Flashcards in Infusion Therapy Deck (91):
Normal serum osmolarity
When must therapy be infused in central circulation where greater flow provides adequate hemodilution?
Primary tubing is good for how long?
Lipids/TPN tubing is good for how long?
Propofol tubing is good for how long?
Blood tubing is good for how long?
Must have primary infusion, Y-site connection above infusion pump
No primary infusion, cap when not in use, both ends being manipulated when hanging drug, good for 24 hrs
Where to place filters?
As close to cath hub as possible
Standard blood filter size
Gross particles filter size
Filter lipid containing TPN
Filter all particles and microorganisms
More potent drugs with what?
Infants and small children, not for viscous infusions
Adequate from most therapies, elderly w/ fragile veins
Adequate for all therapies, minimum size for sx
Requires large vein, preferred for sx
Requires large vein, large volume resuscitation
Reserve for lab draws and emergency access
IV dwell time
What to clean site w/
70% alcohol or chlorohexidine
Length of IV therapy
When to remove PIVs inserted in emergency?
When to change transparent (tegaderm) dressing?
Q 7 days and PRN
When to change opaque (gauze and tape/island)
Q 48 hrs and PRN
How long are midline caths?
3-8 inches, 3-5 Fr
Lumen of midline caths
Single or double
Where are midline caths inserted?
Through vein in upper arm.
Median AC vein is common
-Basilic over cephalic
Where does the tip of midline caths reside?
In peripheral vein
Indications for midline caths
Therapies lasting 1-4 wks
Difficult stick r/t impaired skin
What not to use midline cath for
Vesicant drugs, TPN, drawing blood
Who can insert midline cath?
-Sterile technique, sterile dressing changes
Where does tip reside in central cath?
Central circulation vein, specifically the superior vena cava
Positioning for PE
Left lateral trendelenburg
Lumen of PICC
Single, double, or triple
Who can insert PICC
Requires special training
Where is PICC inserted
AC fossa or middle of upper arm
PICC is good for what?
-Long term therapy (wks-1 year)
-No limitations on pH or osmolality
-Draw blood from larger port
Nursing implications for PICC
-Sterile insertion (CVL bundle)
-Sterile dressing change
-Chest x-ray prior to use
-Routine flushing (SASH)
Common complications of PICC
-Cath related bloodstream inx
Non-tunneled central venous cath insertion site
Subclavian, IJ, femoral
Which cath is available w/ antimicrobial coats
Where does tip reside with non-tunneled
Superior vena cava, typically sutured in
Non-tunneled is commonly used for what?
Emergent trauma, critical care, sx
Nursing implications for non-tunneled
-Roll between shoulders
Common complications of non-tunneled
Cath-related bloodstream infection prevention bundle
-Use a checklist
-Wash hands before
-Maximal barrier precautions (pt is draped from head to toe w/ sterile barrier)
-Sterile gloves, gown, mask
-Minimal people in room during insertion
-Review daily the need for cath
Tunneled central cath
Portion is tunneled through subq tissue, cuff resides in tunnel, tissue granulates into cuff which secures cath, cuff may have antimicrobial solution applied
Benefits of tunneling
Frequent, long term therapy (months-years)
Good when pt is not PICC candidate
Lumens of tunneled
Why do some pts prefer tunneled over a port?
Implanted ports lumen
Single or double
Parts of implanted ports
Body, septum, reservoir, catheter
Where is an implanted port inserted?
Into a subq pocket in skin, cath is inserted into a vein
Where are implanted port sites?
Upper chest or upper extremity
Implanted ports feed into what?
SC or IJ, tip in SVC
How many sticks with implanted ports?
Good for long-term use
Chest: 2000 sticks
UE: 750 sticks
How to access an implanted port?
Non-coring needle with deflected point (huber)
*Needle stick injury risk on removal, sterile access
Used for contrast to identify the implanted port location. Identify the triangle shape and palpate 3 bumps
-Large bore lumen
-Tunneled or non
-Perm cath (tunneled)
-Use only for hemodialysis/pheresis
Heparin locked hemodialysis cath
-Ports typically labeled w/ volume of heparin to infuse for locking purposes
How to care for phlebitis
1. Remove IV
2. Warm compress
How to care for infiltration
1. Remove IV
2. Cool or warm compress
How to care for extravasation
1. Stop infusion
2. Aspirate drug
3. Leave cath in place
4. Notify doc
5. Admin antidote
6. Cool compress
How to care for hematoma
1. Remove device
2. Apply direct pressure, elevate
3. Check for bleeding
How to care for occlusion
1. Assess for bends/kinks or clamped tubing
2. Assess pt flexion
3. Use mild flush. If not successful, remove device
How to care for pain at IV site
1. Decrease flow rate
2. Dilute fluid if possible
3. Consider central access
Signs of circulatory overload
SOB, cough, HTN, peri-orbital edema, dependent edema, JVD, crackles
How to care for circulatory overload
Slow rates, notify MD/HCP, monitor VS, place upright, admin o2 prn, admin diuretics prn
Rapid infusion of drugs or bolus infusion that causes drugs to reach toxic level quickly
S/s of speed shock
Lightheaded/dizzy, chest tightness, flushed appearance, irregular pulse, cardiac arrest
How to care for speed shock
Discontinue infusion and hang isotonic solution to keep vein open, monitor VS, notify doc
Causes of catheter embolism
Insertion, dressing change, excessive admin forces
S/s of catheter embolism
Depends where the catheter embolizes, cardiac arrest
How to care for catheter embolism
Emergently notify doc, determine how much of catheter has embolized (may require removal of catheter if not already done), x-ray, sx intervention may be required
Puncture of pleural covering by introducer. Metal stylet is used during insertion and can puncture things other than vein
S/s of pneumothorax
Chest pain, dyspnea, apprehension, cyanosis, decrease BS on affected side, abnormal x-ray
Tx of pneumothorax
O2, chest tube
Puncture of vein or artery
S/s of hemothorax
Dyspnea, tachycardia, decreased Hgb
Tx of hemothorax
Apply pressure at site, insert chest tube
With lumen occlusion, the catheter lumen is partially or totally blocked. You will not be able to aspirate blood, and may or may not be able to flush. If you can flush, it will be very sluggish flow. How can this be prevented?
With appropriate maintenance flushing
S/s of air embolism
Chest pain, dyspnea, hypoxia, anxiety, hypotension, nausea, lightheaded, possible loud churning over pericardium on auscultation
Tx of air embolism
Clamp cath, place pt in left lateral trendelenburg, notify doc, O2, ABG, EKG
S/s of cath malposition
May have none. Found on chest x-ray. May have ear, neck, back pain or heart palpitations or dysrhythmias