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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.
  • Alarm Cause
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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