Chapter 015 infusion therapy


Published on

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Packed RBC’s are created by removing a large amount of plasma from the whole blood.
  • Medication Safety: with all drug administration, nurses must be knowledgeable about drug indications, proper dosage, contraindications, and precautions. IV administration also requires knowledge of appropriate dilution, rate of infusion, pH and osmolarity, compatibility with other IV medications, and specific aspects of patient monitoring because of its immediate effect. Regardless of familiarity with the drug, never assume that IV administration is the same as giving that drug by other routes . In the 2010 National Patient Safety Goals. strategies to reduce errors include limiting available concentrations of drugs and dispensing all drugs, including catheter flush solutions, in single-dose containers. Smart pumps, in combination with computer physician order entry (CPOE) and bar code medication administration (BCMA) systems, use recent technology to help reduce adverse drug events (ADEs). Electronic medication administration records (MARs) and multiple checks by pharmacists also help reduce errors.
  • Disadvantage to this type of catheter is that a large amount of drug escape into the SQ tissue before the problem is detected. Blood sampling should not be routinely performed. Midline can be made with a pressure sensitive valve at the end that is open under pressure, when you administer the NS, to open the valve or they are open ended.
  • Basilic vein the preferred site for insertion. Single or dual lumen
  • Chemo., LT Abx., TPN
  • Dual of triple lumens
  • Used for TPN clients that need therapy for months or even years of their life. IE Hickman, Broviac
  • Smart pumps are infusion pumps with dosage calculation software, have be noted to decrease the number of adverse drug events. Can pre-program dosing limits to prevent fluid overload.
  • Chapter 015 infusion therapy

