Infusion Therapy Flashcards
Normal serum osmolarity
270-300
When must therapy be infused in central circulation where greater flow provides adequate hemodilution?
Osmolarity >600
pH 9
TPN osmolarity
> 1400
Primary tubing is good for how long?
72-96 hrs
Lipids/TPN tubing is good for how long?
24 hrs
Propofol tubing is good for how long?
6-12 hrs
Blood tubing is good for how long?
4 hrs
Piggyback
Must have primary infusion, Y-site connection above infusion pump
Int tubing
No primary infusion, cap when not in use, both ends being manipulated when hanging drug, good for 24 hrs
Where to place filters?
As close to cath hub as possible
Standard blood filter size
170-220 microns
Gross particles filter size
0.5 microns
Filter lipid containing TPN
1.2 microns
Filter all particles and microorganisms
0.22 microns
More potent drugs with what?
Central accesses
24-26 G
Infants and small children, not for viscous infusions
22 (blue)
Adequate from most therapies, elderly w/ fragile veins
20 (pink)
Adequate for all therapies, minimum size for sx
18 (green)
Requires large vein, preferred for sx
14-16
Requires large vein, large volume resuscitation
Antecubital vein
Reserve for lab draws and emergency access
IV dwell time
72-96 hours
What to clean site w/
70% alcohol or chlorohexidine
Length of IV therapy
3-7 days
When to remove PIVs inserted in emergency?
ASAP
When to change transparent (tegaderm) dressing?
Q 7 days and PRN
When to change opaque (gauze and tape/island)
Q 48 hrs and PRN
How long are midline caths?
3-8 inches, 3-5 Fr
Lumen of midline caths
Single or double
Where are midline caths inserted?
Through vein in upper arm.
Median AC vein is common
-Basilic over cephalic
Where does the tip of midline caths reside?
In peripheral vein
Indications for midline caths
Hydration fluids
Therapies lasting 1-4 wks
Difficult stick r/t impaired skin
Anticoagulation/steroids
What not to use midline cath for
Vesicant drugs, TPN, drawing blood
Who can insert midline cath?
Qualified nurse
-Sterile technique, sterile dressing changes
Where does tip reside in central cath?
Central circulation vein, specifically the superior vena cava
Positioning for PE
Left lateral trendelenburg
PICC length
19-29 inches
Lumen of PICC
Single, double, or triple
Who can insert PICC
Requires special training
Where is PICC inserted
AC fossa or middle of upper arm
PICC is good for what?
- Long term therapy (wks-1 year)
- No limitations on pH or osmolality
- Draw blood from larger port
Nursing implications for PICC
- Informed consent
- Sterile insertion (CVL bundle)
- Sterile dressing change
- Chest x-ray prior to use
- Routine flushing (SASH)
Common complications of PICC
- Cath breakage
- Phlebitis
- Thrombophlebitis
- DVT
- Cath related bloodstream inx
- Tip migration
Non-tunneled central venous cath insertion site
Subclavian, IJ, femoral
Non-tunneled length
1-10 inches
Non-tunneled lumens
1-5
Which cath is available w/ antimicrobial coats
Non-tunneled
Where does tip reside with non-tunneled
Superior vena cava, typically sutured in
Non-tunneled is commonly used for what?
Emergent trauma, critical care, sx
*Short-term use
Nursing implications for non-tunneled
- Informed consent
- Trendelenburg
- Roll between shoulders
- X-ray verification
- Sterile insertion/change
- Site assessment
Common complications of non-tunneled
Infection, occlusion
Cath-related bloodstream infection prevention bundle
- Use a checklist
- Wash hands before
- Maximal barrier precautions (pt is draped from head to toe w/ sterile barrier)
- Sterile gloves, gown, mask
- Minimal people in room during insertion
- Chlorhexidine
- Preferred sites
- Post-placement care
- Review daily the need for cath
Tunneled central cath
Portion is tunneled through subq tissue, cuff resides in tunnel, tissue granulates into cuff which secures cath, cuff may have antimicrobial solution applied
Benefits of tunneling
Infection prevention
Frequent, long term therapy (months-years)
Good when pt is not PICC candidate
Lumens of tunneled
1-3
Why do some pts prefer tunneled over a port?
