Venous catheter placement. Intravenous catheters: sizes, types, fixation. Peripheral intravenous catheter Cubital catheter placement

Puncture and catheterization of peripheral veins is a widely used technique for intravenous therapy, which has a number of advantages for both the patient and the medical staff.

For catheterization of a peripheral vein, as a rule, the vein of the elbow bend of the right or left arm is used. Manipulation is performed with a needle with a plastic cannula put on it - a catheter for catheterization of peripheral veins.

A peripheral intravenous (venous) catheter is a device for long-term intravenous administration of drugs, transfusion or blood sampling.

Indications

Indications for catheterization of peripheral veins are:

1. The need for prolonged repeated intravenous administration of drugs;

2. transfusion or multiple blood sampling;

3. preliminary stage before catheterization of the central veins;

4. the need for anesthesia or regional anesthesia (for minor operations);

5. support and correction of the water balance of the patient's body;

6. the need for venous access in emergency situations.

7. parenteral nutrition.

Technique

The technique of peripheral venous catheterization is quite simple, which is the reason for the popularity of using this method.

1. Carry out the necessary preparation: choose a catheter that is suitable in size and throughput, treat hands, put on gloves and prepare tools and preparations, check their expiration date;

2. Apply a tourniquet 10-15 centimeters above the intended puncture and ask the patient to clench and unclench his fist, which will ensure that the vein is filled with blood;

3. Select the most suitable and well-visualized peripheral vein;

4. Treat the punctured site with a skin antiseptic;

5. Puncture the skin and vein with a needle with a catheter. Blood should appear in the indicator chamber, which means that the puncture can be stopped;

6. Remove the tourniquet and remove the needle from the catheter, put the plug;

7. Fix the catheter to the skin with a plaster.

The algorithm for catheterization of peripheral veins and placement of a peripheral catheter can be clearly seen in this video.

Advantages and disadvantages

The advantages of catheterization of peripheral veins include the following possibilities of this manipulation:

Reliability and convenience of access to the vein;

The ability to take blood samples for analysis without unnecessary injections;

Possibility of use on short operations;

The patient can walk with a catheter in a vein when there is no drip. A plug is placed on the catheter, in other words, a rubber stopper.

The disadvantage of this procedure is that you can use it for no more than 2-3 days.

Complications

The algorithm for catheterization of peripheral veins is quite simple, but since manipulation is associated with a violation of the skin, complications are possible.

1. Phlebitis - inflammation of a vein associated with irritation of its wall with drugs, either due to mechanical action or infection.

2. Thrombophlebitis - inflammation of a vein with the appearance of a blood clot.

3. Thromboembolism and thrombosis - a sudden blockage of a vessel by a thrombus (blood clot).

4. Kinking of the catheter.

Proper care of the peripheral venous catheter is essential to prevent catheter thrombosis. It must be periodically washed with a solution of heparin in saline every 4 to 6 hours.

For the convenience of personnel, a three-way faucet is often used - a tee. This allows you to connect another dropper in parallel if necessary, or administer drugs and anesthetics, measure venous pressure.

The tee is attached to the cannula of the catheter, a dropper is attached to it, and medicines are injected through the side entrance. As can be seen from the figure, there is a switch on the tee, i.e. you can block the dropper and directly inject drugs. The tee is used with the subclavian catheter, and in other cases.

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Venous catheters are widely used in medicine for the administration of drugs, as well as for blood sampling. This medical instrument, which delivers fluids directly into the bloodstream, avoids multiple vein punctures if long-term treatment is required. Thanks to him, you can avoid injury to blood vessels, and consequently, inflammatory processes and thrombosis.

What is a venous catheter

The instrument is a thin hollow tube (cannula) equipped with a trocar (a hard pin with a sharp end) to facilitate its introduction into the vessel. After the introduction, only the cannula is left through which the drug solution enters the bloodstream, and the trocar is removed.

Before staging, the doctor conducts an examination of the patient, which includes:

venous ultrasound.
Chest x-ray.
Contrasting phlebography.

How long does the installation take? The procedure lasts on average about 40 minutes. Insertion site anesthesia may be required when inserting a tunneled catheter.

The rehabilitation of the patient after the installation of the instrument takes about one hour, the sutures are removed after seven days.

Indications

A venous catheter is necessary if intravenous administration of drugs is required for long courses. It is used in chemotherapy in cancer patients, in hemodialysis in people with renal insufficiency, in the case of long-term antibiotic treatment.

Classification

Intravenous catheters are classified in many ways.

By appointment

There are two types: central venous (CVC) and peripheral venous (PVC).

CVCs are intended for catheterization of large veins, such as subclavian, internal jugular, femoral. Medicines and nutrients are administered with this instrument, and blood is taken.

PVC is installed in peripheral vessels. As a rule, these are the veins of the extremities.

Convenient butterfly catheters for peripheral veins are equipped with soft plastic wings with which they are attached to the skin

"Butterfly" is used for short-term infusions (up to 1 hour), because the needle is constantly in the vessel and can damage the vein if left for longer. Usually they are used in pediatrics and outpatient practice when puncturing small veins.

By size

The size of venous catheters is measured in Geich and is denoted by the letter G. The thinner the instrument, the larger the Geich value. Each size has its own color, the same for all manufacturers. The size is selected depending on the application.

The size	Color	Application area
14G	Orange	Rapid infusion of large volumes of blood products or fluids
16G	Grey
17G	White	Transfusion of large volumes of blood products or fluids
18G	Green	Planned RBC transfusion
20G	Pink	Long courses of intravenous therapy (two to three liters per day)
22G	Blue	Long courses of intravenous therapy, oncology, pediatrics
24G	Yellow
26G	Violet	Sclerotic veins, pediatrics, oncology

By models

There are ported and non-ported catheters. Ported ones differ from non-ported ones in that they are equipped with an additional port for the introduction of liquid.

By design

Single channel catheters have one channel and end with one or more holes. They are used for periodic and continuous administration of medicinal solutions. They are used both in emergency care and in long-term therapy.

Multichannel catheters have from 2 to 4 channels. It is used for the simultaneous infusion of incompatible drugs, blood sampling and transfusion, hemodynamic monitoring, for visualization of the structure of blood vessels and the heart. They are often used for chemotherapy and long-term administration of antibacterial drugs.

