How to start an IV

Required Equipment


IV Catheter

IV Tubing

IV Solution
– Tourniquet

Alcohol or Betadine Preparation

Dressing, Tape, Band-aids

Gloves
IV Equipment
IV Equipment:
Equipment Preparation

Remove tubing and IV fluid from
their protective coverings
Equipment Preparation

Remove the protective tab from the
spike port
Equipment Preparation

Remove the protective cover from
the spike (over the inspection bulb)
of the IV tubing
Assembly of IV Equipment

Close the tubing by rotating the
thumb lock to the closed position
Assembly of IV Equipment

Assemble the IV tubing to
the IV fluid
– Insert spike into spike port
– Puncture seal with the spike
by using a twisting, pushing
motion until spike is fully
inserted
 Flushing the IV Tubing

Flush the line with the IV
fluid
– With the spike fully inserted
squeeze the drip chamber
between the index finger
and thumb and immediately
release. The chamber will
fill with the IV fluid
– Release the line clamp by
rotating the thumb lock to
the fully opened position.
Flushing the IV Tubing

– Raise the IV fluid bag to allow for

gravity flow
– Allow the IV fluid to fill the line
completely, eliminating any air within
the line
– Once the tubing is completely filled,
clamp the line again by rotating the
thumb clamp to the closed position
– You are now ready to select an IV site
 Sight Selection

Hand

Forearm

Antecubital Fossa
(Elbow)***
– Usually easiest and most
accessible

Upper Arm

Foot & Lower Leg
– Least favorable, use as last
resort
Sight Selection


Hand
– Posterior (back of hand) may not
accept large bore IV catheter or allow
rapid volume infusion

Forearm
– Sometimes difficult to locate vein
– Good for rapid infusion of fluids and
blood products as well as IV
medications
Arm Veins
Sight Selection


Antecubital Fossa
– Large vessels
– Most accessible
– Allows for rapid infusion
– Accepts large bore IV catheter
Disadvantage
– Elbow must remain straight to allow
for infusion
Sight Selection


Upper arm
– Usually very large vessel
– Sometimes difficult to access
– Straight long vessel (no bends to
occlude catheter)
Sight Selection


Foot and Upper leg
– Used as a last resort
– Usually more painful to patient
– Furthest form the heart
– Difficult to manage

Now you now are ready to attempt
an IV
Sight Preparation


Identify vein

Clean 3 times with alcohol

Apply tourniquet above vein

Wear gloves
Gloves are not worn during demonstration to allow better
visualization of techniques
Sight Preparation


Place the tourniquet above the
desired IV site
– Should be snug to reduce venous flow
– Makes for easier vein identification

Identify vein
– Determine the most appropriate vein
– Choose the site where the IV is to be
inserted
Sight Preparation

Alcohol swab
– Cleanse the area with an alcohol
swab three times if able
– Allow area to air dry or wipe
excess away

Prepare to insert the IV
IV Insertion

Remove the Catheter from the
package

Remove the protective covering
from the Catheter
IV Insertion

Place the hub of the catheter
between the thumb and index
finger of one hand
 IV Insertion

With the other hand grasp the arm lightly

Place the thumb over and below the vein
that you intend to puncture
 IV Insertion

Apply traction to the skin and vein to make
those areas taught

Assure the bevel is in the upward position

Place the needle at the site at a 30° angle
 IV Insertion

Pierce the skin with the needle

Continue with a forward motion forcing the
needle into the vein, you should feel a “popping”
sensation, at this point stop momentarily
IV Insertion

Check the hub for a blood return
IV Insertion


You may have to withdrawal the
catheter partially and reattempt

With blood in the hub, release the
arm with the hand holding traction
 Advancing IV Catheter


While maintaining the
grasp to the catheter
with one hand, hold
the colored portion of
the catheter with the
index finger and
thumb
 Advancing IV Catheter

Separate the two pieces by slowly advancing
the catheter into the vein

Slowly withdraw the needle portion and discard
it in a “sharp box”
Attaching IV tubing


Place thumb over
the end of the
catheter in the
vein and apply
pressure to stop
blood flow out of
the catheter
 Attaching IV tubing

Remove the
protective cap
from the end of
the IV tubing and
insert the tubing
end into the hub
of the catheter
Release Tourniquet
Adjust Drip Rate
Apply Tape Securely
Around Hub
 Apply Tape Securely
Around Hub

