Study Guide: Concepts of Infusion Therapy PDF

**Study Guide: Concepts of Infusion Therapy** Infusion therapy is an essential medical practice where fluids, medications, or nutrients are administered directly into the bloodstream through a parenteral route (e.g., intravenous (IV) catheter). This study guide summarizes the critical concepts rela...

**Study Guide: Concepts of Infusion Therapy** Infusion therapy is an essential medical practice where fluids, medications, or nutrients are administered directly into the bloodstream through a parenteral route (e.g., intravenous (IV) catheter). This study guide summarizes the critical concepts related to infusion therapy for nursing students and healthcare professionals. **1. Overview of Infusion Therapy** - **Definition**: Delivery of fluids or medications by piercing the skin with a needle or catheter (parenteral route). - **Common Uses**: - **Hydration** and volume replacement - **Medications** (e.g., antibiotics, pain management) - **Nutritional support** (e.g., parenteral nutrition) - **Blood transfusions** and components (e.g., packed red blood cells, platelets) - **Chemotherapy/biologic therapy** - **Healthcare Settings**: - **Hospitals** - **Home care** - **Ambulatory care clinics** - **Long-term care facilities** **2. Types of Vascular Access Devices (VADs)** - **Peripheral IV**: - **Short-term use** (for fluids and medications). - **Common locations**: Forearm, hand. - **Used for**: Most general therapies. - **Central Venous Access**: - **Long-term use** (e.g., Total Parenteral Nutrition (TPN), chemotherapy). - **Locations**: Subclavian vein, jugular vein, or femoral vein. - **Catheter Types**: - **Short PIVC**: Peripheral IV, used for shorter periods. - **Central Line (e.g., PICC, Hickman)**: For long-term infusions or hyperosmolar solutions. **3. Types of Fluids and Medications Used** - **Parenteral Solutions**: - **Normal saline** (0.9% NaCl) - **Lactated Ringer's** (electrolyte replenishment) - **Parenteral nutrition** (e.g., TPN for patients who can\'t eat). - **Blood products** (packed red blood cells, platelets). - **Medications** (e.g., antibiotics, chemotherapy). - **Solution Classifications**: - **Tonicity**: Refers to the concentration of a solution relative to blood plasma. - **Isotonic**: Same osmolarity as blood plasma (no fluid shift). - **Hypotonic**: Lower osmolarity than blood plasma (fluid moves into cells). - **Hypertonic**: Higher osmolarity than blood plasma (fluid moves out of cells). - **pH**: Solutions with a pH \9 should be infused centrally to reduce irritation. **4. Complications of Infusion Therapy** - **Phlebitis**: - **Cause**: Inflammation of a vein due to mechanical, chemical, or bacterial irritation. - **Symptoms**: Redness, pain, swelling at the IV site. - **Infiltration**: - **Cause**: IV fluid leaks into surrounding tissue instead of staying within the vein. - **Symptoms**: Swelling, coolness, discomfort. - **Extravasation**: - **Cause**: Leakage of a vesicant medication (e.g., chemotherapy) into tissue, causing severe tissue damage (e.g., blistering, necrosis). - **Symptoms**: Blisters, swelling, pain at the infusion site. **5. Medications and IV Fluids Special Considerations** - **Vesicant Medications**: - Drugs like **dopamine** and **chemotherapeutic agents** can cause significant tissue damage (extravasation) if they leak outside the vein. - **Phlebitis Risk**: - Medications with a pH \9 (e.g., amiodarone, vancomycin) may irritate veins when administered peripherally. - **High Osmolarity Fluids**: - Solutions like **TPN** (osmolarity \>1400 mOsm/L) should **never be infused peripherally** to prevent vein damage. **6. Patient Monitoring and Assessment** - **Site Assessment**: - Monitor for signs of **infiltration**: Swelling, coolness, tingling, redness. - **Phlebitis**: Redness, warmth, tenderness along the vein. - If complications occur, **discontinue the infusion immediately** and notify the healthcare provider. - **Blood Transfusion**: - Positive patient identification with **two identifiers** (e.g., name, DOB) and two qualified professionals before transfusion. **7. Infusion Prescription and Documentation** - **Order Requirements**: - Infusion orders must include specifics: - Type of fluid or medication. - **Rate of administration** (e.g., mL/hr). - **Total volume and duration** (e.g., 1 liter over 4 hours). - For medications: drug name, dose, route, time, and frequency. - **Safety Checks**: - Use **electronic medication administration records (MARs)** to reduce errors. - Verify accuracy and completeness of prescriptions (e.g., ensure rate is specified, not just \"TKO\" or \"KVO\"). **8. Roles and Responsibilities of Nurses** - **RN Generalist Role**: - Responsible for inserting **peripheral IV lines** and ensuring correct infusion procedures. - Accountable for **all aspects of infusion therapy**, including monitoring, documentation, and complication management. - **Delegation**: - **Delegate tasks** as appropriate, ensuring proper supervision and adherence to protocols. - Assess patient needs and determine the best **vascular access device** (VAD) based on therapy requirements. - **Pain Management**: - **Topical anesthetics** or **lidocaine** may be applied to decrease discomfort at the IV insertion site. **Key Nursing Actions and Best Practices** 1. **Patient Education**: Explain the infusion process, potential side effects, and the importance of reporting discomfort or complications. 2. **Proper IV Site Selection**: Select the optimal site (peripheral vs. central) based on the therapy\'s duration, volume, and potential irritants. 3. **Documentation**: Ensure all IV orders are complete, including type, rate, and medication specifics, to avoid errors. 