Ch. 15 Flashcards
infusion therapy is the _____
- delivery of medications in solutions and fluids by parenteral route
the most common route of infusion therapy
IV
most common invasive therapy administered to hospitalized patients
IV therapy
types of infusion therapy fluids
- IV solutions (including parenteral nutrition)
- blood and blood components
- drug therapy (benadryl, antibiotics, replacements)
IV solutions: normal serum osmolarity (adults)
270-300 mOsm/L
isotonic solution (amount)
270-300 mOsm/L
hypertonic solution
fluids > 300 mOsm/L
hypotonic solution
fluids < 270 mOsm/L
isotonic infusate
- water does not move into or out of the body’s cells
patients receiving isotonic solutions are at risk for ____
fluid overload
- esp. older adults
hypertonic infusate
- used to correct fluid, electrolyte, and acid-base imbalances by moving water out of the body’s cells and into the bloodstream
parenteral solutions is an example of ___ infusions
hypertonic infusions
hypotonic infusate moves water
into cells and expands them
hypertonic infusate moves water
out of the body’s cells into the bloodstream
if osmolarity is > 600 mOsm/L, it is best to infuse in _____ circulation
central circulation
- where greater low provides adequate hemodilution
TPN (total parenteral nutrition) has osmolarity of
> 1400 mOsm/L
TPN should never be infused in ___ circulation
peripheral circulation
- can damage blood cells and endothelial lining of vein
common IVFs
- 0.9% Saline
- 0.45% Saline
- D5W
- D10W
- D5/.9%NS
- D5/.45%NS
- Ringer’s Lactated
- D5RL
isotonic IVFs
- 0.9% Saline
- D5W
- Ringer’s Lactated
hypotonic IVFs
- 0.45% Saline
- D5RL
hypertonic IVFs
- D10W
- D5/.9%NS
- D5/.45%NS
components of Saline (0.9%), NaCl, 3% or 5% saline
Na and Cl
indications of Saline (0.9%), NaCl, 3% or 5% saline
- alkalosis
- fluid loss
- sodium depletion
components of D5W, D10W
dextrose in water
indications for D5W, D10W
- replace calories as carbohydrates
- prevent dehydration
- maintain H2O balance
- promote Na diuresis
components of D5NS, D51/2NS, D10NS
dextrose in saline
components of LR or RL
Na, Cl, K, Ca, and lactate
indications of D5NS, D51/2NS, D10NS
- promote diuresis
- correct moderate fluid loss
- prevent alkalosis
- provide calories and NaCl
indications of LR or RL
- replaces fluid lost d/t vomiting or GI suctioning
- treats dehydration
- restores normal fluid balance
blood transfusions: components
- packed RBCs (PRBCs)
- platelets (PLT)
- fresh frozen plasma (FFP) (for clotting d/o)
- albumin (for low protein state)
- several specific clotting factors (for hemophilia)
prescribing infusion therapy: fluids
- type of fluid
- rate of administration in mL/hr (or total amount of fluid and hours for infusion)
- drugs and dose to be added
prescribing infusion therapy: drugs (in IV fluids)
- drug name
- specific dose and route
- frequency of administration
- time(s) of administration
- length of time for infusion (number of doses/days)
- purpose
vascular access device (VAD)
short peripheral catheters
- superficial veins of the hand and forearm
VAD can dwell for ____ and then requires removal and insertion into another venous site
72-96 hours
complaints of what can indicate nerve puncture during insertion of VAD?
- tingling
- pins and needles feeling in the extremity
- numbness
veins cannot be used in patients with
- mastectomy (no blood work in the arm on that side)
- axillary lymph node dissection
- lymphedema
- paralysis of upper extremities
- dialysis graft or fistulas
*usually wearing a bracelet on arm that cannot be used
CDC recommends aseptic preparation and technique including _____ (for infection control)
- hand hygiene
- clip hair, do not shave (shave = infection risk)
- ensure skin is clean
- wear gloves
- prepare skin with 70% alcohol or chlorhexidine
midline catheter
- 3-8” long, 3-5 Fr, double or single lumen
- inserted through vein in upper arm
midline catheters are used for
- hydration
- drug therapy given longer than 6 days, (used up to 14 days)
do not use a midline catheter for:
vesicant drugs
- can cause tissue damage if extravasation occurs
parenteral nutrition formulas with low concentrations of dextrose, or solutions with osmolarity > 600 mOsm/L
drawing blood
central IV therapy
VAD placed in central circulation, specifically within superior vena cava (SVC) junction with right atrium
*placed by IV team, not regular nurse
*may be ultrasound guided
how is the placement of central IV therapy confirmed?