Needless access
Implanted ports lumen
Single or double
Parts of implanted ports
Body, septum, reservoir, catheter
Where is an implanted port inserted?
Into a subq pocket in skin, cath is inserted into a vein
Where are implanted port sites?
Upper chest or upper extremity
Implanted ports feed into what?
SC or IJ, tip in SVC
How many sticks with implanted ports?
Good for long-term use
Chest: 2000 sticks
UE: 750 sticks
How to access an implanted port?
Non-coring needle with deflected point (huber)
*Needle stick injury risk on removal, sterile access
Power port
Used for contrast to identify the implanted port location. Identify the triangle shape and palpate 3 bumps
Hemodialysis caths
- Large bore lumen
- Tunneled or non
- Perm cath (tunneled)
- Vas cath
- Use only for hemodialysis/pheresis
Heparin locked hemodialysis cath
- 1,000-10,000 units/mL
- LABEL!
- Ports typically labeled w/ volume of heparin to infuse for locking purposes
How to care for phlebitis
- Remove IV
- Warm compress
- Monitor
- Document
How to care for infiltration
- Remove IV
- Cool or warm compress
- Monitor
- Document
How to care for extravasation
- Stop infusion
- Aspirate drug
- Leave cath in place
- Notify doc
- Admin antidote
- Cool compress
- Document
How to care for hematoma
- Remove device
- Apply direct pressure, elevate
- Check for bleeding
How to care for occlusion
- Assess for bends/kinks or clamped tubing
- Assess pt flexion
- Use mild flush. If not successful, remove device
How to care for pain at IV site
- Decrease flow rate
- Dilute fluid if possible
- Consider central access
Signs of circulatory overload
SOB, cough, HTN, peri-orbital edema, dependent edema, JVD, crackles
How to care for circulatory overload
Slow rates, notify MD/HCP, monitor VS, place upright, admin o2 prn, admin diuretics prn
Speed shock
Rapid infusion of drugs or bolus infusion that causes drugs to reach toxic level quickly
S/s of speed shock
Lightheaded/dizzy, chest tightness, flushed appearance, irregular pulse, cardiac arrest
How to care for speed shock
Discontinue infusion and hang isotonic solution to keep vein open, monitor VS, notify doc
Causes of catheter embolism
Insertion, dressing change, excessive admin forces
S/s of catheter embolism
Depends where the catheter embolizes, cardiac arrest
How to care for catheter embolism
Emergently notify doc, determine how much of catheter has embolized (may require removal of catheter if not already done), x-ray, sx intervention may be required
Pneumothorax
Puncture of pleural covering by introducer. Metal stylet is used during insertion and can puncture things other than vein
S/s of pneumothorax
Chest pain, dyspnea, apprehension, cyanosis, decrease BS on affected side, abnormal x-ray
Tx of pneumothorax
O2, chest tube
Hemothorax
Puncture of vein or artery
S/s of hemothorax
Dyspnea, tachycardia, decreased Hgb
Tx of hemothorax
Apply pressure at site, insert chest tube
With lumen occlusion, the catheter lumen is partially or totally blocked. You will not be able to aspirate blood, and may or may not be able to flush. If you can flush, it will be very sluggish flow. How can this be prevented?
With appropriate maintenance flushing
S/s of air embolism
Chest pain, dyspnea, hypoxia, anxiety, hypotension, nausea, lightheaded, possible loud churning over pericardium on auscultation
Tx of air embolism
Clamp cath, place pt in left lateral trendelenburg, notify doc, O2, ABG, EKG
S/s of cath malposition
May have none. Found on chest x-ray. May have ear, neck, back pain or heart palpitations or dysrhythmias
Tx of cath malposition
Notify doc to reposition cath. Verify placement with x-ray prior to use
