Peripheral vein catheterization: advantages and disadvantages of the technique

There are situations when a patient with a serious illness needs constant injections and intravenous infusions. In case of emergency care for bad veins, you can be late with resuscitation, so doctors resort to a procedure such as catheterization of peripheral veins. What is this manipulation, for what purpose is it carried out and are complications possible? The answers to these questions are presented in the article.

Catheterization procedure

This is a method that involves installing a peripheral catheter to provide access to the bloodstream. A catheter for peripheral vein catheterization (PVC) is a device designed for insertion into a vein and provides access to vessels for the fastest possible infusion.

This procedure for doctors has become almost routine; over a year, patients receive more than 500 catheters. The emergence of quality systems increases the amount of peripheral vein catheterization compared to central blood vessels. According to studies, intravenous therapy is much more convenient if peripheral vessels are used.

Catheters are central and peripheral. If the first variety is installed only by a doctor, then a catheter on a needle for catheterization of peripheral veins can be installed by a nurse.

Pros and cons of the technique

The procedure has its advantages and disadvantages. If we talk about the pros, then they are as follows:

• Provides quick access to the patient's vein, which allows you to instantly provide assistance if necessary or without problems to enter the drug.
• After installing the catheter, there is no need to do a puncture of the vein each time for drip administration of the drug.
• The procedure does not affect the patient's mobility in any way: after the catheter is inserted, the patient can make hand movements without restrictions.
• Medical staff saves their time, which has to be spent with intravenous administration of the medicine. Yes, and the patient does not have to experience pain every time during the injection.

But do not forget about the shortcomings:

• A catheter for catheterization of peripheral veins cannot be installed for an indefinite period. Maximum 3 days, after which it is necessary to remove it.
• Although minimal, there is a risk of complications after catheter placement. It all depends on the experience of the medical professional in installing such systems.

Peripheral Vein Catheterization System - Indications for Installation

It happens when in an emergency it is necessary to provide assistance to the victim, and access to the bloodstream is not possible due to a shock condition, low blood pressure or veins that are stuck together. In this case, the introduction of the drug directly into the blood is required. Then, puncture and catheterization of the peripheral vein is necessary.

Sometimes you have to access the bloodstream through the femoral vein. Often there is such a need if cardiopulmonary resuscitation is required . Doctors can work in parallel and not interfere with each other. Peripheral vein catheterization is also necessary in the following cases:

• Emergency infusion therapy in an ambulance. After hospitalization, doctors do not have to waste precious time, but you can immediately begin treatment procedures.
• Patients requiring frequent intravenous administration of drugs in large volumes, can not do without a catheter.
• Patients from the surgical department require intravenous infusion, as urgent surgery may be necessary.
• Intravenous anesthesia during surgery.
• Install a catheter for women in labor if there is a risk of problems during labor with access to veins.
• If necessary, frequent sampling of venous blood for analysis.
• Multiple blood transfusions.
• Peripheral vein catheterization is also carried out if necessary parenteral nutrition of the patient.
• Requires support or correction of water-electrolyte balance.
• Peripheral vein catheterization may be a preliminary procedure before a central catheter is inserted.

As you can see, there is an extensive list of indications for the procedure, but contraindications must be taken into account.

When is vein catheterization not indicated?

There are practically no contraindications that would categorically prohibit the procedure. But there are some nuances that do not allow catheterization of this particular vein or on this site.

1. It is advisable to prefer central venous access if:

• the introduction of drugs irritates the vascular wall (most often this phenomenon is observed when infusing solutions with high osmolarity);
• high blood volume transfusion is required;
• superficial veins are not visible and not palpable even after applying a tourniquet.

2. It is necessary to choose another site for the introduction of the catheter, if there are inflammatory processes on the skin or thrombophlebitis in a certain area.

We can say that catheterization of veins with a peripheral catheter is possible in almost all patients. The choice of place is carried out according to individual indications.

What is needed to install a catheter?

The peripheral vein catheterization kit includes the following instruments:

• Tray, but always sterile.
• Trash bin.
• Syringe with heparinized solution.
• Cotton balls and sterile wipes.
• Adhesive bandage or patch.
• Medical alcohol.
• Catheter. Be sure to select the right size taking into account the age of the patient and the place of installation.
  
