ch 17 iv infusions dd

8/8/2019 Ch 17 IV infusions dd

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INFUSION THERAPYINFUSION THERAPY

Chapter 17


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General Information

Elsevier items and derived items 2006 by Elsevier Inc.

y Review Chart 15-1

y Short peripheral catheters can stay in the vein 72-96 hrs

y Therapy requiring IV for greater than 6 daysshould have midline insertion therapy

y Avoid veins on hands of older people or activepatients

y Avoid veins on palms side of wrist because mediannerve location make site painful and it is hardsecure


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Parenteral Nutrition


y Formulas: dextrose, protein, fat, vitamins, andnumerous trace elements tailored to the specificmetabolic needs of the client

y Only used when the gastrointestinal tract cannot beused

y Central

y Peripheral


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Blood Transfusions and Other Components


y Packed red blood cells

y Platelets

y Fresh frozen plasma

y Albumin

y Several specific clotting factors


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Medications


y IV medications provide a rapid therapeutic effect butcan also lead to immediate serious reactions.

y Prescription for infusion therapy is necessary.


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Vascular Access Device (VAD)


y Short peripheral catheters

Superficial veins of the hand and forearm

Dwell for 72 to 96 hours and then require removal and

insertion into another venous sitey Complaints of tingling, feeling of pins and needles

in the extremity, or numbness during thevenipuncture can indicate nerve puncture.


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Midline Catheter


y Catheter that is 6 to 8 inches long, inserted throughveins of the antecubital fossa

y Used for therapies lasting from 1 to 4 weeks

y Should not be used for infusion of vesicantmedications, which can cause tissue damage if theyescape into the subcutaneous tissue (extravasation)


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Peripherally Inserted Central Catheter (PICC)


y Length ranges from 40 to 65 cm.

y Basilic vein is the preferred site for insertion;cephalic vein can be used.

y Placement is confirmed by chest x-ray examination.

y No information is available on optimal dwell time.

y Teach clients to perform normal ADLs, avoiding

excessive physical activity.


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Nontunneled Percutaneous Central Catheter


y Inserted through subclavian vein in the upper chestor jugular veins in the neck

y Usually 15 to 20 cm long

y Tip resides in the superior vena cava

y Placement confirmed by chest x-ray examination

y No recommendations for optimal dwell time


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Tunneled Central Catheter


y A portion of the catheter lying in a subcutaneoustunnel separates the points at which the catheterenters the vein from where it exits the skin.

y Tunneled central catheter is used for infusiontherapy that is frequent and long-term.


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Implanted Port


y Implanted ports consist of a portal body, a denseseptum over a reservoir, and a catheter.

y A subcutaneous pocket is surgically created to

house the port body.

y Port is usually placed in the upper chest or theupper extremity

y Port needs to be flushed after each use and at leastonce a month between courses of therapy.


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Dialysis Catheter


y Lumens are very large to accommodate thehemodialysis procedure or a pheresis procedure thatharvests specific blood cells.

y This catheter should not be used for administrationof other fluids or medications, except in anemergency.


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Infusion System


y Containersy Administration setsy Add-on systemsy

Needleless connection devicesy Rate controlling devices: Controller Pumps

Syringe pumps

Ambulatory pumps


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Catheter Care andMaintenance


y Educating the client

y Confirming tip location

y Performing the nursing assessment

y Securing and dressing the catheter

y Changing administration sets and needlelessconnectors

y

Controlling infusion pressure (Continued)


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Catheter Care andMaintenance (Continued)


y Flushing the catheter

y Obtaining blood samples from the catheter

y Removing the catheter


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Complications


y Table 15-2

y Infiltration stop IV, apply cold compress

y Phlebitis Scale table 15-6, describe

y Hematoma apply direct pressure

y Pulmonary embolus- Oxygen, filters, heparin, anti -throbolytic

y

Air embolus clamp,L

lateral trendelenburgy Circulatory overload slow IV rate, upright position,

diuretic


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Considerations for Older Adults


y Skin care precautions

y Vein and catheter selection

y Cardiac and renal changes


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Alternative Sites for Infusion


y Arterial therapy

y Intraperitoneal infusion

y Subcutaneous infusion

y Intraspinal infusion

y Intraosseous therapy

ch 17 iv infusions dd

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