein in the upper chest area (subclavian vein) or in the neck (internal jugular vein). There is some variation in technique, depending on the type of catheter and the vein to be used. Generally, however, the individual is positioned very carefully, with the head and shoulders slightly lower than the body (Trendelenburg's position), so as to fill the veins with blood (dilate) and to avoid introducing an air embolus. The skin is cleansed with a surgical scrub, and small surgical drapes are placed around the site to help prevent infection. A needle and syringe are used to enter the vein. The syringe is then removed from the needle, and a small guidewire is placed through the needle into the vein; afterward the needle is removed leaving, the guidewire in place. The catheter is inserted into the vein over the guidewire, the guidewire is removed, and the IV tubing connected to the solution is attached to the catheter, allowing infusion to begin. A suture is often used to secure the catheter in place. A dressing is placed over the site, and the tubing is taped to the skin. A plain solution is slowly infused until a chest x-ray confirms that the catheter is in the correct position and that there has been no accidental injury to the lungs. After confirmation of placement, the desired solution at the appropriate rate can be administered.
Vascular access devices are placed by a surgeon through a small incision located in the chest area. This type of IV infusion device is usually placed during a surgical procedure using an x-ray machine (fluoroscopy) to guide placement. A small incision is made, and the catheter is inserted into the vein (often the subclavian, jugular, or cephalic vein). A pocket is made in the subcutaneous tissue, through which the catheter is tunneled. The reservoir is then placed in the pocket and attached to the catheter. The reservoir and the catheters must be flushed with an anticoagulant solution to keep them from clotting closed. The incision is sutured closed and a dressing placed.
Source: Medical Disability Advisor