iv therapy
TRANSCRIPT
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IV TherapyIV Therapy
NSG 1130Sinclair Community College
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Peripheral IV PlacementPeripheral IV PlacementUse distal veins first
Nondominant arm
Select vein◦Easily palpated◦Feels soft and full◦Large for adequate blood flow
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Avoid veins◦ Area of flexion
◦ Highly visible – tend to roll
◦ Damaged by previous use
◦ Knotted, tortuous, or bifurcation
◦ Surgically compromised or injured extremity Mastectomy Casts Decreased circulation Paralysis AV fistula
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20 -22 gauge catheter
18 gauge catheter for blood transfusion
Butterfly catheter
Over the needle catheter
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Secure with StatLock Cover with opsite/tedgaderm
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Veins Used for CVAD Veins Used for CVAD PlacementPlacementSubclavian
Jugular
Cephalic or Basilic
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SubclavianSubclavian
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JugularJugular
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Cephalic or Basilic veins Cephalic or Basilic veins
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Central Venous Access Central Venous Access DevicesDevicesSingle lumen or Multi Lumen CVC
Peripherally inserted central catheter (PICC)
Tunneled CVC (Hickman, Groshong, & Broviac)
Implanted Infusion Ports
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Single lumen or Multi Lumen Single lumen or Multi Lumen CVCCVC
Placed superior vena cava at entrance of the right atrium
Inserted by physician
Advantage◦ Administer multiple meds simultaneously without
risk of incompatibility of solutions
Disadvantages◦ High risk of complications
Pneumothorax Air embolism Infection
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Peripherally inserted central Peripherally inserted central catheter (PICC)catheter (PICC)
Basilic or cephalic vein in the antecubital area
Inserted by physician or trained nurse
Threaded through axillary or subclavian vein until tip rests in the superior vena cava
Long term use, left in several months
Fewer complications of pneumothorax, air embolism, sepsis
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Tunneled CVCTunneled CVC (Hickman, Groshong, & (Hickman, Groshong, &
Broviac)Broviac)Placed surgically through the deltapectoral
groove
Form a subcutaneous tunnel
Dacron cuff on the catheter is positioned between the skin incision and the vein.
The catheter is threaded into the lower part of the superior vena cava at the entrance of right atrium.
Fibrous tissue grow around the cuff and stabilized the catheter decreasing infection rate.
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Long term useGroshong maintained with NS Hickman and Broviac flushed with
Heparin solution
Broviac
Hickman
Groshong
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Implanted Infusion PortsImplanted Infusion PortsLong term access without catheter
protruding from skin.
Surgically inserted & sutured into a subcutaneous pocket under the skin.
Subcutaneous injection port and a Silastic catheter inserted into superior vena cava.
Self-sealing septum or port ◦ Allows repeated use without risk of air
entering the system
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Located injection port by palpation
Access port with a noncorning needle (Huber point needle)
Flush with heparin solution
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Noncorring Needle Noncorring Needle (Huber)(Huber)
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BioPatchBioPatchProtective disk with chlorhexidine
gluconateDecrease infection risk
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Complications of IV Complications of IV TherapyTherapyInfiltration
Phlebitis
Fluid Overload
Infection
Air Embolism
Speed Shock
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Hourly Assessment of IV SiteHourly Assessment of IV SiteCorrect amount solution in bag
Count drip rate/ check pump rate
Check patency
Palpate vein for discomfort
Assess site for infiltration/phlebitis
Assess dressing for dry and intact
Evaluate response to therapy
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Maintenance of IVMaintenance of IVChange IV bag every 24 hours
Change every q 72 hours◦Tubing◦Dressing ◦Saline lock ports ◦IV site