infusion for nurse

1. INTRAVENOUS MEDICATION
Care and Complications
Dr.T.V.Rao MD
10/20/2012 Dr.T.V.Rao MD @ Hospital care 1

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 fistulas
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3. Procedure for Insertion of
Peripheral IV Catheter
1. Obtain and review the order
2. Ascertain allergies
3. Gather Equipment
4. Verify patient’s identity using two patient
identifiers
5. Explain procedure, benefits, care
management, and potential complications to
patient
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4. Procedure for Insertion of
Peripheral IV Catheter (cont)
6. Perform hand hygiene
7. Assemble equipment
8. Apply Tourniquet
9. Assess veins, keeping in mind the rational for
therapy and duration of therapy
10. Apply Non sterile gloves
11. Wash intended insertion site with antiseptic
soap and water. (as needed)
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5. Procedure for Insertion of A
Peripheral IV Catheter (cont)
13. Clean intended insertion site with
antiseptic solution, working
outward using back-and-forth
motion
14. Allow site to dry
15. Perform venipuncture while
stabilizing skin with the
nondominate hand
10/20/2012 Dr.T.V.Rao MD @ Hospital care 5

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. Procedure for Insertion of A
Peripheral IV Catheter (cont)
17. Release tourniquet
18. 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. Procedure for Insertion of A
Peripheral IV Catheter (cont)
22.Discard stylet in
sharps container
23. Remove gloves.
Perform hand
hygiene
24. Document
procedure in the
patient’s medical
record.
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9. 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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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 site
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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 tourniquet
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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 chart
10/20/2012 Dr.T.V.Rao MD @ Hospital care 12

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
threatening
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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.
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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 a
previously attempted venipuncture site.
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17. 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 positive
pressure during the lock
flushing procedure
• Document
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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 gentle
10/20/2012 Dr.T.V.Rao MD @ Hospital care 18

19. Hematoma
Treatment
• Apply direct, light
pressure for 2-3
minutes after needle
removed
• Have patient elevate
extremity
• Apply Ice
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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 catheter
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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 extremities
10/20/2012 Dr.T.V.Rao MD @ Hospital care 22

23. Thrombosis
• Treatment
– Never flush a cannula
to remove an
occlusion
– Discontinue the
cannula
– Notify the physician
and assess the site
for circulatory
impairment
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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 painful
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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 matter
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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 irritation
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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 skin
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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 disease
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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 increase
10/20/2012 Dr.T.V.Rao MD @ Hospital care 30

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 days
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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 phlebitis
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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 extremities
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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 dilution
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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 itself
• 5% from hands
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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 dressing
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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 frequently
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38. Personal safety of Health
Care Workers
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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
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40. 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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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.
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42. • Programme Created by Dr.T.V.Rao MD
for Medical and Paramedical
Professionals in the Developing World
• Email
• doctortvrao@gmail.com
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