D. E. Society’s Smt. Subhadra K.

Jindal
College of Nursing

PRACTICE
TEACHING
DEMONSTRATION
ON
INTRACATH INSERTION

SUBMITTED TO SUBMITTED BY
Mrs. Shubhangi Malavade Meghavarsha Lakra
Lecturer First year MSc. Nursing

DATE OF SUBMISSION
11/03/2020
 INTRACATH INSERTION

NAME OF THE STUDENT : MEGHAVARSHA LAKRA

NAME OF THE GUIDE : Mrs. SHUBHANGI MALAVADE

SUBJECT : MEDICAL-SURGICAL NURSING

UNIT : IX

DATE : 11/03/2020

TIME : 45 min

VENUE : CLASSROOM, FOUNDATION

LABORATORY

CLASS TAUGHT : 2nd YEAR B.Sc NURSING

METHOD OF TEACHING : LECTURE CUM DEMONSTRATION

AUDIO-VISUAL AIDS : CHARTS, FLASH CARDS, HANDOUT

PREVIOUS KNOWLEDGE : THE GROUP WILL HAVE PREVIOUS

KNOWLEDGE ABOUT ANATOMICAL
SITES OF VEIN.
 INTRACATH INSERTION

GENERAL OBJECTIVE :

At the end of the procedure demonstration, students will have an in depth

knowledge about intracath insertion, and will be able to apply this knowledge in clinical field.

SPECIFIC OBJECTIVE :

At the end of the procedure demonstration, students will be able to :

1. Define intracath insertion.

2. Explain the purposes for intracath insertion.

3. Explain the anatomical sites for intracath insertion.

4. Classify the sizes of intracath to be inserted.

5. State the scientific principles of intracath insertion.

6. Enlist the indications and contra-indications of intracath insertion.

7. List down the articles required for intracath insertion.

8. Demonstrate and explain procedure of intracath insertion with rationale.

9. Ennumerate the complications of intracath insertion.

 INTRACATH INSERTION

DEFINITION
The process of puncturing a vein, with a needle, using aseptic technique.

PURPOSES
1. To administer fluids intravenously.
2. To administer bolus medication for investigations or treatment.
3. To draw blood specimen.
4. To administer total parenteral nutrition.
5. To administer blood and blood products.

ANATOMICAL SITES FOR INTRACATH INSERTION

Signs of a good vein.

1. Bouncy 6. Has a large lumen
2. Soft 7. Well supported
3. Above previous sites 8. Straight
4. Refills when depressed 9. Easily palpable
5. Visible
Veins to avoid
 Thrombosed / sclerosed / fibrosed
 Inflamed / bruised
 Thin / Fragile
 Mobile
 Near bony prominences
 Areas or sites of infection, oedema or phlebitis
 Have undergone multiple previous punctures
 Do not use if patient has IV fluid in situ

SIZES OF INTRAVENOUS CATHETERS

Catheter-over-needle device for the cannulation of peripheral blood vessels.

1. The catheter fits snugly over the needle and has a tapered end to prevent fraying of the
catheter tip during insertion.
2. The needle has a clear hub to visualize the “flashback” of blood that occurs when the
tip of the needle enters the lumen of a blood vessel.
 3. Safety needle guard automatically covers the needle's sharp bevel after withdrawal of
needle from the hub, minimizing the risk of needle stick injuries.

INDICATIONS
1. Fluid and electrolyte replacement
 2. Administration of medicines
3. Administration of blood/blood products
4. Administration of Total Parenteral Nutrition
5. Haemodynamic monitoring
6. Blood sampling

CONTRAINDICATIONS
1. An arterio-venous fistula in the extremity.
2. Mastectomy on the same side of the arm/ a surgically compromised extremity
3. Presence of phlebitis, infiltration or sclerosis.
ARTICLES USED
A Clean Tray Containing
1. Sterile needle/ angiocath/ butterfly needle of appropriate size.
2. Sterile cotton swabs in a bowl with antiseptic/ alcohol pads.
3. Tourniquet.
4. Tapes for fixing catheter/ needle.
5. Syringe of required size for blood draws (optional).
6. Specimen bottle (optional).
7. Syringe loaded with medicine (optional).
8. Infusion made ready for administration.
9. Towel/mackintosh for protecting linen.
10. Gloves.
11. IV pole.
12. Kidney tray/ paper bag.