By material

Material	pros	Minuses
Teflon	slippery surface Rigidity	Common occurrences of blood clots
Polyethylene	High permeability to oxygen and carbon dioxide High strength Not wetted by lipids and fats Sufficiently resistant to chemicals	Stable reshaping at folds
Silicone	Thromboresistance Biocompatibility Flexibility and softness slippery surface Chemical resistance Non-wettability	Change in shape and the possibility of rupture with increasing pressure Difficult to pass under the skin Possibility of entanglement inside the vessel
Elastomeric hydrogel		Unpredictable in contact with liquids (changes in size and stiffness)
Polyurethane	Biocompatibility thrombosis Wear resistance Rigidity Chemical resistance Return to previous shape after kinks Easy insertion under the skin Hard at room temperature, soft at body temperature
PVC (polyvinyl chloride)	Abrasion resistance Hard at room temperature, soft at body temperature	Frequent thrombosis The plasticizer can leach into the blood High absorption of some drugs

This is a long tube that is inserted into a large vessel to transport medicines and nutrients. There are three access points for its installation: internal jugular, subclavian and femoral vein. Most often, the first option is used.

When a catheter is inserted into the internal jugular vein, there are fewer complications, less pneumothorax, and it is easier to stop bleeding if it occurs.

With subclavian access, the risk of pneumothorax and damage to the arteries is high.

With access through the femoral vein after catheterization, the patient will remain immobile, in addition, there is a risk of infection of the catheter. Among the advantages, one can note an easy entry into a large vein, which is important in case of emergency assistance, as well as the possibility of installing a temporary pacemaker

Kinds

There are several types of central catheters:

peripheral central. They drive through a vein in the upper limb until it reaches a large vein near the heart.
Tunnel. It is injected into a large cervical vein, through which blood returns to the heart, and is excreted at a distance of 12 cm from the injection site through the skin.
Non-tunnel. It is installed in a large vein of the lower limb or neck.
Port catheter. Injected into a vein in the neck or shoulder. The titanium port is placed under the skin. It is equipped with a membrane that is pierced with a special needle through which liquids can be injected for a week.

Indications for use

A central venous catheter is placed in the following cases:

For the introduction of nutrition, if its intake through the gastrointestinal tract is impossible.
With the behavior of chemotherapy.
For the rapid administration of large volumes of solution.
With prolonged administration of liquids or drugs.
With hemodialysis.
In case of inaccessibility of the veins in the arms.
With the introduction of substances that irritate the peripheral veins.
During blood transfusion.
With periodic blood sampling.

Contraindications

There are several contraindications to central venous catheterization, which are relative, therefore, according to vital indications, the CVC will be installed in any case.

The main contraindications include:

Inflammatory processes at the injection site.
Violation of blood clotting.
Bilateral pneumothorax.
Collarbone injuries.

Introduction order

The central catheter is placed by a vascular surgeon or an interventional radiologist. The nurse prepares the workplace and the patient, helps the doctor put on sterile overalls. To prevent complications, not only installation is important, but also care for it.

After installation, it can stand in a vein for several weeks and even months.

Before installation, preparatory measures are necessary:

find out if the patient is allergic to drugs;
conduct a blood test for clotting;
stop taking certain drugs a week before catheterization;
take blood-thinning medications;
find out if you are pregnant.

The procedure is carried out in a hospital or on an outpatient basis in the following order:

Hand disinfection.
Choice of catheterization site and skin disinfection.
Determining the location of the vein by anatomical features or using ultrasound equipment.
Administration of local anesthesia and incision.
Reducing the catheter to the required length and rinsing it in saline.
Guiding the catheter into the vein with a guidewire, which is then removed.
Fixing the instrument on the skin with adhesive tape and placing a cap on its end.
Applying a dressing to the catheter and applying the insertion date.
When a port catheter is inserted, a cavity is formed under the skin to accommodate it, the incision is sutured with absorbable suture.
Check the injection site (does it hurt, is there any bleeding and fluid discharge).

Care

Proper care of the central venous catheter is very important to prevent purulent infections:

At least once every three days, it is necessary to treat the opening of the catheter and change the bandage.
The junction of the dropper with the catheter must be wrapped with a sterile napkin.
After the introduction of the solution with sterile material, wrap the free end of the catheter.
Avoid touching the infusion set.
Change infusion sets daily.
Do not kink the catheter.

An x-ray is taken immediately after the procedure to make sure the catheter is properly placed. The puncture site should be checked for bleeding, the catheter port should be flushed. Wash your hands thoroughly before touching the catheter and before changing the dressing. The patient is monitored for infection, which is characterized by such signs as chills, swelling, induration, redness of the catheter insertion site, and fluid discharge.

Keep the puncture site dry, clean and bandaged.
Do not touch the catheter with unwashed and undisinfected hands.
Do not bathe or wash with the instrument installed.
Don't let anyone touch him.
Do not engage in activities that could weaken the catheter.
Check the puncture site daily for signs of infection.
Flush the catheter with saline.

Complications after the installation of the CVC

Catheterization of the central vein can lead to complications, including:

Puncture of the lungs with accumulation of air in the pleural cavity.
Accumulation of blood in the pleural cavity.
Puncture of an artery (vertebral, carotid, subclavian).
Embolism of the pulmonary artery.
Misplaced catheter.
Puncture of the lymphatic vessels.
Catheter infection, sepsis.
Cardiac arrhythmias during catheter advancement.
Thrombosis.
Nerve damage.

peripheral catheter

A peripheral venous catheter is placed according to the following indications:

Inability to take liquid orally.
Transfusion of blood and its components.
Parenteral nutrition (introduction of nutrients).
The need for frequent injection of drugs into the vein.
Anesthesia during surgery.

PVK cannot be used if it is required to inject solutions that irritate the inner surface of the vessels, a high infusion rate is required, as well as when transfusion of large volumes of blood

How veins are chosen

A peripheral venous catheter can only be inserted into peripheral vessels and cannot be placed into central ones. It is usually placed on the back of the hand and on the inside of the forearm. Vessel selection rules:

Well-visible veins.
Vessels that are not on the dominant side, for example, for right-handed people, should be selected on the left side).
On the other side of the surgical site.
If there is a straight section of the vessel corresponding to the length of the cannula.
Vessels with a large diameter.

You can not put PVC in the following vessels:

In the veins of the legs (high risk of thrombus formation due to low blood flow velocity).
On the places of the bends of the arms, near the joints.
In a vein close to an artery.
In the middle elbow.
In poorly visible saphenous veins.
In weakened sclerosed.
The deep ones.
on infected areas of the skin.

How to put

Placement of a peripheral venous catheter can be performed by a qualified nurse. There are two ways to take it in your hand: longitudinal grip and transverse. The first option is more often used, which allows you to more securely fix the needle in relation to the catheter tube and prevent it from going into the cannula. The second option is usually preferred by nurses who are accustomed to puncturing a vein with a needle.