• Connecting tube.
• Harness and sterile medical gloves.
• Bandage.
• Scissors.
• "Hydrogen peroxide".

The presence of everything necessary for the installation of a catheter also requires the organization of space for comfortable work. There should be good lighting. It is necessary to remove all unnecessary from the table. The nurse should be in a dressing gown and hat. The patient should be notified in advance about the procedure and have an idea about it.

Peripheral Vein Catheterization - Algorithm

The procedure for installing a catheter requires the following steps:

1. The medical staff is preparing for catheterization: the hands are thoroughly washed, treated with an antiseptic solution and dried.
2. Preparing the patient for the procedure. If required, then you need to remove hair on the site for better fixation.
3. Assemble the peripheral vein catheterization kit, check its integrity and shelf life. The nurse must also ensure that the patient is in front of her.
4. Provide lighting for good visibility, prepare a waste disposal tray and help the patient in a comfortable position.
5. Select a catheter taking into account the size of the blood vessel, the age of the patient, the characteristics of the cannula and the frequency of intravenous infusions. Open the packaging.
6. The area of ​​the skin where the puncture will be performed must be degreased and treated with an antiseptic solution.
7. Place a tourniquet above the catheter insertion site and ask the patient to work with a cam.
   
8. Take the catheter with your right hand, remove the protective cap, fix the vein with your thumb and forefinger and insert the needle at an angle of 5-15 °.
9. Pull off the piston. If blood began to flow into the syringe, then the needle entered the vein.
10. Guide the catheter further through the vein by 0.5 cm, holding the “wings”.
11. Fix the stylet needle and moving the catheter remove it from the guide needle.
12. Remove the harness.
13. Squeeze the vein, finally remove the conductor needle and place it in the waste container.
14. Inspect the catheter insertion site for redness, swelling.
15. To squeeze a vein and disconnect the syringe.
16. Place the catheter in place with an antiseptic solution and apply a sterile dressing or patch.
17. Enter the date and time of catheterization, the size of the system in a special journal.

If the peripheral vein catheterization technique is followed, then, as a rule, there are no complications. But to exclude them is also not worth it.

Catheterization Complications

Most often, complications of peripheral vein catheterization are provoked by the inexperience of the medical staff who conduct this procedure. An important role is played by compliance with all stages of the introduction of the catheter. If the algorithm is not followed, then complications cannot be avoided.

The negative consequences can be divided into two groups:

1. Common complications.
2. Local.

Consider each view in more detail. Local adverse events include:

• Hematoma. It can be formed due to leakage of blood from the vessel and its accumulation in the area of ​​the installed catheter. This usually happens if an unsuccessful puncture of a vein was performed at the time the catheter was inserted or removed.
• Vein thrombosis develops against the background of the formation of a blood clot in a vessel. Most often, this complication is provoked by a mismatch in the size of the catheter and vein, as well as improper care after the procedure.
  
• Infiltration occurs when injected drugs do not enter the blood vessel, but under the skin. The complication is serious, because the intake of hypertonic, alkaline solutions or cytostatics can provoke tissue death. Identification in the early stages of this complication will avoid more serious consequences.
• Phlebitis. It develops due to mechanical, chemical irritation or infection, which happens when hygiene requirements and the sterility of the procedure are not followed. Thrombophlebitis may develop, signs of redness and soreness in the area of ​​the installed catheter. Later, the temperature rises, pus may be released when the catheter is removed.

Common complications include:

1. Thromboembolism. It is diagnosed if a blood clot on a catheter or in a vein comes off and is sent to the heart with a blood stream.
2. Air embolism can develop during intravenous therapy, but as a rule, if a system is used to catheterize peripheral veins, the risk of development is significantly reduced due to the presence of positive venous pressure.
3. Very rarely, but it is quite possible separation of the catheter.

Medical personnel should be prepared to deal with any complications after the catheter is inserted, and preventive measures must be taken to prevent them.