Securing the IV
is very
important. You
do not want to
have to restart an
IV
 Apply Tape Securely
Around Hub

Apply a 4 inch
strip of tape to the
underside of the
catheter hub

Make a chevron
and attach it to
the skin adjacent
to the insertion
point
 Apply Tape Securely
Around Hub

Place tape across
the top of the
bulb on the
tubing to secure
the tubing to the
IV hub and the
arm
Apply Tape Securely
Around Hub

Loop the
tubing and tape
it into position
on the arm.
This helps to
prevent
inadvertent
dislodgment of
the IV
Dress the insertion site with a
Band-Aid or gauze dressing
 Calculating “Rate”

Open the line by using the
thumb line lock

Volume depletion and
heat casualty require more
rapid infusion (“wide
open”)

Head injury and heart
conditions require less
aggressive fluid
resuscitation (very slow; 1
drop every 3 or 4
seconds)
Changing the Bag

Situations arise when a bag will have to
be changed
– Follow the steps when first spiking the bag.
– Remove the protective tab from the new bag
of fluid.
– Remove the spiked end of the tubing from
the expended bag.
– Insert the spike into the port.
– Squeeze and release the inspection bulb,
allow to fill and hang the fluid.

New tubing is not required
 Basic Intravenous Therapy
90-95% of patients in the
hospital receive some type
of intravenous therapy.

This presentation will enhance your

knowledge of how to care for them.
 Vein Anatomy and Physiology


Veins are unlike arteries in that
they are 1)superficial, 2) display
dark red blood at skin surface and
3) have no pulsation


Vein Anatomy
- Tunica Adventitia
- Tunica Media
- Tunica Intima
- Valves
 Tunica Adventitia
the outer layer of the vessel


Connective tissue


Contains the arteries
and veins supplying
blood to vessel wall
 Tunica Media
the middle layer of the vessel


Contains nerve endings
and muscle fibers


The vasoconstrictive
response occurs at this
layer
 Tunica Intima
the inner layer of the vessel

One layer of endothelials

No nerve endings

Surface for platelet aggregation

w/trauma and recognition of

foreign object at this level

PHLEBITIS begins here

 Valves
present in MOST veins


Prevent backflow and
pooling


More in lower extremities
and longer vessels


Vein dilates at valve
attachment
 Veins of the Upper Extremities

Digital Vessels
-Along lateral aspects fingers, infiltrate
easily, painful, difficult to immobilize and
should be your LAST RESORT

Metacarpal Vessels
-Located between joints and Digital
metacarpal bones (act as
natural splint)
-Formed by union of digital veins
-Geriatric patients often lack enough
connective / adipose tissue and skin
turgor to use this area successfully
 Veins of the Upper Extremities


Cephalic (Intern’s Vein)
-Starts at radial aspect of wrist
-Access anywhere along entire length
(BEWARE of radial artery/nerve)


Medial Cephalic (“On ramp” to
Cephalic Vein)
-Joins the Cephalic below the elbow bend
-Accepts larger gauge catheters, but may
be a difficult angle to hit and maintain
 Veins of the Upper Extremities

Basilic
- Originates from the ulner side of the
metacarpal veins and runs along the
medial aspect of the arm. It is often
overlooked becauses of its location on
the “back” of the arm, but flexing the
elbow/bending the arm brings this vein
into view


Medial Basilic
- Empties into the Basilic vein running
parallel to tendons, so it is not always
well defined. Accepts larger gauge
catheters.
- BEWARE of Brachial Artery/Nerve
 Purposes of IV Therapy

To provide parenteral nutrition

To provide avenue for dialysis/apheresis

To transfuse blood products

To provide avenue for hemodynamic monitoring

To provide avenue for diagnostic testing

To administer fluids and medications with the ability to rapidly/accurately change
blood concentration levels by either continuous, intermittent or IV push method.

