intravenous medication care and complication
TRANSCRIPT
-
7/31/2019 Intravenous Medication Care and Complication
1/42
INTRAVENOUS MEDICATION
Care and Complications
Dr.T.V.Rao MD
20-10-2012 Dr.T.V.Rao MD @ Hospital care 1
-
7/31/2019 Intravenous Medication Care and Complication
2/42
Indications for IV Medication
Indications: Intravenous access to patients circulatory
system.
Administration of Meds. & Fluids, as well asblood collection
Contraindications: IV access should be attempted as distal as
possible.
Avoid veins that cross over joints, localinfection/injury
Extremities with renal shunts or fistulas20-10-2012 Dr.T.V.Rao MD @ Hospital care 2
-
7/31/2019 Intravenous Medication Care and Complication
3/42
Procedure for Insertion of
Peripheral IV Catheter
1. Obtain and review the order
2. Ascertain allergies
3. Gather Equipment4. Verify patients identity using two patient
identifiers
5. Explain procedure, benefits, caremanagement, and potential complications to
patient
20-10-2012 Dr.T.V.Rao MD @ Hospital care 3
-
7/31/2019 Intravenous Medication Care and Complication
4/42
Procedure for Insertion of
Peripheral IV Catheter (cont)
6. Perform hand hygiene
7. Assemble equipment
8. Apply Tourniquet9. Assess veins, keeping in mind the rational for
therapy and duration of therapy
10. Apply Non sterile gloves11. Wash intended insertion site with antiseptic
soap and water. (as needed)
20-10-2012 Dr.T.V.Rao MD @ Hospital care 4
-
7/31/2019 Intravenous Medication Care and Complication
5/42
Procedure for Insertion of A
Peripheral IV Catheter (cont)
13. Clean intended insertion site withantiseptic solution, workingoutward using back-and-forthmotion
14. Allow site to dry
15. Perform venipuncture whilestabilizing skin with thenondominate hand
20-10-2012 Dr.T.V.Rao MD @ Hospital care 5
-
7/31/2019 Intravenous Medication Care and Complication
6/42
Procedure for Insertion of A
Peripheral IV Catheter (cont)
16. Enter skin at a 10- to- 30 degree angle.
Decrease angle when the skin has been
penetrated. When blood is obtained in the
flash back chamber, advance catheter 1/16
inch, and then slightly pull stylet back,
advancing catheter gently into vessel.
Continue to advance catheter into vein untilthe catheter hub is against the skin.
20-10-2012 Dr.T.V.Rao MD @ Hospital care 6
-
7/31/2019 Intravenous Medication Care and Complication
7/42
Procedure for Insertion of A
Peripheral IV Catheter (cont)
17. Release tourniquet
18. Occlude tip of catheter by pressingfinger of non dominant hand over vein toprevent blood spillage.
19. Activate needle safety device beforeremoving stylet. Connect IVadministration set or injectioncap/needless device. Begin infusingsolutions slowly.
20-10-2012 Dr.T.V.Rao MD @ Hospital care 7
-
7/31/2019 Intravenous Medication Care and Complication
8/42
Procedure for Insertion of A
Peripheral IV Catheter (cont)
22.Discard stylet in
sharps container
23. Remove gloves.
Perform hand
hygiene
24. Document
procedure in the
patients medical
record.
20-10-2012 Dr.T.V.Rao MD @ Hospital care 8
-
7/31/2019 Intravenous Medication Care and Complication
9/42
Choosing IV catheter Size
Age< 1 year: 22, 24
gauge (g)
1-8 years: 18, 20,22 gauges
> 8 years: 16. 18,20 gauges
20-10-2012 Dr.T.V.Rao MD @ Hospital care 9
-
7/31/2019 Intravenous Medication Care and Complication
10/42
IV Procedure
Use universal precautions (glove and eye
protection)
Allergies (beta dine or latex) Explain procedure to Pt.
Prepare all material
Select vein. Apply tourniquet above theelbow.
