Skills 3-IV Therapy (PARENTERAL)

knowledge of

site selection

devices

equipment

troubleshooting

VAD -vascular access devices

inserted into vein to administer IV solutions and medications

peripheral and central devices

depend on where tip of device (catheter) resides

peripheral

short, midline, locked (flushed) with NS

central/cardiac

tunneled (long term use), nontunneled,

PICC

implanted port/chemo; locked (flushed) with heparin (10 units/mL) or NS

selecting type of VAD

prescribed therapy

length of treatment

duration device can remain in place

vascular characteristics

patients age

co morbidities

history of infusion therapy

preference

resources/ability to care for device

preferred sites

veins in dorsal and ventral surfaces of arm

use most distal site in

nondominant arm if possible

peripheral VAD name

midline catheter

peripheral VAD insertion

right above antecubital , goes right into midline not heart

infilitration

catheter has disloged from vein now theres swelling

gets as big as aht you leak in it

hematoma

ppl with bleeding disorders and elderly you will see this (bruise)

phlebitis

inflammation of a vein, often accompanied by a blood clot, known as thrombophlebitis. 

take IV out

extravasation

leakage of a fluid or substance from a blood vessel or other container into the surrounding tissue due to TOXIC MEDICATION

eats at the skin immediately

nerve injury

infilitration and extravastation

infilitration can cause

blistering

short term CVADs

PICC- inserted simmilarly to midline

Nontunneled

long term CVADs

tunneled

implanted port

tip of CVAD

placed in the superior or inferior vena cava

CVAD catheter tip can be

open ended or valve ended

CVADs lumens

single or multiple

complications associated with CVADs

include local or systemic infection

PICC shorterm name

peripherally inserted central catheter

PICC shorterm

thin flexible tube that is inserted into a vein in the upper arm and threaded into a large vein above the right side of the heart (superior vena cava)

PICC shorterm is used

to give intravenous fluid, bld transfusions, chemo, antibiotics, & drugs

nontunneled percutaneous short term device

placed directly into a large vein

temporary, PPL WHO ARE SEPTIC

commonly used in the internal jugular vein

tunneled catheter long term device

threated into SVC-superior

catheter under skin held in place by cuff

tunneled catheter long term device

open ended

hickman

broviac

catheter tip is open like a straw

tunneled catheter long term device

valve ended

Groshong

rounded catheter tip with a 3 way pressure activated valve that

prevents reflux of blood into catheter to reduce risk of hemorrhage, air

embolism, and occlusion; heparin not needed to maintain patency

implanted venous port long term device

reservoir placed in pocket under skin with catheter inserted into a major vessel (SUBCLAVAIN)

implanted venous port long term device

access port by

inserting a 90 degree angle noncoring needle (prevents a hole) through skin into self sealing injection port in the septum of reservoir

unexpected outcomes

review table 28.8 complications of vascular access devices

other ex…. pneumothorax, hemothorax, air emboli, hydrothorax

sepsis (CLABSI), skin erosion

perioheral salin lock

syringe inserted into injected port, may have a lock adaptor

flush tube doesnt occlude

microdrip

60 gtt/ml

delivers rates less than 100 m/hr

macrodrip

10, 20, or 15 gtt/ml

adjust roller clamp

to increase or decrease rate of infusion

IV FLUIDS unexpected outcomes

fluid volume deficit

fluid volum excess

electrolyte imbalances

can delegate

report leaking, tubing disconnection, low volume or empty container, alarms, patient complaints (burning, bleeding, or swelling) — itll beep and arm may be red

cannot deleagte

inserting a short peripheral IV

changing IV solutions, tubing, dressing,

discontnuing IV line

managing a CVAD

techs cannot disconnect IV

to let pt go to the br or changing gowns, this means theyre discontinuing therapy