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Med Surg 1 > infusion therapy > Flashcards

infusion therapy Flashcards

1
Q

infusion therapy

A

delivery of medications in solutions and or fluids by parenteral route

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2
Q

use of infusion therapy

A
  • maintain or correct fluid balance and electrolyte balance
  • administer medications
  • replace blood or blood products
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3
Q

isotonic

A
  • equal solute concentrations

- no fluid shifts

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4
Q

hypotonic

A

lower solute concentrations

- fluids shifts into the cell

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5
Q

hypertonic solutions

A
  • higher solute concentrations

- fluids shift out of the cell

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6
Q

types of infusion

A
  • blood components

- iv drug therapy

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7
Q

what should be included in an order

A 
drug name 
specfic dose and route 
frequency of admin 
times of admin 
length of time for infusion
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8
Q

milliters per hour equation

A

ordered volume (ml)/ number of hours

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9
Q

drops per min

A

volume (ml)/ time (min) x drop factor (gtts/ml)

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10
Q

modes of Iv infusion

A
  • continuous
  • intermittent
  • direct injection/ iv push (IVP)
  • patient controlled analgesic (PCA)
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11
Q

vascular access devices (VAD)

A
  • peripheral IV therapy (PIV)
    • short infusion catheter
  • midline catheters
  • central IV therapy (CVC)
    • peripherally inserted central catheter (PICC)
    • nontunneled central venous catheters
    • tunneled central venous catheters
    • implanted ports
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12
Q

peripheral IV therapy

A

catheter components

  • stylet (needle)-insertion
  • cannula- continous access

position
- within peripheral vessels

size (gauge)
- 26 gauge (smallest) to 14 gauge (largest)

duration of uses
- rotate sites based on clinical indication

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13
Q

best practice considerations for peripheral IV therapy

A
  • avoid areas of joint flexion
  • choose mosy distal site possible
  • avoid dominant side if possible
  • do not use side of mastectomy, av fistula,, lympth node dissection or paralysis
  • limit unsuccessful attempts to 2 per clinician
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14
Q

midline catheters

A

catheter components
- single or doible lumen

position

  • inserted into median antecubital, basilic or cephalic vein
  • tip resides no further than axillary vein

size

  • 3-8 inches long
  • 3-5 french

duration of use
- 6-14 days

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15
Q

best practice considerations for midline catheters

A
  • do not infuse parenteral nutrition
  • do not use to draw blood
  • do not admin incompatible drugs if double lumen
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16
Q

central venous catheters

A
  • VAD placed in central circulation

placement confirmation

  • CXR
  • magnet tip locator electrocardiogram
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17
Q

peripherally inserted central catheters (PICCC)

A

catheter components
- single dual or triple lumen

position

  • basilic preferred, cephalic okay
  • tip resides in SVC

size

  • 18-29 inches
  • 2-6 fr

duration
- months

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18
Q

best practice considerations for peripherally inserted central catheters (PICCC)

A
  • contrats injection- power PICCC only

- 10ml barrel syringes only

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19
Q

non tunneled

A
  • inserted percutaneously
  • cath exits skin near cannulation site
  • subclavian or internal jugular
  • resides in SVC or IVC
  • short term use
  • up to 5 lumens
20
Q

tunneled

A

portion of catheter under subcu tissue

  • seperates where catheter enters vein and exits skin
  • reduces risk of infection
  • long term use
  • single dual or triple lumen
21
Q

implanted ports

A
  • long term use: 1 year +, chemo

catheter components:

  • portal body, dense septum over a reservoir and catheter
  • subq pocket house the port body

access

  • no part of catheter is visible
  • need non-coring needle
22
Q

primary admin set

A

allows for continous ir intermitted infusion direct from container to catheter

23
Q

secondary admin set

A

piggy back

- delivery of intermittent medications

24
Q

infusion pumps

A

typically seen in acute and longterm care centers

  • measure volume of fluid being infused
  • each pump requires dedicated tubing specific to pump
25
Q

syringe pumps

A
  • largest syringe inserted into pump
  • electronic or battery powered piston to push plunger
  • for small volumes only
26
Q

ambulatory pumps

A
  • home care

- usually programable

27
Q

needlestick saftey and prevention act

A

safety needles
- retractable needle or shielding needles

needlesless connection devices

  • luer lock connectors
  • vigorously scrub connector”hub” for a minimum of 10 seconds with alc
  • scrub the hub
28
Q