Algorithm for placing a peripheral venous catheter:

The puncture site is treated with alcohol or an alcohol-chlorhexidine mixture.
A tourniquet is applied, after filling the vein with blood, the skin is pulled tight and the cannula is set at a slight angle.
A venipuncture is performed (if there is blood in the imaging chamber, then the needle is in the vein).
After the appearance of blood in the imaging chamber, the advancement of the needle stops, it must now be removed.
If, after removing the needle, the vein is lost, re-insertion of the needle into the catheter is unacceptable, you need to pull out the catheter completely, connect it to the needle and reinsert it.
After the needle is removed and the catheter is in the vein, you need to put a plug on the free end of the catheter, fix it on the skin with a special bandage or adhesive tape and flush the catheter through the additional port if it is ported, and the attached system if it is not ported. Flushing is necessary after each fluid infusion.

Care for a peripheral venous catheter is carried out approximately according to the same rules as for the central one. It is important to observe asepsis, work with gloves, avoid touching the catheter, change plugs more often and flush the instrument after each infusion. It is necessary to monitor the bandage, change it every three days and do not use scissors when changing the bandage from the adhesive tape. The puncture site should be carefully monitored.

Although peripheral venous catheterization is considered less dangerous than central venous catheterization, unpleasant consequences are possible if the installation and care rules are not followed.

Complications

Today, the consequences after the catheter occur less and less, thanks to improved models of instruments and safe and low-traumatic methods for their installation.

Of the complications that can happen, the following can be distinguished:

bruises, swelling, bleeding at the insertion site of the instrument;
infection in the area of the catheter;
inflammation of the walls of the veins (phlebitis);
thrombus formation in a vessel.

Conclusion

Intravenous catheterization can lead to various complications, such as phlebitis, hematoma, infiltration, and others, so you should strictly follow the installation technique, sanitary standards and rules for caring for the instrument.

Skin antiseptic (70% ethyl alcohol or others);

Vial with saline solution 0.9%;

Medical latex gloves, sterile;

Containers for waste classes: "A", "B" or "C" (including a waterproof bag, a puncture-proof container).

I. Preparation for the procedure

1. Identify the patient, introduce yourself. Establish a trusting relationship with the patient, assess his condition.

2. Explain the purpose and course of the procedure, make sure that there are no contraindications, clarify the knowledge about the drug, obtain consent to the procedure.

3. Prepare the necessary equipment. Check the integrity of the catheter packaging, date of manufacture. Check the suitability of the medicinal product. Check doctor's orders. Assemble the syringe and draw up the drug into it, or fill the device for infusion of single-use infusion solutions and place it on the infusion stand.

4. Help the patient lie down, take a comfortable position.

5. Select and examine a vein in the cubital fossa by palpation. Make sure that there is no pain, local fever, rashes at the injection site.

6. Place an oilcloth pad under the elbow, help to extend the arm as much as possible in the elbow joint.

7. Wash your hands, put on sterile gloves.

8. In a sterile tray, prepare 3 cotton balls treated with an antiseptic, 2 sterile wipes.

9. Treat the catheter packaging with an antiseptic.

10. Apply a rubber tourniquet (on a shirt or diaper) in the middle third of the shoulder.

11. Check the pulse on the radial artery, make sure it is present.

II. Performing a procedure

1. Ask the patient to squeeze and unclench the hand into a fist several times; simultaneously treat the venipuncture area with a cotton ball moistened with an antiseptic, making strokes in the direction from the periphery to the center, twice.

2. Remove the protective sheath of the catheter. If there is an additional plug on the case, do not throw the case away, but hold it between the fingers of your free hand.

3. Take off cap from the catheter needle, unfold the wings, Take the catheter with 3 fingers of the dominant hand: the 2nd, 3rd fingers of the dominant hand cover the cannula of the needle in the area of the wings, place the 1st finger on the cover of the plug.

4. Fix the vein with the thumb of the left hand, pulling the skin over the venipuncture site.

5. The patient leaves the hand clenched.

6. Insert the catheter needle with the cut up at an angle of 15 degrees. to the skin, observing the appearance of blood in the indicator chamber. There is a stopper at the end of the chamber to prevent blood from leaking out of the cannula.

7. When blood appears in the cannula, the angle of inclination of the stylet needle is reduced and the needle is inserted into the vein by a few millimeters.

8. While holding the steel stylet needle in place, carefully insert the Teflon catheter into the vessel (slide it off the needle into the vein).

9. Remove the tourniquet. The patient unclenches the hand.

NEVER RE-INSERT THE NEEDLE INTO THE VEIN AFTER THE CATHETER IS BEGINNING - this can cause catheter embolism.

10. Clamp the vein to reduce bleeding (press with a finger) and completely remove the steel needle, discard the needle.

11. Remove the plug from the protective sheath and close the catheter (you can immediately attach a syringe or infusion set).

12. Fix the catheter with a fixing bandage.

Algorithm for placing a peripheral venous catheter

Assemble a standard vein catheterization kit, which includes: sterile tray, waste tray, syringe with 10 ml of heparinized solution (1:100), sterile cotton balls and wipes, adhesive tape or adhesive dressing, skin antiseptic, peripheral IV catheters of several sizes, adapter or connecting tube or obturator, tourniquet, sterile gloves, scissors, splint, medium-width bandage, 3% hydrogen peroxide solution.

Check the integrity of the packaging and the shelf life of the equipment.

Make sure you have a patient in front of you who is scheduled for vein catheterization.

Provide good lighting, help the patient to take a comfortable position.

Explain to the patient the essence of the upcoming procedure, create an atmosphere of trust, give him the opportunity to ask questions, determine the patient's preferences in relation to the place of placement of the catheter.

Prepare a sharps disposal container.

Select the site of the proposed vein catheterization: apply a tourniquet above the proposed catheterization zone; ask the patient to squeeze and unclench the fingers of the hand to improve the filling of the veins with blood; select a vein by palpation, taking into account the characteristics of the infusate, remove the tourniquet.

Choose the smallest catheter, considering the size of the vein, the required rate of insertion, the schedule for intravenous therapy, the viscosity of the infusate.

Clean your hands with antiseptic and put on gloves.

Reapply the tourniquet above the selected zone.

Treat the catheterization site with a skin antiseptic, let it dry. DO NOT TOUCH THE TREATED AREA!

Fix the vein by pressing it with your finger below the intended insertion site.

Take the catheter of the selected diameter and remove the protective sheath. If there is an additional plug on the case, do not throw the case away, but hold it between the fingers of your free hand.

Insert the catheter on the needle at an angle of 15° to the skin, observing the appearance of blood in the indicator chamber.

If blood appears in the indicator chamber, reduce the angle of the needle-stylet and insert the needle a few millimeters into the vein.

Fix the stylet needle, and slowly slide the cannula all the way from the needle into the vein (the stylet needle is not completely removed from the catheter yet).

Remove the tourniquet. Do not allow the stylet needle to be inserted into the catheter after it has been moved into the vein!

Clamp the vein to reduce bleeding and permanently remove the needle from the catheter, dispose of the needle in a safe manner.

Remove the cap from the protective sheath and close the catheter or attach the infusion set.

