 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 1

 Septicemia (CRSI)  Fluid overload & pulmonary edema  Catheter embolism  Air embolism  Speed shock 2

 Phlebitis ◦ Mechanical or Chemical  Infiltration/ Extravasation  Local infection  Hematoma/ecchymosis  Thrombophlebitis  Thrombosis (catheter)  Venous spasm 3

4  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 Extravasation  Inadvertent administration of a nonvesicant solution into surrounding tissues.  The inadvertent administration of a visicant solution into surrounding tissue. 5

 IOM report  CDC & INS standards ◦ “follow your hospital policy” –  Changing IV admin sets  IV dressings ◦ How does this contribute to patient safety? 6

 Change IV administration sets  Dressing changes  Changing NAP  Cleanse access port with new alcohol swab for 15 seconds. 7

 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!!! 8

 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 9

 TSM = transparent semipermeable membrane ◦ Tegaderm is one brand out of many ◦ Change ________  Gauze dressing  Procedure: 10

 When: ◦ Leaking, infiltration, pain, phlebitis, Dr. order  Supplies: gloves, 2x2 gauze, bandaid  How: Phillips, Procedure 6-4  Greatest risk: catheter embolism 11

 Power switch  “enter”  Numbers keyboard ◦ Set rate (in ml/hr) ◦ Set volume to be infused (VTBI)  Check volume infused  hold/run button 12

 Run/hold indicator  display screen  alarms  door to put in tubing  Safety mechanism when door shut  Visual -battery, or electrical power.  AlarmCause 13

 Upstream occlusion  Downstream:  Air  Infusion complete  Door/cassette open  Low battery  Error code _____ 14

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,

 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 16

 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) 17