Intravenous medication, Care and Complications


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intravenous Medication, Care and Complication

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Intravenous medication, Care and Complications

  1. 1. INTRAVENOUS MEDICATION Care and Complications Dr.T.V.Rao MD10/20/2012 Dr.T.V.Rao MD @ Hospital care 1
  2. 2. Indications for IV Medication• Indications: • Intravenous access to patient’s circulatory system. • Administration of Meds. & Fluids, as well as blood collection• Contraindications: • IV access should be attempted as distal as possible. • Avoid veins that cross over joints, local infection/injury • Extremities with renal shunts or fistulas10/20/2012 Dr.T.V.Rao MD @ Hospital care 2
  3. 3. Procedure for Insertion of Peripheral IV Catheter1. Obtain and review the order2. Ascertain allergies3. Gather Equipment4. Verify patient’s identity using two patient identifiers5. Explain procedure, benefits, care management, and potential complications to patient10/20/2012 Dr.T.V.Rao MD @ Hospital care 3
  4. 4. Procedure for Insertion of Peripheral IV Catheter (cont)6. Perform hand hygiene7. Assemble equipment8. Apply Tourniquet9. Assess veins, keeping in mind the rational for therapy and duration of therapy10. Apply Non sterile gloves11. Wash intended insertion site with antiseptic soap and water. (as needed)10/20/2012 Dr.T.V.Rao MD @ Hospital care 4
  5. 5. Procedure for Insertion of A Peripheral IV Catheter (cont)13. Clean intended insertion site with antiseptic solution, working outward using back-and-forth motion14. Allow site to dry15. Perform venipuncture while stabilizing skin with the nondominate hand10/20/2012 Dr.T.V.Rao MD @ Hospital care 5
  6. 6. Procedure for Insertion of A Peripheral IV Catheter (cont)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 until the catheter hub is against the skin.10/20/2012 Dr.T.V.Rao MD @ Hospital care 6
  7. 7. Procedure for Insertion of A Peripheral IV Catheter (cont)17. Release tourniquet18. Occlude tip of catheter by pressing finger of non dominant hand over vein to prevent blood spillage.19. Activate needle safety device before removing stylet. Connect IV administration set or injection cap/needless device. Begin infusing solutions slowly.10/20/2012 Dr.T.V.Rao MD @ Hospital care 7
  8. 8. Procedure for Insertion of A Peripheral IV Catheter (cont)22.Discard stylet in sharps container23. Remove gloves. Perform hand hygiene24. Document procedure in the patient’s medical record.10/20/2012 Dr.T.V.Rao MD @ Hospital care 8
  9. 9. Choosing IV catheter Size• Age < 1 year: 22, 24 gauge (g) 1-8 years: 18, 20, 22 gauges > 8 years: 16. 18, 20 gauges10/20/2012 Dr.T.V.Rao MD @ Hospital care 9
  10. 10. 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 the elbow. • Prepare site10/20/2012 Dr.T.V.Rao MD @ Hospital care 10
  11. 11. 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 tourniquet10/20/2012 Dr.T.V.Rao MD @ Hospital care 11
  12. 12. 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 patient’s chart10/20/2012 Dr.T.V.Rao MD @ Hospital care 12
  13. 13. Complications of IV Therapy• Classified according to their location –Local complication: at or near the insertions site or as a result of mechanical failure –Systemic complications: occur within the vascular system, remote from the IV site. Can be serious and life threatening10/20/2012 Dr.T.V.Rao MD @ Hospital care 13
  14. 14. 10/20/2012 Dr.T.V.Rao MD @ Hospital care 14
  15. 15. Local complications• Occur as adverse reactions or trauma to the surrounding venipuncture site• Assessing and monitoring are the key components to early intervention• Good venipuncture technique is the main factor related to the prevention of most local complications associated with IV Therapy.• Local complications include: hematoma, thrombosis, phlebitis, post infusion phlebitis, thrombophlebitis, infiltration, extrav asation, local infection, and veno spasm.10/20/2012 Dr.T.V.Rao MD @ Hospital care 15
  16. 16. 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 a10/20/2012 previously attempted venipuncture site. Dr.T.V.Rao MD @ Hospital care 16