Secure the catheter with a fixation bandage.

Dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime.

Daily catheter care

It must be remembered that maximum attention to the choice of a catheter, the process of its placement and quality care for it are the main conditions for the success of treatment and prevention of complications. Strictly observe the rules for operating the catheter. Time spent in careful preparation is never wasted!

Each catheter connection is a gateway for infection to enter. Touch the catheter as little as possible, strictly follow the rules of asepsis, work only with sterile gloves.

To prevent thrombosis and prolong the functioning of the catheter in the vein, additionally flush it with saline during the day between infusions. After the introduction of saline, do not forget to inject a heparinized solution (at a ratio of 2.5 thousand units of sodium heparin per 100 ml of saline).

Monitor the condition of the fixing bandage, change it if necessary.

Regularly inspect the puncture site for early detection of complications. With the appearance of edema, redness, local fever, catheter obstruction, pain during the administration of drugs and their leakage, the catheter must be removed.

When changing the adhesive bandage, it is forbidden to use scissors, as this can cut off the catheter, and it will enter the circulatory system.

For the prevention of thrombophlebitis, thrombolytic ointments (lyoton-1000, heparin, troxevasin) should be applied in a thin layer to the vein above the site of function.

If your patient is a small child, be careful not to remove the dressing and damage the catheter.

If you experience adverse reactions to the drug (pallor, nausea, rash, shortness of breath, fever), call your doctor.

Information about the volume of drugs administered per day, the rate of their administration, is regularly recorded in the patient's observation chart in order to monitor the effectiveness of infusion therapy.

Catheterization of peripheral veins: technique and algorithm

Puncture and catheterization of peripheral veins is a widely used technique for intravenous therapy, which has a number of advantages for both the patient and the medical staff.

A peripheral intravenous (venous) catheter is a device for long-term intravenous administration of drugs, transfusion or blood sampling.

Indications

Indications for catheterization of peripheral veins are:

1. The need for prolonged repeated intravenous administration of drugs;

2. transfusion or multiple blood sampling;

3. preliminary stage before catheterization of the central veins;

4. the need for anesthesia or regional anesthesia (for minor operations);

5. support and correction of the water balance of the patient's body;

6. the need for venous access in emergency situations.

7. parenteral nutrition.

Technique

The technique of peripheral venous catheterization is quite simple, which is the reason for the popularity of using this method.

1. Carry out the necessary preparation: choose a catheter that is suitable in size and throughput, treat hands, put on gloves and prepare tools and preparations, check their expiration date;

2. Apply a tourniquet centimeters above the intended puncture and ask the patient to clench and unclench his fist, which will ensure that the vein is filled with blood;

3. Select the most suitable and well-visualized peripheral vein;

4. Treat the punctured site with a skin antiseptic;

5. Puncture the skin and vein with a needle with a catheter. Blood should appear in the indicator chamber, which means that the puncture can be stopped;

6. Remove the tourniquet and remove the needle from the catheter, put the plug;

7. Fix the catheter to the skin with a plaster.

The algorithm for catheterization of peripheral veins and placement of a peripheral catheter can be clearly seen in this video.

Advantages and disadvantages

The advantages of catheterization of peripheral veins include the following possibilities of this manipulation:

Reliability and convenience of access to the vein;

The ability to take blood samples for analysis without unnecessary injections;

Possibility of use on short operations;

The patient can walk with a catheter in a vein when there is no drip. A plug is placed on the catheter, in other words, a rubber stopper.

The disadvantage of this procedure is that you can use it for no more than 2-3 days.

Complications

The algorithm for catheterization of peripheral veins is quite simple, but since manipulation is associated with a violation of the skin, complications are possible.

1. Phlebitis - inflammation of a vein associated with irritation of its wall with drugs, either due to mechanical action or infection.

2. Thrombophlebitis - inflammation of a vein with the appearance of a blood clot.

3. Thromboembolism and thrombosis - a sudden blockage of a vessel by a thrombus (blood clot).

4. Kinking of the catheter.

Proper care of the peripheral venous catheter is essential to prevent catheter thrombosis. It must be periodically washed with a solution of heparin in saline every 4 to 6 hours.

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Peripheral venous catheter

Peripheral venous catheter When performing intravenous therapy through a peripheral venous catheter (PVC), complications are excluded if the following basic conditions are met: the method should not be used occasionally (become permanent and habitual in practice), the catheter should be provided with impeccable care. A well-chosen venous access is essential for successful intravenous therapy.

STEP 1. Choosing a puncture site

When choosing a catheterization site, consideration should be given to patient preference, ease of access to the puncture site, and suitability of the vessel for catheterization.

Peripheral venous cannulas are intended for insertion into peripheral veins only. Priorities for choosing a vein for puncture:

Well visualized veins with well developed collaterals.
Veins on the non-dominant side of the body (for right-handers - left, for left-handers - right).
Use distal veins first
Use veins soft and elastic to the touch
Veins from the side opposite to surgical intervention.
Veins with the largest diameter.
The presence of a straight section of the vein along the length corresponding to the length of the cannula.

The most suitable veins and zones for the installation of PVK (the back of the hand, the inner surface of the forearm).

The following veins are considered unsuitable for cannulation:

Veins of the lower extremities (low blood flow in the veins of the lower extremities leads to an increased risk of thrombosis).
Places of bends of the limbs (periarticular areas).
Previously catheterized veins (possibly damage to the inner wall of the vessel).
Veins located close to arteries (possibility of arterial puncture).
Median cubital vein (Vena mediana cubiti). Puncture of this vein according to the protocols is permissible in 2 cases - blood sampling for analysis, in case of emergency assistance and poor expression of other veins.
Veins of the palmar surface of the hands (risk of damage to blood vessels).
Veins in a limb that has undergone surgery or chemotherapy.
Veins of the injured limb.
Poorly visualized superficial veins.
Fragile and sclerosed veins.
Areas of lymphadenopathy.
Infected areas and areas of skin damage.
Deep veins.

PVC throughput

Rapid transfusion of large volumes of fluid or blood products.

Transfusion of large volumes of fluid and blood products.

Patients who undergo transfusion of blood products (erythrocyte mass) in a planned manner.

Patients on long-term intravenous therapy (from 2-3 liters per day).

Patients on long-term intravenous therapy, pediatrics, oncology.

Oncology, pediatrics, thin sclerosed veins.

STEP 2. Choosing the type and size of the catheter

When choosing a catheter, it is necessary to focus on the following criteria:

vein diameter;
the required rate of introduction of the solution;
potential time of the catheter in the vein;
properties of the injected solution;
The cannula should never completely block the vein.

The main principle for choosing a catheter is to use the smallest size that provides the required insertion rate in the largest available peripheral vein.

