The phleboclysis or infusion consists of the cannulation of a vein in such a way that, through it, fluids, blood, drugs or substances for the nutritional support of the patient can be introduced into the circulatory stream. Phleboclysis is also used to inject contrast media for diagnostic purposes such as phlebography, among others..
Although this intravenous injection technique has experimental antecedents from the 17th century, it was not until the second half of the 19th century and part of the 20th century that it was fully developed using the notions of microbiology and asepsis..
In the development process of this technique, the use of the hypodermic needle was first implemented (Wood A., 1853), then the syringe (Pravaz CG) was invented and later the use of the technique began with the discovery of chloral hydrate. intravenous as anesthetic for surgery (1870 Cyprien P.). For the first time, in the late 19th century, a man was injected with intravenous glucose.
Although initially small-caliber and superficial peripheral veins were used, during World War II, large-caliber vein puncture was used for the first time due to the need to inject large doses of glucose and amino acids.
Phleboclysis can be used for direct intravenous injection, for the drip administration of a drug that cannot be delivered by another route or requires its rapid action, and for the continuous infusion of solutions. Venous access routes can be central or peripheral.
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Venous access routes can be central or peripheral. Central lines use the subclavian vein, the internal jugular vein, or less frequently the femoral vein, in order to cannulate the vein all the way to the right atrium..
Central accesses are used in patients who must receive parenteral feeding for a long time or must receive concentrated solutions that can damage small veins..
Peripheral accesses allow cannulation of peripheral veins and are generally used to place isoosmolar solutions with blood. The most commonly used veins are those of the upper limb at the level of the front of the elbow, the forearm or the back of the hand. Veins of the lower limb or foot are sometimes used, but these have an increased risk of thrombosis.
Depending on the type of access, the necessary equipment and materials will be selected. The caliber and length of the catheter, as well as the caliber of the puncture needle, are selected based on the volume to be injected, the thickness of the patient's vein, the type of fluid to be injected, and the age of the patient..
Puncture needle gauges range from 14 to 24 Gauge. The thickest ones like the number 14 or 18 are used for surgeries, transfusions or to deliver large volumes of fluids. Smaller gauges such as number 24 are used in children, newborns, and cancer patients. These venipuncture needles can be made of steel or flexible catheters called yelcos..
The equipment used includes a bum bag with sterile material such as gloves, disposable syringe filled with physiological solution, needles for venipuncture (butterflies or helmets), drip infusion system (sterile), obturator, adhesive, tourniquet, cotton and solution. antiseptic.
- You must first speak with the patient and inform him or her about the procedure to be performed. Any doubts you may have should be clarified, responding in a simple way to the questions that it is good to ask..
- The health personnel who carry out the procedure must first wash their hands with soap and water or with an antiseptic gel. Then you will put on the sterile gloves.
- The material is prepared, the infusion system is removed from its sterile packaging, hung and purged. The shutter closes.
- The tourniquet is placed about 5cm above the site where the venipuncture will be performed. The vein is selected and the catheter or butterfly selection is made according to the parameters described above. The chosen caliber must always be smaller than the caliber of the vein.
- The skin surface immediately attached to the vein to be used is disinfected. This is done in a circular way from the inside out with a cotton swab soaked in alcohol or some other antiseptic solution..
- The puncture is made in the direction of venous flow from the periphery to the heart and with the bevel of the needle pointing upward. If it is a flexible catheter then the puncture is carried out. Once inside the vein, the catheter guided by the needle is inserted and the needle is withdrawn little by little..
- The canalization of the vein should be checked by the blood outlet towards the posterior chamber of the catheter or towards the posterior part of the butterfly..
- The infusion system is connected by pressing the vein above the insertion point. The tourniquet is removed and the catheter or needle (butterfly) is glued to the skin.
- The solution drip is adjusted and the system is checked that it is perfusing correctly.
- The material is collected, the gloves are removed and the hands are washed again.
- The registration is made in the nursing report with the patient's name, the bed number, the time of the procedure, the type of solution and the drugs placed according to the medical indication.
Caring for a phleboclysis is necessary to avoid complications. The most frequent complications are infiltration, flow obstruction, thrombophlebitis, infections, air embolism, and hemodynamic overload..
- Infiltration occurs when the catheter is not well placed in the vein or when it comes out of the vein. Therefore, the solution is injected outside the vein, causing local burning, pain, and edema. This is an indication to change the infusion.
- Flow obstruction can occur from two causes. The first, that there is clotted blood in the needle or in the catheter that prevents the passage of solution or slows its passage. In this case, a heparin solution is placed to uncover the system, otherwise the catheter or butterfly must be changed. The second occurs when the tip of the catheter is attached to the wall of the vein and this obstructs it; in this case the catheter is mobilized and the solution should begin to flow.
- Air embolism can occur from injecting air into the system by failing to purge the lines or the injector that is loaded with medications. For this reason, particular care must be taken with any intravenous injection system, making sure that the system does not contain air..
- Thrombophlebitis usually occurs when the appropriate route is not selected for hypertonic solutions or for the injection of potentially irritating medications that can damage the inner wall of the vein.
- Infections Aseptic standards are extremely important, since any element that is introduced into the bloodstream that is not sterile can generate an infectious problem that can lead to sepsis with multiple organ involvement. For this reason, all the material must be sterile, it cannot be reused and the nursing staff must comply with regulations for the handling of said material and the surfaces that may contaminate it..
- Hemodynamic overload occurs when flow or drip is not controlled and medical indications are not followed. This is particularly important in patients with heart problems in whom strict control over the fluid balance must be maintained..
The most important care that must be maintained daily and each time a medication is placed in the infusion system are:
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