Infusion Therapy

Parenteral Nutrition Formulas: dextrose, protein, fat, vitamins, and numerous trace elements tailored to the specific metabolic needs of the client Only used when the gastrointestinal tract cannot be used Central Peripheral Sentences and phrases

Blood Transfusions and Other Components Packed red blood cells Platelets Fresh frozen plasma Albumin Several specific clotting factors

Medications IV medications provide a rapid therapeutic effect but can also lead to immediate serious reactions. Prescription for infusion therapy is necessary.

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. Sentences and phrases

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. Basilic vein is the preferred site for insertion; cephalic vein can be used. Placement is confirmed by chest x-ray examination. No information is available on optimal dwell time. Teach clients to perform normal ADLs, avoiding excessive physical activity. S&P

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 points 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. Sentence and phrase

Implanted Port 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. Sentences and phrases

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. Sentence and phrase

Infusion System Containers Administration sets Add-on systems Needleless connection devices Rate controlling devices: Controller Pumps Syringe pumps Ambulatory pumps

Catheter Care and Maintenance Educating the client Confirming tip location Performing the nursing assessment Securing and dressing the catheter Changing administration sets and needleless connectors Controlling infusion pressure (Continued)

Catheter Care and Maintenance (Continued) Flushing the catheter Obtaining blood samples from the catheter Removing the catheter

Considerations for Older Adults Skin care precautions Vein and catheter selection Cardiac and renal changes

Alternative Sites for Infusion Arterial therapy Intraperitoneal infusion Subcutaneous infusion Intraspinal infusion Intraosseous therapy

Types of catheter malposition