Infusion Infusion TherapyTherapy

Parenteral NutritionParenteral Nutrition

• Formulas: dextrose, protein, fat, Formulas: dextrose, protein, fat, vitamins, and numerous trace vitamins, and numerous trace elements tailored to the specific elements tailored to the specific metabolic needs of the clientmetabolic needs of the client

• Only used when the gastrointestinal Only used when the gastrointestinal tract cannot be usedtract cannot be used

• CentralCentral

• PeripheralPeripheral

Blood Transfusions and Blood Transfusions and Other ComponentsOther Components

• Packed red blood cellsPacked red blood cells

• PlateletsPlatelets

• Fresh frozen plasmaFresh frozen plasma

• AlbuminAlbumin

• Several specific clotting factorsSeveral specific clotting factors

MedicationsMedications

• IV medications provide a rapid IV medications provide a rapid therapeutic effect but can also therapeutic effect but can also lead to immediate serious lead to immediate serious reactions.reactions.

• Prescription for infusion therapy Prescription for infusion therapy is necessary.is necessary.

Vascular Access Device Vascular Access Device (VAD)(VAD)• Short peripheral cathetersShort peripheral catheters

– Superficial veins of the hand and Superficial veins of the hand and forearmforearm

– Dwell for 72 to 96 hours and then Dwell for 72 to 96 hours and then require removal and insertion into require removal and insertion into another venous siteanother venous site

• Complaints of tingling, feeling of Complaints of tingling, feeling of “pins and needles” in the “pins and needles” in the extremity, or numbness during the extremity, or numbness during the venipuncture can indicate nerve venipuncture can indicate nerve puncture.puncture.

Midline CatheterMidline Catheter

• Catheter that is 6 to 8 inches long, Catheter that is 6 to 8 inches long, inserted through veins of the inserted through veins of the antecubital fossaantecubital fossa

• Used for therapies lasting from 1 to 4 Used for therapies lasting from 1 to 4 weeksweeks

• Should not be used for infusion of Should not be used for infusion of vesicant medications, which can cause vesicant medications, which can cause tissue damage if they escape into the tissue damage if they escape into the subcutaneous tissue (extravasation)subcutaneous tissue (extravasation)

Peripherally Inserted Peripherally Inserted Central Catheter (PICC)Central Catheter (PICC)• Length ranges from 40 to 65 cm.Length ranges from 40 to 65 cm.

• Basilic vein is the preferred site for Basilic vein is the preferred site for insertion; cephalic vein can be used.insertion; cephalic vein can be used.

• Placement is confirmed by chest x-Placement is confirmed by chest x-ray examination.ray examination.

• No information is available on No information is available on optimal dwell time.optimal dwell time.

• Teach clients to perform normal Teach clients to perform normal ADLs, avoiding excessive physical ADLs, avoiding excessive physical activity.activity.

Nontunneled Percutaneous Nontunneled Percutaneous Central CatheterCentral Catheter

• Inserted through subclavian vein in Inserted through subclavian vein in the upper chest or jugular veins in the the upper chest or jugular veins in the neckneck

• Usually 15 to 20 cm longUsually 15 to 20 cm long

• Tip resides in the superior vena cavaTip resides in the superior vena cava

• Placement confirmed by chest x-ray Placement confirmed by chest x-ray examinationexamination

• No recommendations for optimal No recommendations for optimal dwell timedwell time

Tunneled Central CatheterTunneled Central Catheter

• A portion of the catheter lying in A portion of the catheter lying in a subcutaneous tunnel separates a subcutaneous tunnel separates the points at which the catheter the points at which the catheter enters the vein from where it enters the vein from where it exits the skin.exits the skin.

• Tunneled central catheter is used Tunneled central catheter is used for infusion therapy that is for infusion therapy that is frequent and long-term.frequent and long-term.

Implanted PortImplanted Port

• Implanted ports consist of a portal Implanted ports consist of a portal body, a dense septum over a body, a dense septum over a reservoir, and a catheter.reservoir, and a catheter.

• A subcutaneous pocket is surgically A subcutaneous pocket is surgically created to house the port body.created to house the port body.

• Port is usually placed in the upper Port is usually placed in the upper chest or the upper extremitychest or the upper extremity

• Port needs to be flushed after each Port needs to be flushed after each use and at least once a month use and at least once a month between courses of therapy.between courses of therapy.

Dialysis CatheterDialysis Catheter

• Lumens are very large to Lumens are very large to accommodate the hemodialysis accommodate the hemodialysis procedure or a pheresis procedure procedure or a pheresis procedure that harvests specific blood cells.that harvests specific blood cells.

• This catheter should not be used This catheter should not be used for administration of other fluids for administration of other fluids or medications, except in an or medications, except in an emergency.emergency.

Infusion SystemInfusion System

• ContainersContainers• Administration setsAdministration sets• Add-on systemsAdd-on systems• Needleless connection devicesNeedleless connection devices• Rate controlling devices:Rate controlling devices:

– ControllerController– PumpsPumps

•Syringe pumpsSyringe pumps•Ambulatory pumpsAmbulatory pumps

Catheter Care and Catheter Care and MaintenanceMaintenance

• Educating the clientEducating the client

• Confirming tip locationConfirming tip location

• Performing the nursing assessmentPerforming the nursing assessment

• Securing and dressing the catheterSecuring and dressing the catheter

• Changing administration sets and Changing administration sets and needleless connectorsneedleless connectors

• Controlling infusion pressureControlling infusion pressure(Continued)(Continued)

Catheter Care and Catheter Care and MaintenanceMaintenance (Continued)(Continued)

• Flushing the catheterFlushing the catheter

• Obtaining blood samples from Obtaining blood samples from the catheterthe catheter

• Removing the catheterRemoving the catheter

Considerations for Older Considerations for Older AdultsAdults

• Skin care precautionsSkin care precautions

• Vein and catheter selectionVein and catheter selection

• Cardiac and renal changesCardiac and renal changes

Alternative Sites for Alternative Sites for InfusionInfusion

• Arterial therapyArterial therapy

• Intraperitoneal infusionIntraperitoneal infusion

• Subcutaneous infusionSubcutaneous infusion

• Intraspinal infusionIntraspinal infusion

• Intraosseous therapyIntraosseous therapy

•Types of catheter malposition