IV ACCESS

Peripheral
Intraosseous
Intravenous
Catheter
Catheter (PIVC)

Venous Central Venous

Cutdown Catheter (CVC)
 Peripheral intravenous catheter (PIVC)
Persiapan

• Persiapan alat
• Identifikasi identitas
• Informed consent
• Mengidentifikasi vena yang akan menjadi
lokasi pemasangan
• Cuci tangan dan pakai sarung tangan

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual

 Prosedur Tindakan

• Pasang torniket 8 sampai 15 cm diatas lokasi

pemasangan
• Lakukan desinfeksi
• Jarum diinsersikan ke dalam vena dengan bevel jarum
menghadap ke atas, membentuk sudut 30-40o terhadap
permukaan kulit.
• Bila jarum berhasil masuk ke dalam lumen vena, akan
terlihat darah mengalir keluar.

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual

 Prosedur Tindakan

• Turunkan kateter sejajar kulit. Tarik jarum tajam

dalam kateter vena (stylet) kira-kira 1 cm ke arah luar
untuk membebaskan ujung kateter vena dari jarum
agar jarum tidak melukai dinding vena bagian dalam.
Dorong kateter vena sejauh 0.5 – 1 cm untuk
menstabilkannya.
• Tarik stylet keluar sampai ½ panjang stylet. Lepaskan
ujung jari yang memfiksasi bagian proksimal vena.
Dorong seluruh bagian kateter vena yang berwarna
putih ke dalam vena.

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual

 Prosedur Tindakan
• Torniket dilepaskan. Angkat keseluruhan stylet dari
dalam kateter vena.
• Pasang infus set atau blood set yang telah terhubung
ujungnya dengan kantung infus atau kantung darah.
• Tutup dengan kasa steril dan fiksasi dengan plester.
• Cuci tangan dan Dokumentasi

*QHC Intraveonus Guidelines For The Adult Patient Resource Manual

PIVC SELECTION

*Insertion and Management of Peripheral Intravenous Cannulae in Western Australia Healthcare Facilities Policy
INDIKASI USGPIV
Visualizing Vein
Differentiate between arteries and veins
Vein are compressible, thinner wall
Arteries are not compressible, pulsate, thicker wall
Short Axis and Long Axis
Intraosseous Catheter
Indication

• Dificulty in establishing venous access, as in the

following setting : burns, obesity, edema, seizure.

Contraindication

• Abolute: Bone trauma at or porximal to the

insertion site, or previous insertion in same limb.
Infection overlyin the point of insertion.
• Relative: Difficulty in identifying anatomical
landmark
Common Access Site
Humeral Head
• With the elbow bent, and the patient’s hand on their
abdomen, palpate the surgical neck of the humerus to
locate the greater tuberosity. The insertion site
approximately 1 cm above the surgical neck and 2-3 cm
lateral to the bicep tendon. Insert at 45degree angle,
aiming toward the opposite scapula.
Common Access Site
Proximal Tibia
• 2 cm medial and 1-2 cm below patella, palpate the tibial tuberosity and ensure that
you can feel bone below subcutaneous tissue. The needle should be angled
slightly distally, away from knee

Distal Tibia

Distal Femur

Sternum
Procedure
Sterilisation of the skin at the needle insertion site
Manual stabilisation of the bone during insertion
Aspiration after needle insertion confirms successful
placement
In the awake patient, injection of local anaesthetic
(preferably lidocaine) into the IO needle prior to use can
reduce pain for subsequent infusion
Ensure the needle flush with at least 10ml of fluid after drug
administration
Frequent assessment of the IO site for sign of extravasation
Venous Cutdown
Technique

• Infiltrate the skin with local anaesthetic

• Make a 1,5-2 cm transverse incision over the vein
• Bluntly dissect out the vein by opening the forceps in the
line of the vein
• Make a small stab skin incision 1cm distal to the incision
in the line of the vein. Pass two ligature around the vein.
Tie the distal one, but leave the end uncut. Hold the end
of the ligature with the artery forceps
• Whilst holding the ligature tight, make a “V” shaped
incision in the anterior surface of the vein with scissors or
scalpel
• Pass the cannula through the inferior stab incision and
through the “V” shape incision into the vein. Tie the
proximal ligature tighly over the cannulated vein and, if
there is no bleeding,now cut the end of ligatures. If
bleeding occurs place a further ligature around the vein.
Connect the cannula to the giving set and commence
infusion.
• Close the skin with sutures
Central Venous Catheter
Indication
• Vascular access
• Volume loading
• Provision of caustic medication or solution
• Central venous pressure monitor
• Repeated blood sampling

Contraindication
• Distorted anatomy
• Infection at the site access
• Bleeding disorder or anticoagulation
• Combative patient
Sites

Internal jugular Vein Subclavian Vein

Femoral Vein
Technique

• Setup of equipment and sterile preparation

• Landmarking the access site
• Anaesthesia
• Placing the introducer needle into the vein
• Assessment for venous placement
• Insertion of guide wire
• Remove the introducer needle
• Skin incision
• Insertion of dilator
• Placement of catheter
• Remove the guide wire
• Flushing and capping the line
• Secure the catheter