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Creative Teaching Strategy

Creative Teaching Strategy. IV PATENTCY, COMPLICATIONS OF IV THERAPY & INTERVENTIONS . objectives. UPON COMPLETION THE STUDENT WILL: 1. Describe/Identify a patent IV site 2. Discuss 2 risks for IV complications. Learning outcomes.

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Creative Teaching Strategy

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  1. Creative Teaching Strategy IV PATENTCY, COMPLICATIONS OF IV THERAPY & INTERVENTIONS

  2. objectives • UPON COMPLETION THE STUDENT WILL: 1. Describe/Identify a patent IV site 2. Discuss 2 risks for IV complications

  3. Learning outcomes • 1. The student will demonstrate competent skill in the assessment of IV sites for patency and the appearance of complications from IV Therapy. • 2. The student will discuss which patients are at risk for IV therapy complications • 3. The student will identify 2 complications of IV therapy and their causes. • The student will utilize the nursing process to perform interventions to prevent/treat IV complications.

  4. Patients at risk • Elderly • Neonates and very young children • Confused patients, or patients with dementia • Patients with a communication problem, e.g. stroke or unconsciousness • Patients with diabetes, cancer, PVD, Raynaud’s (causing arterial spasm, may compromise peripheral circulation and reduce venous flow), SVCS ( elevated venous pressure may predispose the patient to leakage at the IV site), and patients with blood abnormalities or circulatory problems. • Patients who have had repeated IV infusion and or injections (these may thrombose vessels and limit the number of accessible veins). This may apply to patients with substance misuse problems. ( Lavery 1(2005)

  5. Appearance of a patent IV site • 1. The insertion site is visible • 2. There is no appearance of redness or swelling • 3. The dressing is clean, and intact

  6. Phlebitis • Mechanical phlebitis- inflammation at the insertion site r/t either too large of a cannula or incorrect taping of the cannula • Chemical phlebitis- inflammation of the endothelial lining of the vein r/t IV administration of alkaline or acidic drugs, or the high osmolality of the IV infusion Vancomycin has a pH<4, no matter how dilute, or how fast it is delivered, vancomycin damages the veins and can cause serious extravasation injuries and phlebitis.

  7. phlebitis • Infective phlebitis- usually caused by a bacterial infection, often as a result of poor clinician technique: poor handwashing, inadequate skin preparation, equipment contamination, and use of inappropriate dressings. (CINAHL Information Systems,2010) (Roszell & Jones, 2010)

  8. Phlebitis- signs and symptoms Pain at the insertion site- mild, tender to the touch or extremely painful (most common). Other early signs; slowing of the IV rate & localized redness, warmth, and swelling of the skin around the insertion site. Later signs; hard or “cord-like” vein, and presence of drainage. Systemic infection; malaise , fever, fatigue.

  9. Phlebitis signs and symptoms Categories of IV related phlebitis: 0- No clinical symptoms 1- Erythema with or without pain 2- Pain with erythema and/or edema 3- Pain; erythema and/or edema, streak formation, palpable venous cord≤ 1inch 4- Pain; erythema, streak formation, palpable venous cord > 1 inch, purulent drainage (CINAHL Information Systems 2010

  10. Infiltration Defined as leakage of a non-vesicant medication or solution into the surrounding tissues. It can be complete ( the cannula moves out of the vein or is forced completely through the vessel wall on insertion) or partial (only the tip of the cannula remains in the vein or the vessel wall does not seal around the cannula, allowing the contents to leak slowly into the subcutaneous tissues). (Dougherty, 2008)

  11. Infiltration –signs and symptoms • Coolness or blanching at the site of cannula insertion • Swelling • Tenderness/discomfort • Skin becomes taut or stretched • Leakage at the site • Inability to obtain blood return • Change in quality and flow of the infusion or the injection (Dougherty, 2008)

  12. Prevention of Complications

  13. Prevention of complications • Ensure appropriate cleaning products are used on the skin before insertion of the cannula. • Cover the cannulawith a transparent, semi permeable dressing, allowing the site to be viewed easily. • Change the cannula according to hospital policy (shown to reduce infection rates). • Use an aseptic technique for cannulation and all further manipulations of the IV system to reduce infection. • Avoid lower extremities, joints and nerves when sitting the cannula. Lower extremities are more difficult to view. Cannlation over joints is uncomfortable, reduces patient mobility and, if nerves are damaged, may cause patient harm. (Lavery, 2005)

  14. Prevention of complications • Try to reduce the number of attempts to cannulate, as increased puncture sites means increased entry sites for infection. • Identify patients at risk and take additional precautions, including those who are older or younger, those who already have an infection, are immunosuppressed, have poor nutrition, have a loss of skin integrity, are on antibiotic therapy and patients having multiple invasive procedures. • Clean infusion equipment before and after use. • Good hand washing techniques and precautions to protect staff should always be employed. (Lavery, 2005)

  15. Interventions • Treatment for phlebitis- heat and analgesia. • Treatment for infitration-measure area, use of appropriate compress (hot or cold). (Dougherty, 2008)

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