IV Solutions, Types of Catheters
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| What is purpose of IV therapy? | Provides H20, electrolytes, & nutrientsAdminister medications & blood products.
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| Two types of IV solutions | 1. Crystalloids 2. Colloids
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| Able to pass through semipermeable membrane. Isotonic, hypotonic, hypertonic | Crystalloids
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| Protein substances that cannot pass into extravascular space. Move fluid from interstitial space - Blood vessels | Colloids
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| Ok to use in peripheral IV (PIC), Concentration close to ECF, Solution of choice. 1 L only expands plasma by 0.25 | Isotonic Solutions
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| Normal saline solution, 0.9% sodium chloride, NaCl, NS | Isotonic Solutions
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| Lactated Ringers (common for surgery) | Isotonic Solutions
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| D5W 5% dextrose in water, becomes hypotonic rapidly | Isotonic Solutions
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| Pull fluid out of vascular space & into cells. 0.45% sodium chloride (half-normal saline) Ok to use in PIV | Hypotonic Solutions
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| Main use: Replaces cellular fluid. Administer cautiously: Fluid shift from vascular system to cells, may lead to intravascular fluid depletion, may result in CV collapse & increased intracranial pressure | Hypotonic Solutions
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| Draw fluid from ICF to ECF. From cells to blood vessels. May cause fluid volume excess. | Hypertonic Solutions
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| Should be administered via central vein. 50% dextrose (D50) Only emergency such as hypoglycemia, | Hypertonic Solutions
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| TPN | Total parental nutrition. Do not mix with meds. (Hypertonic solution)
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| Types of Venous Catheters | Peripheral & Central
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| < 7 days 72-96 hrs. | PIV
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| > 7 days Get order | PICC, Midline
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| > 6 months | Tunneled Catheter, Implanted port
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| Emergency IV | Intraosseous (IO)
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| Over the needle catheter, most commonly used, lengths 0.75"-1.25", diameters: 12 gauge-24 gauge | Peripheral IV
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| Disadvantages of peripheral IV's | Site change every 72-96 hrs. Dressing change: gauze every 48 hrs. transparent 3-7 days.
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| Lower extremeties IV site? | No might cause embolism
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| Warm pack, have them relax extremity, fear can result in venous constriction | Peripheral IV's patient preparation
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| Not recommended for continuous infusions. Non-pliable, infiltrate easily. Uses: blood draws, short term infusions 1-4 hrs. | Winged-Infusion Set
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| Peripheral insertion, still in arm, tip located in proximal portion of extremity, may stay in place 2-4 weeks. 7-8 inch. long Not a central line | Midline Catheter
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| Midline Catheters should not be used for | TPN, some antibiotics, chemotherapy, high pressure boluses, peripheral IV solutions only.
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| Confirm placement by x-ray | Central venous catheters
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| Types of Central venous catheters | Peripherally inserted central catheter (PICC), non tunneled catheter, tunneled catheter, implanted port
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| PICC | Antecubital vein-most common insertion site, Tip located in superior vena cava, 20-24 inches long
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| PICC advantages | Ease of insertion, low complication rates, low infection rates, multi-lumen access, comfortable for patients, easy to cover up, can be used long-term up to a year.
