intravenous medication care and complication

7/31/2019 Intravenous Medication Care and Complication

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INTRAVENOUS MEDICATION

Care and Complications

Dr.T.V.Rao MD

20-10-2012 Dr.T.V.Rao MD @ Hospital care 1


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Indications for IV Medication

Indications: Intravenous access to patients circulatory

system.

Administration of Meds. & Fluids, as well asblood collection

Contraindications: IV access should be attempted as distal as

possible.

Avoid veins that cross over joints, localinfection/injury

Extremities with renal shunts or fistulas20-10-2012 Dr.T.V.Rao MD @ Hospital care 2


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Procedure for Insertion of

Peripheral IV Catheter

1. Obtain and review the order

2. Ascertain allergies

3. Gather Equipment4. Verify patients identity using two patient

identifiers

5. Explain procedure, benefits, caremanagement, and potential complications to

patient



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Procedure for Insertion of

Peripheral IV Catheter (cont)

6. Perform hand hygiene

7. Assemble equipment

8. Apply Tourniquet9. Assess veins, keeping in mind the rational for

therapy and duration of therapy

10. Apply Non sterile gloves11. Wash intended insertion site with antiseptic

soap and water. (as needed)



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Procedure for Insertion of A


13. Clean intended insertion site withantiseptic solution, workingoutward using back-and-forthmotion

14. Allow site to dry

15. Perform venipuncture whilestabilizing skin with thenondominate hand



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16. Enter skin at a 10- to- 30 degree angle.

Decrease angle when the skin has been

penetrated. When blood is obtained in the

flash back chamber, advance catheter 1/16

inch, and then slightly pull stylet back,

advancing catheter gently into vessel.

Continue to advance catheter into vein untilthe catheter hub is against the skin.



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17. Release tourniquet

18. Occlude tip of catheter by pressingfinger of non dominant hand over vein toprevent blood spillage.

19. Activate needle safety device beforeremoving stylet. Connect IVadministration set or injectioncap/needless device. Begin infusingsolutions slowly.



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22.Discard stylet in

sharps container

23. Remove gloves.

Perform hand

hygiene

24. Document

procedure in the

patients medical

record.



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Choosing IV catheter Size

Age< 1 year: 22, 24

gauge (g)

1-8 years: 18, 20,22 gauges

> 8 years: 16. 18,20 gauges



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IV Procedure

Use universal precautions (glove and eye

protection)

Allergies (beta dine or latex) Explain procedure to Pt.

Prepare all material

Select vein. Apply tourniquet above theelbow.

Prepare site



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IV Procedure (cont.)

Warn the patient of possible pain

Bevel up at 30 degree above horizontal

Look for flashback of blood into catheter

Upon seeing flashback, advance catheter

another millimeter or two

Advance the sheath completely into the vein

and release tourniquet



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IV Procedure (cont.)

Connect the IV

tubing/heplock

Secure catheter and

tubing Dispose of needles in

sharps container

Document the IV site,catheter size and date

on the patients chart



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Complications of IV Therapy

Classified according to their location

Local complication: at or near the

insertions site or as a result ofmechanical failure

Systemic complications: occur within

the vascular system, remote from theIV site. Can be serious and life

threatening20-10-2012 Dr.T.V.Rao MD @ Hospital care 13


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Local complications

Occur as adverse reactions or trauma to thesurrounding venipuncture site

Assessing and monitoring are the keycomponents to early intervention

Good venipuncture technique is the mainfactor related to the prevention of most localcomplications associated with IV Therapy.

Local complications include: hematoma,

thrombosis, phlebitis, post infusion phlebitis,thrombophlebitis, infiltration, extravasation,local infection, and veno spasm.



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Hematoma

Subcutaneous hematoma is the most common

complication

Can be a starting point for other

complications: thrombophlebitis and infection

Related to:

Nicking the vein

Discontinuing the IV without apply adequate

pressure

Applying the tourniquet to tightly above a

previously attempted venipuncture site.20-10-2012 Dr.T.V.Rao MD @ Hospital care 16


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Hematoma

Signs and symptoms:

Discoloration of the skin

Site swelling and

discomfort Inability to advance the

cannula all the way into

the vein during insertion

Resistance to positivepressure during the lock

flushing procedure

Document



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Hematoma

Prevention Use of an indirect method

Apply tourniquet just before

venipuncture Use a small need in the elderly and

patients on steroids, or patients with thin

skin.