SCIENTIFIC PRINCIPLES
Principle of anatomy and physiology – The anatomical sites for intracath insertion should
be known very well, so that we do not cause pain to the client.
Principle of microbiology - Microorganisms enter the body through an open skin break.
Hand washing and gloves to be worn to prevent spread of infection. A clean antiseptic swabs
to be used to disinfect the site.
Principle of safety – Patient to be given supine position. Follow all the rights of the patient.
Principle of psychology – Prior explanation of the procedure to the client ensures good co-
operation and reduces anxiety. Privacy to be provided.

PROCEDURE

Nursing action Rationale

1. Check physician's order and nursing Ensures that right procedure is being done for
care plan. right patient.

2. Identify client.

3. Explain procedure to patient that there Reduces anxiety and ensures client cooperation.
will be a slight discomfort initially. If
required, demonstrate procedure on a
doll for children.
4. Make sure that clothing can be removed Prevents dislodgment of needle.
over IV tubing if needed. Provide client
with a gown if necessary.

5. Wash hands. Prevents transfer of microorganisms.

6. Select venipuncture site. Unless It is difficult to initiate and maintain IV access

contraindicated select the nondominant if using sclerotic veins. Joint flexion increases
arm of the client. Look for veins that risk of irritation of vein walls by the catheter.
are relatively straight. Consider the
catheter length so that the wrist/elbow
will be away from the catheter tip.

7. Dilate the vein

a. Place extremity in a dependant Gravity slows venous return and distends the
position (lower than heart). vein. Distending the vein makes insertion of
needle easy.
b. Apply a tourniquet firmly about 15 Obstructing arterial flow inhibits venous filling,
to 20cm (6 to 8inches) above the If a radial pulse is felt, arterial flow is not
vein puncture site, explain that obstructed.
tourniquet will feel tight. The
tourniquet must be tight enough to
obstruct venous flow but not tight
enough to obstruct arterial supply.
c. If the vein is not sufficiently dilated, This action helps in filling the vein.
massage/stroke the vein distal to the
site in the direction of venous flow
towards the heart.
d. Encourage the client to clench and Contracting the muscle compresses the distal
unclench the fist. veins, forcing blood along the veins and
distending them.
e. Lightly tap the vein. Tapping the vein may distend it.
f. If all the above steps fail, remove Heat dilates superficial blood vessels causing
the tourniquet and apply heat to the them to fill.
entire extremity for 10 to 15
minutes.

8. Don clean gloves. Prevents nurses from exposure to blood.

9. Clean venipuncture site

a. Clean with antiseptic swab from This movement carries microorganisms away
 center outward in circular motion from site of entry.
for several inches.
b. Permit solution to dry on the skin. Povidone iodine should be in contact with skin
for at least one minute to be effective.
10. Insert the needle/ catheter.
a. Use nondominant hand to pull the This stabilizes the vein and makes skin taut for
skin taut below the entry site. needle entry.
b. Hold catheter/needle at a 15 to 30 Holding the needle at 15 to 30 degree reduces
degree angle with and bevel up, the risk of counter puncture.
insert the catheter through the skin
and into vein in one thrust the vein.
A Sudden lack of resistance is felt
as needle enters the vein.
c. Once blood is seen in the lumen or Reducing the angle of catheter lowers the risk
when a lack of resistance is felt, of counter puncture.
reduce the angle of catheter till it is
almost parallel to the skin and
advance the needle and catheter
approximately 0.5 to 2 cm. Remove
the needle slowly while inserting
the cannula inside the vein. When
fully inside, loosen tourniquet.
d. Remove needle from inside the
angiocath completely and attach
syringe with medication/syringe for
blood draws/IV infusion tube as
required.

