Some terminology
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Some terminology:. Hub (IV catheter) Maintenance (or primary) solution TKO (KVO) rate Parenteral Mechanical gravity devices EID: electronic infusion device NAD: needleless access device NAP: needleless access port. Complications - systemic. Septicemia (CRSI)

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Some terminology

Some terminology:

  • Hub (IV catheter)

  • Maintenance (or primary) solution

  • TKO (KVO) rate

  • Parenteral

  • Mechanical gravity devices

  • EID: electronic infusion device

  • NAD: needleless access device

  • NAP: needleless access port


Complications systemic

Complications - systemic

  • Septicemia (CRSI)

  • Fluid overload & pulmonary edema

  • Catheter embolism

  • Air embolism

  • Speed shock


Complications local

Complications - local

  • Phlebitis

    • Mechanical or Chemical

  • Infiltration/ Extravasation

  • Local infection

  • Hematoma/ecchymosis

  • Thrombophlebitis

  • Thrombosis (catheter)

  • Venous spasm


Phlebitis treatment

Phlebitis: Treatment

  • Discontinue infusion at the first sign of phlebitis

  • Notify physician

  • Apply warm or cold compresses to affected site

  • Notify infection control if part of agency policy


Infiltration vs extravasation

Infiltration vsExtravasation

  • Inadvertent administration of a nonvesicant solution into surrounding tissues.

  • The inadvertent administration of a visicant solution into surrounding tissue.

Infiltration

Extravasation


To err is human

To Err is Human

  • IOM report

  • CDC & INS standards

    • “follow your hospital policy” –

      • Changing IV admin sets

      • IV dressings

    • How does this contribute to patient safety?


Cdc ins guidelines

CDC/INS guidelines

  • Change IV administration sets

  • Dressing changes

  • Changing NAP

  • Cleanse access port with new alcohol swab for 15 seconds.


Needless access ports nap

Needless Access Ports (NAP)

  • Easily converts to/from intermittent

  • 3 types

  • Capped, resealable diaphragm

    • Blunt cannula split septum

    • Luer access – neg. displacement

    • Luer access – pos. displacement

  • Negative pressure or positive pressure?

    • Flushing technique is different!!!


Converting maintenance iv to saline lock

Converting maintenance IV to Saline Lock

  • Does it have a small extension tubing?

    • Yes: only need alcohol swabs & NS

    • No: prime extension tubing; get new dressing

  • Gauze pads

  • Chux pad

  • Hemostats

  • Normal Saline

    • Bacteriostatic 0.9% vs Preservative-free


Dressing change

Dressing Change

  • TSM = transparent semipermeable membrane

    • Tegaderm is one brand out of many

    • Change ________

  • Gauze dressing

  • Procedure:


Discontinuing a peripheral iv

Discontinuing a Peripheral IV

  • When:

    • Leaking, infiltration, pain, phlebitis, Dr. order

  • Supplies: gloves, 2x2 gauze, bandaid

  • How: Phillips, Procedure 6-4

  • Greatest risk: catheter embolism


Characteristics and uses of electronic infusion devices

Characteristics and uses of electronic infusion devices

  • Power switch

  • “enter”

  • Numbers keyboard

    • Set rate (in ml/hr)

    • Set volume to be infused (VTBI)

  • Check volume infused

  • hold/run button


Characteristics and uses of electronic infusion devices1

Characteristics and uses of electronic infusion devices

  • Run/hold indicator

  • display screen

  • alarms

  • door to put in tubing

  • Safety mechanism when door shut

  • Visual -battery, or electrical power.

  • AlarmCause


Alarms

Alarms

  • Upstream occlusion

  • Downstream:

  • Air

  • Infusion complete

  • Door/cassette open

  • Low battery

  • Error code _____


Documentation

Documentation

INS standard:

“…shall be legible, accessible to qualified personnel, and readily retrievable. The protocol for documentation should be established in organizational policies and procedures.”

  • “Shall reflect continuity, quality & safety of care”

    INS standards, 2011


Documentation1

Documentation

  • Patient/family participation

  • Site condition & appearance

    • Does facility have standardized assessment scales?

    • Dressing, type of stabilization, pain

  • Type of therapy: drug, dose, rate

  • Daily assessment of need for VAD


Documentation2

Documentation

  • Multiple sites or lumens: what is infusing where

  • Discontinuation of therapy

  • patient tolerance

    • “tolerated well”: NO, NO, NO NO

    • What are assessments that you made to come to that conclusion? (C. Madsen)


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