Intermittent Infusion Device Insertion
Also called a saline lock, an intermittent infusion device consists of a catheter with an injection cap attached. Filled with saline solution to prevent blood clot formation, the device maintains venous access in patients who are receiving IV medication regularly or intermittently but who don’t require continuous infusion. An intermittent infusion device is superior to an IV line that’s maintained at a moderately slow infusion rate because it minimizes the risk of fluid overload and electrolyte imbalance. It also cuts costs, reduces the risk of contamination by eliminating IV solution containers and administration sets, increases patient comfort and mobility, reduces patient anxiety, and, if inserted in a large vein, allows collection of multiple blood samples without repeated venipuncture.
For intermittent infusion device insertion, choose a vein on the dorsal and ventral surfaces of the upper extremities, including the metacarpal, cephalic, basilic, and median veins. When choosing a site, avoid areas of flexion; areas where there is pain on palpation; veins that are compromised by bruising, infiltration, phlebitis, sclerosis, or cord formation; and areas where procedures are planned. Because of the risk of nerve damage, avoid the lateral surface of the wrist for about 4 to 5 inches. Also avoid the ventral surface of the wrist because of the associated pain on insertion and the risk of nerve damage. Avoid using veins of the lower extremities because of the increased risk of tissue damage, thrombophlebitis, and ulceration. In a patient who has had breast
surgery with axillary node dissection, don’t use veins in the upper extremity on the affected side; also don’t choose veins on an extremity affected by radiation therapy, lymphedema, or stroke.
surgery with axillary node dissection, don’t use veins in the upper extremity on the affected side; also don’t choose veins on an extremity affected by radiation therapy, lymphedema, or stroke.
If the patient has stage 4 or 5 chronic kidney disease, avoid using upper arm veins or forearms that could be used for dialysis access. Collaborate with the patient and his doctor to discuss the risks and benefits of using a vein in an affected extremity if no other options exist.1
Equipment
IV access device with safety shield2 ▪ needleless system device ▪ syringe prefilled with preservative-free normal saline solution ▪ single-use tourniquet (preferably latex-free) ▪ antiseptic pads (alcohol, tincture of iodine, or chlorhexidine-based) ▪ chlorhexidine solution (tincture of iodine, povidone iodine, or alcohol may be used if contraindication exists to chlorhexidine) ▪ transparent semipermeable dressing ▪ catheter securement device, sterile hypoallergenic tape, or sterile surgical strips ▪ gloves ▪ Optional: soap and water, arm board, warm packs, ultrasound device with sterile probe cover, sterile ultrasound gel, local anesthetic, scissors or clippers.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
Explain the procedure to the patient, and describe the purpose of the intermittent infusion device. Provide the patient with information about the insertion process, expected duration of therapy, care and maintenance of the device, and signs and symptoms of complications and when to report them.
Remove the set from its packaging, disinfect the port with an antiseptic pad, and inject preservative-free normal saline solution to fill the tubing and needleless system. This process removes air from the system, preventing formation of an air embolus.
Select the puncture site. If long-term therapy is anticipated, start with a vein at the most distal site so that you can move proximally as needed for subsequent IV insertion sites.8 For infusion of an irritating medication, choose a large vein distal to any nearby joint. Make sure the intended vein can accommodate the cannula.
Place the patient in a comfortable, reclining position, leaving his arm in a dependent position to increase venous fill of the lower arms and hands. If the patient’s skin is cold, cover the entire arm with warm packs for 5 to 10 minutes.
Applying the Tourniquet
Apply a tourniquet about 4″ to 6″ (10 to 15 cm) above the intended puncture site to dilate the vein. Check for a radial pulse. If it isn’t present, release the tourniquet and reapply it with less tension to prevent arterial occlusion.9
Lightly palpate the vein with the index and middle fingers of your nondominant hand. Stretch the skin to anchor the vein. If the vein feels hard or ropelike, select another.
If the vein is easily palpable but not sufficiently dilated, one or more of the following techniques may help raise the vein: Place the extremity in a dependent position for several seconds, or lightly stroke the vessel downward; if you have selected a vein in the arm or hand, tell the patient to open and close his fist several times.
Leave the tourniquet in place for no more than 3 minutes. If you can’t find a suitable vein and prepare the site in that time, release the tourniquet for a few minutes. Then reapply it and continue the procedure.
Preparing the Site
If the intended insertion site is visibly soiled, clean it with soap and water before applying the antiseptic solution.8
Administer a local anesthetic if indicated and prescribed.3
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