Infusion Therapy Overview

Infusion Therapy Overview

• Infusion therapy is a medical procedure for administering fluids, medications, or nutrients directly into the bloodstream.
• It's common in hospitals, home care, ambulatory care clinics, and long-term care facilities.

Definition and Common Uses

• Infusion therapy delivers fluids or medications via a needle or catheter.
• Common uses include hydration, medication administration (e.g., antibiotics, pain relievers), nutritional support (e.g., parenteral nutrition), blood transfusions (e.g., packed red blood cells, platelets), and chemotherapy/biologic therapy.

Types of Vascular Access Devices (VADs)

• Peripheral IVs: Short-term devices for fluids and medications, commonly placed in the forearm or hand. Used for most general therapies.
• Central Venous Access: Long-term use (e.g., total parenteral nutrition (TPN), chemotherapy), placed in the subclavian vein, jugular vein, or femoral vein.

Types of Fluids and Medications

• Parenteral solutions include normal saline (0.9% NaCl), Lactated Ringer's (electrolyte replenishment), parenteral nutrition (TPN), blood products (packed red blood cells, platelets), and medications (e.g., antibiotics, chemotherapy).
• Solutions are classified by tonicity (isotonic, hypotonic, hypertonic), with certain pH solutions best infused centrally to reduce irritation.

Complications of Infusion Therapy

• Phlebitis: Vein inflammation due to mechanical, chemical, or bacterial irritation. Symptoms include redness, pain, and swelling at the IV site.
• Infiltration: IV fluid leaking into surrounding tissue. Symptoms include swelling, coolness, and discomfort.
• Extravasation: Leakage of vesicant medications (e.g., chemotherapy) into tissue, leading to severe tissue damage (e.g., blistering, necrosis). Symptoms include pain, blisters at the IV site.

Medications and IV Fluids Special Considerations

• Certain medications (e.g., dopamine, chemotherapy) can cause significant tissue damage(extravasation) if they leak outside the vein.
• Medications with a pH below 5 or above 9 may irritate veins.
• Solutions with a high osmolarity (e.g., TPN) should not be infused peripherally to prevent vein damage.

Patient Monitoring and Assessment

• Monitor for signs of infiltration (swelling, coolness, tingling, redness).
• Monitor for signs of phlebitis (redness, warmth, tenderness).
• Discontinue infusion immediately and notify the healthcare provider if complications arise.
• Blood transfusions require positive patient identification with two identifiers and two qualified professionals.

Infusion Prescription and Documentation

• Infusion orders must include specifics about the type and rate of medication, total volume, and duration.
• Use electronic medication administration records (MARs) to decrease errors.

Peripheral Intravenous Therapy (PIV)

• Short PIVCs (peripheral IV catheters) are the most commonly used vascular access devices for short-term IV therapies. Typically placed in the superficial veins of an arm (e.g., forearm).
• Common uses include administering fluids, medications, and short-term nutritional support.

Central Intravenous Therapy (CIV) and Central Venous Access Devices (CVADs)

• Central IV therapy involves placing a vascular access device (VAD) into the central circulation, specifically within the superior vena cava near the right atrium.
• Confirmation of placement is crucial; it typically requires a chest x-ray.

Peripherally Inserted Central Catheters (PICCs)

• PICCs are long catheters inserted into a vein in the antecubital fossa or upper arm for use in situations requiring frequent or long-term infusion of medications, fluids, or other substances.

Infusion Systems

• Infusion containers (glass or plastic) are components of infusion systems. Glass containers require an air vent, while plastic containers are a closed system.
• Important aspects of infusion systems include filtering, tubing connections (Luer-Lok), flushing techniques, and use of electronic infusion devices (IV pumps).

Nursing Care for IV Therapy Patients

• Nurses need to evaluate insertion sites for signs of infection, monitor the patient for complications, and ensure that fluids and medications are infused correctly.
• Comprehensive assessments and documentation are crucial for IV therapy management.
• Appropriate techniques for maintaining IV insertion sites, flushing and monitoring, and removing catheters are essential aspects of patient care.