Infusion Therapy.txt

The delivery of parenteral meds & fluids through a variety of catheter types & locations using multiple techniques & procedures

• Blood transfusions
• Maintenance
• Medications
• Nutrition - TPN
• Replacement

• Include IV fluid, electrolyte therapy, & total parenteral nutrition
• Fluids that supply water & sodium & contain electrolyes
• Replace fluid deficits
• Maintain & manage specific fluid/electrolyte disturbances

• Blood components used to increase the colloidal oncotic pressure
• Moves fluid from interstitial into intravascular space
• Called plasma expanders

• Anesthetics
• Fluids
• Medications
• Provides access route
• Route of choice - for products not absorbed orally (hepatic first pass)

• Allergic response
• Dislodgement
• Embolism
• Fluid overload
• Pain
• Precipitation
• Sepsis
• Transmission of HIV/Hepatitis

Fluid contained within the cells. It is 40% of adult body weight & 70% of total body water.

Fluid that is outside the cells. It is 20% of adult body weight & 30% of total body water.

• Intravascular/plasma is fluid within the vascular system
• Interstitial (ISF) fluid surround tissue cells. These solutions exist in small spaces between body structure, cells, & tissue
• Transcellular fluid is confined to a specific area or region of the body such as cerebrospinal fluid, sweat, ocular fluid

• Measures the concentration of dissolved particles in blood.
• IV fluids have an isotonic, hypotonic or hypertonic osmolality.

Balanced cells - no effect on cells

• Remain in intravascular space
• Used to treat hypotension resulting from hypovalemia
• Compatible with plasma
• Can be infused at a faster rate
• Expands intravascular compartment
• EX: Lactated Ringers, 0.9% NaCl (full strength)
• Normal Saline

Over hydrates cells - cells swell

• Used to hydrate intracellular & interstitial compartments
• Rate must be carefully controlled
• EX: 0.45% NaCl (1/2 strength) - No Dextrose

Cells swell

• Greatly expands intravascular compartment
• Extreme caution used to prevent fluid overload
• EX: 3% NaCl, 10% Dextrose 0.45% NaCl, 5% Dextrose - given for low sodium

• Peripheral
• Central
• Arterial-intra-arterial chemotherapy
• Central nervous system
• Clysis
• Intraosseous
• Intraperitoneal

• Don't put in legs or feet
• Don't go higher than 10% Dextrose

• Be careful not to pull out!
• In central vessel, subclavian (most common), jugular

PICC - peripherally inserted central catheter - can last 6 months

In hepatic artery

Into the peritoneal cavity for tumors confined to that area

• 1. Epidural - into the epidural space of the spinal column located between the wall of the vertebral canal & the dura matter
• 2. Intrathecal - into the ventricular cerebrospinal fluid to provide chemotherapy, pain meds, or ABX for patients with cancer, pain, or infection. It is placed into one of the lateral ventricles

Into the medullary space of long bones

Hypodermoclysis - sub q - people who are dying

• Pain
• Vesicant - solution capable of causing destruction or injury if it escapes into the tissue such as KCL or chemotherapy
• Extravasation - vesicant - can cause blistering or sloughing
• Infiltration - IV catheter has become dislodged, resulting in a non-vesicant solution leading into the extravascular space. It causes the site to be cool, pale, swelling & can lead to compartment syndrome.
• Compartment Syndrome - increased tissue pressure in a confined anatomical space which causes decreased blood flow to the area
• Occlusion/displacement - IV in middle of arm & pt bends arm or clot in IV
• Phlebitis - inflammation of the vein, cordlike, erethyma, may feel warm. TX: elevate & warm compresses
• Thrombosis
• Hematoma
• Venous spasm - contraction of vessel wall, cold solutions, certain meds can cause this (Dilantin)
• Cellulitis - diffuse inflammation & infection of cellular & sub q tissue.
• Nerve damage - from incorrect placement

• Contamination
• Sepsis
• Med/fluid incompatibility
• Allergic reaction
• Embolism (air) - turn pt on left side
• Speed shock - too rapid infusion, get a pounding headache, chills, apprehensive
• Circulatory overload - crackles, increased BP

• Handwashing
• Chlorhexidine - antiseptic of choice
• Iodine preps - allergic to shellfish?
• Dressing changes every 72-96 hours
• Tubings q 72-96 hours
• Check policy
• Central line tubing q 24 hours

• Solution ordered
• Rate of infusion
• Type of device
• Site & dressing
• Client teaching/response
• D/C IV

• Altered immune system
• Confusion
• Inadequate diet
• Infection
• Long term diuretics
• Malnutrition
• Skin integrity

• Standard / Macrodrop - 10 gtt/mL, 15 gtt/mL, 20 gtt/mL
• Microdrop Minidrip - 60 gtt/mL