Hazards or Parenteral Therapy

Question 1

4 phases of IV fluid therapy?

Answer 1

• Resuscitation
• optimization
• maintenence
• deescalation

Question 2

what are some consequences of inappropriate use of IV fluid therapy?

Answer 2

• Dehydration
• hypervolemia
• electrolyte abnormalities
• acid-base disorders
• delayed wound healing
• kidney and other organ dysfunction
• coagulation abnormality
• excessive transfusion

Question 3

patients at risk for complications of IV fluid?

Answer 3

• Elderly
• children/infants
• patients with cardiac or pulmonary disease
• patients with significant cerebral or renal disease/ injury
• pregnant patients

Question 4

Clincal s/sx of complications of IV fluids

Answer 4

• Deteriorating resp. status (tachypnea, SOB, decreased oxygen sats)
• elevated BP, HR
• raised CVP , distendd neck veins
• peripheral or pulmonary edema
• weight increase > 2kg over 24-48 hours

Question 5

what are indications for maintence fluids?

Answer 5

• patients who cannot meet their fluid and electrolyte needs by oral or enteral routes
• otherwise well in terms of fluid and elecrolyte balance and handling (homeostasis)

Question 6

• a solution or medication capable of causing blistering, severe tissue injury or necrosis when it escapes from the vascular pathway into surrounding tissues

Answer 6

Vesicant

Question 7

• inflammation of the vein
• causes: Mechanical( movement of the catheter, poorly secured) , chemical, infective, patient characteristics
• s/sx: erythema, warmth, edema at the site; pain or burning at insertion site or along the vein; vein appears red and hard (palpable venous cord)
• management: stop infusion at first sign of redness/pain; apply warm, moist compress to area

Answer 7

Phlebitis

Question 8

• inadvertent delivery of a non-vesicant solution or medication into surrounding tissue
• causes: improper PIV catheter placement or dislodgment/patient movemenet causing cathether to slip out or through venous lumen, inflammatory response to cytotoxic medicaitons
• s/sx: skin blanched, taut, or stretched (feels tight), edema at insertion site, cool skin temperature, discomfort, IV fluid leaking out of insertion site or from under dressing
• managment: stop infusion, remove IV catheter, elevate limb to increase patient comfort

Answer 8

infiltration

Question 9

what are four types of Central Venous Cathethers (CVC)

Answer 9

• Tunneled
• non-tunneled
• implanted port
• PICC - placed in peripheral veins (medial cubital or upper basilic)

Question 10

• complications more frequent but less significant
• Dwell time 72 hours (short); up to 4 weeks for midline
• avoid hyperosmotic infusates
• avoid infusates with extremes in pH
• avoid vesicant infusates or those that associated with severe phlebitis

Answer 10

Peripheral inravenous catheter

Question 11

• complications less frequent but more serious
• Dwell time months to years
• uses for infusates with osmolality > 600 mOsm/L
• Use for infusates with pH < 5 or > 9
• safe for vesicant infusates (causes tissue damage)

Answer 11

Central venous catheter

Question 12

vesicant examples?

Answer 12

• antimicrobials
• electrolytes
• cytotoxic agents
• vasoconstrictors
• others

Question 13

• Inadvertent delivery of vesicant solution or medication into surrounding tissue
• often from erosion/penetration of catheter into/thorugh the vessel wall or loss of vein wall integrity from inflammation. can be caused mechanically, physiologically or pharmalogically
• s/sx: pain, edema, blanching or discoloration of site, erythema, potential blistering and/or skin sloughing
• management: stop IV infusion, estimate amount of extravasated fluid

Answer 13

Extravasation