ICU PROCEDURES: INTRAVENOUS THERAPY

ICU PROCEDURES: INTRAVENOUS (IV) THERAPY – Insertion of IV Lines and Central Venous Catheters, Infusion of Medications and Total Parenteral Nutrition (TPN)

ICU Procedures: Intravenous (IV) Therapy

1. Insertion of IV Lines and Central Venous Catheters (CVCs):

A. Peripheral IV Line Insertion:

• Purpose: Administer medications, fluids, or nutrients directly into the bloodstream.
• Procedure:
  1. Prepare equipment: IV catheter, gloves, antiseptic solution, tourniquet, dressing, and IV fluids/medications.
  2. Select a vein: Use a vein on the hand or forearm. Apply a tourniquet to distend the vein.
  3. Aseptic technique: Clean the site with an antiseptic.
  4. Insert the catheter: Insert the needle at a shallow angle until blood return is visible. Advance the catheter and withdraw the needle.
  5. Secure the catheter: Attach the IV tubing, flush the line, and secure with a dressing.
  6. Monitor: Watch for signs of infiltration or infection.

B. Central Venous Catheter (CVC) Insertion:

• Purpose: Administer medications or fluids that require a larger, central vein (e.g., subclavian, internal jugular).
• Procedure:
  1. Position patient: Supine with head turned away from insertion site.
  2. Prepare equipment: Sterile gloves, gown, mask, catheter kit, ultrasound (optional), antiseptic.
  3. Aseptic technique: Full sterile precautions, draping the patient.
  4. Insert catheter: Use a large needle or guidewire to access the vein under ultrasound guidance. Thread the catheter through the vein.
  5. Confirm placement: X-ray or ultrasound to verify the catheter’s position.
  6. Secure: Suture or adhesive device to prevent dislodgement.
  7. Monitor: Watch for complications like infection, pneumothorax, or catheter-related bloodstream infections (CRBSIs).

2. Infusion of Medications:

• Types of Medications: Antibiotics, analgesics, vasopressors, sedatives, and anticoagulants.
• Procedure:
  1. Medication preparation: Follow aseptic technique, and ensure the correct dose and dilution.
  2. Infusion: Attach to the IV line using a pump for accurate delivery.
  3. Monitor: Monitor the patient’s vital signs and any adverse reactions. Ensure proper flow rate.

3. Total Parenteral Nutrition (TPN):

• Purpose: Provide nutrition intravenously when the gastrointestinal tract cannot be used.
• Components: Carbohydrates, proteins, fats, electrolytes, vitamins, and trace elements.
• Procedure:
  1. Preparation: TPN must be administered through a CVC to prevent vein irritation from the hyperosmolar solution.
  2. Aseptic technique: Strict sterile handling is necessary to prevent infection.
  3. Infusion: Use an infusion pump to ensure precise delivery over 12–24 hours.
  4. Monitor: Check for signs of infection, electrolyte imbalances, hyperglycemia, or liver dysfunction.
  5. Lab tests: Frequent monitoring of blood glucose, electrolytes, and liver function is essential.

Key Points:

• Aseptic technique is critical to prevent infection in all IV and CVC procedures.
• Regular monitoring and assessment of the insertion site are necessary to identify complications early.
• IV therapy in the ICU involves close monitoring of the patient’s response to fluids, medications, and TPN, with careful management of the infusion rate and dosage.