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Some terminology:

Some terminology:. Hub (IV catheter) Maintenance (or primary) solution TKO (KVO) rate Parenteral Mechanical gravity devices EID: electronic infusion device NAD: needleless access device NAP: needleless access port. Complications - systemic. Septicemia (CRSI)

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Some terminology:

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  1. Some terminology: • Hub (IV catheter) • Maintenance (or primary) solution • TKO (KVO) rate • Parenteral • Mechanical gravity devices • EID: electronic infusion device • NAD: needleless access device • NAP: needleless access port

  2. Complications - systemic • Septicemia (CRSI) • Fluid overload & pulmonary edema • Catheter embolism • Air embolism • Speed shock

  3. Complications - local • Phlebitis • Mechanical or Chemical • Infiltration/ Extravasation • Local infection • Hematoma/ecchymosis • Thrombophlebitis • Thrombosis (catheter) • Venous spasm

  4. Phlebitis: Treatment • Discontinue infusion at the first sign of phlebitis • Notify physician • Apply warm or cold compresses to affected site • Notify infection control if part of agency policy

  5. Infiltration vsExtravasation • Inadvertent administration of a nonvesicant solution into surrounding tissues. • The inadvertent administration of a visicant solution into surrounding tissue. Infiltration Extravasation

  6. To Err is Human • IOM report • CDC & INS standards • “follow your hospital policy” – • Changing IV admin sets • IV dressings • How does this contribute to patient safety?

  7. CDC/INS guidelines • Change IV administration sets • Dressing changes • Changing NAP • Cleanse access port with new alcohol swab for 15 seconds.

  8. Needless Access Ports (NAP) • Easily converts to/from intermittent • 3 types • Capped, resealable diaphragm • Blunt cannula split septum • Luer access – neg. displacement • Luer access – pos. displacement • Negative pressure or positive pressure? • Flushing technique is different!!!

  9. Converting maintenance IV to Saline Lock • Does it have a small extension tubing? • Yes: only need alcohol swabs & NS • No: prime extension tubing; get new dressing • Gauze pads • Chux pad • Hemostats • Normal Saline • Bacteriostatic 0.9% vs Preservative-free

  10. Dressing Change • TSM = transparent semipermeable membrane • Tegaderm is one brand out of many • Change ________ • Gauze dressing • Procedure:

  11. Discontinuing a Peripheral IV • When: • Leaking, infiltration, pain, phlebitis, Dr. order • Supplies: gloves, 2x2 gauze, bandaid • How: Phillips, Procedure 6-4 • Greatest risk: catheter embolism

  12. Characteristics and uses of electronic infusion devices • Power switch • “enter” • Numbers keyboard • Set rate (in ml/hr) • Set volume to be infused (VTBI) • Check volume infused • hold/run button

  13. Characteristics and uses of electronic infusion devices • Run/hold indicator • display screen • alarms • door to put in tubing • Safety mechanism when door shut • Visual -battery, or electrical power. • Alarm Cause

  14. Alarms • Upstream occlusion • Downstream: • Air • Infusion complete • Door/cassette open • Low battery • Error code _____

  15. Documentation INS standard: “…shall be legible, accessible to qualified personnel, and readily retrievable. The protocol for documentation should be established in organizational policies and procedures.” • “Shall reflect continuity, quality & safety of care” INS standards, 2011

  16. Documentation • Patient/family participation • Site condition & appearance • Does facility have standardized assessment scales? • Dressing, type of stabilization, pain • Type of therapy: drug, dose, rate • Daily assessment of need for VAD

  17. Documentation • Multiple sites or lumens: what is infusing where • Discontinuation of therapy • patient tolerance • “tolerated well”: NO, NO, NO NO • What are assessments that you made to come to that conclusion? (C. Madsen)

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