All PVCs are divided into ported (with an additional injection port) and non-ported (without a port). Ported PVCs have an additional injection port for the introduction of drugs without additional puncture. With its help, needle-free bolus (intermittent) administration of drugs without interrupting intravenous infusion is possible.

In their structure, there are always such basic elements as a catheter, a guide needle, a plug and a protective cap. With the help of a needle, a venesection is performed, at the same time a catheter is inserted. The plug serves to close the catheter opening when infusion therapy is not performed (in order to avoid contamination), the protective cap protects the needle and catheter and is removed immediately before manipulation. For easy introduction of the catheter (cannula) into the vein, the tip of the catheter has the form of a cone.

In addition, catheters can be accompanied by an additional structural element - "wings". With their help, PVCs are not only firmly fixed on the skin, but also reduce the risk of bacterial contamination, since they do not allow direct contact of the back of the catheter plug and the skin.

STEP 3. Placement of a peripheral venous catheter

wash your hands;
Assemble a standard venous catheter kit, including several catheters of various diameters;
check the integrity of the packaging and the shelf life of the equipment;
make sure that in front of you is the patient who is scheduled for vein catheterization;
provide good lighting, help the patient find a comfortable position;
explain to the patient the essence of the upcoming procedure, create an atmosphere of trust, provide an opportunity to ask questions, determine the patient's preferences for the place where the catheter is placed;
prepare a sharps disposal container within easy reach;
wash your hands thoroughly and dry them;
apply a tourniquet above the proposed catheterization zone;
ask the patient to squeeze and unclench the fingers of the hand to improve the filling of the veins with blood;
select a vein by palpation;
remove the tourniquet;
select the smallest catheter considering: vein size, desired infusion rate, intravenous therapy schedule, infusate viscosity;
re-treat your hands using an antiseptic and put on gloves;
apply a tourniquet above the selected zone;
treat the catheterization site with a skin antiseptic for seconds without touching untreated skin areas, let it dry on its own; DO NOT palpate the vein again;
fix the vein by pressing it with your finger below the intended insertion site of the catheter;
take the catheter of the selected diameter using one of the grip options (longitudinal or transverse) and remove the protective cover. If there is an additional plug on the case, do not throw the case away, but hold it between the fingers of your free hand;
make sure that the cut of the PVC needle is in the upper position;
insert the catheter on the needle at an angle of 15 degrees to the skin, observing the appearance of blood in the indicator chamber;
when blood appears in the indicator chamber, further advancement of the needle must be stopped;
fix the stylet needle, and slowly move the cannula from the needle into the vein to the end (the stylet needle is not completely removed from the catheter yet);
remove the harness. DO NOT INSERT THE NEEDLE INTO THE CATHETER AFTER IT IS DISPLACED FROM THE NEEDLE INTO THE VEIN
clamp the vein throughout to reduce bleeding and finally remove the needle from the catheter;
dispose of the needle in accordance with safety rules;
if, after removing the needle, it turned out that the vein is lost, it is necessary to completely remove the catheter from under the surface of the skin, then, under visual control, collect the PVC (put the catheter on the needle), and then repeat the entire procedure for installing the PVC from the beginning;
remove the plug from the protective cover and close the catheter by placing a heparin plug through the port or attach the infusion set;
fix the catheter on the limb;
register the vein catheterization procedure according to the requirements of the medical institution;
dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime.

Standard kit for peripheral vein catheterization:

sterile tray
trash tray
syringe with heparinized solution 10 ml (1:100)
sterile cotton balls and wipes
adhesive tape and/or adhesive bandage
skin antiseptic
peripheral intravenous catheters of several sizes
adapter and/or connecting tube or obturator
sterile gloves
scissors
splint
bandage medium
3% hydrogen peroxide solution

STEP 4. Removal of the venous catheter

wash your hands
stop infusion or remove protective bandage (if present)
sanitize your hands and put on gloves
from the periphery to the center, remove the fixing bandage without using scissors
slowly and carefully remove the catheter from the vein
gently press the catheterization site with a sterile gauze swab for 2-3 minutes
treat the catheterization site with a skin antiseptic, apply a sterile pressure bandage to the catheterization site and fix it with a bandage. Recommend not to remove the bandage and not to wet the catheterization site during the day
check the integrity of the catheter cannula. In the presence of a thrombus or suspected infection of the catheter, cut off the tip of the cannula with sterile scissors, place it in a sterile test tube and send it to a bacteriological laboratory for examination (as prescribed by a doctor)
Document the time, date, and reason for catheter removal
dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime

Venous catheter removal kit

sterile gloves
sterile gauze balls
adhesive plaster
scissors
skin antiseptic
trash tray
sterile tube, scissors and tray (used if the catheter is clotted or if infection of the catheter is suspected)

STEP 5. Subsequent venipunctures

If there is a need to make several settings of PVK, change them due to the end of the recommended period of PVK in the vein or the occurrence of complications, there are recommendations regarding the choice of the venipuncture site:

The catheterization site is recommended to be changed every hour.
Each subsequent venipuncture is performed on the opposite arm or proximal (higher along the vein) of the previous venipuncture.

STEP 6. Daily catheter care

Each connection of the catheter is a gateway for infection. Avoid repeatedly touching the equipment with your hands. Strictly observe asepsis, work only with sterile gloves.
Change sterile plugs frequently, never use plugs that may have been contaminated on the inside.
Immediately after the introduction of antibiotics, concentrated glucose solutions, blood products, flush the catheter with a small amount of saline.
Monitor the condition of the fixing bandage and change it if necessary or every three days.
Regularly inspect the puncture site for early detection of complications. If swelling, redness, local fever, catheter obstruction, leakage, as well as pain during the administration of drugs, notify the doctor and remove the catheter.
When changing the adhesive bandage, it is forbidden to use scissors. There is a danger for the catheter to be cut off, which will cause the catheter to enter the circulatory system.
To prevent thrombophlebitis, apply a thin layer of thrombolytic ointments to the vein above the puncture site (for example, Traumeel, Heparin, Troxevasin).
The catheter should be flushed before and after each infusion session with heparinized solution (5 ml of isotonic sodium chloride solution + 2500 IU of heparin) through the port.

Despite the fact that peripheral vein catheterization is a significantly less dangerous procedure compared to central venous catheterization, it carries the potential for complications, like any procedure that violates the integrity of the skin. Most complications can be avoided with good nursing technique, strict adherence to asepsis and antisepsis, and proper care of the catheter.

Venous catheter

What is a venous catheter

Before staging, the doctor conducts an examination of the patient, which includes:

How long does the installation take? The procedure lasts on average about 40 minutes. Insertion site anesthesia may be required when inserting a tunneled catheter.

The rehabilitation of the patient after the installation of the instrument takes about one hour, the sutures are removed after seven days.

Indications

Classification

Intravenous catheters are classified in many ways.

By appointment

There are two types: central venous (CVC) and peripheral venous (PVC).

