Why would I need IV therapy?

Understanding the different types of IVs and how St. Joseph’s/Candler is preventing bloodstream infections

Most likely a trip or stay in the hospital is going to result in the need for intravenous (IV) therapy, whether you come in for dehydration or chemotherapy. While the initial prick of a needle is unpleasant to many, IV therapy can be lifesaving.

IV therapy provides a wide variety of treatments and preventative care options. Once an IV catheter tube is inserted into a patient’s vein, medications, fluids or blood can be delivered directly into the bloodstream without having to use a new needle for each individual treatment.

St. Joseph’s/Candler has a group of registered nurses solely dedicated to IV therapy. The Vascular Access Team is comprised of eight nurses between St. Joseph’s Hospital and Candler Hospital. These nurses evaluate patients for appropriate IV therapy, insert IV catheters and educate patients. They are trained to place the most common line, a peripheral IV, to a central line like a physician would place.

“It’s a specialty-focused team. It’s beneficial to the patients, nurses and the medical staff to have someone that is totally focused on this,” says Alicia Motley, MBA, BSN, RN, NE-BC, clinical manager, nursing specialty services. “They are patient advocates, and they are really concerned with vessel preservation.”

For a better understanding of IV therapy, let’s look at the types you or a loved one may receive next time you are at the hospital.

Peripheral IV

Peripheral is the most common form of IV therapy. Peripheral IVs are typically given to surgical or emergency room patients, and could be used on any patients needing medication, fluids or to draw blood.

A needle is inserted into a vein, usually in the arm or hand, and replaced with a small device called a cannula. The IV catheter tube attaches to a cannula before being fixed to the skin with an adhesive bandage. Peripheral IVs typically need to be changed every couple of days, says Michele Roberts, RN, VABC, member of the Vascular Access Team.

Midline Catheter

For patients needing IV therapy longer than four or five days, but not longer than a month, a midline catheter most likely will be used. Midline catheters are a less invasive method for delivering fluids or medications or drawing blood samples.

Midline catheters are placed in a larger vein and higher up on a patient’s arm than a peripheral IV. Midline catheters are a good option for patients with harder to reach veins. 

Central Venous Catheter or Central Line

For patients who require medications, nutrients, blood or fluids for weeks or months, a central line can quickly deliver contents into the heart and produce a fast response for medicines or supply large amounts of blood or fluids into a patient’s system. Chemotherapy patients, those needing kidney dialysis or long-term antibiotics often need a central line, Roberts says.

The central line usually goes into the internal jugular vein (neck), subclavian vein (below the collarbone) or the femoral vein (inner thigh). An ultrasound device helps guide a hollow needle into the selected vein prior to replacing it with a central venous catheter. There are several types of central venous catheters including PICC lines (peripherally inserted central catheter) and implantable ports.

Steps St. Joseph’s/Candler are taking to reduce CLABSI

St. Joseph’s/Candler is focused on reducing central line associated bloodstream infections (CLABSI), which occur when germs (usually bacteria or viruses) enter the blood stream through a central line.

The SJ/C Intravenous Therapy team implemented an evidence based practice model to allow team members to choose the most appropriate infusion device for patient needs. Included in this model was the ability of the Vascular Access Team to place triple lumen central venous catheters in the internal jugular vein in the neck, Roberts says.

Registered nurses in the state of Georgia can place central lines if credentialed by a physician. This allows safe and expedited access to care for patients and reduces the incidence of femoral line replacement.

Each member of the Vascular Access Team is nationally certified in either infusion therapy or vascular access and has been trained by a physician to place triple lumen catheters in the internal jugular vein. This is the first known nursing team in Georgia placing triple lumen catheters in the IJ, Roberts says.

“The biggest outcome is being able to choose the right device for the patient’s need,” adds Motley. “We’ve also had no insertion-related infections, and in a system-wide effort, we have seen a decrease in blood stream infections.”

Since March 2017, more than 200 triple lumen catheters have been inserted in the IJ by the Vascular Access Team, specifically, with no device related infections or complications.