  17. 17. Hematoma• Signs and symptoms: • Document – Discoloration of the skin – Site swelling and discomfort – Inability to advance the cannula all the way into the vein during insertion – Resistance to positive pressure during the lock flushing procedure10/20/2012 Dr.T.V.Rao MD @ Hospital care 17
  18. 18. 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 gentle10/20/2012 Dr.T.V.Rao MD @ Hospital care 18
  19. 19. Hematoma Treatment• Apply direct, light pressure for 2-3 minutes after needle removed• Have patient elevate extremity• Apply Ice10/20/2012 Dr.T.V.Rao MD @ Hospital care 19
  20. 20. 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 catheter10/20/2012 Dr.T.V.Rao MD @ Hospital care 20
  21. 21. 10/20/2012 Dr.T.V.Rao MD @ Hospital care 21
  22. 22. Thrombosis• Signs and Symptoms – Fever and Malaise – Slowed or stopped infusion rate – Inability to flush• Prevention – Use pumps and controllers to manage flow rate – Micro drip tubing for rate below50mL/hr – Avoid areas of flexion – Use filters – Avoid lower extremities10/20/2012 Dr.T.V.Rao MD @ Hospital care 22
  23. 23. Thrombosis • Treatment – Never flush a cannula to remove an occlusion – Discontinue the cannula – Notify the physician and assess the site for circulatory impairment10/20/2012 Dr.T.V.Rao MD @ Hospital care 23
  24. 24. 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 painful10/20/2012 Dr.T.V.Rao MD @ Hospital care 24
  25. 25. 10/20/2012 Dr.T.V.Rao MD @ Hospital care 25
  26. 26. Phlebitis• Mechanical: – To large a catheter for the size of the vein – Manipulation of the catheter: improper stabilization• Chemical: vein becomes inflamed by irritating or vesicant solutions or medication – Irritation medication or solution – Improperly mixed or diluted – Too-rapid infusion – Presence of particulate matter10/20/2012 Dr.T.V.Rao MD @ Hospital care 26
  27. 27. 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 irritation10/20/2012 Dr.T.V.Rao MD @ Hospital care 27
  28. 28. 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 skin10/20/2012 Dr.T.V.Rao MD @ Hospital care 28
  29. 29. 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 disease10/20/2012 Dr.T.V.Rao MD @ Hospital care 29
  30. 30. Phlebitis• Immune system causes leukocytes to gather at the inflamed site• Pyrogens stimulate the hypothalamus to raise body temperature• Pyrogens stimulate bone marrow to release more leukocytes• Redness and tenderness increase10/20/2012 Dr.T.V.Rao MD @ Hospital care 30
  31. 31. 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 days10/20/2012 Dr.T.V.Rao MD @ Hospital care 31
  32. 32. 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 phlebitis10/20/2012 Dr.T.V.Rao MD @ Hospital care 32
  33. 33. 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 extremities10/20/2012 Dr.T.V.Rao MD @ Hospital care 33
  34. 34. 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 dilution10/20/2012 Dr.T.V.Rao MD @ Hospital care 34
  35. 35. 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 itself10/20/2012 • 5% from hands MD @ Hospital care Dr.T.V.Rao 35
  36. 36. 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 dressing10/20/2012 Dr.T.V.Rao MD @ Hospital care 36
  37. 37. 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 frequently10/20/2012 Dr.T.V.Rao MD @ Hospital care 37
  38. 38. Personal safety of Health Care Workers10/20/2012 Dr.T.V.Rao MD @ Hospital care 38
  39. 39. 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 immediately in puncture-resistant containers 10/20/2012 Dr.T.V.Rao MD @ Hospital care 39
  40. 40. Risks to you - if Careless • Risks after needle Sticks Exposure • Hepatitis B: 10-30% • Hepatitis C: 2% • HIV: 0.4 % • Other blood borne pathogens10/20/2012 Dr.T.V.Rao MD @ Hospital care 40
  41. 41. POLICY ON ACCIDENTAL NEEDLE STICKS • Immediately wash injured area. • Report all needle sticks immediately to your instructor or immediate supervisor. • Complete an incident report and report to employee health or 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.10/20/2012 Dr.T.V.Rao MD @ Hospital care 41
  42. 42. • Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World • Email • doctortvrao@gmail.com10/20/2012 Dr.T.V.Rao MD @ Hospital care 42