Infusion Therapy and Central Lines: A Comprehensive Guide for Healthcare Professionals - P | Study notes Nursing

Infusion Therapy + Central Lines

Infusion Therapy: •

Delivered in the hospitals, extended care facilities, outpatient clinics, infusion ◦

centers, oncology clinics, pediatric clinics, offices and homes

WHY: ◦

Initiate to maintain and restore fluid and electrolytes balance when it is not ‣

possible to maintain balance with oral intake of fluids or due to sensible and

insensible fluid losses.

Fluid and electrolytes may also be required because of losses related to ‣

hemorrhage surgery burns, vomiting, or diarrhea.

Certain medications are administered only via IV because of their ‣

pharmacological composition or because of the need to be given

intravenously to attain higher blood levels or faster action. !

When the GI tract is unable to absorb sufficient amounts of nutrients the IV ‣

route can be utilized

Solutions containing proteins, lipids, and high concentration of dextrose, •

can provide the calories and nutrients needed to sustain life.

Osmolality: •

Normal blood and body-osmolality 270 to 300 mOsm/L. ◦

A measure of the concentration of the solution that is expressed in terms of the ◦

number of particles (osmoles) per liter of solution.

The concentration of the solution influences how water moves between the ◦

intracellular and extracellular compartments of the body.!

Isotonic Solutions: •

250-375 osmolality. ◦

0.9% sodium chloride, 5% Dextrose, Lactated Ringers ‣

Isotonic solutions remain in the extracellular compartments in either the ◦

intravascular of interstitial compartments.

Isotonic solutions are administered to dehydrated pts. with deficits in ◦

intravascular volume because they increase the amount of fluid circulating in

the vascular system without causing movement of fluid in and out of cells.

Hypotonic Solutions: •

Have lower solution concentration than plasma and cause fluid to move from the ◦

intravascular space into both the intracellular and interstitial spaces.

Hypotonic solutions are used in the management of hypernatremia, ◦

hyperosmolar conditions, hypertonic dehydration and diabetic ketoacidosis

after initial sodium chloride replacement.

0.45%, 2.5% sodium chloride, 0.33% sodium chloride! ‣

Hypertonic Solutions: •

Has concentration higher than plasma and cause fluid to move from the cells into ◦

the intravascular space.

Because of the danger of circulatory overload, these solutions are given only in ◦

critical situations.

Solutions with a concentration greater than 600 mOsm/L should be administered ◦

via central venous access.

3% sodium chloride, 5% sodium chloride, Dextrose 5% sodium chloride. ‣

•

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Infusion Therapy + Central Lines

Infusion Therapy: ◦ Delivered in the hospitals, extended care facilities, outpatient clinics, infusion centers, oncology clinics, pediatric clinics, offices and homes ◦ WHY: ‣ Initiate to maintain and restore fluid and electrolytes balance when it is not possible to maintain balance with oral intake of fluids or due to sensible and insensible fluid losses. ‣ Fluid and electrolytes may also be required because of losses related to hemorrhage surgery burns, vomiting, or diarrhea. ‣ Certain medications are administered only via IV because of their pharmacological composition or because of the need to be given intravenously to attain higher blood levels or faster action. ‣ When the GI tract is unable to absorb sufficient amounts of nutrients the IV route can be utilized - Solutions containing proteins, lipids, and high concentration of dextrose, can provide the calories and nutrients needed to sustain life.
Osmolality: ◦ Normal blood and body-osmolality 270 to 300 mOsm/L. ◦ A measure of the concentration of the solution that is expressed in terms of the number of particles (osmoles) per liter of solution. ◦ The concentration of the solution influences how water moves between the intracellular and extracellular compartments of the body.
Isotonic Solutions: ◦ 250-375 osmolality. ‣ 0.9% sodium chloride, 5% Dextrose, Lactated Ringers ◦ Isotonic solutions remain in the extracellular compartments in either the intravascular of interstitial compartments. ◦ Isotonic solutions are administered to dehydrated pts. with deficits in intravascular volume because they increase the amount of fluid circulating in the vascular system without causing movement of fluid in and out of cells.
Hypotonic Solutions: ◦ Have lower solution concentration than plasma and cause fluid to move from the intravascular space into both the intracellular and interstitial spaces. ◦ Hypotonic solutions are used in the management of hypernatremia, hyperosmolar conditions, hypertonic dehydration and diabetic ketoacidosis after initial sodium chloride replacement. ‣ 0.45%, 2.5% sodium chloride, 0.33% sodium chloride
Hypertonic Solutions: ◦ Has concentration higher than plasma and cause fluid to move from the cells into the intravascular space. ◦ Because of the danger of circulatory overload, these solutions are given only in critical situations. ◦ Solutions with a concentration greater than 600 mOsm/L should be administered via central venous access. ‣ 3% sodium chloride, 5% sodium chloride, Dextrose 5% sodium chloride.

• PH:

◦ A measure of the concentration of hydrogen ions in a solution and indicates acidity or alkalinity of the solution. ‣ Medications with a pH of less than 7 are acidic ; ‣ Medications with a pH greater then 7 are alkaline. ◦ Most IV solutions are slightly acidic , which increases their stability and shelf life. ◦ Fluids on medications with a pH value of less than 5 or greater then 9 should be administered via CVAD. ◦ Acidic medications are irritating to the walls of the vessels and can cause chemical phlebitis. ‣ Vancomycin pH 2.

