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the delivery of meds in solution and fluids by parenteralroute through a wide variety of catheter types and locations using multiple procedures

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infusion therapy

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-maintain fluid balance or correct fluid imbalance -maintain electrolyte or acid base balance or correct electrolyte or acid base imbalance -administer meds -replace blood or blood products

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common reasons for IV therapy

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between 270-300 mOsm/L (isotonic)

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normal serum osmolarity for adults is

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fluids greater than 300 mOsm/L

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hypertonic

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fluids less than 270 mOsm/L

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hypotonic

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solution that is infused into the body

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infusate

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the inflammation of a vein caused by mechanica, chemical, or bacterial irritation

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phlebitis

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when IV solution leaks into the tissues around the vein

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infiltration

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blood clot in the vein

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thrombosis

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chemicals that damage body tissues on direct contact

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vesicants

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results in severe tissue integrity impairment as manifested by blistering, tissue sloughing, or necrosis from infiltration into the surrounding tissues

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extravasation

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an unexpected occurence involving serious physical or psychological injury or the risk thereof and requiring an intense analysis of the contributing factors and corrective action

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sentinel event

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IV drugs provide a rapid therapeutic effect but can lead to immediate serious reactions

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adverse drug events

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-specific type of fluid -rate of administration -drugs and the specific dose

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prescription for infusion fluids should include

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-drug name -specific dose or route -frequency of administration -time of administration -length of infusion time -purpose

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prescription for drugs should include

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infusion catheter; VAD; a plastic tube placed in a blood vessel to deliver fluids and meds; seven types: -short peripheral catheters -midline -peripherally inserted central catheters (PICC) -nontunneled percutaneous central venous catheters (CVCs) -tunneled catheters -implanted ports -hemodialysis catheters

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vascular access device

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short infusion catheters are the most commonly used vascular access devices (VADs); usually placed in the veins of the arm

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peripheral IV therapy

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composed of a plastic cannula built around a sharp stylet extending slightly beyond the cannula

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short peripheral catheters

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shortest, smallest (3/4in length); not ideal for viscous infusions, expect blood transfusion to take longer, preferred for infants and small children. approx 24mL/min (1440 mL/hr)

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24-26 gauge

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adequate for most therapies, blood can infuse without damage. 39mL/min (2280 mL/hr)

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22 gauge

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(1-1 1/4 in leangth) adequate for all therapies, most providers of anesthesie perfer not to use smaller size than this for surgery cases. 65 mL/min (3900 mL/hr)

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20 gauge

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preferred size for surgery, vein needs to be large enough to accomodate the catheter. 110mL/min (6600 mL/hr)

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18 gauge

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for trauma and surgical patients requiring rapid fluid resuscitation; needs to be in a vein that can accomodate that

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14-16 gauge

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subclavian vein

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cephalic vein

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axillary vein

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brachial vein

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basilic vein

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median cephalic vein

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median basilic vein

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radial vein

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ulnar vein

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median vein

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anywhere from 3-8in long, double or single lumen, inserted through upper arm veins

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midline catheters

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midline catheters should not be used for these; drugs that cause severe tissue damage if they escape into subcutaneous tissue (extravasation)

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vesicant medications

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the VAD is placed in the central circulaiton, specifically within the superior vena cava near its junction with the right atriu, also called the caval-atrial junction

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central IV therapy

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PICC; a long catheter inserted through a vein of the antecubital fossa, or the middle of the upper arm; lengths range from 18-29in

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peripherally inserted central catheter

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CVCs, inserted by a physician, trained PA, or NP through the subclavian vein in the upper chest or the internal jugular veins in the neck using sterile technique

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nontunneled percutaneous central venous catheters

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VADs that have a portion of the catheter lying in a subcutaneous tunnel, seperating the points where the catheter enters the vein from where it exits the skin

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tunneled cental venous catheters

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very different from other central vascular access devices, chosen for patients who are expected to require IV therapy for more than a year

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implanted ports

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"piggybacks", attached to the primary set at a Y-junction site and is used to deliver intermittent meds

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secondary administration set

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an electronic or battery powered piston to push the plunger continuously at a selected milliliter per hour rate; limited to small volume continuous or intermittent infusions and depnds on the syringe size

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syringe pumps

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generally used for home care patients and allow them to return to their usual activities while receiving infusion therapy

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ambulatory pumps

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infusion pumps with dosage calculation software; promotoed to reduce adverse drug events

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smart pumps

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-date/time of insert -name of nurse who inserted it -vein used -type of VAD -number of attempts and locations -patient response to insertion -type of dressing applied -type of securment device is used -special barrier precautions used -patient and family education provided

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when inserting a venous catheter, remember to document

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used for a variety of drug infusions; administration of pain meds and insulin therapies

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subcutaneous infusion therapy

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"clysis"; the slow infusion of isotonic fluids into the patient's subcutaneous tissue

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hypodermoclysis

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allows access to the rich vascular network in the red marrow of bones

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intraosseous therapy

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condition in which increased tissue pressure in a confied anatomic space causes decreased perfusion (blood flow to the area)

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compartment syndrome

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monitor various hemodynamic pressures continuously and to infuse chemotherapy agents or fibrinolytics

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intra-arterial infusion therapy

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the administration of chemotherapy agents into the peritoneal cavity

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intraperitoneal infusion therapy

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space between the dura mater and vertebrae and the subarachnoid space

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epidural

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medications are infused into the subarachnoid space and directly into the cerebral spinal fluid allowing reduced doses

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intrathecal

Chapter 13: Infusion Therapy – Flashcards

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