considerations for older adults: skin integrity

A
  • thins, looses sub q fat —-> decreased elasticity
  • increase risk for infilitration/ extravasation d/t fluid leakage
  • increase skin tears
29
Q

considerations for older adults: cardiac renal changes

A
  • poor perfusion/circulation
  • risk for circulatory overload
  • decreased filtration/ excretion
  • decrease dosing may be needed
30
Q

complications of infusion therapy

A
  • local
  • systemic
  • cvc dwell
31
Q

local complications

A
  • occur near catheter site
32
Q

systemic complications

A
  • involve entire vascular system

- may affect multiple systems

33
Q

cvc dwell complications

A

complications specifc to central line insertion or dwelling

34
Q

examples of local complications

A
  • infiltration
  • extravasation
  • thrombosis
  • site infection
  • phelbitis
35
Q

infiltration

A

complication: leakage of nonvesicant solution

causes

  • inflammation
  • puncture of opposite vessel wall

clinical manifestations

  • skin- cool, tight, tender
  • fluid leaking from the puncture site

interventions

  • stop infusion, remove site
  • elevate extremity
  • cold compress

prevention

  • stabilize catheter
  • avoid pressure
  • assess frequently
36
Q

extravasation

A

complication
- leakage of vesicant solution

causes
- same as infiltration

clinical manifestations

  • in attrition to those associated with infiltration
  • blistering/ tissue sloughing

intervention

  • stop infusion
  • surgical intervention may necessary

prevention
- see infiltration

37
Q

phlebitis

A

complication
- inflammation

causes
- mechanical- insertion technique
- chemical- fluid or medications
pathogenic-break in aseptic technique

clinical manifestations

  • pain at site
  • skin- red, inflammed, potentially hard

interventions

  • remove site if possible
  • head and elevate extremity

prevention

  • choose smallest guage necessary
  • avoid flexion sites
38
Q

thrombosis

A

blood clot within vein

causes

  • damage to endothelial linning
  • traumatic or multiple venipunctrues
  • too large a catheter for size vein

clinical manifestations
- swollen extremitiy
- tenderness/redness
slowed stopped infusion

interventions

  • stop infusion, apply cold compress
  • elevate extremity
  • potential need for surgical intervention

prevention
- use ebp ventipuncture techniques

39
Q

site infection

A

infection at insetion point, port pocket or sub c tunnel

causes

  • break in aspetic technique
  • lack of hand hygiene

clinical manifestations

  • site- red swollen warm
  • potential purelent or ordor

interventions
- clean exit site, remove catheter, send for culture, cover with dry sterile dressing

prevention

  • aseptic technique
  • hand hygiene
40
Q

circulatory overload

A
  • excess fluid in circulatory system
  • infusion rate greater than pt. system can accommodate
  • SOB, cough, increased bp
41
Q

speed shock

A
  • systemic reaction to rapid infusion of unfamiliar substances
  • drugs reach toxic levels
  • change in loc, irregular pulse, chest tightness
42
Q

catheter embolism

A
  • piece of catheter breaks off into circulation
  • anything the damages catheter
  • potentially life threatening
43
Q

cvc migration

A
  • Movement of catheter tip to another vein
  • Changes in intrathoracic pressure
  • Coughing, sneezing, heaving lifting

-STOP Infusion, Notify HCP

44
Q

cvc dislodegemnt

A
  • Movement of catheter from insertion site
  • Inadequate catheter securement
  • Changes external catheter length
  • STOP Infusion, NEVER Readvance, Notify HCP
45
Q

occlusion

A
  • Lumen is partially or totally blocked
  • Precipitate from medications, blood clots, inadequate flushing
  • Increased resistance, difficulty administering fluids/drawing blood, infusion pump stops/alarms
  • Administer appropriate medications to dissolve precipitate or blood clot
    PREVENTION!!!
  • FLUSH, FLUSH, FLUSH
    Before, between and after
46
Q

catheter related bloodstream infection

A

Occurs when pathogenic organism invades patients’ circulatory system

Clinical Manifestations
- Fever, HA, Chills, malaise
Tachycardia, hypotension, decreased U/O

Treatment

  • Determine Cause
  • Infusate – change entire infusion system, send to lab
  • Catheter – remove, send catheter tip to lab

PREVENTION
H.A.N.D.S

Med Surg 1 (25 decks)

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