CVCs are intended for catheterization of large veins, such as subclavian, internal jugular, femoral. Medicines and nutrients are administered with this instrument, and blood is taken.

PVC is installed in peripheral vessels. As a rule, these are the veins of the extremities.

Convenient butterfly catheters for peripheral veins are equipped with soft plastic wings with which they are attached to the skin

By size

By models

There are ported and non-ported catheters. Ported ones differ from non-ported ones in that they are equipped with an additional port for the introduction of liquid.

By design

By material

slippery surface
Rigidity

Common occurrences of blood clots

High permeability to oxygen and carbon dioxide
High strength
Not wetted by lipids and fats
Sufficiently resistant to chemicals

Stable reshaping at folds

Thromboresistance
Biocompatibility
Flexibility and softness
slippery surface
Chemical resistance
Non-wettability

Change in shape and the possibility of rupture with increasing pressure
Difficult to pass under the skin
Possibility of entanglement inside the vessel

Unpredictable in contact with liquids (changes in size and stiffness)

Biocompatibility
thrombosis
Wear resistance
Rigidity
Chemical resistance
Return to previous shape after kinks
Easy insertion under the skin
Hard at room temperature, soft at body temperature

Abrasion resistance
Hard at room temperature, soft at body temperature

Frequent thrombosis
The plasticizer can leach into the blood
High absorption of some drugs

Central venous catheter

When a catheter is inserted into the internal jugular vein, there are fewer complications, less pneumothorax, and it is easier to stop bleeding if it occurs.

With subclavian access, the risk of pneumothorax and damage to the arteries is high.

There are several types of central catheters:

peripheral central. They drive through a vein in the upper limb until it reaches a large vein near the heart.
Tunnel. It is injected into a large cervical vein, through which blood returns to the heart, and is excreted at a distance of 12 cm from the injection site through the skin.
Non-tunnel. It is installed in a large vein of the lower limb or neck.
Port catheter. Injected into a vein in the neck or shoulder. The titanium port is placed under the skin. It is equipped with a membrane that is pierced with a special needle through which liquids can be injected for a week.

Indications for use

A central venous catheter is placed in the following cases:

For the introduction of nutrition, if its intake through the gastrointestinal tract is impossible.
With the behavior of chemotherapy.
For the rapid administration of large volumes of solution.
With prolonged administration of liquids or drugs.
With hemodialysis.
In case of inaccessibility of the veins in the arms.
With the introduction of substances that irritate the peripheral veins.
During blood transfusion.
With periodic blood sampling.

Contraindications

There are several contraindications to central venous catheterization, which are relative, therefore, according to vital indications, the CVC will be installed in any case.

The main contraindications include:

Inflammatory processes at the injection site.
Violation of blood clotting.
Bilateral pneumothorax.
Collarbone injuries.

Introduction order

After installation, it can stand in a vein for several weeks and even months.

Before installation, preparatory measures are necessary:

find out if the patient is allergic to drugs;
conduct a blood test for clotting;
stop taking certain drugs a week before catheterization;
take blood-thinning medications;
find out if you are pregnant.

The procedure is carried out in a hospital or on an outpatient basis in the following order:

Hand disinfection.
Choice of catheterization site and skin disinfection.
Determining the location of the vein by anatomical features or using ultrasound equipment.
Administration of local anesthesia and incision.
Reducing the catheter to the required length and rinsing it in saline.
Guiding the catheter into the vein with a guidewire, which is then removed.
Fixing the instrument on the skin with adhesive tape and placing a cap on its end.
Applying a dressing to the catheter and applying the insertion date.
When a port catheter is inserted, a cavity is formed under the skin to accommodate it, the incision is sutured with absorbable suture.
Check the injection site (does it hurt, is there any bleeding and fluid discharge).

Proper care of the central venous catheter is very important to prevent purulent infections:

At least once every three days, it is necessary to treat the opening of the catheter and change the bandage.
The junction of the dropper with the catheter must be wrapped with a sterile napkin.
After the introduction of the solution with sterile material, wrap the free end of the catheter.
Avoid touching the infusion set.
Change infusion sets daily.
Do not kink the catheter.

Keep the puncture site dry, clean and bandaged.
Do not touch the catheter with unwashed and undisinfected hands.
Do not bathe or wash with the instrument installed.
Don't let anyone touch him.
Do not engage in activities that could weaken the catheter.
Check the puncture site daily for signs of infection.
Flush the catheter with saline.

Complications after the installation of the CVC

Catheterization of the central vein can lead to complications, including:

Puncture of the lungs with accumulation of air in the pleural cavity.
Accumulation of blood in the pleural cavity.
Puncture of an artery (vertebral, carotid, subclavian).
Embolism of the pulmonary artery.
Misplaced catheter.
Puncture of the lymphatic vessels.
Catheter infection, sepsis.
Cardiac arrhythmias during catheter advancement.
Thrombosis.
Nerve damage.

peripheral catheter

A peripheral venous catheter is placed according to the following indications:

Inability to take liquid orally.
Transfusion of blood and its components.
Parenteral nutrition (introduction of nutrients).
The need for frequent injection of drugs into the vein.
Anesthesia during surgery.

PVK cannot be used if it is required to inject solutions that irritate the inner surface of the vessels, a high infusion rate is required, as well as when transfusion of large volumes of blood

How veins are chosen

Well-visible veins.
Vessels that are not on the dominant side, for example, for right-handed people, should be selected on the left side).
On the other side of the surgical site.
If there is a straight section of the vessel corresponding to the length of the cannula.
Vessels with a large diameter.

You can not put PVC in the following vessels:

In the veins of the legs (high risk of thrombus formation due to low blood flow velocity).
On the places of the bends of the arms, near the joints.
In a vein close to an artery.
In the middle elbow.
In poorly visible saphenous veins.
In weakened sclerosed.
The deep ones.
on infected areas of the skin.

How to put

Algorithm for placing a peripheral venous catheter:

The puncture site is treated with alcohol or an alcohol-chlorhexidine mixture.
A tourniquet is applied, after filling the vein with blood, the skin is pulled tight and the cannula is set at a slight angle.
A venipuncture is performed (if there is blood in the imaging chamber, then the needle is in the vein).
After the appearance of blood in the imaging chamber, the advancement of the needle stops, it must now be removed.
If, after removing the needle, the vein is lost, re-insertion of the needle into the catheter is unacceptable, you need to pull out the catheter completely, connect it to the needle and reinsert it.
After the needle is removed and the catheter is in the vein, you need to put a plug on the free end of the catheter, fix it on the skin with a special bandage or adhesive tape and flush the catheter through the additional port if it is ported, and the attached system if it is not ported. Flushing is necessary after each fluid infusion.

Although peripheral venous catheterization is considered less dangerous than central venous catheterization, unpleasant consequences are possible if the installation and care rules are not followed.

