One of the most important skills a nurse can master, is the starting of infusions, administering of IV medications and managing IV therapy. These skills are used daily by nurses all over the world, in all kinds of healthcare settings. These infusions can restore the patient's health and save lives.

The most fear evoking experience of a young nurse is the starting of peripheral IV's. Start by assessing the hand, wrist, forearm, and the anti-cubital area. Apply a tourniquet and palpate the vein with your finger. The best way to become more efficient in locating veins for IV's, is to close your eyes and feel for the veins. There are often veins present that you cannot see, but you can feel them.

Apply an anesthetic cream over the injection site. This will help to numb the area and the patient will feel less pain when the IV cannula is inserted into the skin. Attempt to penetrate the layers of the vein in one motion. The more IV's you start, the better you will become in starting them. If time permits, offer to start IV's for other nurses. This will do two things, improve your skills and earn brownie points with your peers.

When starting the IV, use your thumb and gently tighten the skin distal to the site. This helps to anchor the vein and it doesn't tend to roll as much. Placing the needle directly above the vein, with the bevel up helps with the insertion into the vein.

If you have checked the patient and have been unable to see a vein that you feel you can start the IV in, then apply warm packs for the patient's arm for at least 10 minutes and then take another look. You will be surprised at the difference with some people. Some hospitals now have the support of a visualization device to help locate veins in the patients. These are actually becoming more popular. If one of these devices are not available, then use a blood pressure cuff on a low setting.

Don't be too rough on yourself, there is not a nurse alive that starts every IV every time. The best thing for you to do is to start IV's. The more you start the better you will become. Don't shy away from starting them on any patient. The old saying, "Practice make perfect", is true in this circumstance.

The implanted venous ports consist of an injection port, a self-sealing septum, and a radiopaque catheter. This catheter lays just above the superior vena cava. The position of this radiopaque catheter, allows for the faster dilution and a more effective flow of the injected fluid into the circulatory system of the patient. These implanted systems can be used for infusion of medications, blood products, imaging solutions, total parenteral nutritional solutions, and for the withdrawal of blood samples. The port is accessed with the use of the Huber needle.

The Huber needles is special, because it optimizes percutaneous access to the septum of the implanted port. It goes through the skin into the port septum and into the port reservoir, where the fluids are delivered. The access area of the implanted port is usually easily detected. Palpation of the area where the port is located under the skin, will allow you to feel the ring that is around the insertion area. It usually feels raised and solid, approximately the size of a quarter. The Huber needle is inserted into the soft center of the circle.

The size of the needle used to access the port will be determined by the size of the patient. A thinner patient will only require a 1-inch needle, when a heavier patient might require a 1 1/2-inch needle. The shorter needles such as the 3/4-inch needles are usually used for children. Wolf-Pak provides safety Huber needles, to help prevent needle sticks.

Always wash your hands with soap and water and then use surgical gloves when inserting the Huber needle. Apply "scream cream" (this is an anesthetic cream mixture used in some facilities), over the area where the port is located. Apply the cream approximately a half hour before the insertion of the needle. This helps with the comfort of the patient while accessing the site and receiving the medications. Always explain to the patient what procedure you are doing.

Cleanse the skin where you will insert the Huber needle with prep for at least 30 seconds to sterilize the area. Attach the Huber needle to a syringe that is filled with sterile saline. After feeling the patient's skin for the port access area, hold the port in place with the non-dominant hand and push the Huber needle at a 90 degree angle through the skin. When you feel it touch the bottom of the port, stop insertion. Aspirate a little blood into the syringe and then inject the saline. Tape or secure the needle and catheter per protocol of the facility.

Attach the needle to the intravenous line and start the medication slowly, allowing no more than 5 ml a second infusion. If using the line to extract blood, always discard the first 5 ml of blood because it will be diluted with saline. After discarding the first 5 ml, withdraw the necessary amount of blood. After the blood is withdrawn, flush the line with 10 ml of saline or 5 ml of heparin, per facility protocol.

If unable to withdraw a little of the patients' blood, the needle is probably not in the correct place and should be removed and attempted again. All facilities have protocols and procedures in place for the use of the implanted venous ports and the insertion of the Huber needles. The nursing staff receives education as to the procedures and are responsible for the accessing and deaccessing of the implanted ports.

Urinary incontinence is the most common type of incontinence, although some patients also experience bowel incontinence. The cost of caring for these patients can be very high. Whether the patient is in the hospital, nursing home or at home, supplies such as incontinent underpads, are a necessary thing. The typical thought when your hear the term incontinence, is that the person is bedfast or wheelchair confined, but this is not always the case. There are many people who function quite well in a job and society, that have problems with incontinence.

In the hospital, patients should be treated as individuals and choices should be given to them about their own care whenever possible. The patient should be treated with respect and according to the clinical need, rather than age. A significant proportion of people in the hospitals today, are over the age of 65.

Approximately 35% of the patients that are over the age of 65, experience incontinence. Some of these patients had the problem prior to being admitted to the hospital and will continue to have incontinence when they are discharged. These patients are often accustomed to using incontinent underpads when going to bed. With the elderly, incontinence is often related to impaired cognitive condition or with the treatment of urinary tract infections.