Types of Peripheral Venous Access Devices

•Butterfly(winged) or Scalp vein needles (SVN) – not recommended for non compliant
patient as it can easily penetrate the vein wall causing extravasation. We use these
frequently for phlebotomy
•Safety Over the needle catheters (ONC)
- PROTECTIV ® -ACUVANCE ®
 Starting a Peripheral IV

Finding a vein can be challenging
- Go by “feel”, not by sight. Good veins are bouncy to the touch, but are not
always visible.
- Use warm compresses and allow the arm to hang dependently to fill veins.
- A BP cuff inflated to 10mmHg below the known systolic pressure creates the
perfect tourniquet. Arterial flow continues with maximum venous
constriction.
- If the patient is NOT allergic to latex, using a latex tourniquet may provide
better venous congestion
- Avoid areas of joint flexion
- Start distally and use the shortest length/smallest gauge access device that will
properly administer the prescribed therapy

(BE AWARE: Blood flow in the lower forearm and hand is 95ml/min)
 IV Start Pain Management
One of the most frequent contributors to patient dissatisfaction is painful
phlebotomy and IV starts

• Use 25-27g insulin syringe to create a wheal similar to a TB skin test on top of or
just to side of vein with 0.1 -0.2 ml normal saline or 1% xylocaine without
epinephrine

• Topical anesthesia cream (ie EMLA) may be applied to children>37 weeks

gestation 1 hr. prior to stick. It might be a good idea to anesthetize a couple of sites

• Have the patient close their fist (NO PUMPING) prior to stick

• Make sure the skin surface cleansing agent (alcohol/chlorhexidine) is dry prior to
stick. Drawing this into the vein may stimulate the vasoconstrictive action of the
tunica media layer
 Flushing Peripheral IV’s
Use prefilled saline and heparin flush syringes located in PYXIS
Heparin flush concentrations available:
-100u/ml (5ml in a 10ml syringe)
-10u/ml (2ml in a 3ml syringe)

Flushing intervals and amounts

- Peds: q 6hrs.
<22ga 1ml 0.9%NS followed by 1ml heparinized
(10units/ml) saline

- Adults: q 8hrs
w/1ml. 0.9%NS [3ml heparinized saline for OB]
 Dressing/Bag Changes
Ch a n gin g dr essin gs
Physician orders are 1 2 3 4 5 6 7
Ga u ze q TSM q 7 d
required if a peripheral 2d

catheter is left in the same

site for more than 3 days. Ch a n gin g ba gs a n d t u bin g
1 2 3 24
n or m a lly ever y 3d hrs
If r espiked or m eds a dded
ou t side ph a r m a cy

It is best to have the

Ch a n gin g Sit es
pharmacy add medications
to the infusion bags under
1 2 3 4 5 6 7
n or m a lly ever y 3d E ver y 7 d c MD or der

laminare flow to reduce

contamination
 Percutaneous
Central Venous Catheters
Tunneled PICC’s Implanted Ports Dialysis
Insertion MD @ bedside w/x- MD in OR under MD/trained RN @bedside MD in OR under fluoroscopy MD in OR under
ray confirmation fluoroscopy w/x-ray confirmation fluoroscopy
Location Visible externally. Visible ext. usually Visible externally around Completely internal. Titanium or plastc Visible externally.
Enters subclavian, midway bet. clavicle antecubital fossa, upper port is implanted in a surgically created Arm or leg
ext. juglar,or int. and nipple. Tunneled arm or neck pocket and catheter is threaded into placement
juglar vein near under skin & subclavian or int. juglar vein. Access is
clavicular area threaded through through skin into self sealing port using
subclavian or IJ special non coring needle
Material/Cost Polyurethane Silicone Silicone / polyurethane Silicone catheter. Port is titanium or Various materials
$200-$400 $3500-$5000 $350-$500 plastic w/self sealing diaphragm
$3500-$5000
Lumen 2-3 2-3 1-2 1-2 2-3
Sutured Yes/entire life Yes, until internal No Yes Yes
Dacron cuff healed
Duration Short term 4-10 Long term Long term Long term Mid term
days
Flushes 5-10ml NaCl after 5-10ml NaCl after 5-10ml NaCl after use and 10ml NaCl followed by 4.5ml Done ONLY by IV
use and daily use and daily daily heparinized saline (adults-100units/ml; team or dialysis
peds-10units/ml) after ea. use or nurses
monthly if not accessed

Brands/ Arrow Howe, Triple Hickman, Broviac PICC, PIC, EDPC, Arrow Bard, Accces Port-A-Cath Bard, Tesio,
Names Lumen, Subclavian, Howe, Gesco, PASV Vescath, Quinton
IJ
Discontinue MD or speically MD in OR Specially trained RN @ MD in OR MD in OR
trained RN @ bedside
bedside
 Central Venous Catheter
Sites

Percutaneous(Subclavian)
PICC (Peripherally inserted
Central
Catheter)

Implanted Port
(single or double
lumen)

Percutaneous (IJ-Int. Jugular)

Tunnelled (Hickman)
 CVC Care/Maintenance

Percutaneous Tunneled

 Flush after each access or daily for

catheters>21ga, q 6 hrs <21 ga
-adults: 10ml saline
- peds/neonates: 5ml saline
(preservative free for
infants <1yr) PICC

 Transparent dressing change q 7 days & prn

 CVC Care/Maintenance

 Flush after each use and weekly while accessed;

monthly when not acessed
Implanted Port
- 10ml saline (preservative free for pts. <1yr)
- followed by 4.5ml-5ml heparinized saline
100units/ml for adults
10units/ml for peds

 Transparent dressing/ access needle change q

7days
 Monitor and
document site Site Care
condition:
• Hourly for peds
•Q 2 hr for adult
* Indicates
complication:
•Infiltration
•Phlebitis
•Thrombosis
•Cellulitis
•Septicemia
 Infiltration/Extravasation

The most common cause is damage to the

wall during insertion or angle of placement.

STOP INFUSION and treat

as indicated by Pharmacy,
Medication package insert
or drug reference book.

Notify MD and document

 Phlebitis/Thrombophlebitis
 Chemical
- Infusate chemically erodes
internal layers. Warm compresses may
help while the infusate is
stopped/changed. Anti-inflammatory
and analgesic medications are often
used no matter what the cause

 Mechanical  Bacterial
- Caused by irritation to - Caused by introduction of
internal lumen of vein during insertion bacteria into the vein. Remove the
of vascular access device and usually device immediately and treat
appears shortly after insertion. The w/antibiotics. The arm will be
device may need to be removed and painful, red and warm; edema may
warm compresses applied accompany
 Cellulitis

 Inflammation of loose connective

tissue around insertion site.
- Caused by poor insertion technique
- Red swollen area spreads from
insertion site outwardly in a diffuse circular
pattern
- Treated w/antibiotics
 Septicemia/Pulmonary Edema/
Embolism
 Septicemia
- Severe infection that occurs to a system or entire body
- Most often caused by poor insertion technique or poor site care
- Discontinue device immediately, culture and treat appropriately
 Pulmonary edema- caused by rapid infusion
 Pulmonary embolism - Caused by any free floating substances that
require thrombolytic therapy for several months. Increased risk w/lower ext.
 Air embolism- caused by air injected into IV system. Keep insertion site
below level of heart
 Troubleshooting


Vascular access device will not flush/can’t draw blood
- Evaluate for kink in tubing or catheter tip against vein wall.

Vascular access device (VAD) leaking when flushed
- Verify that hub access cap is connected correctly

Patient complains of pain while VAD being flushed
- Assess for infiltration

VAD broken
- PICC’s may be repaired. All other devices must be replaced

Call IV therapy team member for any concerns or questions.

 Policy notes
KVO ra te :
RN’s and LPN’s can start Adu lt s - 10 m l/h r On ly u n til ra te

peripheral IV’s after initial P edia t r ics - 2-3 m l/h r

Neon a t es - 0.5-1 m l/h r
o rd e r re ce iv e d

training and observation by Ve rifi c a tio n re qu i re d fo r:

preceptor • In su lin
• H epa r in
• P ot a ssiu m
• Digoxin
LPN’s CANNOT infuse blood • Ch em ot h er a py

products or high risk IV

medications. LP N’s ca n n ot pu sh IV
m edica t ion s
 IV Medication Administration
 Many medications require patient All Med ica t ion s Ca n n ot Be
monitoring that cannot be done on Ad m in is t er ed on All U n it s
units where the nurse/patient Ge n e r a l Ca r e U n i t s : C a n give m ed s
r equ ir in g on ly ba s ic p h ys ica l
ratios are greater than 1:2 a s s es s m en t d a t a
S t e p d o w n U n i t s : Ca n give m ed s
t h a t r equ ir e m or e in va s ive or
fr equ en t m on it or in g t h a n is a va ila ble
on gen er a l ca r e u n it s
 A patient can be moved to a unit
In t e n s i v e Ca r e U n i t s : Ca n give
where the ratio is appropriate for m ed s t h a t r equ ir e m or e in va s ive or
invasive/frequent monitoring or fr equ en t m on it or in g t h a n is a va ila ble
on t h e S t ep d own u n it s .
another nurse can be brought to
care for the patient during the med VANDERBILT URL LINK FOR IV
administration MEDICATIONS:
www.mc.vanderbilt.edu/pharmacy/ivroom/IV
MedAdm061003.pdf
 IV Medication
Administration
Sample page
from the
Pharmacy med
administration
web site

See “APPROVED
FOR” section.
You will find if
the medication
can be
administered on
your unit.
 www.ins1.org

Infusion Nurses Society (INS)

• Professional Organization that sets the standards of

care for clinicians practicing in the field of infusion
therapy.

