Flebocálisis: Equipment, Materials, Preparation And Procedure

The phleboclysis or infusion is a vein cannulation so that, through it, can be introduced to the liquid stream circulation, blood, drugs or substances for nutritional support of the patient. Phleboclysis is also used to inject contrast media for diagnostic purposes such as phlebography, among others.

Although this intravenous injection technique has an experimental background 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 process of developing 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 superficial and small caliber peripheral veins were initially used, during World War II the puncture of large caliber veins 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. 

Equipment and materials

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 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 a higher risk of thrombosis.

Depending on the type of access, the necessary equipment and materials will be selected. The gauge and length of the catheter, as well as the gauge 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. Thicker ones like the number 14 or 18 are used for surgeries, transfusions or to deliver large volumes of fluids. Smaller gauges like 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 yelcos), drip infusion system (sterile), obturator, adhesive, tourniquet, cotton and solution antiseptic.

Preparation and procedure

– First you must talk to the patient and inform him 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. You will then put on the sterile gloves.

– The material is prepared, the perfusion system is removed from its sterile packaging, hung up 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 caliber chosen 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 pad soaked in alcohol or some other antiseptic solution.

– The puncture is made in the direction of the venous flow that goes from the periphery towards the heart and with the bevel of the needle directed upwards. 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 through the blood outlet towards the posterior chamber of the catheter or towards the posterior part of the butterfly.

– The perfusion system is connected by pressing the vein above the insertion point. The tourniquet is removed and the catheter or needle (butterfly) is adhesively secured to the skin.

– The solution drip is adjusted and it is checked that the system is perfusing correctly.

– The material is collected, the gloves are removed and the hands are washed again.

– The record 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.

Care

The care of a phleboclysis is necessary to avoid complications. The most frequent complications are infiltration, flow obstruction, thrombophlebitis, infections, air embolism, and hemodynamic overload.

Complications

– 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 for two reasons. The first, that there is coagulated 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 the injection of air into the system by not purging the lines or the injector that is loaded with medications. For this reason, particular care must be taken with any intravenous injection system, ensuring 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 standards for handling such material and 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.

General care

The most important care that must be maintained on a daily basis and each time any medication is placed in the infusion system are:

  • Check the permeability of the road.
  • Maintain the standards of asepsis.
  •  Keep the infusion set and any solution added to the system purged without air.

References

  1. Burgess, RE, & Von, PHA (1966). US Patent No. 3,230,954 . Washington, DC: US ​​Patent and Trademark Office.
  2. Decker, HB (1998). US Patent No. 5,800,401 . Washington, DC: US ​​Patent and Trademark Office.
  3. Geraldez, RAN, & Gonzales, MLM (2005). The effect of topical application of mupirocin in intravenous catheter site in the incidence of superficial phlebitis. PIDSP Journal , 9 (2).
  4. Noguera, JB (1984). Intravenous treatment, phleboclysis: standardization project. Revista de enfermeria (Barcelona, ​​Spain) , 7 (74), 27-34.
  5. Nunez, TC, Voskresensky, IV, Dossett, LA, Shinall, R., Dutton, WD, & Cotton, BA (2009). Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption). Journal of Trauma and Acute Care Surgery , 66 (2), 346-352.

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