chapter 015 infusion therapy

Chapter 15Infusion Therapy

Infusion Therapy

Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Intravenous Solutions

• Normal serum osmolarity for adults are 270 to 300 mOsm/L:– Parenteral solutions are isotonic within that

range.• Fluids greater than 300 mOsm/L are

hypertonic.• Fluids less than 270 mOsm/L are hypotonic.

Isotonic Infusate

• Water does not move into or out of the body’s cells.

• Patients receiving isotonic solutions are at risk for fluid overload, especially older adults.

Hypertonic Infusate

• Used to correct fluid, electrolyte, and acid-base imbalances by moving water out of the body’s cells and into the bloodstream.

• Parenteral nutrition is an example of hypertonic infusions.

Hypotonic Infusate

• Move water into the cells and expand them.

Blood Transfusions and Other Components

• Packed red blood cells• Platelets• Fresh frozen plasma• Albumin• Several specific clotting factors

Blood Transfusions and Other Components (Cont’d)

Administering IV Medications

• Medication safety• Rapid therapeutic effect• Never assume that IV administration is the

same as giving that drug by other routes• Prescribing infusion therapy – Refer to page

215 in Iggy.

Vascular Access Device (VAD)

• Short peripheral catheters:– Superficial veins of the hand and forearm– Dwell for 72 to 96 hours and then require removal

and insertion into another venous site• Complaints of tingling, feeling of “pins and

needles” in the extremity, or numbness during the venipuncture can indicate nerve puncture.

Vascular Access Device (VAD) (Cont’d)

Midline Catheter

• Catheter that is 6 to 8 inches long, inserted through veins of the antecubital fossa

• Used for therapies lasting from 1 to 4 weeks• Should not be used for infusion of vesicant

medications, which can cause tissue damage if they escape into the subcutaneous tissue (extravasation)

Peripherally Inserted Central Catheter (PICC)

• Length ranges from 40 to 65 cm• Inserted through a vein in the antecubital

fossa• Placed using sterile technique by a certified

nurse• Tip of the catheter rests in the SVC• Chest x-ray to determine placement • Can be open or have a valve at the end of the

catheter

PICC continued

• Can be utilized for blood sampling if 4F or larger

• Indications– All infusion types, no limits on PH or osmality of

solutions– Lengthy IV therapy treatments

Peripherally Inserted Central Catheter (PICC) (Cont’d)

PICC Line

Nontunneled Percutaneous Central Catheter

• Inserted through subclavian vein in the upper chest or jugular veins in the neck using sterile technique

• Usually 15 to 20 cm long• Tip resides in the superior vena cava• Placement confirmed by chest x-ray

examination• No recommendations for optimal dwell time

but usually used short term

Tunneled Central Catheter• A portion of the catheter lying in a subcutaneous

tunnel separates the point at which the catheter enters the vein from where it exits the skin.

• Catheter has a cuff made of rough material that is usually positioned inside the subcutaneous tunnel. Tissue granulates into the cuff, providing a barrier to microorganisms.

• Tunneled central catheter is used for infusion therapy that is frequent and long-term.

Tunneled Central Catheter (Cont’d)

Tunneled Catheter

Hickman Catheter

Groshong Tip

Implanted Ports

• Implanted ports consist of a portal body, a dense septum over a reservoir, and a catheter.

• A subcutaneous pocket is surgically created to house the port body.

• Port is usually placed in the upper chest or the upper extremity.

• Port needs to be flushed after each use and at least once a month between courses of therapy.

Dual-Lumen Implanted Port—Huber Needle

Port-A-Cath

Infusion System

• Containers• Administration sets—secondary, intermittent• Add-on systems• Needleless connection devices• Rate-controlling devices:

– Controller– Pumps:

• Syringe pumps• Ambulatory pumps• Smart pumps

Local Complications of Intravenous Therapy

• Infiltration• Extravasation• Phlebitis and post-infusion phlebitis• Thrombosis• Thrombophlebitis• Ecchymosis and hematoma• Site infection• Venous spasm• Nerve damage

Systemic Complications of Intravenous Therapy

• Circulatory overload• Speed shock• Allergic reaction• Catheter embolism

Older Adult Care

• Skin care• Vein and catheter selection• Cardiac and renal changes

Alternative Sites for Infusion

• Arterial therapy• Intraperitoneal infusion• Subcutaneous infusion• Intraspinal infusion• Intraosseous therapy