Prevent the development of complications

Of course, the outcome of the procedure cannot be predicted at 100%, because the body of each patient is individual. But doctors should do everything possible to reduce the risk of developing undesirable consequences if peripheral vein catheterization is performed. How to avoid complications? A competent specialist will always give the necessary advice to young doctors on this question:

1. Do not choose imperceptible vessels for the procedure.
2. You can prevent the formation of a hematoma if you press with your fingers the place where the catheter was installed, and hold for 3-4 minutes.
3. Thrombosis is prevented by the right choice of catheter size. It is also important to consider the material from which the cannula is made, for example, polyurethane, polytetrafluoroethylene is less thrombogenic. It is advisable to use a patch of skin over the intended catheter with heparin ointments (Lyoton is suitable).
4. To avoid infiltration, it is necessary to use a turnstile to stabilize the catheter (especially if it is installed at the place of the bend of the arm or leg).
5. To prevent phlebitis during the installation of the catheter, it is necessary to carefully observe the rules of antiseptics, use high-quality devices whenever possible. The introduction of drugs should be carried out slowly, be sure to comply with the instructions for breeding. For prophylaxis, it is recommended to change the vein for catheter placement if a second procedure is required.
6. It is undesirable to install PVC on the lower extremities, this increases the risk of blood clots. After the end of the infusion due to the formation of a clot on the catheter, it is worth removing it and installing a new one.
7. Air embolism is prevented by complete removal of air from the infusion system before connecting it to the catheter. All parts must also be tightly interconnected.
   

These important recommendations will help to avoid many complications if catheterization of the cubital and other peripheral veins is performed.

Catheter Care Procedure

If the procedure for installing PVC has been successful, then this does not mean that you can forget about the catheter. Proper care is important to notice the onset of the very first symptoms of developing complications.

The rules of care are as follows:

1. Every day, a nurse should inspect the place where the PVC is installed. If contamination is detected, they are immediately removed.
2. When carrying out manipulations with a catheter and infusion system, aseptic rules must be observed.
3. The catheter must be changed after 2-3 days. If blood products are used for transfusion, then every day.
4. For washing catheters, an isotonic sodium chloride solution must be used.
5. When attaching a catheter, be careful not to touch the equipment.
6. All manipulations should be carried out with sterile gloves.
7. Change plugs regularly and do not reuse them.
8. After the administration of drugs, the catheter must be washed with saline.
9. Change the retaining bandage as necessary.
10. Do not use scissors during manipulations with the catheter.
11. To prevent thrombophlebitis after a puncture above the site of catheter insertion, treat the skin area with thrombolytic ointments and gels.

Compliance with all recommendations for care will allow you to timely detect problems or completely avoid the negative consequences.

Features of catheterization in children

The peripheral vein catheterization in infants has its own characteristics, taking into account the age of the patients. The child needs to be prepared. The temperature in the treatment room should be comfortable (if required, a heater must be installed to avoid a stressful reaction to the cold). It is not recommended to carry out the procedure immediately after eating.

Peripheral vein catheterization in newborns is performed according to the following algorithm:

1. A blood vessel is selected to establish a catheter. In babies, it is preferable to use the vessels on the back of the hand, on the forearm, on the head, foot, in the elbow or in the ankle.
   
2. The selected area must be warmed.
3. Apply a tourniquet and tighten until the ripple stops on the periphery.
4. Treat the skin with an antiseptic composition.
5. Connect the syringe to the catheter and adapter, check the patency using saline.
6. Disconnect syringe.
7. Take the catheter on the needle for peripheral vein catheterization with your index finger and thumb and hold by the “wings”.
8. Press the vessel with a finger and a needle to pierce the skin just below the puncture site.
9. The needle is inserted into the vein until blood appears in the cannula when the conductor is pulled out.
10. Remove Explorer. Do not allow the needle to move further - this can lead to damage to the opposite wall of the vessel.
11. Place the catheter as far as possible and remove the tourniquet.
12. Connect the adapter and syringe and inject a small amount of saline in order to make sure the catheter is positioned correctly.
13. Secure the catheter so that the baby cannot damage the system.

The procedure for installing PVC in children can cause many problems. If in adult patients this is almost an ordinary procedure, then in babies it can turn into a small surgical intervention. Often for a young doctor, catheterization in children becomes an impossible task.

The catheterization procedure is sometimes the only way out for effective treatment of the patient. If the doctor approaches the procedure and its preparation with knowledge of the matter, then there are no difficulties. Medical personnel will not have to deliver unpleasant sensations to the patient and do a vein puncture every time before administering an intravenous drug. In addition, often the installation of PVC allows you to provide the necessary help urgently in order to save the patient's life.