4. **Monitoring**: Continuously assess the infusion site for signs of infiltration, phlebitis, and other complications. **Conclusion** Infusion therapy is a vital aspect of patient care in many healthcare settings. Nurses play a central role in managing and monitoring infusion therapy to ensure safety and effectiveness. Understanding the types of fluids and medications, complications, and protocols is crucial for providing optimal care. By adhering to safety guidelines and maintaining vigilance, nurses help mitigate risks and promote positive patient outcomes. **Study Guide: Peripheral Intravenous Therapy (PIV)** This guide provides an overview of the essential concepts related to **Peripheral Intravenous Therapy (PIV)**, including catheter types, placement techniques, complications, and best practices. It is designed for nursing students and healthcare providers involved in administering IV therapy. **1. Overview of Peripheral Intravenous Therapy (PIV)** - **Peripheral IV Catheters** are the most commonly used vascular access devices (VADs) for short-term therapy. - **Short PIVC**: These are typically placed in the superficial veins of the arm (e.g., forearm), although use in lower extremities is avoided in adults due to the increased risk of complications like deep vein thrombosis (DVT) and infiltration. **2. Types of Peripheral Intravenous Catheters** - **Short Peripheral Intravenous Catheters (Short PIVCs)**: - **Construction**: Made of a plastic cannula and a sharp stylet (used for venipuncture). - **Sizes**: Range from **26 gauge (smallest)** to **14 gauge (large bore)**. - **Length**: Between **¾ inch and 1¼ inch**. - **Insertion**: Most often inserted into the veins of the **forearm** (avoid lower extremities in adults). - **Considerations**: Choose the smallest gauge catheter that can deliver the required therapy, as larger sizes increase the risk of **phlebitis**. - **Midline Catheters**: - **Length**: Typically **3 to 8 inches**. - **Gauge**: Ranges from **2 to 5 Fr** (French) or occasionally **18 to 22 gauge**. - **Lumen**: May be single or double lumen. - **Indications**: Used for fluids or drugs that need to be administered over **6 to 14 days**. - **Insertion**: Inserted into a vein in the upper arm. - **Additional Training**: Insertion of midline catheters requires special education and skill assessment for nurses. **3. Best Practices for Insertion of Short Peripheral IVs** - **Prescribe Therapy**: Ensure the prescription for the IV therapy is complete and appropriate for peripheral administration. - **Site Selection**: - **Preferred sites**: Veins in the **forearm** (avoid wrist and antecubital fossa). - **Avoid lower extremities** in adults due to DVT and infiltration risks. - **Aseptic Technique**: Use appropriate hygiene and antisepsis: - **H**: **Hygiene** --- Wash hands and wear gloves before insertion. - **A**: **Antisepsis** --- Clean the skin with a skin antiseptic (chlorhexidine, alcohol) before insertion. - **Insertion Attempt Limit**: Limit the number of unsuccessful attempts to **two per clinician** to reduce pain and infection risk. **4. Maintenance and Monitoring** - **Assessment**: - **Continuous Infusion**: Assess the PIVC site at least every **4 hours**. - **Critically Ill Patients**: Assess every **1-2 hours**. - **Vesicant Medications**: More frequent assessments are needed when vesicant drugs are administered (potential for extravasation). - **Saline Lock**: - For patients who do not need continuous IV fluids but may need emergency access, convert the PIVC into a **saline lock** (intermittent IV lock). - **Flushing**: Flush with saline before and after drug administration to maintain catheter patency and prevent occlusion. - **Technology**: - **Vascular Visualization Tools** (e.g., near infrared or ultrasound devices) can assist with the placement of PIVCs, especially in patients with difficult venous access. **5. Complications** - **Phlebitis**: - **Cause**: Inflammation of the vein, often due to chemical or mechanical irritation. - **Prevention**: Use the smallest appropriate catheter size and avoid prolonged use of the same vein. - **Infiltration**: - **Cause**: IV fluid leaks into the surrounding tissue, causing swelling, coolness, and discomfort. - **Prevention**: Ensure proper placement and monitor the site frequently. - **Nerve Injury**: - **Signs**: **Tingling**, a sensation of **\"pins and needles\"**, or **numbness** during venipuncture can indicate nerve puncture. If these symptoms occur, immediately stop the procedure and remove the catheter. - **Catheter-Related Bloodstream Infections (CRBSI)**: - **Prevention**: Follow aseptic technique and monitor for signs of infection (e.g., redness, warmth at the IV site). **6. Choosing the Appropriate Catheter Size and Location** - **Gauge Size**: - **Smaller gauges** (e.g., 26-22 gauge) are suitable for slower infusions, medications, or fluids. - **Larger gauges** (e.g., 14-18 gauge) are used for faster flow rates but increase the risk of **phlebitis** and discomfort. - **Site Location**: - **Forearm veins** are preferred due to better accessibility and lower risk for complications compared to veins in the hand or wrist. - **Avoid veins in flexion areas** (e.g., antecubital fossa) for vesicants, as these sites can irritate veins and lead to infiltration. **7. Patient Considerations** - **Pre-existing Conditions**: - **Mastectomy, axillary lymph node dissection, lymphedema, or dialysis access**: Avoid using the affected arm for IV insertion. - **Paralysis or impaired circulation**: Choose alternative sites based on vascular health. - **Signs of Nerve Injury**: - Tingling, \"pins and needles,\" or numbness should prompt immediate cessation of the insertion procedure to avoid nerve damage. **8. NCLEX Focus: Key Points** - **Short PIVC Insertion**: A **20-gauge catheter** is typically used for a patient requiring IV access for moderate therapy, while **smaller gauges** (e.g., 22 or 24 gauge) are ideal for patients needing slower infusions or for fragile veins. - **Vesicant Drugs**: Avoid infusing **vesicants** (e.g., chemotherapy) into areas of flexion (e.g., antecubital fossa) to reduce the risk of extravasation. **Conclusion** Peripheral intravenous therapy is a vital part of patient care, and nurses must be skilled in selecting the correct type of catheter, maintaining aseptic technique, monitoring for complications, and understanding best practices for