Peripheral venous catheter

Central venous catheter access results in faster and higher peak drug concentrations than peripheral venous administration, but central line access is not needed in most resuscitation attempts. However, if a central line is already present, it should be the access site of choice. If IV access (either central or peripheral) has not been established, a large peripheral venous catheter should be inserted. Intraosseous (IO) administration is the preferred alternative if IV administration cannot be achieved. 

For short-term feeding (less than 14 days) NICE (2006) recommends parenteral feeding via a peripheral venous catheter for those patients who do not need central access. A GTN patch can be applied above the peripheral venous catheter site to promote vasodilatation of the vein for those patients who have narrow veins. Some TPN is unsuitable for peripheral administration due to the nitrogen and glucose concentration these must go through a central venous catheter. 

Metabolic acidosis involves a build-up of hydrogen ions in the blood, thus lowering blood pH. Under normal physiological conditions, the kidneys excrete excess hydrogen ions, and release more bicarbonate ions into the bloodstream to buffer the excess acid. However, in renal failure, or in diabetic ketoacidosis, this mechanism either fails, or is unable to compensate to an adequate extent. Hence, metabolic acidosis is usually treated with sodium bicarbonate, either intravenously (1.26% or 8.4% i.v. solution) or orally (typically 1 g three times a day). Sodium bicarbonate 1.26% intravenous solution is isotonic with plasma (and with sodium chloride 0.9%), so may be given in large volumes (1-2 L) by peripheral venous catheter to correct metabolic acidosis and provide fluid replacement at the same time. Sodium bicarbonate 8.4% may only be given by central venous catheter. 

Intravenous administration of erythromycin into peripheral veins relatively commonly causes thrombophlebitis, although the lactobionate form of erythromycin may be less irritating to veins than other parenteral forms (11,12). In a prospective study of 550 patients with 1386 peripheral venous catheters, the incidence of phlebitis was 19% with antibiotics and 8.8% without erythromycin was associated with an increased risk (13). 

A peripheral venous catheter or indwelling venous cannula (see Fig. 13.7) is the most commonly used vascular access. Often these infusion devices are named by their brand name such as Venflon marketed by BD or Brauniile marketed by B.Braun Melsungen. The cannula or peripheral venous catheter is inserted into a peripheral vein at the hand or the arm to administer infusion solutions... 

Peripheral venous catheters Administration of intravenous fluids, medication, or parenteral nutrition sampling blood... 

Monitoring the patient in shock requires vigilance on the part of the nurse The patient s heart rate, blood pressure, and ECG are monitored continuously. The urinary output is measured often (usually hourly), and an accurate intake and output is taken. Monitoring of central venous pressure via a central venous catheter will provide an estimation of the patient s fluid status. Sometimes additional hemodynamic monitoring is necessary with a pulmonary artery catheter. The use of a pulmonary artery catheter allows the nurse to monitor a number of parameters, such as cardiac output and peripheral vascular resistance The nurse adjusts therapy according to the primary health care provider s instructions. 

TPN may be administered through a peripheral vein or through a central venous catheter. Peripheral TPN is used for patients requiring parenteral nutrition for relatively short periods of time (no more than 5-14 days) and when the central venous route is not possible or necessary. Peripheral TPN is used when the patient s caloric needs are minimal and can be partially met by normal... 

S. aureus has become more prevalent as a cause of endocarditis because of increased IV drug abuse, frequent use of peripheral and central venous catheters, and valve-replacement surgery. Coagulase-negative staphylococci (CNST, usually S. epidermidis) are prominent causes of PVE. 

Amiodarone IV concentrations greater than 3 mg/mL in D5Whave been associated with a high incidence of peripheral vein phlebitis however, concentrations of 2.5 mg/mL or less appear to be less irritating. Therefore, for infusions more than 1 hour, amiodarone IV concentrations should not exceed 2 mg/mL unless a central venous catheter is used. Use an in-line filter during administration. 

Hydration to establish diuresis both prior to and during administration is recommended to minimize renal toxicity the standard 24 mg/ml sol may be used undiluted via a central venous catheter, dilute to 12 mg/ml with D5W or NS when a peripheral vein catheter is used... 

Second- or third-degree burns greater than 10%-20% TBSA or patients with significant smoke inhalation injury will require fluid resuscitation. Peripheral IV catheters can be used, but placement of a central venous catheter is optimal. An indwelling urine catheter should be placed so that output measures can he used to monitor the status of fluid resuscitation. 

Magagnoli, M., Masci, G., Castagna, L., Pedicini, V., Poretti, D., Morenghi, E., Bramhilla, G., Santoro, A. (2006). Prophylaxis of central venous catheter-related thrombosis with minidose warfarin in patients treated with high-dose chemotherapy and peripheral-hlood stemcell transplantation retrospective analysis of 228 cancer patients. Am. J. Hematol. 81(1) 1-4. 

