Infusion Therapy

Front 1

infusion therapy:

Back 1

The delivery of parenteral medications and fluids through a wide variety of catheter types and locations using multiple techniques and procedures.

Front 2

Goals of IV infusion:

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Achieving normal fluid and electrolyte balance.
Achieving optimal nutrional status.
Maintaining hemostasis through blood and blood component administration.
Treating numerous conditions with medications.

Front 3

Parenteral Nutrition Formulas

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Include dextrose, protein, fat, vitamins, and numerous trace elements tailored to the specific metabolic needs of the client.

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IV Order must contain:

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Specific type of fluid.
Rate of administration.
Medications and the specific dose to be added to the fluid such as electrolytes or vitamins.
Medication name, preferably the generic name.
Specific dose and route.
Frequency of administration.

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Catheter

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(VAD) Vascular access device: a plastic tube placed in a blood vessel to deliver fluids and medications.

Front 6

Short Peripheral Catheters

3/4 in - 1 1/4 in
26 - 14 gauge

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A plastic cannula built around a sharp stylet extending slightly beyond the cannula.

Inserted into superficial veins of the hand and forearm.

In emergent situations, these catheters can also be used in the external jugular vein of the neck.

72-96 hours then removal is required...if more therapy needed then new site must be located.

Dorsal venous network, basilic, cephalic, and median veins as well as their branches.

Front 7

Always choose the smallest gauge capable of delivering the prescribed therapy...why?

Back 7

The larger the gauge, the faster the flow BUT w/ an increased risk for phlebitis.

Front 8

If a client will be receiving iv therapy for more that 6 days...what VAD shoud be used?

Back 8

A midline or PICC line.

Front 9

Veins on the palm side of the wrist should not be used...why?

Back 9

The median nerve is located close to veins in this area, making venipuncture very painful and difficult to stabilize.

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Peripheral Catheters:
24- and 26-gauge

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Neonates, pediatric, and older clients.
Recommended when extremely small-diameter veins are the only choice.
Blood return in the flash chamber may be slower.
Suitable for most infusions, but flow rates are slower.
May be used for blood transfusion w/out an infusion pump; a unit of packed red blood cells should be divided into two bags to accomodate the extended infusion time.

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Peripheral Catheters:
22-gauge

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Used for all infusions including blood and blood products.
Infusion rates will be slightly slower.
Recommended formost adults, especially those with small or fragile veins.
Not appropriate when rapid flow rates are required such as trauma or surgery.

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Peripheral Catheters:
20-gauge

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Used for all infusions including blood and blood products suitable for minor surgical procedures.
Most commonly used size.

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Peripheral Catheters:
18-Gauge

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Trauma and surgery.
Rapid flow rates.
Requires a large vein to allow room for blood to flow in the vein around the catheter.
Irritation to the vein wall and phlebitis results when the catheter is too large for the chosen vein.

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Peripheral Catheters:
16- and 14-gauge

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High-risk surgical procedures and trauma.
Large volumes and rapid flow.
Requires a large vein.
Mechanical irritation and phlebitis are likely.

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Common IV Sites

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Inner arm and dorsal surface of hand.

Front 16

Midline Catheters:

6-8 in

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Inserted through the veins of the antecubital fossa. The basilic vein is favored over the cephalic vein because of it's larger diameter, and it will allow greater hemodilution of the fluids and medications being infused.

Catheter tip is located in the upper-arm level w/ the axilla.

Therapies from 1 to 4 weeks.

Used when skin integrity or limited peripheral veins make it difficult to maintain a short peripheral catheter.
Fluids for hydration.
5-10 days of antibiotics to treat urosepsis or pneumonia.
Heparin infusions for deep vein thrombosis.
Bronchodialators, such as aminophylline.
Steroids.

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Midline catheters should not be used:

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for infusion of 'vesicant' medications (cause tissue damage if contacts sub-q tissue called extravasation)

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Peripherally Inserted Central Catheters (PICC):

catheter length: 40-65 cm
(tip resides in SVC-superior vena cava)

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A long catheter inserted through the veins of the antecubital fossa or the middle of the upper arm.

Avoid placement of catheter tip in veins distal to the SVC.

Basilic vein is the preferred site for insertion; however, the cephalic vein can be used if necessary.

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PICCS can be used for blood sampling?

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Yes. But lumen sizes of 4F or larger are recommended.

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Nontunneled Percutaneous Central Catheter:

15-20 cm long w/ dual or triple lumens

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Inserted through the subclavian vein in the upper chest or the jugular veins in the neck using sterile technique.

The tip rests in the SVC verified by chest xray.

Used for emergent or trauma situations, critical care and surgery.

Client must be in Trendelenburg position usually with a rolled towel in between the shoulder blades.

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Tunneled Central Catheters

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A portion of the catheter is lying in a subcutaneous tunnel. Separating where the catheter enters the vein from where it exits the skin.

This prevents the organisms on the skin from entering the bloodstream.

Needed when infusion therapy is frequent and long-term.

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Implanted ports:

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Consist of a portal body, a dense septum over a reservoir, and a catheter. Usually sits in a subcutaneous pocket that is surgically created.

Sub-Clavian/Jugular Vein

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Huber needles

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Noncoring port access needles

May have a straight shaft or right angle.
Some come with wings to stabalize the needle.

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Dialysis catheters:

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Very large lumens to accommadate the hemodialysis procedure or a pheresis procedure that harvests specific blood cells.

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Local complications of IV

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Occur at or near the catheter.

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Systemic complications:

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Occurs in complete vascular system or multiple systems.

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Short and midline catheters should not be routinely used for blood samples? T/F

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True.

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If blood sampling from a central venous catheter is the best alternative...

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use methods that do not require the use of a needle.

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Phlebitis Scale

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0: No symptoms
1: Erythemia w/out pain.
2: Pain at access site with erythema and/or edema
3: Pain at access site w/ erythemia and/or edema
Streak formation
Palpable cord.
4: Pain at access site w/ erythemia and/or edema
Streak formation
Palpable venous cord >1 in long.
Purulent Drainage.