Infusion Therapy

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Author:
Danette
ID:
146423
Filename:
Infusion Therapy
Updated:
2012-04-08 22:52:09
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Exam One
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IV
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  1. Infusion therapy definition
    The delivery of parenteral meds & fluids through a variety of catheter types & locations using multiple techniques & procedures
  2. What is infusion therapy used for?
    • Blood transfusions
    • Maintenance
    • Medications
    • Nutrition - TPN
    • Replacement
  3. Parenteral Replacement - Crystalloids
    • Include IV fluid, electrolyte therapy, & total parenteral nutrition
    • Fluids that supply water & sodium & contain electrolyes
    • Replace fluid deficits
    • Maintain & manage specific fluid/electrolyte disturbances
  4. Parenteral Replacement - Colloids
    • Blood components used to increase the colloidal oncotic pressure
    • Moves fluid from interstitial into intravascular space
    • Called plasma expanders
  5. Advantages of IV therapy
    • Anesthetics
    • Fluids
    • Medications
    • Provides access route
    • Route of choice - for products not absorbed orally (hepatic first pass)
  6. Disadvantages of IV therapy
    • Allergic response
    • Dislodgement
    • Embolism
    • Fluid overload
    • Pain
    • Precipitation
    • Sepsis
    • Transmission of HIV/Hepatitis
  7. Water Distribution - Intracellular fluid (ICF)
    Fluid contained within the cells. It is 40% of adult body weight & 70% of total body water.
  8. Water distribution - Extracellular Fluid
    Fluid that is outside the cells. It is 20% of adult body weight & 30% of total body water.

    • Intravascular/plasma is fluid within the vascular system
    • Interstitial (ISF) fluid surround tissue cells. These solutions exist in small spaces between body structure, cells, & tissue
    • Transcellular fluid is confined to a specific area or region of the body such as cerebrospinal fluid, sweat, ocular fluid
  9. Water Distribution - Osmolality
    • Measures the concentration of dissolved particles in blood.
    • IV fluids have an isotonic, hypotonic or hypertonic osmolality.
  10. Isotonic
    Balanced cells - no effect on cells

    • Remain in intravascular space
    • Used to treat hypotension resulting from hypovalemia
    • Compatible with plasma
    • Can be infused at a faster rate
    • Expands intravascular compartment
    • EX: Lactated Ringers, 0.9% NaCl (full strength)
    • Normal Saline
  11. Hypotonic
    Over hydrates cells - cells swell

    • Used to hydrate intracellular & interstitial compartments
    • Rate must be carefully controlled
    • EX: 0.45% NaCl (1/2 strength) - No Dextrose
  12. Hypertonic
    Cells swell

    • Greatly expands intravascular compartment
    • Extreme caution used to prevent fluid overload
    • EX: 3% NaCl, 10% Dextrose 0.45% NaCl, 5% Dextrose - given for low sodium
  13. Routes of Administration
    • Peripheral
    • Central
    • Arterial-intra-arterial chemotherapy
    • Central nervous system
    • Clysis
    • Intraosseous
    • Intraperitoneal
  14. ROA - Peripheral
    • Don't put in legs or feet
    • Don't go higher than 10% Dextrose
  15. ROA - Central
    • Be careful not to pull out!
    • In central vessel, subclavian (most common), jugular

    PICC - peripherally inserted central catheter - can last 6 months
  16. ROA - Arterial-intra-arterial chemotherapy
    In hepatic artery
  17. ROA - Intraperitoneal
    Into the peritoneal cavity for tumors confined to that area
  18. ROA - Central Nervous System
    • 1. Epidural - into the epidural space of the spinal column located between the wall of the vertebral canal & the dura matter
    • 2. Intrathecal - into the ventricular cerebrospinal fluid to provide chemotherapy, pain meds, or ABX for patients with cancer, pain, or infection. It is placed into one of the lateral ventricles
  19. ROA - Intraosseous
    Into the medullary space of long bones
  20. ROA - Clysis
    Hypodermoclysis - sub q - people who are dying
  21. Assessment - Local problems
    • Pain
    • Vesicant - solution capable of causing destruction or injury if it escapes into the tissue such as KCL or chemotherapy
    • Extravasation - vesicant - can cause blistering or sloughing
    • Infiltration - IV catheter has become dislodged, resulting in a non-vesicant solution leading into the extravascular space. It causes the site to be cool, pale, swelling & can lead to compartment syndrome.
    • Compartment Syndrome - increased tissue pressure in a confined anatomical space which causes decreased blood flow to the area
    • Occlusion/displacement - IV in middle of arm & pt bends arm or clot in IV
    • Phlebitis - inflammation of the vein, cordlike, erethyma, may feel warm. TX: elevate & warm compresses
    • Thrombosis
    • Hematoma
    • Venous spasm - contraction of vessel wall, cold solutions, certain meds can cause this (Dilantin)
    • Cellulitis - diffuse inflammation & infection of cellular & sub q tissue.
    • Nerve damage - from incorrect placement
  22. Assessment - Systemic Complications
    • Contamination
    • Sepsis
    • Med/fluid incompatibility
    • Allergic reaction
    • Embolism (air) - turn pt on left side
    • Speed shock - too rapid infusion, get a pounding headache, chills, apprehensive
    • Circulatory overload - crackles, increased BP
  23. Infection Control
    • Handwashing
    • Chlorhexidine - antiseptic of choice
    • Iodine preps - allergic to shellfish?
    • Dressing changes every 72-96 hours
    • Tubings q 72-96 hours
    • Check policy
    • Central line tubing q 24 hours
  24. Documentation
    • Solution ordered
    • Rate of infusion
    • Type of device
    • Site & dressing
    • Client teaching/response
    • D/C IV
  25. Geriatric Considerations
    • Altered immune system
    • Confusion
    • Inadequate diet
    • Infection
    • Long term diuretics
    • Malnutrition
    • Skin integrity
  26. Equipment - drip sizes
    • Standard / Macrodrop - 10 gtt/mL, 15 gtt/mL, 20 gtt/mL
    • Microdrop Minidrip - 60 gtt/mL

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