IV therapy By: Susan Mberenga, RN, MSN 1
IV Therapy Types of solutions Isotonic Hypotonic Hypertonic Caution: Too rapid or excessive infusion of any IV fluid has the potential to cause serious problems Vascular access devices 2
Vascular Access Devices Major types: Short peripheral catheters Midline catheters Peripherally inserted central catheters (PICC) Nontunneled percutaneous central venous catheters (CVC) Tunneled catheters Implanted ports Hemodialysis catheters 3 3
Nontunneled Percutaneous Central Venous Catheter Inserted through subclavian vein in upper chest or jugular veins in neck May require insertion in femoral vein Rate of infection is high 7 to 10 inches (15 to 25 cm) long; up to 5 lumens Tip resides in superior vena cava Chest x-ray confirms placement 4 4
Central Venous Line 5
Central IV Therapy Vascular access device (VAD) placed in central circulation, specifically within superior vena cava (SVC) near junction with right atrium Chest x-ray to confirm placement 6 6
Midline Catheter 3 to 8 inches long, 3 to 5 Fr, double or single lumen Inserted through vein in upper arm Used for therapies lasting 1 to 4 wk Can cause tissue damage if extravasation occurs Do not use to draw blood 7 7
Peripherally Inserted Central Catheter (PICC) Length of 18 to 29 inches (45 to 72 cm) Chest x-ray determines placement Power ICCs used for contrast injection; can also attach to transducers for CVP monitoring 8 8
Tunneled Central Venous Catheter Portion lies in subcutaneous tunnel Used for frequent and long-term infusion therapy (i.e. chemo) Has cuff of antibioticcontaining material to help reduce infection 9 9
Implanted Port Consists of portal body, dense septum over a reservoir, and catheter Single or double Surgically created subcutaneous pocket houses the port body Usually placed in upper chest/extremity Not visible externally Flushing after each use and at least once per month between therapies prevents clot formation in internal chamber 10 10
Dual-Lumen Implanted Port and Noncoring Needle 11 11
Hemodialysis Catheter Large lumens accommodate hemodialysis or plasmapheresis procedure (harvests specific blood cells) Catheter-related bloodstream infections (CR- BSI), vein thrombosis are common problems Do not use for administering other fluids/medications (except in emergency) 12 12
Dialysis catheters 13 13
Initiating IV Therapy Equipment Vascular access devices (VADs), tourniquets, clean gloves, dressings, IV fluid containers, various types of tubing, and electronic infusion devices (EIDs), also called infusion pumps Initiating the intravenous line Regulating the infusion flow Electronic infusion devices (EIDs or IV pumps) Nonelectronic volume control devices 14
Initiating IV Therapy Maintaining the system Keeping system sterile and intact Changing intravenous fluid containers, tubing, and dressings Assisting patient with self-care activities Complications Fluid overload, infiltration, extravasation, phlebitis, local infection, bleeding at the infusion site Discontinuing peripheral IV access 15
Over-the-Needle Catheter 16
Peripheral IV Therapy Short peripheral catheters: Superficial veins of dorsal surface of hand and forearm Dwell for 72 to 96 hr, then require removal and insertion into another site Portable vein transilluminators available https://www.youtube.com/watch?v=0csywptvh FM Courtesy Becton, Dickinson and Company. 17 17
Common IV Sites 18
Potential Contamination Sites of VADs 19
Infusion System Containers Plastic (PVC-free or DEHPfree), glass Administration sets Secondary, intermittent Add-on systems Needleless connection devices Rate-controlling infusion devices Use of IV pumps does not decrease the nurse s responsibility to carefully monitor the patient s infusion rate and site! 20 20
Remember Veins cannot be used in patients with: Mastectomy Axillary lymph node dissection Lymphedema Paralysis of upper extremities Dialysis graft or fistulas 21 21
Infusion Therapy Delivery of medications in solutions and fluids by parenteral route Intravenous (IV) therapy most common route IV therapy most common invasive therapy administered to hospitalized patients 5 rights! 22 22
Types of Infusion Therapy Fluids IV solutions (including parenteral nutrition) Blood and blood components Drug therapy 23 23
Infection Control CDC recommends aseptic preparation and technique including: Hand hygiene Clip hair; do not shave Ensure skin is clean Wear gloves Prepare skin with 70% alcohol or chlorhexidine 24 24
Infiltration Local Complications of IV Therapy Phlebitis and post-infusion phlebitis Thrombosis Thrombophlebitis Ecchymosis and hematoma Site infection Venous spasm Nerve damage 25 25
Systemic Complications of Circulatory overload Speed shock Allergic reaction Catheter embolism IV Therapy 26 26
Alternative Sites for Infusion Intra-arterial therapy Intraperitoneal (IP) infusion Intraspinal infusion Intraosseous therapy 27 27
Blood Transfusion Blood component therapy = IV administration of whole blood or blood component Blood groups and types Autologous transfusion Transfusing blood Transfusion reactions and other adverse effects 28
Blood types The most important grouping for transfusion purposes is the ABO system, which identifies A, B, O, and AB blood types. Determination of blood type is based on the presence or absence of A and B red blood cell (RBC) antigens. People with type O blood are considered universal blood donors because they can donate packed RBCs and platelets to people with any ABO blood type. People with type AB blood are called universal blood recipients because they can receive packed RBCs and platelets of any ABO type. 29 29
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Tubing for Transfusions 31
Blood Transfusions and Other Components Packed red blood cells Platelets Fresh frozen plasma Albumin Several specific clotting factors 32 32
Different types of transfusion reactions Acute hemolytic Febrile nonhemolytic Mild allergic reaction Anaphylactic reaction Transfusion associated circulatory overload Transfusion transmitted bacterial infection Post transfusion purpura Transfusion-related graft vs. host disease 33 33
most common Febrile nonhemolytic The patient s antibodies react with donor WBC antigens Doesn t cause hemolysis Quick onset Stop transfusion, administer antipyretic and antihistamine as ordered, monitor vital signs per hospital policy, and follow hospital policy for blood post transfusion reaction protocol 34 34
Remember... Change lipid tubing every 24 hr Change blood tubing within 4 hr Change propofol (Diprovan) tubing every 6 to 12 hr Interventions to reduce infection risk: Clean needleless system connections before use with antimicrobial for 30 seconds Do not tape connections between tubing sets Use evidence-based hand hygiene guidelines from CDC and OSHA 35 35