When blood is collected from a central venous catheter or arterial line, it is necessary to ensure that the composition of the specimen is not affected by the fluid that is infused into the patient. The fluid is shut off using the stopcock on the catheter, and lOmL of blood is aspirated through the stopcock and discarded before the specimen for analysis is withdrawn. Blood properly collected from a central venous catheter and compared with blood drawn from a peripheral vein at the same time shows notable differences in composition. A comparison of arterial blood with central and peripheral venous blood is illustrated in Table 2-5. 

With peripheral blood stem cell harvesting, the most frequent problems relate to central venous catheter occlusion and bone pain in association with the G-CSF priming. Infectious complications during harvesting were experienced in 16% of patients during the PBSC harvesting. 

Catheter device selection is based on a number of factors, including the plarmed application and placement site, duration of implantation, composition of fluids infused, and frequency of access (Namyslowski and Patel, 1999). Vascular catheters can be divided into two genei groups shortterm, temporary catheters that are placed percutaneously, and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters (Pearson, 1996). Tunneled central venous catheters and totally implantable intra-... 

The incidence and duration of phlebitis seems to be dependent on a variety of factors. Physical-chemical factors such as low pH, hypertonicity, particles and precipitation play a role in the cause. Active substances that are poorly soluble in water may precipitate and can cause acute phlebitis. Active substances with adequate aqueous solubility may tend to cause phlebitis only because of prolonged or chronic administration. Clinical factors involving injection technique (infiltration, extravasation, type of needle, duration of infusion) but also irritating characteristics of the active substance can contribute to the occurrence of phlebitis [9, 10]. Sometimes (septic) phlebitis is caused by bacterial infection (e.g. cause of inappropriate aseptic technique during catheter insertion) and is characterised by inflammation with suppuration of the vein wall. Local responses to the parenteral challenges can be diminished by dilution of the medicine or by central venous instead of peripheral venous administration (see Sect. 13.10.3). 

Nimodipine is poorly soluble in water <0.1 mg/mL. The licensed pharmaceutical product Nimotop infusion solution contains 0.2 mg/mL nimodipine and 170 mg/mL macrogol 400. This high concentration of macrogol is needed to dissolve the active substance but causes phlebitis when Nimotop is administered via a peripheral vein. Therefore in the product information it is recommended to administer Nimotop via a central venous catheter. 

Osmolarity of the nutrient admixtures and thereby the infusion route is determined by the type and amount of the components mixed. In general the admixtures are hyperosmolar and to be administered via a central venous catheter in a big vein (vena cava superior or vena subclavia). Only admixtures with a maximum osmolarity of900 mOsm/ L can be administered via a peripheral vein and only for a limited period of time [69]. Lmig term parenteral nutrition can be also administered via a port (see Sect. 13.10.3) especially when patients are treated at home. Because of the high probability of incompatibilities nutrition admixtures should always be administered via a separate line and Y-site infusion should be avoided. 

Fig. 13.7 Cannula or venous catheter for peripheral access, schematic.

MidUne catheters and peripherally inserted central catheters (PlCC) are inserted in a peripheral vein but the tip rests in a larger vein. The infusion fluid flows directly in the larger vein which diminishes the chance of phlebitis. Both types of catheters are typically inserted in a vein in the upper arm. The midline catheter ends at armpit height the tip of the PICC rests in the vena cava superior. The PlCC may have single or multiple lumens. The PlCC line can be used as a central venous catheter for infusion which needs fast dilution or distribution or both such as antibiotics, pain medicine, chemotherapy, nutrition, etc. 

Central venous access device Non-tunelled CVC Tunelled CVC PICC Apheresis/ haemodialysis catheter Implantable Port Peripheral venous access device Cannula Midline catheter... 

Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H, Singh Y, Waybill PN (2000) Venous thrombosis associated with the placement of peripherally central catheters. J Vase Interv Radiol 11 1309-1314... 

Donaldson JS, Morello FP, Junewick JJ, O Donovan JC, Lim-Dunham J (1995) Peripherally inserted central venous catheters US-guided vascular access in pediatric patients. Radiology 197 542-544... 

Flynn PM, Shenep JL, Stokes DC, Barrett FF (1987) In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis J 6 729-734 Foley MJ (1995) Radiologic placement of long-term central venous peripheral access system ports (PAS Port) results in 150 patients. J Vase Interv Radiol 6 255-262 FraneyT, DeMarco LC,Geiss AC, Ward RJ (1988) Catheter fracture and embolization in a totally implanted venous access catheter. JPEN J Parenter Enteral Nutr 12 528-530 Freytes CO, Reid P, Smith KL (1990) Long-term experience with a totally implanted catheter system in cancer patients. J Surg Oncol 45 99-102... 

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