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| PICC Disadvantages | Mechanical phlebitis, frequency of dressing change
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| Non-Tunneled Central Lines | Used for therapy <2 weeks, generally limited to 5-7 days, Commonly used in ICU/ER, Multi-lumen access, Neck, chest or groin
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| Non-Tunneled Central Lines Advantages | Infuse large volumes quickly, any medication or blood, hemodynamic monitoring, multi-lumen access
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| Non-Tunneled Central Lines Disadvantages | High infection rate, limited time of use (1 week) Increased complications with insertion, pneumothorax, bleeding, air embolus
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| Designed to be permanent, but may be removed, Healed after 6-8 weeks, inconspicuous under clothing, may perform all daily activities except swimming (infection) | Skin-Tunneled Catheters
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| Commonly called: Broviac, Hickman Tunnel provides distance between entry site in vein and exit site in skin | Skin-Tunneled Catheters
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| Indicated for frequent or continuous administration of IV substances, commonly called Port-a-Cath Central, long term | Implanted Ports
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| Surgically inserted under skin, minor surgical procedure, usually upper chest, sometimes in arm or abdomen | Implanted Ports
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| Port, Septum: silicone bubble for needle insertion, self sealing, may be punctured up to 1,000 times. | Implanted Ports
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| Implanted Ports Uses: | Delivery of TPN & other fluids, including blood products, chemotherapy & other drugs, obtaining blood specimens
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| Implanted Port Risks: | Infection, thrombosis, mechanical failure, age- can grow out of
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| Systemic IV complications | Fluid overload/pulmonary edema, embolism, infection, allergic reaction
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| Fluid overload s/s | Dyspnea, tachypnea, crackles, tachycardia, edema, weight gain, pulmonary edema
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| Pulmonary edema s/s | Restlessness, tachycardia, dyspnea, cough, crackles on auscultation, frothy sputum
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| Fluid Overload Treatment | High fowler's position, Notify RN/MD, Frequent vital signs, frequent assessment of breath sounds
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| Fluid Overload Intervention | Slow or stop infusion rate, O2, diuretics
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| Fluid Overload Prevention | Infusion pump, close monitoring check every hr., patient teaching: report dizziness, pain at IV site, short of breath
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| Accidental entry of air into vasculature. Piece of catheter breaks off & enters circulation, can block major vessel, blood clot into heart & pulmonary artery | Embolism
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| Air embolism s/s | Usually associated with central line, chest, shoulder, low back pain, dyspnea, weak pulse, hypotension, cyanosis, sudden loss of consciousness, cardiac arrest
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| Air embolism treatment | Clamp cannula, ABC'S, left-sided trendelenburg position, Notify RN/MD, Frequent assessment & vital signs, High-flow O2 if ordered
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| Air embolism Prevention | Use air filters, clamp tubing when changing administration set, use luer lock connection, prime all tubing
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| Intracellular fluid | Inside of cells
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| Extracellular fluid | Outside of cells
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| Catheter related blood stream infection | Septicemia
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| Bacteria on skin enters on catheter insertion, catheter movement at insertion site, external sources | Septicemia
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| Septicemia s/s | Fever, backache, headache, malaise, tachypnea, signs of poor perfusion: delayed cap. refill, poor color
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| TPN can't hang longer then | 24 hrs. due to infection
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| #1 cause of CRBSI's | Hub contamination, wipe vigorously every time accessed, change cap every 7 days
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| Biopatch | Designed to continually release chlorhexidine over 7 days (antimicrobial & antifungal) Provides one inch zone of inhibition, infection decreased 60%
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| Stat-lock | Preferred method of stabilization PICC lines
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| Allergic reaction s/s | Chills & fever, erythema, itching, dyspnea or wheezing, anaphylatic shock, cardiac arrest
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| Allergic reaction treatment | Stop infusion immediately, maintain vascular access, notify RN/MD, frequent assessment including VS
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| Allergic reaction interventions | O2, antihistamines, epinephrine, steroids
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| Local complications | Infilltration & extravasion, phlebitis, thrombophlebitis, hematoma, clotting & obstruction
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| IV solution enters surrounding tissues, occurs when IV cannula dislodges or perforates wall of vein | Infiltration
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| Infiltration s/s | Edema at insertion site, leaking at site, pain, site cool to touch, decreased rate of infusion, drip rate, blanching, can cause permanent damage
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| Extravasation | Similar to infiltration, Inadvertent adminstration of chemo, vesicant or irritant
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| Extravasation s/s | Pain, Burning, redness at site, blistering, inflammation, tissue necrosis
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| Extravasation treatment | Don't take IV out. Leave in place to administer antidote
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| Phlebitis s/s | Reddened, warm area around site or along vein path, pain, vein may feel hard when palpated
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| Plebitis treatment | Stop infusion, assess site, notify RN/MD, disinfect site and remove catheter, restart IV opposite extremity, warm moist compress
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| Phlebitis prevention | Aseptic technique during IV insertion, clean gloves ok, sterile for central line
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| Phlebitis | Inflammation of vein r/t chemical or mechanical irritation or both, catheter moving in and out
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| Hematoma | Blood leaks into tissues surrounding IV insertion site
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| Hematoma possible causes | Opposite wall of vein perforated, catheter slipping out of vein, insufficient pressure to site after catheter removal
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| Hematoma s/s | Ecchymois-bruising, immediate swelling, blood leaking at site
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| Catheter Occlusion possible causes | Clot or precipitate, kinked tubing, very slow infusion rate, allowing IV bag to run dry
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