1. Infusion Therapy

2. 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
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3. Blood Transfusions and Other Components
Packed red blood cells
Platelets
Fresh frozen plasma
Albumin
Several specific clotting factors

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

5. 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.
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6. 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)

7. 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

8. 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

9. 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.
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10. 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.
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11. 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.
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12. Infusion System Containers Administration sets Add-on systems
Needleless connection devices
Rate controlling devices:
Controller
Pumps
Syringe pumps
Ambulatory pumps

13. 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)

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

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

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

22. Types of catheter malposition