IV Therapy Flashcards
Infusion therapy
-delivery of meds and solutions by parenteral route
- Intervenous (IV)= most common
Uses for infusion therapy
- nutrients
-maintain fluid balance (or correct) - maintain electrolyte or acid balance (or correct)
-admin meds (ex. Antibiotics) - replace blood or blood products
Isotonic
=equal solute concentration
(No shift in fluids)
-Ex. 0.9% normal saline
- older pt @ risk for fluid overload
Hypotonic
=lower solute concentration
(Fluid shift into the cell)
- pt @ risk for phlebitis and infiltration
- used for dehydration
Hypertonic
= higher solute concentration
(Fluids shift out of the cell)
-ex. Parenteral nutrition
5% dextrose
0.9% normal saline
Blood/ blood components
= blood transfusion
-check compatibility
IV drug therapy
= rapid therapeutic effect
-Ex. Antibiotic= amoxicillin
*special considerations
- dilution
-rate of infusion
-IV compatibility
- appropriate infusion site
Prescribing Infusion Therapy: Fluids
- Type
- Rate(mL/hr)(total amount and hours for infusion)
- Drugs and dose to be added
Prescribing Infusion Therapy: Drugs in IV Fluids
- Drug name
- Specific dose and route
- Frequency of admin
- Time(s) of admin
- Length of time for infusion (#of doses/days)
- Purpose
Phlebitis
=inflammation of vein
-Causes: mechanical- insertion technique
chemical- fluid or med
pathological- break in aseptic technique/ long dwell length
- Clinical man: pain @ sight
Skin= red, inflamed, potentially hard
- Prevention: choose smallest gauge possible
avoid areas of flexion
- Intervention: remove site
heat and elevate extremity
Infiltration
=leakage of non-vesicant solution into surrounding tissues
-Causes: inflammation
puncture of opposite vessel wall
- Clinical Man: skin= cool, tight, tender
fluid leaking from puncture site
-Prevention: stabilize cath
avoid pressure on/near site (ex. Restraints/ bp cuff)
assess frequently
-Intervention: stop infusion, remove site
elevate extremity
cold/warm compress
Extravasation
= leaking of vesicant solution
-Causes: inflammation
puncture of opposite vessel wall
-Clinical man: blistering/tissue sloughing
-Prevention: Stabilize cath
avoid pressure on their site (ex. Restraints and bp cuff)
access frequently
-Intervention: stop infusion
surgical intervention may be necessary
  Thrombosis
= blood clot within vein
-Causes: damage to endothelial lining (traumatic multiple veiny punctures, two large catheter for size of vein)
-Clinical man: swollen extremity
tenderness/redness
slowed/stopped infusion
-Prevention: use EBP vein puncture techniques
- Intervention: stop a infusion, apply cold compress
elevate extremity
potential need for surgical intervention
Site Infection
=infection @ insertion point, port pocket, or subQ tunnel
-Causes: break in aseptic technique
lack of hand hygiene
-Clinical Man: site=red, warm, swollen
potential purulent or odorous exudate
-Prevention: aseptic technique
hand hygiene
-Intervention: clean exit site, remove cath, send for culture, cover w/ dry sterile dressing
Circulatory Overload
(systemic complication)
=excess fluid in the circulatory system
-The infusion rate is > than pts system can accommodate
-Clinical man: SOB, cough, increased BP
Speed Shock
(systemic complication)
=systemic reaction to rapid infusion of unfamiliar substance
-drugs reach a toxic level
-Clinical man: change in LOC, irregular pulse, chest tightness
Catheter Embolism
(systemic complication)
=piece of cath breaks off into circulation
-anything that damages cath
-potentially life threatening
Central Intravenous Therapy
=vascular access device (VAD) placed in central circulation, specifically w/in Superior vena cava (SVC) near junction w/rigth atrium
-chest x-ray needed to confirm placement
-newer tech (magnet tip locator, electrocardiogram) can also be used to detect placement)
Migration
(Central venous Cath Complication)
=movement of cath tip to another vein
-Caused by: changes in intrathoracic pressure
-Ex. coughing, sneezing, heavy lifting