Prepare site
20-10-2012 Dr.T.V.Rao MD @ Hospital care 10
-
7/31/2019 Intravenous Medication Care and Complication
11/42
IV Procedure (cont.)
Warn the patient of possible pain
Bevel up at 30 degree above horizontal
Look for flashback of blood into catheter
Upon seeing flashback, advance catheter
another millimeter or two
Advance the sheath completely into the vein
and release tourniquet
20-10-2012 Dr.T.V.Rao MD @ Hospital care 11
-
7/31/2019 Intravenous Medication Care and Complication
12/42
IV Procedure (cont.)
Connect the IV
tubing/heplock
Secure catheter and
tubing Dispose of needles in
sharps container
Document the IV site,catheter size and date
on the patients chart
20-10-2012 Dr.T.V.Rao MD @ Hospital care 12
-
7/31/2019 Intravenous Medication Care and Complication
13/42
Complications of IV Therapy
Classified according to their location
Local complication: at or near the
insertions site or as a result ofmechanical failure
Systemic complications: occur within
the vascular system, remote from theIV site. Can be serious and life
threatening20-10-2012 Dr.T.V.Rao MD @ Hospital care 13
-
7/31/2019 Intravenous Medication Care and Complication
14/42
20-10-2012 Dr.T.V.Rao MD @ Hospital care 14
-
7/31/2019 Intravenous Medication Care and Complication
15/42
Local complications
Occur as adverse reactions or trauma to thesurrounding venipuncture site
Assessing and monitoring are the keycomponents to early intervention
Good venipuncture technique is the mainfactor related to the prevention of most localcomplications associated with IV Therapy.
Local complications include: hematoma,
thrombosis, phlebitis, post infusion phlebitis,thrombophlebitis, infiltration, extravasation,local infection, and veno spasm.
20-10-2012 Dr.T.V.Rao MD @ Hospital care 15
-
7/31/2019 Intravenous Medication Care and Complication
16/42
Hematoma
Subcutaneous hematoma is the most common
complication
Can be a starting point for other
complications: thrombophlebitis and infection
Related to:
Nicking the vein
Discontinuing the IV without apply adequate
pressure
Applying the tourniquet to tightly above a
previously attempted venipuncture site.20-10-2012 Dr.T.V.Rao MD @ Hospital care 16
-
7/31/2019 Intravenous Medication Care and Complication
17/42
Hematoma
Signs and symptoms:
Discoloration of the skin
Site swelling and
discomfort Inability to advance the
cannula all the way into
the vein during insertion
Resistance to positivepressure during the lock
flushing procedure
Document
20-10-2012 Dr.T.V.Rao MD @ Hospital care 17
-
7/31/2019 Intravenous Medication Care and Complication
18/42
Hematoma
Prevention Use of an indirect method
Apply tourniquet just before
venipuncture Use a small need in the elderly and
patients on steroids, or patients with thin
skin.
