Basic Pharmacology for Nurses Chapter 11 Implantable infusion ports - Used for long-term therapy when intermittent accessing of the central vein is required for IV fluids, medications, TPN, chemotherapy, and blood products. Provides the most flexibility

Basic Pharmacology for Nurses Chapter 11 Implantable infusion ports - Used for long-term therapy when intermittent accessing of the central vein is required for IV fluids, medications, TPN, chemotherapy, and blood products. Provides the most flexibility for patients. midline catheter - 3-8 inches long, double or single lumen; inserted through intermediate sized veins and advanced to larger vessels. Used for therapies lasting 1-4 weeks but no recommended optimal dwell time (fluid hydration, long-term antibiotics, heparin infusions for DVT). Hypotonic solution - Solute concentration is less than that inside the cell; cell gains water. Used in cellular dehydration. Dextrose 5% in water (D5W) - A sterile solution that contains a concentration of 5% dextrose in water. Hypotonic solution. Winged needle IV catheter - - A.K.A butterfly catheter, scalp catheter - SHORT TERM USE! - Blood collection. - Admin of non-irritating meds. - Easy to puncture vessel wall, allowing SQ infiltration. - Plastic wings facilitate placement syringe pump - Infusion control device is used to administer morphine through a patient-controlled analgesia (PCA) pump What can the nurse do to prevent fungal infection on a IV site? - Refrain from applying topical ointment or cream Every 24 hours - How often should the nurse change the IV administration set used for TPN? Subclavian vein - Most commonly used vein for central venous catheters Veins of the lower extremities - IV sites at greatest risk for development of thrombi Microdrip chamber - 60 drops/ml Implanted Central Venous Catheter - consist of an implanted long term venous access port device composed of a catheter and reservoir with a self-sealing septum. Can last for more than a year if properly flushed with saline-heparin solution after every use and once monthly. Groshong catheter - Contains 1-3 rounded valve tips (Lumens). Opens inward for blood sampling, outward for infusion. Remains closed when not in use. Flushed weekly with saline, no need to clamp-remains capped when not in use. SASH guideline - Saline flush first Administer the prescribed drug Saline flush after the drug Heparin flush line symptoms of pulmonary embolism - Tachycardia, Pleuritic pain, unexplained hemoptysis Infiltration Scale - 0: no symptoms; 1: skin blanched, edema 1" in any direction, cool to touch, w/or w/o pain; 2: skin blanched, edema 1-6" in any direction, cool to touch, w/or w/o pain; 3: skin blanched, gross edema 6" in any direction, cool to touch, mild to mod pain, poss numbness; 4: skin blanched, translucent, skin discoulored, bruised, swollen, gross edema 6" in any direction, deep pitting tissue edema; circulatory impairment, mod to severe pain, infiltrate of any amount of blood product, irritant or vesicant symptoms of air embolism - Palpations, chest pain, and shortness of breath implantable venous infusion ports - placed into central veins for long term therapy Symptoms of excess IV fluids in elderly - Frothy sputum, thready pulse, cardiac dysrhythmias IV SITES: Infants - Back of the hand, dorsum of the foot, and temporal region of the scalp What prevents backflow of blood in implanted venous access device? - Maintaining firm pressure on the plunger of the syringe when withdrawing the needle Intervention in nursing care plan for pt receiving IV therapy - I&O TKO - to keep open-minimum rate 10 mL/hr Older adult IV site precaution - refrain from inserting catheter in the hands 0.9 Normal Saline (NaCl) is an example of - an isotonic solution. May be used to maintain vascular volume in a patient who is hypovolemic and hypotensive speed shock - caused by rush of IV fluid administered; med races to blood-rich heart and brain and floods them w/toxic levels of med. First priority is stopping the infusion immediately. Midline access catheters - They are used if it is anticipated that IV access will be needed for 7 days or more Irritation of the vein by catheter, infection, chemical irritation from the medication - Situations associated with intravenous therapy can cause thrombophlebitis Slow infusion to TKO - Which course of action would the nurse take if a patient with an intravenous (IV) line has signs of pulmonary edema? Tunneled Central Venous Catheter - Long-term use Implanted into the internal or external jugular or subclavian vein Length of catheter is 8 cm depending on patient size Broviac, Hickman, Groshong Lactated Ringers - isotonic solution Ideal for patients that have intravascular fluid deficit (acute blood loss, as a result of hemorrhage, GI bleed, trauma) Refrain from forcing the flush into the IV catheter - This intervention is essential for preventing a pulmonary embolism. Changing the solution of IV when the same tubing will be used - - Clamp the tubing on the primary IV line before changing the container - Use aseptic technique to change the container quickly for the empty one - Ensure that the compatibility of the new IV solution is checked with the current solution Steps would a nurse follow when discontinuing an intravenous (IV) infusion when the IV site is to be converted to a saline lock? - - Attach the flush syringe to the extension tubing - Stabilize the catheter hub when disconnecting the primary IV tubing - Shut off the infusion equipment after clamping the tubing on the IV line Flushing an intravenous (IV) line and are unable to aspirate blood during the procedure - - Check whether the clamp on the IV tubing is open - Remove the injection cap and aspirate the blood clot - Reposition the patient's upper body and help perform Valsalva maneuver Physiological fluids through IV device - - Change the administration set every 72 hours - Monitor the patient's intake and output carefully - Report decline in hourly outputs to the primary healthcare provider hypertonic solution - - They should not be administered in peripheral veins if the osmolalities are more than approximately 600 to 700 mOsm/L - They are administered through central infusion lines, where the solution can be rapidly diluted by large volumes of rapidly flowing blood - They cause cellular dehydration and vascular volume overload, by pulling fluid from the intracellular and interstitial compartments into the intravascular compartment educating a patient regarding the use of over-the-needle catheters - - Teflon-like plastic is used to make over-the-needle catheters - The metal needle is removed after the catheter is inserted into the veins - Over-the-needle catheters should ideally be changed every 72 to 96 hours Midline catheter - Devices used for 2-4 weeks of IV therapy D5W - example of a hypotonic solution 0.9% normal saline - Which fluid may be used to maintain vascular volume in a patient who is hypovolemic and hypotensive? Application of heat to the site - A patient receiving IV vincristine for the treatment of acute leukemia develops extravasation. Which action does the nurse implement? Irritation of the vein by the catheter Infection Chemical irritation from medication - Causes of thrombophlebitis statements that are true about IV administration of medications - -IV administration is the most rapid of all parenteral routes. -Large volumes of fluids can be rapidly infused into a vein -The nurse should always check for drug allergies before administration