Chapter 15

Chapter 15

Chapter 15 Infusion Therapy Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Infusion Therapy QuickTime and a YUV420 codec decompressor are needed to see this picture. Copyright 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2

Intravenous Solutions Normal serum osmolarity for adults are 270 to 300 mOsm/L: Parenteral solutions are isotonic within that range. Fluids greater than 300 mOsm/L are

hypertonic. Fluids less than 270 mOsm/L are hypotonic. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Isotonic Infusate Water does not move into or out of the bodys cells. Patients receiving isotonic solutions are at

risk for fluid overload, especially older adults. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Hypertonic Infusate Used to correct fluid, electrolyte, and acidbase imbalances by moving water out of the bodys cells and into the bloodstream. Parenteral nutrition is an example of hypertonic infusions.

Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Hypotonic Infusate Move water into the cells and expand them. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Blood Transfusions and Other

Components Packed red blood cells Platelets Fresh frozen plasma Albumin Several specific clotting factors Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7

Blood Transfusions and Other Components (Contd) QuickTime and a YUV420 codec decompressor are needed to see this picture. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Administering IV Medications

Medication safety Rapid therapeutic effect Never assume that IV administration is the same as giving that drug by other routes Prescribing infusion therapy Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 Vascular Access Device (VAD)

Short peripheral catheters: Superficial veins of the hand and forearm Dwell for 72 to 96 hours and then require removal and insertion into another venous site Complaints of tingling, feeling of pins and needles in the extremity, or numbness during the venipuncture can indicate nerve puncture. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

10 Vascular Access Device (VAD) (Contd) Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Midline Catheter

Catheter that is 6 to 8 inches long, inserted through veins of the antecubital fossa Used for therapies lasting from 1 to 4 weeks Should not be used for infusion of vesicant medications, which can cause tissue damage if they escape into the subcutaneous tissue (extravasation) Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 Peripherally Inserted Central Catheter (PICC)

Length ranges from 40 to 65 cm Chest x-ray to determine placement Indications Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Peripherally Inserted Central Catheter (PICC) (Contd) Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

14 Nontunneled Percutaneous Central Catheter Inserted through subclavian vein in the upper chest or jugular veins in the neck Usually 15 to 20 cm long

Tip resides in the superior vena cava Placement confirmed by chest x-ray examination No recommendations for optimal dwell time Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Tunneled Central Catheter 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. Tunneled central catheter is used for infusion therapy that is frequent and longterm. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Tunneled Central Catheter (Contd) Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17

Implanted Ports Implanted ports consist of a portal body, a dense septum over a reservoir, and a catheter. A subcutaneous pocket is surgically created to house the port body. Port is usually placed in the upper chest or

the upper extremity. Port needs to be flushed after each use and at least once a month between courses of therapy. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Dual-Lumen Implanted Port Huber Needle Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Dialysis Catheter

Lumens are very large to accommodate the hemodialysis procedure or a pheresis procedure that harvests specific blood cells. This catheter should not be used for administration of other fluids or medications, except in an emergency. Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20

Temporary Dialysis Venous Access Catheter Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 Infusion System Containers

Administration setssecondary, intermittent Add-on systems Needleless connection devices Rate-controlling devices: Controller Pumps: Syringe pumps Ambulatory pumps Smart pumps Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22

Local Complications of Intravenous Therapy Infiltration Extravasation Phlebitis and post-infusion phlebitis

Thrombosis Thrombophlebitis Ecchymosis and hematoma Site infection Venous spasm Nerve damage Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Systemic Complications of Intravenous Therapy

Circulatory overload Speed shock Allergic reaction Catheter embolism Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24 Older Adult Care

Skin care Vein and catheter selection Cardiac and renal changes Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Alternative Sites for Infusion Arterial therapy

Intraperitoneal infusion Subcutaneous infusion Intraspinal infusion Intraosseous therapy Elsevier items and derived items 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26

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