Complications

Today, the consequences after the catheter occur less and less, thanks to improved models of instruments and safe and low-traumatic methods for their installation.

Of the complications that can happen, the following can be distinguished:

bruises, swelling, bleeding at the insertion site of the instrument;
infection in the area of the catheter;
inflammation of the walls of the veins (phlebitis);
thrombus formation in a vessel.

Conclusion

Intravenous catheters: sizes, types, fixation. Peripheral intravenous catheter

You can inject drugs directly into the blood using intravenous catheters. They are installed once and can be used multiple times. Thanks to this, there is no need to constantly prick your hands in search of veins.

The principle of the device of catheters

First of all, the medical staff should know how to make an intravenous infusion of medicines. But if patients know about the procedure, then perhaps they will be less afraid.

A catheter for intravenous administration of drugs is a hollow thin tube. It is inserted into the bloodstream.

This can be done on the arms, neck, or head. But it is not recommended to introduce catheters into the vessels of the legs.

Install these devices so that there is no need to constantly pierce the veins. After all, from this they can be injured, inflamed. Permanent damage to their walls leads to thrombosis.

Types of fixtures

Medical facilities may use one of four types of catheters. There are such types:

Models intended for short-term use;

Central peripheral intravenous catheters, which are installed in the veins of the hands;

Tunneled catheters, which are inserted into wide blood vessels, such as the vena cava;

Subcutaneous venous catheters inserted under the skin in the chest area.

Depending on the materials used in the manufacture of these devices, metal and plastic models are distinguished. The choice of the option needed in each specific case is carried out only by a doctor.

A metal catheter for intravenous infusion is a needle that is connected to a special connector. The latter can be metal or plastic, some of them are equipped with wings. Such models are not used very often.

Plastic catheters are a connected plastic cannula and a transparent connector that are pulled over a steel needle. These options are much more common. After all, they can be operated longer than metal catheters. The transition from a steel needle to a plastic tube is smooth or cone-shaped.

Steel catheters

There are several metal versions of models designed for intravenous drug administration. The most popular among them are butterfly catheters. They are a needle made of chromium-nickel alloy, which is integrated between two plastic wings. On the other side of them is a flexible transparent tube. Its length is about 30 cm.

There are several modifications of such catheters.

So, they can be with a short cut and a small needle or with a flexible tube installed between the connector and the needle. This is intended to reduce the mechanical irritation that occurs when a steel IV catheter is used. A photo of such a device makes it possible to understand that there is nothing to worry about if they put it on you. The picture shows that the needles in them are quite short.

A special peripheral intravenous catheter with soft wings can ensure the safety of puncture even with hidden and hard-to-reach veins.

Disadvantages and advantages of metal models

In modern medical practice, steel options are used extremely rarely. After all, their service life is quite short - they can be in a vein for no more than 24 hours. In addition, hard needles cause irritation of the veins. Because of this, thrombosis or phlebitis may develop. Also, the possibility of traumatization or necrosis of part of the vein wall cannot be excluded. And this can cause extravasal administration of the drug.

Through such catheters, solutions are introduced not along the course of the blood flow, but at a certain angle. This causes chemical irritation of the inner layer of the vessel.

To prevent complications when working with steel intravenous catheters, they must be firmly fixed. And this limits the mobility of patients.

But, despite all the shortcomings described, they also have a number of advantages. The use of metal catheters reduces the risk of developing infectious lesions, because steel does not allow microorganisms to enter the bloodstream. In addition, they are easier to install in thin, hard-to-visualize veins. Therefore, their use is practiced in neonatology and pediatrics.

Modern fixtures

In medical practice, catheters with steel needles are practically not used at present, because the comfort and safety of the patient come to the fore. Unlike a metal model, a plastic peripheral intravenous catheter can follow the curves of a vein. This greatly reduces the risk of injury. It also minimizes the likelihood of blood clots and infiltrates. At the same time, the residence time of such a catheter in the vessel is significantly increased.

Patients who have such a plastic device installed can move freely without fear of damaging the veins.

Varieties of plastic models

Doctors can choose which catheter to insert into a patient. On sale you can find models with additional injection ports or without them. They can also be equipped with special fixation wings.

To protect against accidental injections and prevent the risk of infection, special cannulas have been developed. They are equipped with a protective self-activating clip that is mounted on the needle.

For the convenience of injecting medications, an intravenous catheter with an additional port can be used. Many manufacturers place it above the wings, designed for additional fixation of the device. There is no risk of dislodging the cannula when administering medications through such a port.

When purchasing catheters, you should be guided by the recommendations of doctors. After all, these devices, with external similarities, can vary significantly in quality. It is important that the transition from the needle to the cannula is atraumatic, and there is minimal resistance when inserting the catheter through the tissues. The sharpness of the needle and the angle of its sharpening are also important.

An intravenous catheter with a Braunulen port has become the standard for developed countries. It is equipped with a special valve, which prevents the possibility of reverse movement of the solution introduced into the injection compartment.

Materials used

The first plastic models were not too different from steel catheters. In their manufacture could use polyethylene. As a result, thick-walled catheters were obtained, which irritated the inner walls of blood vessels and led to the formation of blood clots. In addition, they were so hard that they could even lead to perforation of the vessel walls. Although polyethylene itself is a flexible, inert material that does not form loops, it is very easy to process.

Polypropylene can also be used in the production of catheters. Thin-walled models are made from it, but they are too rigid. They were mainly used to access arteries or to insert other catheters.

Later, other plastic formulations were developed and used in the manufacture of these medical devices. So, the most popular materials are: PTFE, FEP, PUR.

The first one is polytetrafluoroethylene. Catheters made from it glide well and do not lead to thrombosis. They have a high level of organic tolerance, so they are well tolerated. But thin-walled models made of this material can be compressed and form loops.

FEP (Fluoroethylene Propylene Copolymer), also known as Teflon, has the same positive characteristics as PTFE. But, in addition, this material allows better control of the catheter and increases its stability. A radiopaque medium can be introduced into such an intravenous device, which will allow you to see it in the bloodstream.

PUR material is a well-known polyurethane. Its hardness depends on temperature. The warmer it is, the softer and more elastic it becomes. It is often used to make central intravenous catheters.

Advantages and disadvantages of ports

Manufacturers produce several types of devices designed for the intravenous administration of drug solutions. According to many, it is preferable to use cannulas equipped with a special port. But it is not always the case. They are necessary if the treatment involves additional jet administration of medications.

If this is not required, a conventional intravenous catheter may be placed.

A photo of such a device makes it possible to see that it is very compact. Devices without additional ports are cheaper. But this is not their only advantage. When used, there is less chance of contamination. This is due to the fact that the injection element of this system is separated and changed daily.