Use blood pressure cuff to apply pressure
Be gentle20-10-2012 Dr.T.V.Rao MD @ Hospital care 18
-
7/31/2019 Intravenous Medication Care and Complication
19/42
Hematoma
Treatment
Apply direct, light
pressure for 2-3
minutes after needle
removed
Have patient elevate
extremity
Apply Ice
20-10-2012 Dr.T.V.Rao MD @ Hospital care 19
-
7/31/2019 Intravenous Medication Care and Complication
20/42
Thrombosis
Catheter-related obstructions can be
mechanical or non-thrombotic
Trauma to the endothelial cells of the venous
wall causes red blood cells to adhere to the
vein wall, forms a clot or Thrombosis
Drip rate slows, line does not flush easily,
resistance is felt
Never forcible flush a catheter
20-10-2012 Dr.T.V.Rao MD @ Hospital care 20
-
7/31/2019 Intravenous Medication Care and Complication
21/42
20-10-2012 Dr.T.V.Rao MD @ Hospital care 21
-
7/31/2019 Intravenous Medication Care and Complication
22/42
Thrombosis Signs and Symptoms
Fever and Malaise
Slowed or stopped infusionrate
Inability to flush
Prevention Use pumps and controllers
to manage flow rate
Micro drip tubing for ratebelow50mL/hr
Avoid areas of flexion
Use filters
Avoid lower extremities
20-10-2012 Dr.T.V.Rao MD @ Hospital care 22
-
7/31/2019 Intravenous Medication Care and Complication
23/42
Thrombosis
Treatment Never flush a cannula
to remove an
occlusion
Discontinue the
cannula
Notify the physicianand assess the site
for circulatory
impairment20-10-2012 Dr.T.V.Rao MD @ Hospital care 23
-
7/31/2019 Intravenous Medication Care and Complication
24/42
Phlebitis
Inflammation of the vein
in which the endothelial
cells of the venous wall
become irritated and cells
roughen, allowing
platelets to adhere and
predispose the vein to
inflammation-induced
phlebitis
Tender to touch and can
be very painful
20-10-2012 Dr.T.V.Rao MD @ Hospital care 24
-
7/31/2019 Intravenous Medication Care and Complication
25/42
20-10-2012 Dr.T.V.Rao MD @ Hospital care 25
-
7/31/2019 Intravenous Medication Care and Complication
26/42
Phlebitis
Mechanical: To large a catheter for the size of the vein
Manipulation of the catheter: improper stabilization
Chemical: vein becomes inflamed by irritating orvesicant solutions or medication
Irritation medication or solution
Improperly mixed or diluted Too-rapid infusion
Presence of particulate matter
20-10-2012 Dr.T.V.Rao MD @ Hospital care 26
-
7/31/2019 Intravenous Medication Care and Complication
27/42
Phlebitis
Chemical (cont):
The more acidic the IV solution the greater the
risk
Additives: Potassium
Type of material
Length of dwell:
30% by day 2, 39-40% by day 3 (Macki and Ringer)
The slower the rate of infusion the less irritation
20-10-2012 Dr.T.V.Rao MD @ Hospital care 27
-
7/31/2019 Intravenous Medication Care and Complication
28/42
Phlebitis
Bacterial
Also called Septic phlebitis: least common
Inflammation of the intima of the vein
Contributing factors
Poor aseptic technique Failure to detect breaks in the integrity of the equipment
Poor insertion technique
Inadequate stabilization
Failure to perform site assessment Aseptic preparation of solutions
Hand washing and preparing the skin
20-10-2012 Dr.T.V.Rao MD @ Hospital care 28
-
7/31/2019 Intravenous Medication Care and Complication
29/42
Phlebitis
Post infusion
Inflammation of the vein 48-96 hr after discontinued
Factors that contribute:
Insertion technique
Condition of the vein used Type, compatibility, pH of solution used
Gauge, size, length, and material
Dwell time
Infrequent dressing change
Host factors: age, gender, age and presence of disease
20-10-2012 Dr.T.V.Rao MD @ Hospital care 29
-
7/31/2019 Intravenous Medication Care and Complication
30/42
Phlebitis
Immune system causes leukocytes to
gather at the inflamed site
Pyrogens stimulate the hypothalamus toraise body temperature
Pyrogens stimulate bone marrow to
release more leukocytes Redness and tenderness increase
20-10-2012 Dr.T.V.Rao MD @ Hospital care 30
-
7/31/2019 Intravenous Medication Care and Complication
31/42
Phlebitis