insertion and care. By adhering to guidelines and prioritizing patient safety, healthcare providers can effectively manage peripheral IV therapy for a variety of clinical needs. **Study Guide: Central Intravenous Therapy (CIV) and Central Venous Access Devices (CVADs)** This guide provides an overview of **Central Intravenous Therapy (CIV)**, including types of **Central Venous Access Devices (CVADs)**, insertion sites, complications, and best practices. It is designed for nursing students and healthcare professionals involved in managing central venous access. **1. Overview of Central Intravenous Therapy (CIV)** - **Central IV Therapy** involves placing a vascular access device (VAD) into the central circulation, specifically within the **superior vena cava (SVC)** near its junction with the **right atrium** of the heart. - **Confirmation of Placement**: Most central venous access devices (CVADs) require **chest x-ray** confirmation to verify the catheter tip is correctly positioned at the **caval-atrial junction (CAJ)** before any solutions are infused. **2. Types of Central Venous Access Devices (CVADs)** **Peripherally Inserted Central Catheter (PICC)** - **Insertion Site**: A long catheter inserted through a vein in the **antecubital fossa** (bend of the arm) or the **upper arm**. - **Configurations**: Available in **single**, **dual**, or **triple lumen** designs. - **Power PICCs**: Specially designed for **contrast material injections** in imaging procedures. - **Complications**: Common issues include **phlebitis**, **thrombophlebitis**, **deep vein thrombosis (DVT)**, and **central line-associated bloodstream infections (CLABSI)**. - **Infection Risk**: PICCs tend to have a lower rate of CLABSI compared to other CVADs, as the insertion site on the upper arm has fewer microorganisms than other sites like the neck or chest. - **Dwell Time**: While PICCs can remain in place for **several months**, the optimal dwell time is not established. - **Patient Education**: Advise patients to avoid heavy lifting or excessive physical activity to prevent catheter dislodgment and lumen occlusion. - **Flushing**: Use **10 mL of sterile saline** to flush before and after medication administration. Follow manufacturer instructions for **saline locking** or **heparin locking**. **Central Venous Catheters (CVCs)** - **Insertion Sites**: CVCs can be inserted through the **subclavian vein** (upper chest) or **internal jugular veins** (neck) using sterile technique. In emergency cases, the **femoral vein** may be used, though this site carries a higher risk of infection. - **Types**: CVCs can have **one to five lumens**, allowing for the administration of multiple infusions at once. - **Tip Location**: The catheter tip should reside in the **superior vena cava** unless inserted via the femoral vein, in which case it terminates in the **inferior vena cava**. - **Confirmation of Placement**: **Chest x-ray** is required to confirm correct placement. - **Nontunneled CVCs**: Commonly used for **emergent situations**, **trauma**, **critical care**, and **surgery**. **Tunneled Central Venous Catheters** - **Design**: A part of the catheter lies in a **subcutaneous tunnel**, separating the vein entry point from the skin exit. This design helps reduce infection risk by creating a barrier between the external environment and the catheter. - **Use**: Primarily for patients who need **frequent or long-term** infusion therapy. - **Insertion**: Requires **surgical techniques** for placement and removal. **Implanted Ports** - **Use**: Often chosen for patients expected to require **long-term IV therapy** (e.g., more than a year). Commonly used for patients receiving **chemotherapy** or for those who need repeated blood draws. - **Design**: No external catheter parts; the port is completely under the skin, providing minimal visibility and impact on body image. - **Accessing the Port**: Requires a **noncoring needle** (e.g., Huber needle) that slices through the dense septum without coring a piece of it. **Masking** and **aseptic technique** are essential during access. - **Complications**: **Infections** can occur, particularly in immunocompromised patients, so **sterile technique** is critical. - **Flushing**: Always check for **blood return** before drug administration to confirm patency. - **Topical Anesthesia**: Can be used to reduce discomfort during port access. **3. Hemodialysis Catheters** - **Purpose**: Designed for **hemodialysis** or **pheresis procedures** (e.g., blood cell collection). - **Design**: These catheters have **very large lumens** to accommodate the high flow rates required for dialysis. - **Types**: May be **tunneled** (long-term) or **nontunneled** (short-term). **4. Complications of CVADs** - **Phlebitis**: Inflammation of the vein, often due to irritation from the catheter or medication. - **Thrombophlebitis**: A clot forming around the catheter. - **Deep Vein Thrombosis (DVT)**: A clot deep within the vein, which may lead to serious complications like pulmonary embolism. - **Catheter-Related Bloodstream Infections (CRBSI)**: Infection due to the presence of the catheter. - **Risk Reduction**: The infection risk is lower in PICCs (due to the upper extremity insertion site) compared to other CVADs. **5. Best Practices for CVAD Maintenance** - **Flushing**: Always use **10 mL syringes** to flush any central line. Using smaller syringes may increase pressure and potentially rupture the catheter. - **Infection Control**: Always use **aseptic technique** when accessing a CVAD to reduce the risk of infections. - **Checking Blood Return**: Always check for blood return before administering medication to confirm the catheter is patent and functioning properly. - **Proper Locking**: Follow manufacturer instructions on **locking** the catheter (either saline or heparin) to maintain patency. **6. Special Considerations** - **Physical Activity**: Patients with a **PICC** or other central line devices should avoid **excessive physical activity** (e.g., heavy lifting), as muscle contractions can lead to **dislodgment** of