In intensive care, anesthesiology, ported catheters are preferred. In all other areas of medicine, it is enough to establish the usual version.

By the way, in pediatrics, a catheter with a port for jet administration of drugs can be installed even in cases where children do not need to install a dropper. So they can inject antibiotics, replacing injections into the muscle with intravenous injection. This not only increases the effectiveness of the treatment, but also facilitates the procedure. It is easier to insert the cannula once and inject the medicine almost imperceptibly through the port than to make painful injections several times a day.

Dimensions of plastic models

The patient does not have to choose which one he needs to buy an intravenous catheter.

The size and type of these devices is selected by the doctor depending on the purposes for which they will be used. After all, each of them has its own purpose.

The size of catheters is determined in special units - Geich. In accordance with their size and throughput, a unified color marking is established.

The orange catheter has a maximum size of 14G. This corresponds to 2.0 by 45 mm. Through it, you can let 270 ml of solution per minute. It is established in cases where it is necessary to transfuse large volumes of blood products or other fluids. For the same purposes, gray (16G) and white (17G) intravenous catheters are used. They are capable of passing 180 and 125 ml / min, respectively.

A green catheter (87G) is placed in patients who are scheduled for a transfusion of red blood cells (blood products). It works at a rate of 80 ml/min.

Patients who are undergoing long-term daily intravenous therapy (infused from 2-3 liters of solutions per day) are recommended to use the pink model (20G). When installed, infusion can be carried out at a rate of 54 ml / min.

For cancer patients, children, and patients requiring long-term intravenous therapy, a blue catheter (22G) may be placed. It passes 31 ml of liquid every minute.

Yellow (24G) or purple (26G) catheters can be used for catheter placement in thin sclerosed veins in pediatrics and oncology. The size of the first is 0.7 * 19 mm, and the second - 0.6 * 19 mm. Their throughput is 13 and 12 ml, respectively.

Carrying out the installation

Every nurse should know how to insert an intravenous catheter. To do this, the injection site is pre-treated, a tourniquet is applied and measures are taken to ensure that the vein is filled with blood. After that, the cannula, which the nurse takes in her hand with a longitudinal or transverse grip, is inserted into the vessel. The success of the venipuncture is indicated by the blood that should fill the catheter imaging chamber. It is important to remember: the larger its diameter, the faster this biological fluid will appear there.

Because of this, thin catheters are considered more difficult to handle. The cannula should be inserted more slowly, and the nurse should also be guided by tactile sensations. When the needle enters the vein, a dip is felt.

After hitting, it is necessary to advance the device further into the vein with one hand, and fix the guide needle with the other. After the insertion of the catheter is completed, the guide needle is removed. It cannot be reattached to the part remaining under the skin. If the vein has been lost, then the entire device is removed, and the insertion procedure is repeated anew.

It is also important to know how intravenous catheters are secured. This is done with adhesive tape or a special bandage. The very site of entry into the skin is not sealed, as this can lead to the development of infectious phlebitis.

The final step is to flush the installed catheter. This is done through the installed system (for non-ported versions) or through a special port. The device is also flushed after each infusion. This is necessary in order to prevent the formation of blood clots in the vessel with the catheter in place. It also prevents the development of a number of complications.

There are certain rules for working with devices for intravenous administration of drugs.

They should be known to all health care workers who will choose or install an intravenous catheter. The algorithm for their use provides that the first installation is carried out from the non-dominant side at a distal distance. That is, the best option is the back of the hand. Each subsequent installation (if long-term treatment is necessary) is done on the opposite arm. The catheter is inserted upstream of the vein. Compliance with this rule minimizes the likelihood of developing phlebitis.

If the patient will undergo surgery, it is better to install a green catheter. It is the thinnest of those through which blood products can be transfused.

The placement of a catheter into a vein is performed in cases where uninterrupted access to the patient's bloodstream is necessary, namely:

if necessary, stabilize and maintain the water-salt balance of the blood;
for intravenous administration of drugs;
for parenteral nutrition;
for transfusion of blood or its components;
to immerse the patient in anesthesia;
for detoxification of the body;
for a course of chemotherapy.

In such cases, insertion of an intravenous catheter can be performed immediately after the approval of the treatment plan, if the patient has no contraindications to this procedure.

Placement of a catheter in a vein

Before inserting a catheter into a vein, the doctor examines the site of the future puncture for damage, inflammation, and infection. Then the skin area is disinfected and the catheter is inserted in one of three ways:

On the needle. The puncture of the vein is performed with the sharp end of the needle on which the catheter is put on. The needle is used to insert a subclavian catheter and catheterize the jugular vein.
Through a large lumen needle. The vein is punctured with a needle, inside which a flexible and soft catheter is passed.
Catheterization by the Seldinger method. This method involves puncturing a vein with a needle through which a special conductor is passed, and a catheter is inserted through it. In this way, a catheter is placed in a central vein.

Features of placing a catheter in a central vein

The placement of a central jugular or subclavian catheter into a vein is performed on an outpatient or inpatient basis. Before placing the catheter in the central vein, local anesthesia or anesthesia is performed. The procedure is carried out under sterile conditions, under X-ray or ultrasound control. A catheter is inserted through a needle or conductor into a vein, the other end of the catheter is brought out and fixed on the skin. When installing the U-PORT catheterization system from YURiA-PHARM, the entire structure is placed under the skin, and injections are performed in a special subcutaneous reservoir.

Peripheral catheter and its placement in a vein

The setting of a peripheral intravenous catheter begins with the selection of an appropriate catheter and the choice of a vein, antiseptic treatment of the hands and the site of the future puncture. Then a tourniquet is applied above the puncture site, the vein is fixed and catheterization is performed using the “through the needle” method. Then the tourniquet is removed, the needle is carefully removed. The catheter is carefully fixed on the skin. All waste after the procedure is disposed of in accordance with the established procedure. Immediately after insertion, the peripheral catheter can be used for infusion and blood sampling.

Wash your hands.

Check the integrity of the packaging and the shelf life of the equipment.

Make sure you have a patient in front of you who is scheduled for vein catheterization.

Provide good lighting, help the patient to take a comfortable position.

Prepare a sharps disposal container.

Select the site of the proposed vein catheterization: apply a tourniquet 10-15 cm above the proposed catheterization zone; ask the patient to squeeze and unclench the fingers of the hand to improve the filling of the veins with blood; select a vein by palpation, taking into account the characteristics of the infusate, remove the tourniquet.

Choose the smallest catheter, considering the size of the vein, the required rate of insertion, the schedule for intravenous therapy, the viscosity of the infusate.

Clean your hands with antiseptic and put on gloves.

Re-apply the tourniquet 10-15 cm above the selected area.

Treat the catheterization site with a skin antiseptic for 30-60 seconds, let it dry. DO NOT TOUCH THE TREATED AREA!