Signs and Symptoms Redness at the site
Site warm to touch
Local swelling
Palpable cord along the vein
Sluggish infusion rate
Increase in basal temperature of 1degree C or more
Prevention Use larger veins for hypertonic solutions
Central lines for Infusions lasting longer than 5 days
20-10-2012 Dr.T.V.Rao MD @ Hospital care 31
-
7/31/2019 Intravenous Medication Care and Complication
32/42
Thrombophlebitis
Thrombophlebitis denotes a twofold
injury: thrombosis and inflammation
Related to: Use of veins in the lower extremity
Use of hypertonic or highly acidic infusion
solutions Causes similar to those leading to phlebitis
20-10-2012 Dr.T.V.Rao MD @ Hospital care 32
-
7/31/2019 Intravenous Medication Care and Complication
33/42
Thrombophlebitis
Signs and Symptoms
Sluggish flow rate
Edema in the limbs Tender and cord like vein
Site warm to the touch
Visible red line above venipuncture site Diminished arterial pulses
Mottling and cyanosis of the extremities20-10-2012 Dr.T.V.Rao MD @ Hospital care 33
-
7/31/2019 Intravenous Medication Care and Complication
34/42
Thrombophlebitis
Prevention
Use veins in the forearm rather than the hands
Do not use veins in a joint
Assess site q 4 hr in adults, q 2 hr in children
Catheter securement
Infuse at rate prescribed
Use the smallest size catheter to do the job
Proper dilution
20-10-2012 Dr.T.V.Rao MD @ Hospital care 34
-
7/31/2019 Intravenous Medication Care and Complication
35/42
Thrombophlebitis
Septic thrombophlebitis can be
prevented:
Appropriate skin preparation Aseptic technique in the maintenance of
infusion
Proper hand hygiene 60% from patients skin
35% from the line itself
5% from hands20-10-2012 Dr.T.V.Rao MD @ Hospital care 35
-
7/31/2019 Intravenous Medication Care and Complication
36/42
Extravasations
Signs and Symptoms
Complaints of pain or burning
Swelling proximal to or distal to the IV site
Puffiness of the dependent part of the limb
Skin tightness at the venipuncture site
Blanching and coolness of the skin
Slow or stopped infusion
Damp or wet dressing
20-10-2012 Dr.T.V.Rao MD @ Hospital care 36
-
7/31/2019 Intravenous Medication Care and Complication
37/42
Extravasations
Prevention: Use of skilled practitioners
Knowledge of vesicants
Condition of the patients veins
Drug administration technique
If continuous give in CVAD
Only with brisk blood return of 3-5 cc
Use of a free flow IV
Do not use a pump on vesicants given peripherally
Assess for blood return frequently
20-10-2012 Dr.T.V.Rao MD @ Hospital care 37
-
7/31/2019 Intravenous Medication Care and Complication
38/42
Personal safety of Health
Care Workers
20-10-2012 Dr.T.V.Rao MD @ Hospital care 38
S
-
7/31/2019 Intravenous Medication Care and Complication
39/42
Steps to prevent
needle sticks
Wear gloves
Do Not Bend or Break Needles
Never RECAP!!!
If you must, use the One Handed technique
Take your time
Dispose of contaminated needles immediatelyin puncture-resistant containers
20-10-2012 Dr.T.V.Rao MD @ Hospital care 39
-
7/31/2019 Intravenous Medication Care and Complication
40/42
Risks to you - if Careless
Risks after needle Sticks Exposure
Hepatitis B: 10-30%
Hepatitis C: 2%
HIV: 0.4 %
Other blood borne pathogens
20-10-2012 Dr.T.V.Rao MD @ Hospital care 40
-
7/31/2019 Intravenous Medication Care and Complication
41/42
POLICY ON ACCIDENTAL NEEDLE
STICKS
Immediately wash injured area.
Report all needle sticks immediately to your instructor orimmediate supervisor.
Complete an incident report and report to employee healthor ED.
Determine if the needle was clean or dirty.
Cleansing wound with antiseptic.
Request that the identified patient be tested for Hepatitis B
surface antigen and HIV antibodies. Have your blood tested for Hepatitis B and HIV antibodies as
soon as possible.
Begin drug treatment (if necessary) & counseling.
20-10-2012 Dr.T.V.Rao MD @ Hospital care 41
-
7/31/2019 Intravenous Medication Care and Complication
42/42
Programme Created by Dr.T.V.Rao MD
for Medical and ParamedicalProfessionals in the Developing World
Email