- chest x-ray
- new technologies: magnet tip locator, electrocardiogram
peripherally inserted central catheter (PICC)
- length of 18-29” (45-72cm/2-3 ft long)
- single (1), dual (2), or triple (3) lumen available
- can stay in for weeks, months or up to 1 year
what determines the placement of a PICC?
- chest x-ray
Power PICCs are used for
contract injection
- can also be attached to transducers for CVP monitoring
Power PICCs
a wider catheter in comparison to normal PICC
complications of PICCs
- phlebitis
- thrombophlebitis
- DVT
- CRBSIs
PICC uses
- no limitation on pH or osmolarity of fluids that can be infused (meds, fluids, nutrition)
- can be used for blood sampling (lumen size 4 Fr or larger recommended)
- patients on IV therapy for 6-8 weeks, ie. endocarditis, cellulitis
- limes disease
patient teaching: PICC
- avoid excessive physical activity and heavy lifting
CRBSI bundle includes
- proper aseptic hand hygiene
- measuring upper arm circumference as a baseline before insertion
- maximal barrier precautions on insertion
- chlorhexidine skin antisepsis
- optimal catheter site selection and post-placement care with avoidance of the femoral vein for central venous access in adult patients
- daily review of line necessity with prompt removal of unnecessary lines
nontunneled percutaneous central venous catheter are inserted
through subclavian vein in upper chest or jugular veins in neck
- may require insertion in femoral vein (*rate of infection is high)
nontunneled percutaneous central venous catheter
- 7-10” (15-25cm) long
- up to 5 lumens
- tip resides in superior vena cava
- used for long-term infusions (short- not as often, but possible)
what confirms the placement of a nontunneled percutaneous central venous catheter?
chest x-ray
tunneled central venous catheter
- used for frequent and long-term infusion therapy
- portion lies in subcutaneous tunnel
- has cuff of antibiotic-containing material to help reduce infection
- back up if can’t do a PICC line
tunneled central venous catheter: Broviac, Hickman, Leonard
the physicians that designed these catheters
implanted ports consist of
- a portal body
- a dense septum over a reservoir
- a catheter
what houses the port body of an implanted port?
- a subcutaneous pocket
where is an implanted port placed?
a subcutaneous pocket in the upper chest or upper extremity
how often does a port need to be flushed?
- after each use
- at least once a month between courses of therapy
hemodialysis catheters
- very large lumens accommodate hemodialysis or pheresis procedure
- can be tunneled or nontunneled
what are common complications of hemodialysis catheters?
- CRBSI
- vein thrombosis (blood clots)
hemodialysis catheters are maintained by
specially trained hemodialysis nurses
nursing care for patients receiving IV therapy
- educate patient
- perform the nursing assessment: edema, redness, tenderness, heat, signs of infection
- securing and dressing the catheter
- changing administration sets and needleless connectors (change every 72-96 hours)
- controlling infusion pressure
- flushing the catheter (with NS, before and after medication administration)
- obtaining blood samples from CVCs
- removing the vascular access device (VAD)
- documenting IV therapy
local complications of IV therapy
- infiltration
- extravasation
- phlebitis and post-infusion phlebitis
- thrombosis
- thrombophlebitis
- ecchymosis and hematoma
- site infection
- venous spasm
- nerve damage
systemic complications of IV therapy
- circulatory overload
- speed shock
- allergic reaction
- catheter embolism
interventions to reduce infection risk with IV therapy
- clean needleless system connections before use with antimicrobial for 30 seconds
- do not tape connections between tubing sets
- use evidence-based hand hygiene guidelines from CDC and OSHA
older adult care with IV therapy
- skin care
- vein and catheter selection
- cardiac and renal changes
infiltration
- swollen, tender, cool to touch, fluid outside the site
extravasation
occurs due to extricate medication (Ca, IV dopamine)
phlebitis
inflammation of the vein
- d/c I/V fluids
- take out site
- warm, red, tender, hard cord-like
thrombosis
blood clott in the vein
- d/c IV fluids
- take out site
ecchymosis
- bruising
hematoma
collection of blood under skin
- hard bump where IV site is
s/sx of a site infection
- redness, purulent drainage, edema, warmth
venous spasm
insertion of IV
- take out if patient reports numbness and tingling
nerve damage
insertion of IV
- take out if patient reports numbness and tingling
general measures for local IV
d/c fluid
d/c site
elevate arm (2 pillows)
call HCP to determine further care
cold/warm compress
s/sx of circulatory overload
- SOB, crackles
speed shock
rapidly infusing drugs through IV and patient becomes light-headed or dizzy
allergic reaction
- rash, hives, swelling
- stop what is causing reaction
catheter embolism
- small piece of catheter breaks off and travels into bloodstream, and gets stuck
- can cause PE