11. Tape the catheter using 3 strips of Prevents dislodgement of needle.

adhesive tapes.
a. Place one strip with sticky side up
under the catheter hub.
b. Fold over each side so that sticky
sides are a skin.
c. Place second strip sticky side down
over catheter hub_
d. Place 3rd strip sticky side down over
catheter hub/ infusion tubing.

12. Dress and label the venipuncture site as

per agency policy.
a. Place a sterile gauze piece with
povidone/ iodine over the
venipuncture site. Apply pad
over the site. Apply occlusive
dressing over site.
b. Label the dressing with date,
time of insertion, Size of needle
used, catheter used and initials.

13. Remove gloves and wash hands. Reduces risk of infection.

POSSIBLE COMPLICATIONS
1. Direct access to a patient's vascular system so provides a potential route for entry of
micro-organisms into that system.
2. Cause serious infection if they are allowed to enter and proliferate in the IV cannula,
insertion site, or IV fluid.

IV-Site Infection: Does not produce much

(if any) pus or inflammation at the IV site.
This is the most common cannula-related
infection.

Cellulites: Warm, red and often tender

skin surrounding the site of cannula
insertion; pus is rarely detectable.

Infiltration or tissuing: Occurs when the

infusion (fluid) leaks into the surrounding
tissue. It is important to detect early as
tissue necrosis could occur – re-site
cannula immediately

Thrombolism / thrombophlebitis: occur

when a small clot becomes detached from
the sheath of the cannula or the vessel wall
– prevention is the greatest form of
defence. Flush cannula regularly and
consider re-siting the cannula if in
prolonged use.

Extravasation: Accidental administration

of IV drugs into then surrounding tissue,
because the needle has punctured the vein
and the infusion goes directly into the arm
tissue. The leakage of high osmolarity
solutions or chemotherapy agents can
result in significant tissue destruction, and
significant complications.

Bruising: Commonly results from failed

IV placement -particularly in the elderly
and those on anticoagulant therapy.

Air embolism: Occurs when air enters the infusion line, although this is very rare it is best if
we consider the preventive measures – Make sure all lines are well primed prior to use and
connections are secure.

Haematoma: Occurs when blood leaks

out of the infusion site. The common cause
of this is using cannula that are not tapered
at the distal end. It will also occur if on
insertion the cannula has penetrated
through the other side of the vessel wall –
apply pressure to the site for
approximately 4 minutes and elevate the
limb.

Phlebitis: It is common in IV therapy and can be caused in many ways. It is inflammation of

a vein (redness and pain at the infusion site). Prevention can be using aseptic insertion
techniques, choosing the smallest gauge cannula possible for the prescribed treatment, secure
the cannula properly to prevent movement and carry out regular checks of the infusion site.
 SUMMARY
A plastic tube, usually attached to a puncturing needle, inserted into a blood vessel for
infusion, injection, or pressure monitoring. Catheters are made of synthetic polymers
(polyurethane and silicone) that are chemically inert, biocompatible, and resistant to chemical
and thermal degradation. Peripheral vascular catheters (arterial and venous), central venous
catheters, and pulmonary artery catheters are mostly made of polyurethane, peripherally
inserted central venous catheters (PICCs) are mostly made of silicone.

CONCLUSION
The procedure demonstration on the topic Intracath insrertion was given to the second
year BSc nursing students. The students will be able to use it in the clinical field. The
objectives of the demonstration was covered during the presentation.

REFERANCES
Book :
1. Annamma Jacob, “Clinical nursing procedures - The art of nursing practice”, 3rd
edition, Jaypee publication, Page no.- 242 to 245.
2. B.T. Basavanthappa, “Fundamentals of nursing”, 2nd edition, Jaypee publication, Page
no. – 491 to 495.
3. PR Ashalata, “Textbook of anatomy and physiology”, 4th edition, Jaypee publication,
page no. – 383 to 431
- 567 to 574

Online ;
1. www.opentextbc.ca/clinicalskills/chapter/10-2-intracath.insertion
2. www.intracath.insertion.com/The-Procedure
3. www.cincinnatichildrens.org/health/intracath.insertion