• Standards set by INS are reflected in our policies and

procedures related to infusion therapy for health care
providers.

• In a court of law, the standards set by the INS are

used to assess the infusion clinician’s performance.
CENTRAL LINES
AND
ARTERIAL LINES
 LEARNING OUTCOMES
THE STUDENT SHOULD BE
ABLE TO:-

IDENTIFY A CENTRAL LINE AND ARTERIAL
LINE

DISCUSS THE INDICATIONS FOR CENTRAL
LINES AND ARTERIAL LINES

DISCUSS THE COMPLICATIONS ASSOCIATED
WITH CENTRAL LINES AND ARTERIAL LINES

ARTICULATE THE MANAGEMENT OF A
PATIENT WITH A CENTRAL LINE AND/OR
ARTERIAL LINE
WHAT IS A CENTRAL LINE

It is a catheter that
provides venous access
via the superior vena
cava or right atrium
COMMON CENTRAL LINE
INSERTION SITES

Right internal 
Or peripherally
jugular inserted central
catheters (PICC)

left internal
which are inserted
jugular
via the antecubital

right subclavian veins (basilic vein

left subclavian is the best) in the
arm and is

femoral (as a last
advanced into the
resort)
central veins
TYPES OF CENTRAL LINE

SINGLE LUMEN

TRIPLE LUMEN

QUADRUPLE LUMEN

QUINTUPLE LUMEN
CENTRAL LINES


Indications for CVP lines are:-
– fluid resuscitation
– Parenteral feeding
– measurement of central venous
pressure
– poor venous access
– administration of irritant drugs
COMPLICATIONS
FOLLOWING CVP LINE
INSERTION

Malposition of 
Catheter
the catheter embolism

haematoma 
Thrombosis

arterial puncture 
Haemothorax

pneumothorax 
Cardiac

haemorrhage tamponade

sepsis

Cardiac
arrhythmias

air emboli
CENTRAL
VENOUS
PRESSURE
WHAT IS CENTRAL
VENOUS PRESSURE

IS THE PRESSURE WITHIN THE
SUPERIOR VENA CAVA OR
THE RIGHT ATRIUM
CVP READINGS ARE
USED:-

TO SERVE AS A GUIDE TO
FLUID BALANCE IN
CRITICALLY ILL PATIENTS

TO ESTIMATE THE
CIRCULATING BLOOD
VOLUME

TO ASSIST IN MONITORING
CIRCULATORY FAILURE
CENTRAL VENOUS
PRESSURE MONITORING

THIS IS A HELPFUL TOOL IN THE
ASSESSMENT OF CARDIAC FUNCTION,
CIRCULATING BLOOD VOLUME,
VASCULAR TONE AND THE PATIENT’S
RESPONSE TO TREATMENT

HOWEVER, CVP SHOULD NOT BE
INTERPRETED SOLELY BUT IN
CONJUNCTION WITH OTHER SYSTEMIC
MEASUREMENTS, AS ISOLATED CVP
MEASUREMENTS CAN BE MISLEADING
METHODS OF CVP
MONITORING

There are two methods of CVP
monitoring
– manometer system: enables
intermittent readings and is less
accurate than the transducer system
– transducer system:enables continuous
readings which are displayed on a
monitor.
MONITORING WITH
TRANSDUCERS

Transducers enable the pressure readings
from invasive monitoring to be
displayed on a monitor

To maintain patency of the cannula a
bag of normal saline or heparinised
saline should be connected to the
transducer tubing and kept under
continuous pressure of 300mmHg thus
facilitating a continuous flush of 3mls/hr
PROCEDURE FOR CVP
MEASUREMENT USING A
TRANSDUCER