-Clinical man: depend on vein migration
-Intervention: Stop infusion, notify HCP
Occlusion
(Central venous Cath Complication)
=lumen is partially or totally blocked
-precipitate from meds, blood clots, inadequate flushing
-Causes: increased resistance, difficulty admin fluids/ drawing blood, infusion pump stops/ alrams
-Prevention: flush, flush, flush (before, between, after)
Dislodgement
(Central venous Cath Complication)
=movement of cath from the insertion site
-Caused by: inadequate cath securement
-will change cath length
-Intervention: stop infusion, never readvance, notify HCP
Midline Catheters
-Cath Components: single or double lumen
-Position: inserted into median antecubital basilic or cephalic vein
tip resided no further than the axillary vein
-Size: 3-8 inches long
3-5 Fr ( larger the #= larger the diameter)
-Duration of use: 6-14 days
Special considerations do not infuse parenteral nutrition, use to draw blood, admin incompatible drugs simultaneously if double lumen
Peripherally Inserted Central Catheter
(PICC)
-Cath components: single, double, or triple lumen
-Position: basilic preferred, cephalic okay
tip resided in SVC
-Size: 18-29 inches
2-6 Fr (4 or > for blood draws)
-Duration: months
Special considerations contrast injection= power PICC only
10mL barrel syringes ONLY
Catheter-Related Bloodstream Infection (CRBI) BUNDLE
-proper aseptic hand hygiene
-measuring upper arm circumference as a baseline before insertion
-maximal barrier precautions on insertion
-chlorohexidine skin antisepsis
-optimal cath site selection and post-placement care w/ avoidance of the femoral vein for central venous access in adult pts
-daily review of line necessity w/ prompt removal of unnecessary lines
Non-tunneled Percutaneous Central Venous Catheter
-Position: inserted through a subclavian vein in the upper chest or jugular veins in the neck
-may require insertion in femoral vein- the rate of infection is high
*tip resided in SVC
-Size: 7-10 inch (15-25cm); up to 5 lumens
-Duration: short-term use
Tunneled Central Venous Catheter
-portion lies in subQ tunnel
-has a cuff of antibiotics-containing material to help reduce inflammation
-used for frequent and long-term infusion therapy
-Broviac, Hickman, Leonard
Implanted Ports
-consists of portal body, dense septum over a reservoir, and cath
-surgically created subQ packet houses the port body
-some are power injectable
-used most often for chemotherapy
-flush after each use and @ least once monthly between therapy
Containers: Infusion System
stores the fluid/med
1. glass: require air vent
2. plastic: closed system, no air vent needed for air flow for infusion= uses gravity
Administration Sets: Infusion System
connects the container to cath
-Primary Admin Set: allows for continuous or intermittent infusion direct from container to cath
-Secondary Admin Set(Piggyback): delivery of intermittent meds
Rate Controlling Devices: Infusion System
-Infusion pumps: acute or long-term care and infusion centers
they measure the volume of fluid being infused
each pump requires dedicated tubing specific to pump
-Syringe Pumps: large syringe is inserted into pump
electronic or battery-powered piston to push the plunger
for small volume only
Nursing care for Pts Recieving IV Therapy
-educate pt
-performing the nursing assessment
-securing and dressing the cath
-changing admin sets and needleless caths
-controlling infusion pressure
-flushing
-obtaining blood samples for CVCs
-removing the vascular access device
-documenting IV therapy
Considerations for Older Adults
-Skin integrity: thin, loose subQ fat= decreased elasticity
=increased risk for infiltration/extravasation d/t fluid leakage
=increased skin tears
-Cardiac/ Renal Changes: poor perfusion/circulation
=risk for circulatory overload
decreased filtration/excretion
=decreased dosing may be needed (renal dosing)
Normal serum osmolarity for adults
270-300 m0sm/L
Hypertonic value
> 300 m0sm/L
Hypotonic value
<270 m0sm/L
Measure of pH in solution
3.5-6.2