the catheter. - **Femoral Vein Insertion**: Although a **femoral vein** insertion may be used in emergencies, it is associated with a higher risk of infection and should be removed as soon as possible. - **Long-Term Use**: **Tunneled** and **implanted ports** are ideal for patients who require **long-term therapy**, such as chemotherapy or frequent blood draws. **7. Key Points for NCLEX and Clinical Practice** - **Confirming Placement**: Always confirm CVAD placement with a **chest x-ray** to verify the tip is in the correct position (CAJ or SVC). - **Flushing CVADs**: Use **10 mL syringes** to avoid excessive pressure on the catheter. - **Accessing Implanted Ports**: Always use **aseptic technique** and ensure only trained professionals access implanted ports to reduce infection risk. - **PICC Complications**: Be aware of complications such as **phlebitis**, **thrombophlebitis**, and **CLABSI** when managing PICCs. The infection risk is lower with PICCs compared to other CVAD types. **Conclusion** Central intravenous therapy provides vital access for patients requiring long-term, high-volume, or concentrated infusions. Understanding the different types of CVADs, their insertion sites, complications, and maintenance is essential for safe and effective patient care. By following proper protocols, including aseptic technique and regular flushing, healthcare providers can minimize risks and improve patient outcomes in the use of central venous access devices. **Study Guide: Infusion Systems** This study guide provides an overview of **infusion systems**, including infusion containers, administration sets, filters, and electronic infusion devices (IV pumps). It is designed for healthcare professionals involved in intravenous therapy. **1. Types of Infusion Containers** Infusion containers hold the fluids that are infused into the patient. These containers come in different materials, each with specific characteristics. **Glass Containers** - **Air Vent Requirement**: Glass containers need an **air vent** to allow the fluid to flow freely as the fluid is infused. - **Common Use**: Typically used less frequently than plastic containers. **Plastic Containers** - **Closed System**: Plastic containers are considered a **closed system**, meaning they do not rely on outside air for fluid flow. - **No Vent Needed**: Unlike glass bottles, plastic containers do not require **vented administration sets**. - **More Common**: Plastic containers are used more frequently than glass containers due to their convenience and ease of use. **Inspection of Containers** - **Cracks & Damage**: Always check for **cracks**, **damage**, or **pinholes** in the container before use. - **Visual Inspection**: Inspect the fluid for signs of **turbidity** (cloudiness), **particulate matter**, or **unusual color**, which may indicate contamination. **2. Infusion Administration Sets** **Primary Continuous Administration Set** - **Purpose**: Used to administer the **primary IV fluid** continuously. It can be used with either a **gravity infusion** system or an **electronic infusion pump**. **Secondary Administration Set (Piggyback Set)** - **Purpose**: A shorter secondary set that is attached to the primary set at a **Y-injection port**. It is typically used for infusing additional medications or fluids. **Set Lifespan** - **Primary & Secondary Sets**: These administration sets can be used for up to **7 days**, but they should be replaced as frequently as **every 96 hours** depending on institutional protocols. - **Blood Tubing**: Blood tubing should be changed within **4 hours** to prevent infection and contamination. **Sterility Maintenance** - **Importance**: Ensure the **sterility** of the **spike** (the part of the set that pierces the container) and the **connection end** to prevent introducing microorganisms into the catheter or bloodstream. **Connection Design** - **Luer-Lok Design**: All connections (including extension sets) should have a **Luer-Lok** design to ensure that the set remains securely connected and does not leak. **3. Filters in Infusion Systems** Filters are used to remove unwanted particles from the infusion system. - **Purpose**: Filters remove **particulate matter**, **microorganisms**, and **air** from the fluid, which can help prevent complications such as air embolism or infection. - **Types**: Filters can be **integrated into the administration set** or used as **separate add-on components**. - **Placement**: Filters should be placed as **close to the catheter hub as possible** to ensure the most efficient filtration. **4. "Scrub the Hub" Technique** Proper technique is essential to maintain the integrity of the infusion system and prevent contamination. - **Disinfection**: Before and after each use of the connector, it is imperative to actively disinfect the connector with **alcohol** or **chlorhexidine/alcohol**. - **Scrub Duration**: Use a vigorous scrub for **5 to 15 seconds** to ensure thorough disinfection. **5. Electronic Infusion Devices (IV Pumps)** **Purpose of Electronic Infusion Devices** - **Smart Pumps**: These devices provide the latest infusion technology, including **dose calculation software** and advanced safety features, to help reduce the risk of medication errors. - **Wide Use in Acute Care**: Electronic infusion devices, especially **smart pumps**, are commonly used in **acute care** settings for precision in medication delivery. **Safety Features** - **Dosage Calculation**: **Smart pumps** are equipped with **dosage calculation software** to reduce errors related to improper medication dosing. - **Alarms**: These devices come with various alarms to enhance patient safety: - **Air-in-line**: Detects air bubbles in the line. - **Occlusion**: Alarms for upstream or downstream blockages. - **Infusion Complete**: Alerts when the infusion is finished. - **Low Battery/Power**: Warns when the device is running low on power. **Nurse's Role with Smart Pumps** - **Patient Monitoring**: Even with the use of smart pumps, the nurse remains responsible for closely monitoring the **infusion