infusion therapy Flashcards
1
Q
infusion therapy
A
delivery of medications in solutions and or fluids by parenteral route
2
Q
use of infusion therapy
A
- maintain or correct fluid balance and electrolyte balance
- administer medications
- replace blood or blood products
3
Q
isotonic
A
- equal solute concentrations
- no fluid shifts
4
Q
hypotonic
A
lower solute concentrations
- fluids shifts into the cell
5
Q
hypertonic solutions
A
- higher solute concentrations
- fluids shift out of the cell
6
Q
types of infusion
A
- blood components
- iv drug therapy
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
8
Q
milliters per hour equation
A
ordered volume (ml)/ number of hours
9
Q
drops per min
A
volume (ml)/ time (min) x drop factor (gtts/ml)
10
Q
modes of Iv infusion
A
- continuous
- intermittent
- direct injection/ iv push (IVP)
- patient controlled analgesic (PCA)
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
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
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
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
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
16
Q
central venous catheters
A
- VAD placed in central circulation
placement confirmation
- CXR
- magnet tip locator electrocardiogram
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
18
Q
best practice considerations for peripherally inserted central catheters (PICCC)
A
- contrats injection- power PICCC only
- 10ml barrel syringes only
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
syringe pumps
- largest syringe inserted into pump
- electronic or battery powered piston to push plunger
- for small volumes only
26
ambulatory pumps
- home care
| - usually programable
27
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
28
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
29
considerations for older adults: cardiac renal changes
- poor perfusion/circulation
- risk for circulatory overload
- decreased filtration/ excretion
- decrease dosing may be needed
30
complications of infusion therapy
- local
- systemic
- cvc dwell
31
local complications
- occur near catheter site
32
systemic complications
- involve entire vascular system
| - may affect multiple systems
33
cvc dwell complications
complications specifc to central line insertion or dwelling
34
examples of local complications
- infiltration
- extravasation
- thrombosis
- site infection
- phelbitis
35
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
36
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
37
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
38
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
39
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
40
circulatory overload
- excess fluid in circulatory system
- infusion rate greater than pt. system can accommodate
- SOB, cough, increased bp
41
speed shock
- systemic reaction to rapid infusion of unfamiliar substances
- drugs reach toxic levels
- change in loc, irregular pulse, chest tightness
42
catheter embolism
- piece of catheter breaks off into circulation
- anything the damages catheter
- potentially life threatening
43
cvc migration
- Movement of catheter tip to another vein
- Changes in intrathoracic pressure
- Coughing, sneezing, heaving lifting
Clinical manifestations - dependent on vein migration
-
-STOP Infusion, Notify HCP
44
cvc dislodegemnt
- Movement of catheter from insertion site
- Inadequate catheter securement
- Changes external catheter length
- STOP Infusion, NEVER Readvance, Notify HCP
45
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
46
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
