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Trainer’s tip: Age-related considerations for intravenous therapy

LTC Nursing Assistant Trainer, May 3, 2012

The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) requires nurses to be familiar with age-related considerations and possess age-related competencies. The following considerations apply to geriatric residents:

• Fragile veins may cause infiltration immediately upon catheter insertion. If the vein is palpable and visible, consider starting the IV without a tourniquet, which increases pressure. A blood pressure cuff inflated to 30 to 40 mm Hg may be effective as a tourniquet replacement.
• Skin becomes paper-thin in the elderly. Secure the catheter with hypoallergenic tape, or cover with an IV transparent dressing.
• Immobilize the catheter well to prevent movement, which may cause skin tears.
• Stabilize the vein well, as veins in the elderly have a tendency to roll upon insertion.
• Dehydration, vascular disease, and obesity may limit available sites for intravenous access. Initiate therapy as low on the vein as possible so that sites above it may be used if necessary.
• The elderly are at high risk for circulatory overload, making close monitoring essential. Signs and symptoms include:

-Elevated blood pressure
-Rapid respirations
-Coughing and shortness of breath
-Signs and symptoms of pulmonary edema

If you suspect fluid overload, assess body weight, specific gravity, and intake and output. Notify the physician promptly.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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