site** and ensuring the **infusion rate** is appropriate. - **Technology Limitations**: While smart pumps provide safeguards, the **\"smarter\" the pump**, the more extensive the programming steps and the greater the number of alarms the nurse must manage. It\'s essential to be vigilant in responding to these alerts to ensure patient safety. **6. Advantages and Challenges of Smart Pumps** - **Advantages**: - Reduces the risk of **adverse drug events (ADEs)** by providing **safeguards** such as dose limits and alerts for improper programming. - **Increased patient safety** due to enhanced technology features. - **Saves nursing time** by automating calculations and reducing manual checks. - **Challenges**: - **Complexity**: The more advanced the pump, the more complex the programming, and the more alarms that must be managed. - **Dependency on Technology**: Nurses must remain vigilant, as over-reliance on the technology could lead to missed alarms or errors. **7. Key Takeaways** - **Infusion Containers**: Plastic containers are more commonly used due to their **closed system** design and lack of air vent requirement, whereas glass containers require air vents to function properly. - **Administration Sets**: Ensure sterility at all connections, and use **Luer-Lok** connections to maintain secure fittings. - **Filters**: Filters should be placed near the catheter to remove particulates and microorganisms, reducing the risk of complications. - **Electronic Infusion Devices**: **Smart pumps** enhance safety by preventing dosing errors and providing real-time alerts, but the nurse must continue to monitor the infusion site and rate. **8. Final Notes** - **Technology and Safety**: The evolution of **smart pumps** and infusion systems has significantly improved patient safety, but nurses must remain engaged and proactive in managing these systems, including proper preparation, monitoring, and responding to alarms. - **Sterility**: Maintaining sterility throughout the infusion process is paramount in preventing infections and ensuring the effectiveness of IV therapy. This study guide summarizes essential information about infusion systems, administration sets, and electronic infusion devices, which are critical components in IV therapy and patient safety. 4o mini **Study Guide: Nursing Care for Patients Receiving Intravenous Therapy** This study guide provides an overview of key nursing responsibilities for patients receiving intravenous (IV) therapy. It includes steps for assessment, securing the catheter, dressing changes, flushing protocols, and more. **1. Nursing Assessment for Infusion Systems** A thorough and systematic assessment is essential for ensuring the safety and effectiveness of intravenous therapy. **Assessment Steps** - **Start at the Insertion Site**: Begin the assessment at the **insertion site** and work upward through the tubing to the **infusion bag**. - **Catheter Details**: Know the type of catheter in place, including its **length**, **insertion site**, and **tip location**. - **Insertion Site Inspection**: Look for signs of infection or complications at the site, such as: - **Redness** or **hyperpigmentation** - **Swelling** - **Pain** or **tenderness** - **Dressing Integrity**: Check that the dressing is **clean**, **dry**, and **secure** to the skin on all sides. - **Connection Checks**: Ensure all connections on the **administration set** are **secure** (not taped). - **Infusion Rate**: Verify that the infusion rate is appropriate for the patient's therapy. **2. Securing the Catheter** Proper catheter securement is essential for preventing complications, such as catheter dislodgement or infection. **Key Points for Securing Catheters** - **Tape Handling**: Do not use tape that has been taken from rolls used between rooms, from other procedures, or from your uniform pockets to avoid contamination. - **Avoid Precutting Tape**: Avoid placing precut tape on patient bedrails, scrubs, or other items to reduce the risk of infection transmission. - **Securement Devices**: Consider using newer **securement devices**, such as the **StatLock IV stabilization device**, to prevent movement of the catheter, especially in patients with peripherally inserted central catheters (PICC) or other vascular access devices (VADs). **3. Catheter Types and Dressing Changes** **Types of Catheters** - **Short Peripheral IV Catheters (PIVC)**: These catheters typically do not remain in place for more than a few days. - **Central Venous Catheters (CVC)**, **Midline Catheters**, and **Tunneled Catheters**: These catheters may require more extensive dressing care. **Dressing Care** - **Short PIVC**: The dressing does not need to be changed unless it becomes **loose** or **soiled**. - **Central Lines and Midlines**: - Use **tape** and **sterile gauze** or **transparent membrane dressings** (e.g., **Tegaderm**). - **Change gauze dressings** every **48 hours**. - **Change transparent dressings** every **7 days** or according to institutional protocols. - **Tunneled Catheters**: Sutures are typically placed near the skin exit site but are removed after the tunnel has healed. An **occlusive dressing** is often used after catheter removal. **Proper Dressing Removal** - When removing the dressing: - Pull **laterally** from side to side, or stabilize the catheter and pull it toward the insertion site (not away). - After dressing removal, compare the **external catheter length** with the **original length** to detect any movement of the catheter. **4. Flushing and Maintaining Catheter Patency** Maintaining catheter patency and preventing complications is critical. **Flushing Protocols** - **Assess Catheter Patency**: Always assess the catheter's patency by flushing with **normal saline**. - If there is resistance, **stop the procedure immediately** and do not continue with forceful flushing. - **Flush Volumes**: - **Short PIVC**: Typically, **3 mL** of saline is adequate. - **Other Catheters** (e.g., CVCs, PICCs): **5-10 mL** of **preservative-free normal saline** is typically used. - **Flushing Technique**: Use the **push-pause method** or **pulsatile flush** for all **centrally located vascular access devices** to help prevent occlusions. **5. Special Considerations for IV Therapy** Specific nursing interventions are required to avoid complications such as infection, catheter movement, or other vascular access device (VAD) issues. **Assistive Personnel (AP) Reminders** - **Blood Pressure**: Instruct assistive personnel not to take blood pressure on the arm with an IV catheter, as compression during blood pressure measurement could damage the catheter or the vein. - **Bathing**: When giving a patient a bath, cover the IV site with a **plastic bag** or wrap to keep the dressing and site **dry**. **Removing Short PIVC** - **Procedure**: After explaining the procedure to the patient: 1. **Lift** the sides of the transparent dressing and pull **laterally** to remove it. 2. **Stabilize** the catheter and slowly withdraw it. 3. Apply **sterile gauze** over the site after removal and obtain **hemostasis** before applying a sterile occlusive dressing. **6. Complications and Troubleshooting** **Preventing Venous Air Embolism** - **CVC Removal**: When removing a central venous catheter, including PICCs, position the patient **supine** or in the **Trendelenburg** position to prevent air from entering the venous system. - **Post-Removal Care**: Apply **sterile gauze** over the site, apply pressure to achieve hemostasis, and place an **occlusive dressing** over the site. This dressing should remain in place for at least **24 hours**. **Catheter Removal Documentation** - When a catheter is removed, always **measure the length** of the catheter and compare it to the length documented at insertion. If there is a discrepancy, notify the primary health care provider immediately, as part of the catheter may have been retained. **7. Documentation** Proper documentation of the IV insertion and maintenance process is essential for patient care and continuity. **Document the Following Information:** - **Date and time** of the catheter insertion - **Nurse's name** (who performed the insertion) - **Vein/location** used for insertion - **Type of catheter** used (including gauge and length) - **Insertion technique** and any complications **8. Key Takeaways** - **Systematic Assessment**: Always assess from the insertion site up to the infusion bag, looking for signs of complications. - **Securing Catheters**: Properly secure the catheter using sterile techniques and evidence-based devices like the **StatLock IV stabilization device**. - **Dressing Changes**: Change dressings per institutional protocols, ensuring a clean, dry, and intact dressing at all times. - **Flushing Protocol**: Ensure proper flushing techniques to maintain patency, using saline and the push-pause method for centrally placed catheters. - **Complication Prevention**: Prevent air embolism during CVC removal and document all catheter-related activities accurately. This study guide provides an essential framework for understanding nursing care for patients receiving intravenous therapy, including assessment, catheter care, dressing changes, flushing protocols, and documentation. Proper management of intravenous therapy is crucial for patient safety and successful outcomes. **Study Guide: Nursing Care for Patients Receiving Intravenous Therapy** **1. Systematic Assessment of Infusion Systems** - Begin at the insertion site and work upward along the tubing to the infusion bag. - Check for: - **Insertion site:** redness, swelling, or hyperpigmentation. - **Integrity of dressing:** clean, dry, and fully adherent. - **Connections:** secure and not taped. - **Infusion rate:** correct as per prescription. **2. Catheter-Specific Assessments** - **Know your patient's catheter:** - Type, length, insertion site, and tip location. - Note external catheter length to monitor for tip migration. - **Peripheral Intravenous Catheters (PIVC):** - Short-term use, typically a few days. - Dressing must be dry, clean, and intact. - Avoid routine replacement unless clinically indicated. - **Central Venous Catheters (CVC) and Midlines:** - Use sterile gauze or transparent dressings. - Change tape/gauze dressings every 48 hours and transparent dressings every 7 days or if soiled/loose. - **PICC Lines:** - Sutured in place initially; replaced with securement devices over time. **3. Dressing and Securement** - **Prevention of Infection:** - Avoid taping connections or using shared tape rolls. - Do not precut tape and place on bedrails, uniforms, or other surfaces. - **Securement Devices:** - Use evidence-based devices (e.g., StatLock IV) to prevent catheter movement. - **Changing Dressings:** - Remove dressings laterally from side to side or toward the insertion site. - Never pull away from the insertion site to avoid catheter displacement. **4. Special Care Considerations** - Avoid taking blood pressures on extremities with catheters. - Protect the catheter site during bathing by covering it with plastic wrap. **5. Flushing and Patency** - Check patency before each use: - Use **3 mL of normal saline** for short PIVCs. - Use **5--10 mL preservative-free saline** for central catheters. - Employ pulsatile flush (\"push-pause\" method) for all vascular devices. - **If resistance is felt:** - Stop immediately to prevent damage or complications. **6. Blood Sampling** - Avoid using short PIVCs for blood sampling to reduce irritation. - Use central venous catheters (CVCs) or midlines if sampling is necessary. **7. Catheter Removal** - For short PIVCs: - Stabilize the catheter and withdraw slowly. - Apply sterile gauze and secure with an occlusive dressing for 24 hours. - For CVCs: - Position patient supine or in Trendelenburg to prevent air embolism. - Apply sterile gauze and ensure hemostasis. - **Post-removal:** - Measure and compare catheter length to documented insertion length. - Report discrepancies immediately. **8. Documentation** - Record the following: - Date, time, and location of insertion. - Name of the nurse performing insertion. - Type, gauge, and length of catheter. - Patient's tolerance