High risk infusions:

Question 1

EN SCOPE:

Answer 1

• Heparin infusion
• Iron infusion
  These medication infusions are deemed outside of scope of enrolled nurses. CANNOT be administered by an EN. ENs are able to care/monitor for a patient receiving these infusions working together with an RN.
• Opioid IV infusions via patient control
• Fluids and medications via central venous catheters including total parenteral nutrition
  Care of and administration of IV fluids and medications vis a CVC OR PICC is outside of an EN. ENs however are able to monitor a patient only

Question 2

IV Heparin:

Answer 2

• anticoagulant - interrupts clotting by inhibiting thrombin
• anticoagulant therapy does not dissolve clot. clot breakdown occurs naturally.
• SC heparin for prophylaxis against VTE
• IV heparin for treatment of VTE
• Monitoring for therapeutic effect:
• IV heparin requires close monitoring of clotting profile via APTT blood tests
• Normal APPT (clotting time) range: 25-35 seconds
• therapeutic APPT range: 46-70 seconds
• Adverse effects:
• risk of bleeding/haemorrhage, external bleeding
• internal bleeding, monitor vital signs, check for haematuria; bruising, swelling

Question 3

Pulmonary embolism:

Answer 3

• Pulmonary embolism (PE) is a major cause of mortality and morbidity
• PE is a condition in which one of the pulmonary arteries in the lungs gets blocked by a blood clot. This causes chest pain, breathlessness and cough.

Question 3

IV iron infusions:

Answer 3

• iron via IV is indicated for iron deficiency anemia when: oral therapy is contraindicated, or enteric absorption is not effective
• hypersensitivity reactions are associated with IV administration of iron
• Precautions:
• fatal anaphylactic and anaphylactoid reactions have occurred
• risk is increased in patients with allergies
• resuscitation equipment and medical support must be available during infusion

Question 3

Prevention of VTE/PE:

Answer 3

• assess VTE risk on arrival
• accurate measurement and fitting of anti-embolic stockings
• encourage prophylactic exercises
• encourage hydration

Question 4

Monitoring patient receiving Iron infusion:

Answer 4

• take baseline vital signs prior to commencement of infusion
• monitor vital signs as per procedure
• be alert for signs of anaphylaxis - swelling, breathing difficulties, anxiety etc.
• monitor IV site closely for infiltration - iron causes staining
• educate patient to report any localised pain

Question 4

Adverse effects of Iron infusion/injection:

Answer 4

• Musculoskeletal:
• joint stiffness and pain, muscle pain
• CVS:
• tachycardia, hypotension, collapse, cardiac arrest
• Immune system:
• lymph node enlargement
• Neurological:
• headaches and dizziness
• Other:
• flushing, sweating, chills, fever, back and chest pain
• monitor closely for at least 30 minutes post infusion, if reaction occurs stop infusion immediately

Question 5

Patient controlled analgesia (PCA):

Answer 5

• is a method that allows the patient to self-administer pre-set doses of analgesic within a prescribed time period by activating an infusion pump
• PCAs with opioids uses a locked infusion system in which the patient pushes a button to receive a bolus infusion of an analgesic

Question 5

Intravenous opioids:

Answer 5

• patients in acute pain may be administered small bolus doses of morphine - outside of EN scope
• opioids may be infused to maintain pain relief in causing ongoing acute pain when oral relief is not possible
• opioids such as morphine may be administered via IV PCA