NCLEX-PN

maintaining the integrity and functionality of CVADs. For more detailed steps in administering intravenous therapies, refer to “ Selecting the Appropriate Vein ” and “ Inserting a Peripheral Intravenous Catheter ” in the next section. Venous Access Venous access is achieved through various methods, including peripheral intravenous devices and central venous access devices. Peripheral intravenous devices are typically utilized for short-term intravenous therapy involving fluids, electrolytes, medications, and chemotherapy when suitable veins are accessible. It's important to note that peripheral intravenous catheters should be of minimal length, usually around 3 inches for adults, and their use should be brief to reduce the risk of catheter-related infections. Meanwhile, short peripheral catheters can usually remain in place for up to 72 hours, while longer peripherally inserted midline catheters , ranging up to 8 inches in length, can be used for up to about 4 weeks. These midline catheters are advanced into the brachial, basilic, or cephalic veins. The choice of intravenous catheter size depends on the client's condition and anticipated needs. For example, an 18-gauge catheter is employed for blood transfusions, while larger 16-gauge catheters are used for clients with major trauma whose needs may be unpredictable. Smaller 22 or 24-gauge intravenous catheters suffice when clients only require intravenous fluids and medication via their peripheral venous catheter. Butterflies are suitable for short-term peripheral intravenous access of less than 24 hours, whereas angiocatheters are employed for peripheral intravenous therapy lasting longer than 24 hours. After successful intravenous catheter insertion, the nurse monitors and maintains the intravenous line and insertion site. The intravenous line is observed to ensure it remains patent and the flow rate matches the prescribed rate. The intravenous site is checked for any signs of infiltration and infection. Dressings are changed and dated according to the healthcare facility's policy, usually every 24 hours. Central Venous Catheters Central venous catheters are inserted into the right atrium of the heart via the central venous superior vena cava. These catheters can be advanced into the superior vena cava through a peripheral vein, such as a peripherally inserted central venous catheter (PICC), or into the central venous system through the subclavian or jugular vein. Some of these catheters have multiple lumens, up to three, and their duration in place varies. For instance, a percutaneous, non-tunneled subclavian catheter is used for immediate and short-term treatments, while other central venous catheters are tunneled and cuffed. An implanted tunneled and cuffed central venous catheter may have a subcutaneously placed port accessed with a non-coring needle into the port's reservoir. Central venous catheters are often preferred for venous access when: ●​ Suitable peripheral veins for necessary therapies are lacking. ●​ The client requires continuous or intermittent multiple therapies such as chemotherapy, blood transfusions, medications, and total parenteral nutrition. ●​ There is a long-term chronic disease or condition, such as cancer.

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