to the procedure. **9. Evidence-Based Practices** - Use newer securement devices to reduce complications. - Follow the meta-analysis finding: routine replacement of PIVCs (every 72--96 hours) is not necessary unless clinically indicated. **Key Reminders for Patient Safety** - Educate assistive personnel (AP) on avoiding blood pressure measurements on catheterized limbs. - Keep the site dry and protected. - Act promptly to address any signs of infection, catheter dislodgement, or patient discomfort. This guide provides a structured approach to ensure best practices in intravenous therapy and patient care. 4o **Study Guide: Complications of Intravenous Therapy** **1. Overview of IV Therapy Complications** - Complications can range from minor issues to life-threatening conditions. - **Catheter-Related Bloodstream Infection (CRBSI):** - A severe complication that can lead to death. - Common in central venous access devices (VADs) but can occur with peripheral catheters. **2. Local Complications** 1. **Infiltration** (Leakage of a nonvesicant into extravascular tissue): - **Signs & Symptoms:** - Slowed IV rate, edema, coolness, tightness, discomfort, fluid leakage. - **Interventions:** - Stop infusion, remove catheter, elevate extremity, apply warm or cold compress. - **Prevention:** - Use the smallest catheter, stabilize site, avoid areas of flexion. 2. **Extravasation** (Leakage of a vesicant into tissue): - **Signs & Symptoms:** - Similar to infiltration, plus blistering and tissue damage. - **Interventions:** - Stop infusion, aspirate drug, leave catheter for antidote delivery if applicable, apply compress. - **Prevention:** - Select appropriate device/site, recognize vesicant potential before administering. 3. **Phlebitis** (Vein inflammation): - **Signs & Symptoms:** - Pain, redness, hardened vein. - **Interventions:** - Remove catheter, apply warm compress, document on Phlebitis Scale, insert new catheter in opposite extremity. - **Prevention:** - Use the smallest-gauge catheter, avoid flexion sites, monitor solution pH (5-9). 4. **Thrombosis** (Blood clot in vein): - **Signs & Symptoms:** - Slowed infusion, swelling, tenderness, and for CVCs, engorged peripheral veins. - **Interventions:** - Stop infusion, apply cold compress, notify healthcare provider. - **Prevention:** - Use evidence-based venipuncture techniques, limit attempts, and secure catheter properly. 5. **Ecchymosis & Hematoma**: - **Signs & Symptoms:** - Swelling, bruising, tenderness. - **Interventions:** - Apply pressure until bleeding stops, use caution with patients with coagulopathy. - **Prevention:** - Avoid lacerating large veins, use gentle techniques. 6. **Site Infection**: - **Signs & Symptoms:** - Redness, swelling, tenderness, drainage. - **Interventions:** - Clean site, remove catheter, apply sterile dressing. - **Prevention:** - Follow aseptic technique, avoid shaving the site. 7. **Venous Spasm**: - **Signs & Symptoms:** - Sudden pain at site, slowed infusion. - **Interventions:** - Slow infusion, apply warm compress. - **Prevention:** - Infuse fluids at room temperature. 8. **Nerve Damage**: - **Signs & Symptoms:** - Tingling, pain, or \"pins and needles.\" - **Interventions:** - Stop procedure, remove catheter if symptoms persist. - **Prevention:** - Avoid veins near wrist palm, use careful technique. **3. Systemic Complications** 1. **Circulatory Overload**: - **Cause:** Excessive fluid infusion. - **Prevention:** - Monitor infusion rates, especially in older adults. 2. **Catheter-Related Bloodstream Infection (CRBSI)**: - **Causes:** Pathogen invasion due to improper technique or hygiene. - **Prevention:** - Use sterile field, avoid shaving before insertion, protect skin integrity. **4. Special Considerations for Older Adults** - Avoid fragile veins (e.g., on the back of the hand). - Protect skin from tourniquets and dressings. - Use low insertion angles (10-15 degrees) for venipuncture. - Monitor for fluid overload due to cardiac/renal changes. **5. Key Points for Prevention and Best Practices** - Always prioritize aseptic technique. - Use the smallest catheter suitable for therapy. - Avoid repeated attempts at the same site. - Monitor closely for early signs of complications to intervene promptly. 4o Top of Form Bottom of Form **Study Guide: Other Types of Infusion Therapy** **1. Subcutaneous Infusion Therapy** - **Uses:** - Pain management. - Insulin therapy. - Palliative care when oral medications are not tolerated. - **Advantages:** - Useful for patients unable to receive medications through traditional routes. **2. Intraosseous (IO) Therapy** - **Description:** - Provides access to the vascular network in bone marrow. - Primarily used in emergency settings when IV access is unavailable. - **Key Points:** - Short-term use only (less than 24 hours). - Contraindicated in fractures at the insertion site. - Uses a 15- or 16-gauge needle, often inserted with a battery-powered drill. - Common sites: proximal tibia, distal femur. - Must secure the needle to prevent movement. - **Complication:** - **Compartment Syndrome:** Increased tissue pressure reduces perfusion, leading to hypoxia and pain. **3. Arterial Infusion Therapy** - **Uses:** - Repeated arterial blood sampling. - Continuous hemodynamic monitoring. - **Nursing Considerations:** - Monitor insertion site and distal extremity for perfusion. - Assess warmth, capillary refill, sensation, and pulse. **4. Intraperitoneal (IP) Infusion Therapy** - **Uses:** - Administering chemotherapy for intra-abdominal malignancies (e.g., ovarian or GI tumors). - **Procedure:** - Patient in semi-Fowler's position to reduce diaphragmatic pressure. - Assist patient in moving to evenly distribute fluid. - After drainage, flush catheter with saline. - **Common Side Effects:** - Nausea, vomiting, and respiratory discomfort from fluid pressure. **5. Epidural and Intrathecal Infusion Therapy** - **Epidural Infusion:** - For postoperative and chronic pain relief. - Medications diffuse through the dura mater, binding to receptors in the dorsal horn. - Temporary catheters typically used for short durations. - **Intrathecal Infusion:** - Administered directly into the subarachnoid space. - Provides direct access to the CNS. - **Key Points:** - **Sterile Technique:** Crucial to prevent infection and complications. - Use preservative-free medications. - Avoid alcohol-based products at the insertion site. **6. Nursing Considerations Across Infusion Types** - **General Precautions:** - Secure catheters to prevent dislodgement or migration. - Use appropriate equipment (e.g., in-line filters) to prevent infusion of particulate matter. - **Common Complications:** - Infection. - Bleeding or hematoma. - Catheter occlusion or migration. - Leakage of cerebrospinal fluid (CSF). - **Special Populations:** - Older adults may require careful site selection and monitoring due to fragile veins and skin. **7. Complications to Monitor** 1. **Infections:** - Signs: redness, swelling, warmth, discharge. 