Test 3 Flashcards
(10 cards)
Indications for IV Therapy
Provides administration of medications and fluids.
Quickest route, most effective method.
Nursing Alert** IV Site
** when selecting IV extremity, always choose the most distal site; prevents injury to the veins superior to the site and allows additional access sites should complications develop in the most distal site
Peripheral Access Devices
over-the-needle catheters or winged-infusion sets, commonly referred to as “butterflies” or scalp vein needles. These devices are inserted into the vein and then connected to the IV solution via tubing to provide a continuous infusion of fluid. These devices can also be inserted for intermittent use if the child does not require a continuous fluid infusion. Typically, the hub of the device is capped or plugged to allow intermittent access, such as for administering medications or obtaining blood specimens. When used in this manner, these devices are termed peripheral intermittent infusion devices or saline or heparin locks. Needle size on the device also varies. Typically, the needle ranges from 21- to 25-gauge, depending on the child’s size. The rule of thumb is to use the smallest-gauge catheter with the shortest length possible to prevent traumatizing the child’s fragile veins. Typically, peripheral IV devices are used for short-term therapy, usually averaging 3 to 5 days (O’Grady et al., 2011). Midline catheters or peripherally inserted central catheter (PICC) are also available, and recommended for use if therapy is to exceed 6 days
Explain the purpose and importance of infusion control devices.
Infants and young children are at increased risk for fluid volume overload compared with adults. Also, malfunction at the IV insertion site, such as infiltration, may result in much greater injury than a similar incident would cause in an adult. Therefore, IV fluids must be carefully administered and monitored. To ensure accurate fluid administration, infusion control devices such as infusion pumps, syringe pumps, and volume control sets may be used. Infusion pumps used for children are similar to those used for adults. In addition, syringe pumps are often used to deliver fluid and medications to children. These pumps can be programmed to deliver minute amounts of fluid over controlled periods of time (syringe pumps are discussed further in the next section)
Describe strategies for preparing the child and family for insertion of a peripheral IV access device.
Use therapeutic play to assist the child in preparation and coping for the procedure
Identify and correctly apply the formula used to administer IV fluids to children.
If possible, select a site using hand veins rather than wrist or upper arm veins to reduce the risk of phlebitis. Avoid sites where excessive movement may occur, such as the lower extremity veins and areas of joint flexion if possible because these are associated with an increased risk of thrombophlebitis and other complications (Bowden & Greenberg, 2016). Ensure adequate pain relief using pharmacologic and nonpharmacologic methods prior to insertion of the device (see Chapter 14 for more information about management of pain related to procedures). Allow the antiseptic used to prepare the site to dry completely before attempting insertion. Use a barrier such as gauze or a washcloth or the sleeve of the child’s gown under the tourniquet to avoid pinching or damaging the skin. If the child’s veins are difficult to locate, use a device to transilluminate the vein (utilizes a bright light, which illuminates the vein’s size and direction of travel). Make only two attempts to gain access; if you are unsuccessful after two attempts, allow another individual two attempts to access a site. If still unsuccessful, evaluate the need for insertion of another device.Encourage parental participation as appropriate in helping to position the child or to provide comfort positioning, such as therapeutic hugging.
Coordinate care with other departments such as the laboratory for blood specimen collection to minimize the number of venipunctures for the child.
Secure the IV line using a minimal amount of tape or transparent dressing.
Protect the site from bumping by using a security device such as the IV house dressing
Central Access Devices
The type chosen depends on several factors, including the duration of the therapy, the child’s diagnosis, the risks to the child from insertion, and the ability of the child and family to care for the device. The device may have one or multiple lumens. Although central venous access devices can be used short term, the majority are used for moderate- to long-term therapy.
child lacks suitable peripheral access, requires IV fluid or medication for a prolonged period of time, or is to receive specific treatments, such as the administration of highly concentrated solutions or irritating drugs like chemotherapeutic agents, parenteral nutrition or blood and blood products. Child preference is also a consideration. Central venous access is advantageous because it provides vascular access without the need for multiple IV starts, thus decreasing discomfort and fear. However, central venous access devices are associated with complications such as infection at the site, sepsis due to the direct access to the central circulation, and thrombosis due to partial occlusion of the vessel. Typically, a chest radiograph is performed after a central venous access device is inserted to verify proper placement. No fluids are administered until correct placement is confirmed
Maintaining IV Therapy
Throughout the course of therapy, monitor the fluid infusion rate and volume closely, as often as every hour. If a volume control set is used to administer the IV infusion, fill the device with the allotted amount of fluid that the child is to receive in 1 hour. Doing so prevents inadvertent administration of too much fluid. Never assume that just because an infusion pump is in use, the infusion is being administered without problems. Pumps can malfunction. The tubing can become blocked, or the IV device can move out of the vein lumen. Not enough fluid, fluid overload, or infiltration of the solution into the tissues can occur. In addition to monitoring the fluid infusion, closely monitor the child’s output. Expected urine output for children and adolescents is 1 to 2 mL/kg/hour.
**weigh the diaper to determine output
*flushing helps maintain latency
Preventing Complications
IV therapy is an invasive procedure that is associated with numerous complications. Strict aseptic technique is necessary when inserting the device and caring for the site. Adherence to standard precautions is key. Inspect the insertion site every 1 to 2 hours for inflammation or infiltration (inadvertent infusion of a nonirritant solution or medication into the surrounding tissue). Note signs of inflammation such as warmth, redness, induration, or tender skin. Check closely for signs of infiltration such as cool, blanched, or puffy skin. Use of a transparent dressing or IV house dressing provides easy access for assessing the IV insertion site. These types of dressings also help to prevent movement of the catheter hub, thus minimizing the risk of mechanical irritation, dislodgement, and complications such as phlebitis or infection
Discontinuing
** allow child to assist in removing the tape or dressing. This gives the child since of control of the situation and encourages his or her cooperation.
Prepare the child for removal of the IV device in much the same manner as for insertion. Many children may fear the removal of the device to the same extent that they feared its insertion. Explain what is to occur and enlist the child’s help in the removal.
**If the IV site was in the arm at or near the antecubital space, apply pressure until the bleeding stops. Do not have the child bend his or her arm after removal of the device as this is not sufficient pressure to prevent hematoma formation