Good bedside nursing is highly important with the incontinent patient. If the patient is unable to get out of bed or even turn themselves, then good skin care is a high priority. If incontinence of urine continues on a regular basis, there will be a need for incontinent underpads for the patient.

Incontinent underpads are available in 17" x 24" and 23' X24" size. This allows for comfort for the different size patients. These pads are very absorbent and are filled with soft fluff. The backing on the pads are a non-skid waterproof blue. All four sides of the pads are sealed to help prevent leaking. They are available in 300/case and 200/case. These pads will need to be changed every few hours or as needed and the skin needs to be cleansed thoroughly with soap and water. After patting the patient dry with a soft towel, apply a moisture barrier.

Bowel incontinence can be the result of a disease process or because the patient is unconscious. If the patient is conscious, offer the bedpan on a regular basis to help avoid the incontinence. The use of the incontinent underpads makes the patient more comfortable and at the same time helps prevent the need for the linen to be changed frequently. Thoroughly cleansing the patient in the same manner after bowel incontinence helps prevent skin breakdown. The bowel movement can soil hair in that area and can often be harder to remove.

Patients are often embarrassed and even humiliated that they are incontinent and need incontinent underpads. Some patients will even stop eating or drinking so that they won't be incontinent, this can cause serious problems. It is very important that you communicate with the patient, maintain privacy, provide an adequate amount of time for urine and bowel functions, and listen to their concerns.

The bone marrow is in the center of the large bones. Bone marrow is spongy and consists of platelets, red blood cells, and white blood cells. A biopsy procedure is usually done to test the function of the bone marrow. The red blood cells carry the oxygen through the body. The cells that fight infections are the white blood cells and the platelets cells stop the bleeding in the body.

The procedure that is done can be a combination of a biopsy, with an aspiration of the solid tissue of the bone. This is called a bone marrow exam. This procedure is usually painful, but the good thing is that the pain only lasts for a few seconds. The physician gives a local anesthetic that numbs the skin over the area where the biopsy is going to be done. When the needle is inserted, there will be crunching sounds and pressure. This is caused by the needle going through the bone. When the physician withdraws the bone marrow, there is a quick shooting pain that typically shoots down the leg. The site of the biopsy may be sore and bruised for a few days.

The Jamshidi Bone Marrow needle is 4" long and is an 11G needle. This large gauge needle is used to aspirate the bone marrow. They come 10/box. There is a difference in doing a biopsy and an aspiration. Sometimes one is done and sometimes both are done. With a biopsy, a small amount of the bone, along with a small amount of the bone marrow is removed. With the aspiration, only the marrow is removed.

A bone marrow biopsy or aspiration will help diagnosis the conditions in a patient that will cause them to have too many or too few of the different types of cells. Another thing that can be helpful is that it will show if there are any problems with the structure of the red blood cells. The typical problems that the physician may be looking for is disorders such as leukemia, Hodgkin's lymphoma or non-Hodgkin's lymphoma or myelofibrosis. This test goes a long way in helping the physician determine what course of treatment to take with cancers and infections.

Problems that can occur after this procedure is bleeding from the biopsy site. Pressure is to be held for at least 10 minutes after the procedure. People who take blood thinners or who have bleeding problems have an increased chance of bleeding after the procedure. Another possible risk is infection at the site of the biopsy site. On a rare occasion, the biopsy is taken from the sternum or the breastbone. If this is done, there is a possibility of injuring the lungs, the heart or one of the major blood vessels.

Bone marrow tests are usually simple and for most people are safe. Complications with this procedure are actually fairly rare. Because of some pre-existing conditions, there are some people for whom this test is not safe. The test should be discussed with your physician before you decide whether you will have the bone marrow test done.

Intravenous IV treatment definitely has a broad definition. The simple form of this treatment can be as simple as giving fluids in order to combat dehydration. Usually many different medications are given directly into the vein through an IV drip, to take care of a variety of medical conditions. The length of time that is required for the IV treatment depends on what the physician orders. This treatment could be for a one time dose of medication or could be the administration of fluids and antibiotics that last for several hours or days.

IV therapy can be beneficial for such problems as asthma, hepatitis, malnutrition, acute viral illnesses, coronary heart disease, and detoxification. There is even a Myer's Cocktail, which consist of IV vitamin and mineral therapy that was developed at John Hopkins University. This was considered a treatment for chronic fatigue, fibromyalgia, muscle spasms, hives, congestive heart failure, infections, and senile dementia.

IV treatment can be administered in a hospital, a nursing home or in the home. IV therapy bags come in several different sizes and solutions. The Lactated Ringer's injection bags come in 250ml, 500ml, and 1000ml bags. Different fluids, such as D5W, Normal saline, D5LR, and others, also come in the 250ml, 500ml, and 1000ml bags. The type of infusion is ordered by the physician and is determined by the age of the patient, the size of the patient, the disease process, and history of the patient.