EXPLAIN THE PROCEDURE TO THE PATIENT

ENSURE THE LINE IS PATENT

POSITION THE PATIENT SUPINE (IF
POSSIBLE) AND ALIGN THE TRANSDUCER
WITH THE MID AXILLA (LEVEL WITH THE
RIGHT ATRIUM)

ZERO THE MONITOR

OBSERVE THE CVP TRACE

DOCUMENT THE READING AND REPORT
ANY CHANGES OR ABNORMALITIES
THE CVP WAVEFORM

The CVP waveform reflects changes in
right atrial pressure during the cardiac cycle
 NORMAL CVP
MEASUREMENTS

Central venous presure monitoring should
normally show measurements as follows:

Mid Axilla: 0 - 8 mmHg (Woodrow 2000)

An isolated CVP reading is of limited value; a
trend of readings is much more significant and
should be viewed in conjuncton with other
parameters e.g. BP and urine output.
CARDIAC BLOOD
COMPETENCE VOLUME
(REDUCED
(INCREASED
VENTRICULA
VENOUS
R FUNCTION
RETURN
RAISES CVP)
CENTRAL RAISES CVP
VENOUS
PRESSURE
CVP

INTRATHOR SYSTEMIC
ACIC AND VASCULAR
INTRAPERIT RESISTENC
ONEAL E
PRESSURE
MANAGEMENT OF A
PATIENT WITH A CVP
LINE

Monitor the patient for signs of
complications

Label CVP lines with drugs/fluids etc.
being infused in order to minimise the
risk of accidental bolus injection

If not in use, flush the cannula regularly
to help prevent thrombosis. A 500ml bag
of 0.9% normal saline should be
maintained at a pressure of 300mmHg.

Ensure all connections are secure to prevent
exsanguination, introduction of infection
and air emboli

Observe the insertion site frequently for
signs of infection.

The length of the indwelling catheter should
be recorded and regularly monitored.

CVP lines should be removed when
clinically indicated
REMOVAL OF CENTRAL
LINE

THIS IS AN ASEPTIC PROCEDURE

THE PATIENT SHOULD BE SUPINE WITH HEAD
TILTED DOWN

ENSURE NO DRUGS ARE ATTACHED AND
RUNNING VIA THE CENTRAL LINE

REMOVE DRESSING

CUT THE STITCHES

SLOWLY REMOVE THE CATHETER

IF THERE IS RESISTENCE THEN CALL FOR
ASSISTANCE

APPLY DIGITAL PRESSURE WITH GAUZE UNTIL
BLEEDING STOPS

DRESS WITH GAUZE AND CLEAR DRESSING EG
TEGADERM
ARTERIAL
LINES
WHAT IS AN ARTERIAL LINE?

AN ARTERIAL LINE IS
A CANNULA USUALLY
POSITIONED IN A
PERIPHERAL ARTERY

SUCH AS

Radial artery

brachial artery

dorsalis pedis artery

femoral artery
INDICATIONS FOR USING
ARTERIAL LINE

Ease of access

Continuous monitoring of
arterial blood pressure
– if patient is on intropic
drugs
– if patient is on
vasoactive drug
– if patient requires
frequent arterial blood
sampling
COMPLICATIONS
ASSOCIATED WITH
ARTERIAL LINES

HYPOVOLAEMIA

ACCIDENTAL INTR-ARTERIAL
INJECTION OF DRUGS

LOCAL DAMAGE TO ARTERY
THE ARTERIAL WAVEFORM

The arterial waveform
reflects the pressure
generated in the arteries
following ventricular
contraction and can be
described as having:-
– Anacrotic notch
– Peak systolic pressure
– Dicrotic notch
– Diastolic pressure
REMOVAL OF ARTERIAL
LINE

THIS IS AN ASEPTIC PROCEDURE

REMEMBER UNIVERSAL PRECAUTIONS

THE PROCEDURE SHOULD BE EXPLAINED
TO THE PATIENT

TAKE DRESSING OFF LINE

REMOVE ARTERIAL LINE ENSURING THAT
THE ENTRY SITE IS COVERED WITH GAUZE

APPLY DIGITAL PRESSURE FOR AT LEAST 5
MINUTES TO ENSURE HAEMOSTASIS

DRESS SITE WITH GAUZE AND MICROPORE

ASSESS THE PERIPHERAL CIRCULATION AS
THROMBOSIS CAN OCCUR AFTER
REMOVAL
QUESTIONS????