Tips in Inserting IV Device to Elderly
For some, inserting an IV cannula is a difficult challenge itself, what more when it comes to inserting an Intravenous device to an elderly patient? Yes, the veins may seem very visible, but they are also very fragile. This is because older adults experience significant changes in their skin in terms of texture, depth and integrity, making them more prone to tears and bruising. Also, the veins have increased peripheral resistance which may render them unsuitable for cannulation.
Here are some tips for nurses to consider when it comes to starting an IV line to elderly clients:
- Don’t apply too much friction when preparing the skin.
Be gentle to avoid bruising or skin tears. Keep in mind that older adults have more fragile skin and too much friction may damage surface tissues, thus putting them at risk for bacterial infection.
- Use the smallest catheter if possible.
Yes, IV catheter choice often depends on the patient’s IV treatment needs, but the nurse must also bear in mind that older adults experience changes in their skin’s tone and elasticity, and are more prone to bruising. Also, their veins are less stable and are at high risk of developing vein tears. Usually, a gauge 24 is used. According to Infusion Nurses Society standards, smaller-gauge needles are great for older patients who are in need of antibiotic administration or hydrating solutions by infusion pump.
- Know the vein’s depth
This is done in order to determine how far you will be inserting the needle, as well as what angle you can use in inserting. Usually, an almost flat insertion angle, which is approximately 10 to 20 degrees is done since adult patient have very shallow veins.
- If possible, do not use a tourniquet
Instead, you might lower the patient’s arm first or apply a warm compress before performing venipuncture. In cases wherein you need to use a tourniquet, be sure that it’s made of soft material and that you apply it lightly. Remember to never use a tight tourniquet on an older adult since it can cause petechiae, hematoma formation, or venous pressure, resulting in a “blown” vein.
- Stabilize the vein
You may do this by applying traction to the side of the insertion site with your non-dominant hand to limit unnecessary movements during insertion. After such, insert the catheter ON TOP of the vein. Establishing a side access may only push the vein away from the needle.
- When inserting, do it slowly and steadily. Do not rush.
Using the bevel-up approach, insert the needle slowly on top of the vein while making sure that the vein is still stabilized. Try to keep it in a 20 to 30 degree angle or almost flat with the skin. After penetrating the vein with one short stroke, advance the needle and the cannula slowly.
- Use hypoallergenic tape
Since the skin of older adults has lost its normal tone and elasticity, the nurse has to make sure that he/she secures the catheter with enough hypoallergenic tape or dressing.
- Apply pressure after removing the needle
Older adults tend to have prolonged bleeding times and clot formation may take longer to occur, even if they’re not using any anticoagulant.
- Immobilize the catheter properly
This is to lower the risk of skin tearing. Older patients tend to roll upon their insertion sites, which may cause bleeding and, worse, infiltration.