There are two different types of IV solutions: colloids and crystalloids. The human blood is considered a colloid, as well as water that is mixed with insoluble material such as a gelatin. A crystalloid is usually made up of soluble materials and water. Although these are different types of solution, they are typically administered in the same way.

Chemotherapy and blood administration are given by IV administration. There is usually no serious side effects from the IV solution itself. There can be soreness or redness at the IV catheter injection site. Only in rare cases, has a patient had an allergic reaction to a plain IV solution. Patients should always keep a list of any allerergies they may have.

A peripheral IV site is the most common route of administration. If people require fluids, antibiotics or other treatments for an extended length of time, then it might be required to have a permanent or implanted IV site. Most IV therapy is given in a hospital setting, but if the treatment is going to continue over a length of time, the treatments may be received in the home. Home health care nurses usually go to the home and administer the fluids and medications.

The nurse checks to be sure the IV is functioning well and that there are no signs and symptoms of an infection. Problems that can arise are swelling of the vein, a hole in your skin where the IV site is, redness, pain, bleeding, chest pain, respiratory distress, a fast heart rate or dizziness. Ultimately, IV treatment is very useful in treating many different conditions. Check for any side effects and be safe.

During cancer treatments, the most common needle nurses will use on their patients will be the Huber needles. This is a curved needle that is designed to make the chemotherapy treatment process easier. With the use of implanted ports, the needle is designed to slip through the port, without causing silicone and tissue from entering into the catheter line. When they have been installed, they won’t need to be taken out for a few days, so patients needing frequent treatments can benefit from dialysis, blood transfusions or other intravenous therapies without having to be stuck numerous times.

Huber needles will be found in a variety of gauges and lengths, so the nursing staff needs to pay attention to the port that is in place. If a needle is too short, it won’t deliver the treatment properly. In turn, a needle that is too long can cause pain and discomfort, while potentially causing the needle move, which can break the silicone seal on it.

The most common lengths that range from .5” – 1.5” in length, which will work with most infusion port sizes. Typically, they will offer color coding to help determine the right option for the ports they will be used in. This helps to make the use of the port easier if different departments will be treating the same patient. Most gauges on the Huber needle will be between 21 – 25 and it is important to notate this information in the patients chart to ensure that there is a lower risk for them. Having the length and gauge reduces the pain and discomfort the patient experiences when another department tries to put a line into their port.

There will be times when you have the port in place, but there is still a degree of pain that the patient experiences. Because of this, you will need to ensure you do what you can to reduce this discomfort for them. That will mean taking the time to apply Emla cream or Lidocaine to the area. This should make the needle slide in with less pain and prevent jerking or other involuntary movements that can cause the silicone septum to become damaged.

When the needle is done, it should be removed carefully and disposed of properly in the medical sharps container. This needle can cause injury and infection if a person is accidentally stuck with it. Make sure to handle it carefully and have it placed in the sharps container immediately upon removal. You should then apply a bandage to the area where the needle was removed from as there is a potential for leakage after an infusion.

Huber needles are an important medical tool that makes treatments easier. Make sure you choose the right size and gauges for your medical facility and ensure each department is trained to effectively use these tools so there is minimal risk for the patient.

IV treatment is a very common scenario in the hospital today. Nearly any time that the body requires something extra, including medications, those medications or other fluids may be administered via intravenous therapy. IV therapy is typically put into play any time there is a hospital admission in order to ensure that health care practitioners have an open line in case of need.

In order for life saving fluids to read the body, in many cases they must be administered intravenously. In some cases the need to administer intravenous fluid is imperative and it must be done very rapidly. This can take place in circumstances where the volume of fluid has been depleted for a wide range of reasons. Some reasons that your volume may be depleted might include:

• Traumatic injuries

• Massive blood loss

• Dehydration

• Surgical intervention

• Vomiting

• Massive diarrhea

IV Therapy may be used to supply medication, to transfuse blood, to prevent or to treat dehydration, to add basic nutrition to the body and for a wide range of other factors. It is imperative to not only supply the fluid, but to control the flow rate of the medication and of the fluids which are being introduced into the body. Too rapid a rate of infusion in some medications can cause severe problems and too slow comes with its own set of issues.

As with every other kind of fluid introduction and any type of therapy, there are certain contraindications and dangers which are inherent in using the therapy. IV medication therapy is typically more likely to cause an allergic reaction. This is due to the fact that the medication is not buffered by going through the system first, but is directly introduced into the veins. Adding too much fluid to the body in too short a time can cause severe symptoms and even systemic collapse. Ensuring that those who are administering and setting the IV therapy are well versed in their craft and making sure that some checks and balances are in play is imperative.

IV Therapy may be accomplished by means of a central line, a pic line, a needle or a peripheral cannula. It may be accomplished in many areas of the body including the carotid, the veins in the head (particularly in children) as well as the veins of the arm, the hand, or the foot.

The method by which IV therapy is given as well as the speed with which it is introduced into the body and the amount of medication or fluid being infused will tell you a great deal about the need for speed or the reason for treatment in intravenous therapy.