Use blood pressure cuff to apply pressure

Be gentle20-10-2012 Dr.T.V.Rao MD @ Hospital care 18


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Hematoma

Treatment

Apply direct, light

pressure for 2-3

minutes after needle

removed

Have patient elevate

extremity

Apply Ice



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Thrombosis

Catheter-related obstructions can be

mechanical or non-thrombotic

Trauma to the endothelial cells of the venous

wall causes red blood cells to adhere to the

vein wall, forms a clot or Thrombosis

Drip rate slows, line does not flush easily,

resistance is felt

Never forcible flush a catheter



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Thrombosis Signs and Symptoms

Fever and Malaise

Slowed or stopped infusionrate

Inability to flush

Prevention Use pumps and controllers

to manage flow rate

Micro drip tubing for ratebelow50mL/hr

Avoid areas of flexion

Use filters

Avoid lower extremities



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Thrombosis

Treatment Never flush a cannula

to remove an

occlusion

Discontinue the

cannula

Notify the physicianand assess the site

for circulatory

impairment20-10-2012 Dr.T.V.Rao MD @ Hospital care 23


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Phlebitis

Inflammation of the vein

in which the endothelial

cells of the venous wall

become irritated and cells

roughen, allowing

platelets to adhere and

predispose the vein to

inflammation-induced

phlebitis

Tender to touch and can

be very painful



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Phlebitis

Mechanical: To large a catheter for the size of the vein

Manipulation of the catheter: improper stabilization

Chemical: vein becomes inflamed by irritating orvesicant solutions or medication

Irritation medication or solution

Improperly mixed or diluted Too-rapid infusion

Presence of particulate matter



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Phlebitis

Chemical (cont):

The more acidic the IV solution the greater the

risk

Additives: Potassium

Type of material

Length of dwell:

30% by day 2, 39-40% by day 3 (Macki and Ringer)

The slower the rate of infusion the less irritation



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Phlebitis

Bacterial

Also called Septic phlebitis: least common

Inflammation of the intima of the vein

Contributing factors

Poor aseptic technique Failure to detect breaks in the integrity of the equipment

Poor insertion technique

Inadequate stabilization

Failure to perform site assessment Aseptic preparation of solutions

Hand washing and preparing the skin



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Phlebitis

Post infusion

Inflammation of the vein 48-96 hr after discontinued

Factors that contribute:

Insertion technique

Condition of the vein used Type, compatibility, pH of solution used

Gauge, size, length, and material

Dwell time

Infrequent dressing change

Host factors: age, gender, age and presence of disease



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Phlebitis

Immune system causes leukocytes to

gather at the inflamed site

Pyrogens stimulate the hypothalamus toraise body temperature

Pyrogens stimulate bone marrow to

release more leukocytes Redness and tenderness increase



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Phlebitis

Signs and Symptoms Redness at the site

Site warm to touch

Local swelling

Palpable cord along the vein

Sluggish infusion rate

Increase in basal temperature of 1degree C or more

Prevention Use larger veins for hypertonic solutions

Central lines for Infusions lasting longer than 5 days



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Thrombophlebitis

Thrombophlebitis denotes a twofold

injury: thrombosis and inflammation

Related to: Use of veins in the lower extremity

Use of hypertonic or highly acidic infusion

solutions Causes similar to those leading to phlebitis



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Thrombophlebitis

Signs and Symptoms

Sluggish flow rate

Edema in the limbs Tender and cord like vein

Site warm to the touch

Visible red line above venipuncture site Diminished arterial pulses

Mottling and cyanosis of the extremities20-10-2012 Dr.T.V.Rao MD @ Hospital care 33


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Thrombophlebitis

Prevention

Use veins in the forearm rather than the hands

Do not use veins in a joint

Assess site q 4 hr in adults, q 2 hr in children

Catheter securement

Infuse at rate prescribed

Use the smallest size catheter to do the job

Proper dilution



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Thrombophlebitis

Septic thrombophlebitis can be

prevented:

Appropriate skin preparation Aseptic technique in the maintenance of

infusion

Proper hand hygiene 60% from patients skin

35% from the line itself

5% from hands20-10-2012 Dr.T.V.Rao MD @ Hospital care 35


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Extravasations

Signs and Symptoms

Complaints of pain or burning

Swelling proximal to or distal to the IV site

Puffiness of the dependent part of the limb

Skin tightness at the venipuncture site

Blanching and coolness of the skin

Slow or stopped infusion

Damp or wet dressing



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Extravasations

Prevention: Use of skilled practitioners

Knowledge of vesicants

Condition of the patients veins

Drug administration technique

If continuous give in CVAD

Only with brisk blood return of 3-5 cc

Use of a free flow IV

Do not use a pump on vesicants given peripherally

Assess for blood return frequently



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Personal safety of Health

Care Workers


S


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Steps to prevent

needle sticks

Wear gloves

Do Not Bend or Break Needles

Never RECAP!!!

If you must, use the One Handed technique

Take your time

Dispose of contaminated needles immediatelyin puncture-resistant containers



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Risks to you - if Careless

Risks after needle Sticks Exposure

Hepatitis B: 10-30%

Hepatitis C: 2%

HIV: 0.4 %

Other blood borne pathogens



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POLICY ON ACCIDENTAL NEEDLE

STICKS

Immediately wash injured area.

Report all needle sticks immediately to your instructor orimmediate supervisor.

Complete an incident report and report to employee healthor ED.

Determine if the needle was clean or dirty.

Cleansing wound with antiseptic.

Request that the identified patient be tested for Hepatitis B

surface antigen and HIV antibodies. Have your blood tested for Hepatitis B and HIV antibodies as

soon as possible.

Begin drug treatment (if necessary) & counseling.



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Programme Created by Dr.T.V.Rao MD

for Medical and ParamedicalProfessionals in the Developing World

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