infusion therapy Flashcards
infusion therapy
delivery of medications in solutions and or fluids by parenteral route
use of infusion therapy
- maintain or correct fluid balance and electrolyte balance
- administer medications
- replace blood or blood products
isotonic
- equal solute concentrations
- no fluid shifts
hypotonic
lower solute concentrations
- fluids shifts into the cell
hypertonic solutions
- higher solute concentrations
- fluids shift out of the cell
types of infusion
- blood components
- iv drug therapy
what should be included in an order
drug name specfic dose and route frequency of admin times of admin length of time for infusion
milliters per hour equation
ordered volume (ml)/ number of hours
drops per min
volume (ml)/ time (min) x drop factor (gtts/ml)
modes of Iv infusion
- continuous
- intermittent
- direct injection/ iv push (IVP)
- patient controlled analgesic (PCA)
vascular access devices (VAD)
- 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
peripheral IV therapy
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
best practice considerations for peripheral IV therapy
- 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
midline catheters
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
best practice considerations for midline catheters
- do not infuse parenteral nutrition
- do not use to draw blood
- do not admin incompatible drugs if double lumen
central venous catheters
- VAD placed in central circulation
placement confirmation
- CXR
- magnet tip locator electrocardiogram
peripherally inserted central catheters (PICCC)
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
best practice considerations for peripherally inserted central catheters (PICCC)
- contrats injection- power PICCC only
- 10ml barrel syringes only
non tunneled
- inserted percutaneously
- cath exits skin near cannulation site
- subclavian or internal jugular
- resides in SVC or IVC
- short term use
- up to 5 lumens
tunneled
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
implanted ports
- 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
primary admin set
allows for continous ir intermitted infusion direct from container to catheter
secondary admin set
piggy back
- delivery of intermittent medications
infusion pumps
typically seen in acute and longterm care centers
- measure volume of fluid being infused
- each pump requires dedicated tubing specific to pump
syringe pumps
- largest syringe inserted into pump
- electronic or battery powered piston to push plunger
- for small volumes only
ambulatory pumps
- home care
- usually programable
needlestick saftey and prevention act
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
considerations for older adults: skin integrity
- thins, looses sub q fat —-> decreased elasticity
- increase risk for infilitration/ extravasation d/t fluid leakage
- increase skin tears
considerations for older adults: cardiac renal changes
- poor perfusion/circulation
- risk for circulatory overload
- decreased filtration/ excretion
- decrease dosing may be needed
complications of infusion therapy
- local
- systemic
- cvc dwell
local complications
- occur near catheter site
systemic complications
- involve entire vascular system
- may affect multiple systems
cvc dwell complications
complications specifc to central line insertion or dwelling
examples of local complications
- infiltration
- extravasation
- thrombosis
- site infection
- phelbitis
infiltration
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
extravasation
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
phlebitis
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
thrombosis
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
site infection
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
circulatory overload
- excess fluid in circulatory system
- infusion rate greater than pt. system can accommodate
- SOB, cough, increased bp
speed shock
- systemic reaction to rapid infusion of unfamiliar substances
- drugs reach toxic levels
- change in loc, irregular pulse, chest tightness
catheter embolism
- piece of catheter breaks off into circulation
- anything the damages catheter
- potentially life threatening
cvc migration
- Movement of catheter tip to another vein
- Changes in intrathoracic pressure
- Coughing, sneezing, heaving lifting
-STOP Infusion, Notify HCP
cvc dislodegemnt
- Movement of catheter from insertion site
- Inadequate catheter securement
- Changes external catheter length
- STOP Infusion, NEVER Readvance, Notify HCP
occlusion
- 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
catheter related bloodstream infection
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