Incompatibility: ◦ An undesirable reaction occurring between two medications or a medication and its diluent. ◦ 3 types of Incompatibility: ‣ Physical incompatibility- - Causes a visible change in the form of color, cloudiness, haziness, turbidity the formation of precipitate even the formation of gas. ‣ Chemical incompatibility: - Causes break down of the medication. Reaction will not be visible. - The most common reaction is the acid-alkaline reaction that result in an unstable pH of one of the medications. ‣ Therapeutic incompatibility: - Causes an increase or decrease therapeutic response.
Intraosseous (IO): ◦ IO device is inserted into the vasculature of the bone marrow using a handheld driver allowing for infusion of fluids and medications ◦ The insertion site is covered with a sterile occlusive dressing to decrease the risk of infection ◦ The IO route is acceptable for only medication that requires a central venous route and any medication or fluids that is administered by the IV route. ◦ It is especially useful in severely dehydrated clients and for per-hospital vascular access. ‣ It is becoming more common for 10 lines to be placed by emergency medical technician prior to arrival to the hospital. ‣ Frequently used sites in the adult include the p roximal humerus, proximal tibia and distal tibia. ◦ The IO route provides rapid central venous access in emergency situations and is recommended as an alternative route in cardiopulmonary resuscitation by the American Heart Association.

Intravenous Fluid Administration Terms: ◦ Phlebitis: ‣ Inflammation of the vein, is characterized by pain and erythema along the vein. ‣ Phlebitis is caused by chemical, mechanical and bacterial irritating solutions. ◦ Infiltration: ‣ Occurs when a solution or medication is inadvertently infused into the tissue surrounding the vein and is a complication that can occur when any IVAD, peripheral or central. ◦ Extravasation: ‣ Leakage of IV fluid into subcutaneous tissue has occurred. ‣ When the solution or medication that infiltrates is a vesicant (able to cause blisters) ◦ Continuous: ‣ Ongoing administration; Specific rate per hour ◦ Bolus: ‣ A specific amount over a period of time (1000mL over 8 hours) ◦ Keep Vein Open (KVO): ‣ Defined in institutional protocol ‣ Depends on the age, and weight of the client, heart condition. ‣ No dial-a-flow for elderly children.
Midline Catheter: ◦ Inserted into a peripheral vein in the upper arm with the tip termination distal to the shoulder. ◦ No vesicants, chemotherapy, parenteral nutrition, or solutions with a pH les than 5 or greater than 9 or osmolarity greater than 500 mOm/L. ◦ Doesn’t require x-ray confirmation. ◦ 1 to 4 weeks (29 days) dwell time. ◦ Placed at bedside
Central Venous Access Device (CVAD) ◦ What is It: ‣ CVAD tip terminates at the Superior Vena Cava (SVC) ‣ Multi-lumens provide separate fluid pathways that make it possible to deliver two or more solutions at the same time. ‣ Because the lumens are separate, incompatible solutions can be infused using the different ports attached to a separate lumen that provides a distinct fluid pathway within the catheter. ‣ Confirmation is required. ◦ Factors that need to be taken into consideration when the selection of an appropriate CVAD is made include: ‣ The therapy required, the condition of the client’s veins, the length of the therapy, the ph and osmolarity of the solutions, multiple incompatible drugs, is frequent lab draws required and the resources available to care for the device after insertion. ◦ CVAD are designed for long term administration of medications and fluids. ◦ Client with a history of needing vascular access or central lines or chronic illness such as cystic fibrosis, sickle cell, burns, cirrhosis, decubitus ulcers, meningitis, pancreatic cancer, pancreatitis.

Central Lines ◦ PICC: ‣ Inserted into a peripheral vein and advanced into the central vasculature. ‣ Frequently inserted by trained nurse at the bedside. ‣ Cost effective and easy to place. ‣ Moderate to long dwell time. ‣ X-ray confirmation ‣ ECG guidance is more reliable and of lower cost compared with ultrasound guidance. The ECG guided techniques is accurate for the correct positioning in terms of catheter tip carina distance and catheter tip tracheobronchial angle. ‣ Unless a PICC is specially designed to withstand higher pressures, only 10 mL or larger syringes on flushing, which limits the amount of pressure exerted ◦ Tunneled Catheters: ‣ Exit the skin from a site distal from the site where they enter the vein and are tunneled through the subcutaneous tissue between the exit and insertion site. ‣ The tip of the catheter is advanced form the insertion site to the central vascular. ‣ The tunneled portion of the catheter contains a Dacron cuff that tissue adheres to after insertion. ‣ The cuff stabilizes the catheter and provides a barrier to organisms, minimizing infection. ‣ This type of CVAD can be permanent and appropriate for patient requiring long-term therapy. ‣ The exit site is usually located on the chest and allows the client easy access, promoting self care. ‣ Tunneled catheters are inserted in non-emergency situations in an operating room. ◦ Non-Tunneled Catheters: ‣ Non-tunneled inserted in the jugular (IJ-internal jugular) or ( subclavian) with the tip terminating at the SVC. ‣ X-Ray Confirmation ◦ Ports: ‣ Used for long term therapy and offer the added advantage of requiring minimal care when not in use. ‣ An implanted port consists of a small reservoir with a septum and on attacked catheter. The reservoir is placed under the skin. ‣ The preferred site is the upper chest wall because it allows the client to move easily, care for the implanted port; but can also be placed in the upper extremity, abdomen and back. ‣ The entire device is located internally. ‣ Accessed with a specialty designed non-coring needle (Huber needle) that is inserted using sterile techniques through the skin and into the septum of the reservoir

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Infusion Therapy + Central Lines

• PH: