Many options exist in regards to intravenous catheters, intravenous solutions, drip sets, and other equipment. The type of equipment available at different institutions may vary greatly. The devices depicted below are commonly used at our institutions and should be similiar to devices that will be available to you; however, it is important to be familiar with your equipment before beginning a procedure.

CatheterS
Basic Components | Catheter Size | Safety Features

Basic Components

There are several basic components to IV catheters. The metal needle has a beveled tip and is used to the enter the vein. The catheter, made of Teflon or other synthetic material, slides over and off the needle. The flash chamber is located behind the needle, and will fill with blood upon entry into the vein to confirm proper placement. Finger grips on the sides of the flash chamber allow the device to be held securely in the hand.

  
Catheter Size

IV catheters come in various sizes. Two parameters must be considered, gauge and length. Gauge refers to the external diameter of the catheter, with smaller gauges (e.g. 14 ga) representing larger diameters than larger gauges (e.g. 20 ga).

 

 

 

Catheters with larger gauges and shorter lengths allow for faster infusion of fluids.

 

 

Ultimately, the appropriate catheter size will depend upon multiple factors. These include age of the patient (e.g. infant vs. adult); purpose of IV access (e.g. fluid resuscitation in a trauma patient vs. a "maintenance" line in a medical patient), and the quality of the patient's veins (e.g. the veins of a young healthy adult will usually accomodate a larger catheter than those of a debilitated elderly patient. The chart can be used as a rough guide.

 
 
Safety Features

Transmission of blood-borne viruses to health care workers (HCWs) is a topic of great importance. The CDC estimates that there are over 300,000 percutaneous exposures per year to HCWs (CDC abstracts). As of 1997, there were an estimated 94 documented and 170 possible cases of HIV transmission to HCWs. (Moloughney, Brent W). In response to this problem, the biotechnology industry has responded by manufacturing many new devices designed to prevent needlestick injuries. (Russo, Philip L)

 

The catheters used at our institution feature a retractable needle and flash chamber that retract into a safety chamber when the user presses a button. This system prevents needlestick injuries by covering the sharp end of the needle once it has been used.

 

 

As mentioned above, it is important to be familiar with the devices that are used at your institution. For more information about needlestick prevention, refer to the Safety section of this chapter.

 
Intravenous Solutions
In most cases, an intravenous solution will infused through the intravenous catheter. (Occasionally, a saline "lock" will be placed instead of infusing fluids.) There is a wide variety of IV fluids available, and a full discussion on the rationale for choosing an appropriate fluid is beyond the scope of this chapter. In brief, the clinician must decide on the tonicity of the solution as well as any additives, such as potassium or dextrose.
Drip Sets
The IV solution is attached to the IV catheter via IV tubing, or a "drip set". While many types of drip sets exist, all share common components. These include a "spike" that is inserted into the IV solution bag; a drip chamber, which collects fluid as it drains from the bag; a "pinch clamp" which can be used to stop flow; a "regulating clamp" that is used to control the rate of infusion; a various number of access ports which are used to administer intravenous medications; and a Luer lock adapater which attaches to the IV catheter.
 
There are many different type of drip sets available, and the clinician must be vigilant to choose the appropriate tubing for the specific indication. "Macro" drip sets deliver 1 cc of solution for every 10 drops of fluid that falls from the bag into the drip chamber. Macro drip sets are used when a relatively large volume of fluid must be administered. "Micro" drip sets deliver 1 cc in every 60 drops, and are used when smaller fluid volumes or precise dosages are required, such as in pediatrics and in delivering intravenous medications. Special drip sets containing filters are required for blood transfusions.
Equipment List

In addition to the devices listed above, several other pieces of equipment are need to establish a peripheral IV. These are depicted below, and their use will be demonstrated in the Procedure section.

 
List of Required Items
  • Gloves
  • Alcohol prep
  • Torniquet
  • Intravenous catheter
  • Connector tubing
  • Drip set
  • Saline flush
  • Dressing (such as Tegaderm)
  • Tape
  • Gauze
  • IV fluid
 

 

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