    1. 1. Chapter 15 Infusion Therapy
    2. 2. Infusion Therapy Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
    3. 3. Intravenous Solutions <ul><li>Normal serum osmolarity for adults are 270 to 300 mOsm/L: </li></ul><ul><ul><li>Parenteral solutions are isotonic within that range. </li></ul></ul><ul><li>Fluids greater than 300 mOsm/L are hypertonic. </li></ul><ul><li>Fluids less than 270 mOsm/L are hypotonic. </li></ul>
    4. 4. Isotonic Infusate <ul><li>Water does not move into or out of the body’s cells. </li></ul><ul><li>Patients receiving isotonic solutions are at risk for fluid overload, especially older adults. </li></ul>
    5. 5. Hypertonic Infusate <ul><li>Used to correct fluid, electrolyte, and acid-base imbalances by moving water out of the body’s cells and into the bloodstream. </li></ul><ul><li>Parenteral nutrition is an example of hypertonic infusions. </li></ul>
    6. 6. Hypotonic Infusate <ul><li>Move water into the cells and expand them. </li></ul>
    7. 7. Blood Transfusions and Other Components <ul><li>Packed red blood cells </li></ul><ul><li>Platelets </li></ul><ul><li>Fresh frozen plasma </li></ul><ul><li>Albumin </li></ul><ul><li>Several specific clotting factors </li></ul>
    8. 8. Blood Transfusions and Other Components (Cont’d)
    9. 9. Administering IV Medications <ul><li>Medication safety </li></ul><ul><li>Rapid therapeutic effect </li></ul><ul><li>Never assume that IV administration is the same as giving that drug by other routes </li></ul><ul><li>Prescribing infusion therapy – Refer to page 215 in Iggy. </li></ul>
    10. 10. Vascular Access Device (VAD) <ul><li>Short peripheral catheters: </li></ul><ul><ul><li>Superficial veins of the hand and forearm </li></ul></ul><ul><ul><li>Dwell for 72 to 96 hours and then require removal and insertion into another venous site </li></ul></ul><ul><li>Complaints of tingling, feeling of “pins and needles” in the extremity, or numbness during the venipuncture can indicate nerve puncture. </li></ul>
    11. 11. Vascular Access Device (VAD) (Cont’d)
    12. 12. Midline Catheter <ul><li>Catheter that is 6 to 8 inches long, inserted through veins of the antecubital fossa </li></ul><ul><li>Used for therapies lasting from 1 to 4 weeks </li></ul><ul><li>Should not be used for infusion of vesicant medications, which can cause tissue damage if they escape into the subcutaneous tissue (extravasation) </li></ul>
    13. 13. Peripherally Inserted Central Catheter (PICC) <ul><li>Length ranges from 40 to 65 cm </li></ul><ul><li>Inserted through a vein in the antecubital fossa </li></ul><ul><li>Placed using sterile technique by a certified nurse </li></ul><ul><li>Tip of the catheter rests in the SVC </li></ul><ul><li>Chest x-ray to determine placement </li></ul><ul><li>Can be open or have a valve at the end of the catheter </li></ul>
    14. 14. PICC continued <ul><li>Can be utilized for blood sampling if 4F or larger </li></ul><ul><li>Indications </li></ul><ul><ul><li>All infusion types, no limits on PH or osmality of solutions </li></ul></ul><ul><ul><li>Lengthy IV therapy treatments </li></ul></ul>
    15. 15. Peripherally Inserted Central Catheter (PICC) (Cont’d)
    16. 16. PICC Line
    17. 17. Nontunneled Percutaneous Central Catheter <ul><li>Inserted through subclavian vein in the upper chest or jugular veins in the neck using sterile technique </li></ul><ul><li>Usually 15 to 20 cm long </li></ul><ul><li>Tip resides in the superior vena cava </li></ul><ul><li>Placement confirmed by chest x-ray examination </li></ul><ul><li>No recommendations for optimal dwell time but usually used short term </li></ul>
    18. 18. Tunneled Central Catheter <ul><li>A portion of the catheter lying in a subcutaneous tunnel separates the point at which the catheter enters the vein from where it exits the skin. </li></ul><ul><li>Catheter has a cuff made of rough material that is usually positioned inside the subcutaneous tunnel. Tissue granulates into the cuff, providing a barrier to microorganisms. </li></ul><ul><li>Tunneled central catheter is used for infusion therapy that is frequent and long-term. </li></ul>
    19. 19. Tunneled Central Catheter (Cont’d)
    20. 20. Tunneled Catheter
    21. 21. Hickman Catheter
    22. 22. Groshong Tip
    23. 23. Implanted Ports <ul><li>Implanted ports consist of a portal body, a dense septum over a reservoir, and a catheter. </li></ul><ul><li>A subcutaneous pocket is surgically created to house the port body. </li></ul><ul><li>Port is usually placed in the upper chest or the upper extremity. </li></ul><ul><li>Port needs to be flushed after each use and at least once a month between courses of therapy. </li></ul>
    24. 24. Dual-Lumen Implanted Port — Huber Needle
    25. 25. Port-A-Cath
    26. 26. Infusion System <ul><li>Containers </li></ul><ul><li>Administration sets — secondary, intermittent </li></ul><ul><li>Add-on systems </li></ul><ul><li>Needleless connection devices </li></ul><ul><li>Rate-controlling devices: </li></ul><ul><ul><li>Controller </li></ul></ul><ul><ul><li>Pumps: </li></ul></ul><ul><ul><ul><li>Syringe pumps </li></ul></ul></ul><ul><ul><ul><li>Ambulatory pumps </li></ul></ul></ul><ul><ul><ul><li>Smart pumps </li></ul></ul></ul>
    27. 27. Local Complications of Intravenous Therapy <ul><li>Infiltration </li></ul><ul><li>Extravasation </li></ul><ul><li>Phlebitis and post-infusion phlebitis </li></ul><ul><li>Thrombosis </li></ul><ul><li>Thrombophlebitis </li></ul><ul><li>Ecchymosis and hematoma </li></ul><ul><li>Site infection </li></ul><ul><li>Venous spasm </li></ul><ul><li>Nerve damage </li></ul>
    28. 28. Systemic Complications of Intravenous Therapy <ul><li>Circulatory overload </li></ul><ul><li>Speed shock </li></ul><ul><li>Allergic reaction </li></ul><ul><li>Catheter embolism </li></ul>
    29. 29. Older Adult Care <ul><li>Skin care </li></ul><ul><li>Vein and catheter selection </li></ul><ul><li>Cardiac and renal changes </li></ul>
    30. 30. Alternative Sites for Infusion <ul><li>Arterial therapy </li></ul><ul><li>Intraperitoneal infusion </li></ul><ul><li>Subcutaneous infusion </li></ul><ul><li>Intraspinal infusion </li></ul><ul><li>Intraosseous therapy </li></ul>