What are the most important points to address when teaching patients about their short peripheral I.V. catheters?-P.H., FLA.
Sharon Spencer, MSN, RN, and Patricia Gilliam, MSN, RN, ACNS-BC, OCN, respond: When patients are admitted to the hospital or an outpatient unit, most will need a peripheral venous access device.1-3 Some common questions are, "Why do I need an I.V.?" and "How long will I need it?" Nurses are responsible for ensuring safe patient outcomes that reduce disability and cut costs.4 They should provide education on caring for, monitoring, and preventing injury to the peripheral venous access site.
Inform patients about treatment plans that may include I.V. fluids, medications, or blood transfusions and why they're needed. Explain that nurses follow best practices and hospital policies to ensure safe care of their I.V. access. (See Infusion Nurses Society recommendations for short peripheral catheters.)
If a patient tells you of past unsuccessful attempts to insert an I.V. catheter or other problems related to I.V. therapy, obtain a history of these experiences, such as difficulties with particular access sites and allergies, including tape or antiseptics. Inform the patient that hand dominance, skin condition, joint mobility, and any abnormalities of the extremity are assessed prior to catheter insertion. Teach the patient how using an arm board can stabilize a site near an area of flexion. Advise the patient to keep the I.V. access site clean and dry at all times, make sure the site is covered before bathing, and use hand wipes for hand hygiene. Always include patients in the plan of care to ensure their active participation.5
Teach the patient that nurses will monitor the insertion site frequently, including its appearance and the condition of the dressing. Let the patient know that each nurse will palpate the site to determine if it's edematous or tender.6 Instruct the patient to report any pain or discomfort to the nurse. Finally, let the patient know that a nurse will remove the I.V. catheter when I.V. therapy is discontinued or if any problems occur, such as edema.6
Discuss and demonstrate precautions taken to prevent injury and infection. For example, in the presence of the patient, the nurse should perform hand hygiene with soap and water or an alcohol-based hand rub whenever inserting or accessing an I.V. catheter, and emphasize the importance of hand hygiene to the patient.5 Explain how a skin antiseptic used to prepare the site, such as chlorhexidine, will minimize infection risks.5 The patient should see the nurse scrub the access port with antiseptic before accessing it to minimize contamination.5 Explanations encourage patients to adhere to the plan of care, reducing complications and costs.
Initiating I.V. therapy with a short peripheral catheter can be anxiety-provoking for the patient. Knowing what to say, adhering to best practices, and communicating appropriately can improve patient outcomes and increase patient safety and satisfaction.
Infusion Nurses Society recommendations for short peripheral catheters
* Select a site appropriate for the therapy and needle gauge required.
* Perform hand hygiene, don gloves, and use aseptic nontouch technique.
* Clean site with approved skin antiseptic before inserting I.V. catheter.
* Place transparent dressing over stabilized site; date and initial dressing.
* Monitor for signs and symptoms of complications such as phlebitis or infiltration.
* Clean injection ports before each use.
* Replace an I.V. dressing when it becomes loose, wet, or soiled.
* Don gloves to remove the I.V. catheter when it's no longer needed, and dispose of the catheter according to facility protocol.
Source: Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2011;34(suppl 1):S1-S110.
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