There are situations when placing an intravenous catheter, which is normally a routine act for nursing staff in any hospital, may be challenging. This is the case with elderly patients or those with vascular problems, as well as patients admitted with multiple traumas.
Elderly patients often present with vein stiffness, either as a result of clinical conditions such as atherosclerosis or other conditions brought on by ageing. Furthermore, they often present a pathology requiring the use of anticoagulants.
In these cases it may be hard to place a peripheral venous catheter due to the fragility of vein walls, which may have become stiff and may be damaged more easily. Furthermore, the risk of phlebitis is significantly higher in these patients.
Nursing staff must exercise extreme caution, both when inserting the catheter and in their regular checks for signs of phlebitis or extravasation which may lead to greater complications.
Special measures for placing intravenous catheters in elderly patients
- Asses the physical and mental condition of the patient as it may be necessary to immobilize the limb where the catheter is to be inserted.
- Avoid varicose, thrombosed, or previously used veins.
- If possible, choose a vein which is not in an area that is subject to movement. This will be more comfortable for the patient and reduce the risk of damage.
- Use the smallest catheter possible in keeping with the medication to be administered.
- Exercise extreme caution in patients receiving anticoagulant treatment, both in the placing and removal of the catheter, especially when using larger catheters.
- Secure the catheter with a transparent dressing to allow for regular inspection of the insertion point.
- Pay special attention to any symptoms such as reddening of the skin, pain, edema, induration, and haematomas. If these present, the catheter must be removed.
It must be remembered that elderly patients are more likely to suffer infections due to the natural deterioration of their immune system. Increasing hygiene and disinfection measures and looking out for any symptoms of phlebitis is crucial in these cases.
In some cases, placing a peripheral venous catheter may be especially difficult, in which case we may have to turn to alternative methods, such as central lines.
For treatment of moderate dehydration, which presents relatively often in elderly patients, medical literature suggests subcutaneous administration as a valid alternative (Rosanna de la Rosa, E. and Zamora Monge, G. Ágora de Enfermería, vol 19, nº 1, 2015). This route of administration, which is technically simpler and less uncomfortable for the patient, may be an effective rehydration technique.
In any case, nursing staff must make full use of their training and experience to tackle complex cases which may present in elderly patients.