Chapter 15 Infusion 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

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 Chest x-ray to determine placement Indications

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

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

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.

Tunneled Central Catheter (Cont’d)

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

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.

Temporary Dialysis Venous Access Catheter

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