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Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 15 Infusion Therapy.

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Presentation on theme: "Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 15 Infusion Therapy."— Presentation transcript:

1 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 15 Infusion Therapy

2 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Infusion Therapy Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

3 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 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.

4 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 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.

5 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 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.

6 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Hypotonic Infusate  Move water into the cells and expand them.

7 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Blood Transfusions and Other Components  Packed red blood cells  Platelets  Fresh frozen plasma  Albumin  Several specific clotting factors

8 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Blood Transfusions and Other Components (Cont’d)

9 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 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

10 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 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.

11 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Vascular Access Device (VAD) (Cont’d)

12 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 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)

13 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Peripherally Inserted Central Catheter (PICC)  Length ranges from 40 to 65 cm  Chest x-ray to determine placement  Indications

14 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Peripherally Inserted Central Catheter (PICC) (Cont’d)

15 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Nontunneled Percutaneous Central Catheter  Inserted through subclavian vein in the upper chest or jugular veins in the neck  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

16 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 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.  Tunneled central catheter is used for infusion therapy that is frequent and long- term.

17 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Tunneled Central Catheter (Cont’d)

18 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 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.

19 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Dual-Lumen Implanted Port— Huber Needle

20 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Dialysis Catheter  Lumens are very large to accommodate the hemodialysis procedure or a pheresis procedure that harvests specific blood cells.  This catheter should not be used for administration of other fluids or medications, except in an emergency.

21 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 Temporary Dialysis Venous Access Catheter

22 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 Infusion System  Containers  Administration sets—secondary, intermittent  Add-on systems  Needleless connection devices  Rate-controlling devices:  Controller  Pumps: Syringe pumps Syringe pumps Ambulatory pumps Ambulatory pumps Smart pumps Smart pumps

23 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Local Complications of Intravenous Therapy  Infiltration  Extravasation  Phlebitis and post-infusion phlebitis  Thrombosis  Thrombophlebitis  Ecchymosis and hematoma  Site infection  Venous spasm  Nerve damage

24 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24 Systemic Complications of Intravenous Therapy  Circulatory overload  Speed shock  Allergic reaction  Catheter embolism

25 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Older Adult Care  Skin care  Vein and catheter selection  Cardiac and renal changes

26 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26 Alternative Sites for Infusion  Arterial therapy  Intraperitoneal infusion  Subcutaneous infusion  Intraspinal infusion  Intraosseous therapy


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