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LPN

IV Therapy

IV THERAPY

Alternative Access & Complications

Study Guide

Central Lines Overview

DeviceKey FactsCommon Uses
CVCShort-term central line inserted into jugular/subclavian veinHospital IV therapy
Tunneled CatheterTunneled under skin with cuff barrierLong-term therapy
PICC LineInserted in arm, threaded to SVCAntibiotics, TPN
Implantable PortImplanted under skin, accessed with Huber needleChemotherapy
Tesio CatheterDialysis catheter onlyHemodialysis

Central Venous Catheter (CVC)

Key Points

  • Short-term use (< 60 days)
  • Single, double, triple, or quad lumen
  • Inserted into:
    • Internal jugular vein
    • Subclavian vein
  • Sutured in place
  • Can be inserted bedside

Care

  • Sterile dressing changes
  • Flush daily/per policy
  • Heparin flush may be used

Tunneled Catheters

Examples

  • Hickman
  • Broviac
  • Groshong

Features

  • Tunneled under skin
  • Surgically placed in OR
  • Long-term use (up to 1 year)
  • Two surgical wounds:
    • Entry site
    • Exit site
  • Cuff prevents bacterial migration

PICC Line

Features

  • Peripheral insertion → Central destination
  • Threaded to Superior Vena Cava (SVC)
  • Often inserted through basilic vein
  • Used for:
    • Long-term antibiotics
    • TPN
  • Can remain for ~6 weeks

Important

MUST be confirmed by X-ray before use

PICC Care

  • Flush daily/per policy
  • Use 10 mL syringe ONLY
  • Monitor:
    • Site hourly
    • Arm circumference
    • Fever/infection
  • Avoid:
    • Heavy lifting
    • Water submersion

LPN Restriction

  • Cannot insert PICC
  • Cannot discontinue PICC

Implantable Ports (Port-A-Cath)

Features

  • Surgically implanted under skin
  • Accessed with Huber needle
  • Single or dual lumen
  • Commonly used for chemotherapy
  • Can remain for 1 year

Needle Change

  • Every 5–7 days (check policy)

LPN Restriction

  • Cannot access ports
  • Cannot flush ports

Tesio Catheters

Important Rules

  • Hemodialysis ONLY
  • Dialysis staff ONLY

DO NOT:

  • Access
  • Flush
  • Aspirate
  • Administer medications

Caring for Central Lines

SCRUB THE HUB!

  • Scrub 15–20 seconds
  • Use:
    • Alcohol
    • Chlorhexidine
    • Scrub caps
  • Apply antibacterial caps
  • NEVER reuse caps

Central Line Dressing Change Steps

  1. Remove old dressing
  2. Clean outward from insertion site (4–6 inches)
  3. Clean with alcohol then chlorhexidine
  4. Use circular motion
  5. Allow to dry
  6. Assess site
  7. Apply transparent dressing
  8. Reinforce with tape
  9. Apply BIOPATCH if policy allows
  10. Label:
  • Date
  • Time
  • Initials
  1. Document

Documentation Must Include

  • Insertion procedure
  • Site condition
  • Dressing condition
  • Blood return
  • Patient education
  • Infusions/tubing

IV Therapy Complications

SystemicLocal
Affect entire bodyAffect IV site
Example: SepsisExample: Phlebitis

Systemic Complications

Circulatory Overload

Causes

  • IV infused too quickly
  • Cardiac disease
  • Renal disease
  • Hepatic disease

Signs/Symptoms

  • Dyspnea
  • Cough
  • Crackles
  • Edema
  • Weight gain

Interventions

  • Slow IV rate
  • Elevate HOB
  • Obtain vitals
  • Notify provider

Infection / Sepsis

Signs/Symptoms

  • Fever
  • Chills
  • Tachycardia
  • Tachypnea
  • Headache

Causes

  • IV contamination
  • Break in sterile technique

Interventions

  • Notify provider
  • Blood cultures
  • Remove IV
  • Treat symptoms
  • Establish new IV site

Venous Air Embolism

Danger

Air blocks blood flow to pulmonary artery.

Signs/Symptoms

  • Tachycardia
  • SOB
  • Shoulder pain
  • JVD
  • Hypotension
  • Weak pulse
  • Dizziness

Emergency Interventions

  1. Place patient on LEFT side
  2. Trendelenburg position
  3. Apply oxygen
  4. Obtain vitals
  5. Notify provider

Speed Shock

Cause

Medication infused too rapidly

Example

  • Vancomycin → Red Man Syndrome

Interventions

  • Slow infusion
  • Notify provider

Local Complications

Phlebitis

Signs

  • Redness
  • Pain
  • Swelling
  • Induration

Interventions

  • Remove IV
  • Warm compress
  • Restart IV elsewhere

Infiltration

Definition

IV fluid leaks into tissue

Signs

  • Cool skin
  • Edema
  • Pain

Interventions

  • Stop infusion
  • Remove IV
  • Cold compress
  • Elevate extremity

Extravasation

Definition

Vesicant medication leaks into tissue

High-Risk Medications

  • Chemotherapy
  • Potassium
  • Dopamine
  • Dilantin
  • Flagyl

Signs

  • Blistering
  • Tissue sloughing

Interventions

  • Stop infusion
  • Aspirate medication if possible
  • Apply cold compress

Hematoma

Definition

Blood leaks into tissue

Risk Factors

  • Anticoagulants
  • Elderly patients
  • Difficult IV insertion

Signs

  • Bruising
  • Discoloration

Preventing Complications

  • Hand hygiene
  • Sterile technique
  • Inspect equipment
  • Secure tubing
  • Avoid joints when possible
  • Monitor for overload:
    • JVD
    • Elevated BP
    • Crackles
    • Edema
    • Weight gain

LPN Scope of Practice

LPNs MAY:

  • Insert peripheral IVs
  • Flush peripheral IVs
  • Discontinue peripheral IVs
  • Administer TPN/lipids
  • Be second signature for blood

LPNs CANNOT:

  • Insert/discontinue central lines
  • Access or flush ports
  • Administer blood products
  • Administer titratable drips:
    • Insulin
    • Heparin
    • Cardizem

Quick Memory Tips

TopicMemory Aid
PICC Line“Peripheral insertion, Central destination”
Air Embolism“LEFT side saves life”
Extravasation“Vesicants destroy tissue”
Scrub the HubMinimum 15–20 seconds

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