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Infusion Therapy Overview

  • Definition: Infusion therapy delivers medications in solution and fluids via parenteral routes (skin/mucous membrane) through catheters.

  • Common Method: Intravenous (IV) therapy is widely used to directly deliver solutions into the vascular system.

  • Delivery Settings: Applicable in hospitals, home care, ambulatory care clinics, primary health care, and long-term care facilities.

  • Main Purposes of Infusion Therapy:

    • Maintain or correct fluid balance.

    • Maintain or correct electrolyte or acid-base balance.

    • Administer medications.

    • Replace blood or blood products.

  • Importance in Chronic Diseases: Advances allow patients with chronic diseases (diabetes, kidney disease, malabsorption) to undergo long-term infusion therapy, requiring specialized administration skills due to poor vascular integrity.

Types of Infusion Therapy Fluids

  • Categories of IV Solutions: Over 200 IV fluids categorized by tonicity and pH:

    • Tonicity:

      • Isotonic: 270-300 mOsm/L; no net water movement.

      • Hypertonic: >300 mOsm/L; draws water out of cells.

      • Hypotonic: <270 mOsm/L; moves water into cells.

    • pH Range: Typically 3.5 to 6.2; extremes can cause vein damage.

  • Risks: Hypertonic/hypotonic solutions can lead to phlebitis and infiltration.

    • Phlebitis: Inflammation of a vein due to various irritations.

    • Infiltration: Leakage of IV solution into surrounding tissues.

IV Therapy: Types of IV Solutions

  • Fluid Locations: Fluid in the body is categorized into:

    • Intracellular (ICF): Inside the cells.

    • Extracellular (ECF): Outside the cells—including interstitial and intravascular fluid.

  • IV Solution Types:

    • Hypertonic Solutions:

      • Uses: Cerebral edema, low sodium levels, etc.

    • Isotonic Solutions:

      • Uses: Expand blood volume, replace fluid loss (e.g., burns, hemorrhage).

    • Hypotonic Solutions:

      • Uses: Intracellular dehydration (e.g., DKA).

Blood and Blood Components

  • Components: Includes packed red blood cells, platelets, fresh frozen plasma, albumin, clotting factors.

  • Safety Protocols: The Joint Commission mandates strict compatibility checks and monitoring during transfusion.

  • Identification: Requires two patient identifiers and two qualified health care professionals.

Drug Therapy in Infusion

  • Rapid Effects: IV drugs provide quick therapeutic effects but can cause adverse drug events (ADEs).

  • Nurses' Responsibilities: Must know drug indications, dosages, contraindications, dilution requirements, pH, osmolarity, and patient monitoring protocols.

  • Medication Safety: High-alert drugs require careful control to prevent medication errors (e.g., having look-alike, sound-alike precautions).

Prescribing Infusion Therapy

  • Prescription Requirements:

    • Specific fluid type and rate of administration.

    • Details of included drugs and dosages.

    • Author’s details and purpose if required.

Vascular Access Devices

  • Infusion Catheter Overview: Used for fluid delivery, varies in type:

    • Types:

      • Short Peripheral Catheters

      • Midline Catheters

      • PICCs

      • Tunneled catheters

      • Non-tunneled CVCs

      • Implanted ports

      • Hemodialysis catheters

Short Peripheral Catheters

  • Insertion: Typically into arm veins, avoiding lower extremities unless necessary due to DVT risk.

  • Gauge Sizes: Varies for different applications; 24-16 gauge for blood transfusions and surgery.

  • Dwell Time Recommendations: Regular assessment required; CDC and INS recommend timely removal/rotation based on clinical signs.

Engagement in Practice (Best Practices)

  • Site Selection and Preparation:

    • Best veins: basilic, cephalic, median veins; avoid joint flexion areas.

  • Infection Prevention:

    • Clean skin thoroughly, clip hair not shave, use antiseptics without touching the area after application.

Midline Catheters

  • Specifications: 3-8 inches long, inserted via upper arm veins, effective for therapies longer than 6 days.

  • Limitations: Should not be used for vesicant drugs or high osmolarity solutions (>600 mOsm/L).

  • Key Usage: Suitable when long-term IV access is required but peripheral lines are ineffective.

Central Venous Access

  • Types:

    • PICCs: Inserted into upper arm, ideal for long duration therapy, requires x-ray confirmation for placement.

    • Nontunneled CVCs: Inserted into subclavian or internal jugular veins for short-term, higher infection risk at femoral sites.

    • Tunneled CVCs: Designed for long-term use, provides skin barrier to reduce infection.

    • Implanted ports: For patients needing long-term access with the least visible impact on body image.