2. **Compartment Syndrome:** - Symptoms: pain, swelling, decreased perfusion. 3. **Catheter-Related Issues:** - Migration, occlusion, or leakage. **8. Key Safety Measures** - Use the smallest catheter necessary. - Employ sterile techniques. - Ensure all medications are appropriate for the infusion route. - Monitor for early signs of complications. This guide provides a summary of key considerations for administering and managing various types of infusion therapy effectively and safely. **Comprehensive Nursing Study Guide: IV Therapy and Central Line Care** **1. Choosing an Appropriate Peripheral Intravenous Catheter (PIV)** - **Considerations for PIV Size and Site:** - **Size:** Use the smallest gauge catheter appropriate for the therapy to minimize trauma to the vein (e.g., 22--24 gauge for fragile veins). - **Site Selection:** - Avoid areas of joint flexion unless stabilized. - Use non-dominant arm if possible. - Avoid veins near infections, bruising, or edema. - Start with distal sites and move proximally as needed. **2. Protecting Older Adults\' Skin During PIV Insertion** - Use a protective barrier (e.g., a washcloth) between the skin and tourniquet. - Avoid veins on the back of the hand or fragile, tortuous veins. - Use a lower insertion angle (10--15 degrees). - Avoid excessive pressure or tapping on veins to reduce trauma. - Use skin protectants to prevent irritation from adhesives. **3. Complications of IV Therapy** 1. **Circulatory Overload:** - **Prevention:** Monitor fluid infusion rates, especially in patients with cardiac or renal issues. - **Signs/Symptoms:** Dyspnea, crackles, edema, hypertension. - **Interventions:** Slow infusion, raise head of bed, administer diuretics as prescribed, monitor vitals. 2. **Infection:** - **Prevention:** Aseptic technique, hand hygiene, change dressings per protocol. - **Signs/Symptoms:** Redness, warmth, swelling, purulent drainage. - **Interventions:** Stop infusion, remove catheter, culture the tip, administer antibiotics. 3. **Infiltration:** - **Prevention:** Secure catheter, avoid high-pressure infusions. - **Signs/Symptoms:** Edema, coolness, tight skin, discomfort. - **Interventions:** Stop infusion, remove catheter, elevate limb, apply warm/cold compress. 4. **Extravasation:** - **Prevention:** Use appropriate catheter/site for vesicant medications, monitor frequently. - **Signs/Symptoms:** Pain, blistering, tissue necrosis. - **Interventions:** Stop infusion, aspirate drug if possible, leave catheter in place for antidote administration, consult policy for compress type. 5. **Phlebitis:** - **Prevention:** Use the smallest-gauge catheter, avoid infusing irritating medications in peripheral veins. - **Signs/Symptoms:** Pain, redness, cord-like vein. - **Interventions:** Remove catheter, apply warm compress, monitor site, document using Phlebitis Scale. **4. Central Line Care** - **Immediately After Insertion:** - Confirm placement via X-ray before use. - Assess for signs of complications (e.g., pneumothorax, bleeding). - **Maintenance Care:** - Perform dressing changes with sterile technique every 7 days or as needed. - Use chlorhexidine for site cleaning. - Flush regularly with preservative-free normal saline using a **10 mL syringe** to prevent catheter damage. - Monitor for patency and signs of complications (e.g., redness, swelling). **5. Preventing CLABSI (Central Line-Associated Bloodstream Infection)** - Maintain strict hand hygiene. - Use sterile barriers during insertion. - Clean catheter ports with antiseptic (alcohol or chlorhexidine) before access. - Change dressings regularly or if soiled/loose. - Minimize the number of times the catheter is accessed. **6. Patient Teaching: Peripherally-Inserted Central Catheters (PICCs)** - Avoid heavy lifting with the arm where the PICC is placed. - Keep the dressing clean and dry. - Report redness, swelling, or drainage at the insertion site. - Flush the line as instructed to maintain patency. - Avoid excessive bending of the arm. **7. Nursing Care for Central Venous Catheters** - Inspect the site daily for signs of infection or dislodgement. - Maintain patency with routine flushing. - Use a positive-pressure cap or pulsatile flushing technique. **8. Nursing Care for Implanted Ports** - Access using a non-coring (Huber) needle. - Palpate the port for stability before accessing. - Flush the port monthly when not in use to maintain patency. **9. Nursing Care for Tunneled Catheters** - Monitor for infection along the tunnel path. - Ensure dressing at the exit site is clean and dry. - Educate the patient on avoiding pulling or tugging on the catheter. **10. Nursing Care for Hemodialysis Catheters** - Avoid using the catheter for other purposes unless absolutely necessary. - Assess for patency (presence of bruit/thrill) and signs of infection. - Maintain sterile technique during dressing changes. **11. Syringe Size for Flushing Central Venous Catheters** - Always use a **minimum of a 10 mL syringe** to avoid excessive pressure, which can damage the catheter. This guide consolidates essential nursing considerations for IV therapy and central line care, ensuring patient safety and optimal outcomes. 4o