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Chapter 13 Intravenous Infusion and Blood Transfusion

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Title: Chapter 13 Intravenous Infusion and Blood Transfusion


1
Chapter 13 Intravenous Infusion and Blood
Transfusion
2
SECTION ONEIntravenous Infusion
  • DefinitionIV infusion is a method that a large
    volume of solution is infused into vein to
    correct fluid and electrolyte disturbance.
  • solution passage (infusion set) vein

3
Intravenous Infusion
  • IV infusion is a serious and complex
    responsibility that requires the nurse
  • proficiency in performance
  • familiarity with the anatomy involved
  • mindful use of principles of asepsis
  • expertise in prevention, management of
    complications that may occur with treatment

4
Intravenous Infusion
  • Fluids are medications--IV infusion requires a
    physicians order
  • the type and amount of fluid administered will be
    based on types of patients need
  • the patients age
  • general health status
  • the results of
    laboratory tests

5
Types of solutions
  • There are many methods of classification.
  • according to their osmolality in relation to
    normal blood plasma
  • according to their purpose

Hypotonic fluids Isotonic fluids Hypertonic fluids
Nutrient solutions Electrolyte solutions Volume
Expanders
6
Hypotonic fluids
  • have lower osmolality than plasma
  • to correct dehydration as they move from blood
    vessels into the cells
  • examples are 0.45 NaCl, 0.2 NaCl, or 5GS
  • excessive infusion can cause water intoxication

7
Isotonic fluids
  • have the same effective osmolality as plasma
  • to expand the intravascular space to correct
    hypovolemia as in shock
  • examples are lactated Ringers,
  • 0.9 ( normal )
    saline(0.9NaCl),
  • 5 dextrose in
    normal saline(5GNS).
  • 1.4NaHCO3
  • excessive infusion can cause circulatory overload
    and pulmonary edema

8
Hypertonic fluids
  • have greater osmolality than plasma
  • to pull fluid from cells and the interstitial
    space into the intravascular space to relieve
    edema
  • examples are gt5 dextrose solutions,
  • colloidal products
    such as dextran,
  • 3 saline ( rarely
    used ).
  • excessive infusion can cause cellular dehydration
    and circulatory overload or diuresis.

9
Nutrient solutions
  • contain some form of glucose and water
  • for calories and fluids replacement
  • examples are 5 or 10dextrose in water
  • Hypertonic ( gt10 percent dextrose )
    parenteral nutrition solutions are irritating to
    peripheral veins and so must be infused into
    central veins.

10
Electrolytes solutions
  • contain varied amounts of cations and anions
  • examples are normal saline,Ringers solution,
    and lactated Ringers solution
  • commonly be used to restore vascular
    vo1ume,particularly after trauma or surgery
  • also be used to replace fluid and electrolytes
    for patients with continuing losses,for
    example,gastric suction or wound drainage

11
Volume expanders
  • be used to increase the blood volume following
    severe loss of blood or loss of plasma
  • examples are dextran,plasma,and human serum
    albumin

12
Clinical routine
  • In clinic, prepare fluids fall into the following
    three categories
  • Crystalloid Solution
  • Colloidal Solution
  • Parenteral Nutrition Solutions

13
Crystalloid Solution
  • have small molecular weights and stay in blood
    vessel for a short time
  • maintain the balance of fluids in intracellular
    and extra- cellular
  • correct the fluids and electrolytes disturbance
  • commonly used crystalloid solutions are
  • Dextrose in Water Solutions
  • Isotonic Electrolytes Solutions
  • Alkaline solutions
  • Hypertonic Solutions

14
Dextrose in Water Solutions
  • Be used for fluids and calories
    replacement,decreasing the consumption of
    albumen,and preventing the production of ketone.
  • glucose is decomposed quickly in body, usually
    doesnt cause hypertonic and diuretic effects.
  • Clinically there are usually 5GS and 10GS
  • (25GS 50GS rarely used)

15
Isotonic Electrolytes Solutions
  • be used in electrolytes replacement.
  • Loss of body fluids usually is accompanied with
    disturbance of electrolytes.So, the balance of
    fluids and electrolytes must be maintained during
    fluids replacement.
  • examples are o.9 NaCl,Ringers isotonic solution
    and 5 GNS.

16
Alkaline solutions
  • NaHC03 in Water Solutions
  • Be used in correcting acidosis, and regulating of
    acid-base balance.
  • NaHC03 Na and HCO3- HCO3- H
    H2CO3
  • C02 H2 O.
  • Commonly used solutions are 5 NaHC03 and 1.4
    NaHC03 Solutions.
  • Sodium Lactate in Water Solutions
  • The concentrations of the solution usually used
    in clinic are 11.2 and 1.84.

17
Hypertonic Solutions
  • be used for diuretic and dehydration purposes
  • increase osmolality of blood plasm pulling
    fluids into plasma reduce the edema of
    tissues
  • can decrease intracerebral pressure and improve
    the function of central nervous system.
  • Clinically,mannitol 20,sorbitol 25 and dextrose
    25-50 in water solutions are often used.

18
Colloidal Solution
  • have large molecular weight,can stay in blood for
    a long time
  • can maintain plasma colloid osmotic pressure
    effectively,
  • expand the blood volume,
  • improve microcirculation,
  • elevate the blood pressure.
  • examples are dextran
  • plasma
    substitutes
  • blood
    products

19
Dextran
  • It is water-soluble polysaccharide of high
    molecular polymer.
  • moderate molecular dextran elevate plasma
    colloid osmotic pressure,expand blood volume
  • small molecular dextran reduce the viscosity of
    blood,decrease the accumulation of
    erythrocytes,improve microcirculation and tissue
    perfusion volume,and prevent the formation of
    thrombosis

20
Plasma Substitutes
  • can expand vascular volume and cardiac output
    greatly
  • can be used with whole blood in acute massive
    hemorrhage
  • examples are 706 (hydroxyethylamylum),povidone
    and oxypolygelation

21
Blood Products
  • can elevate colloid osmotic pressure
  • expand vascular volume
  • provide protein and antibody
  • help with tissue repair and enhance immunity of
    body

22
Parenteral Nutrition Solutions
  • be intravenously given to the patients who are
    unable to get nutrition via gastrointestinal
    tract or have inadequate intake of nutrients
  • provide calories,proteins,vitamins and
    minerals,and maintain the balance of nitrogen
  • main compositions amino acids,fatty
    acids,vitamins,minerals,high concentration of
    glucose ,and water
  • commonly used solutions multiple amino acids
    solutions , fat emulsions

23
sequence principle of solution transfusion
  • First crystalloid solutions then colloidal
    solutions
  • First sodium chloride solutions then dextrose in
    water solutions
  • first fast then slow, rather shortage than
    overload
  • rather acid than alkaline
  • Potassium solutions properly

24
Sites of Venipuncture
  • Peripheral Superficial Vein
  • veins in dorsal hands the first choice for
    adult patients
  • median cubital,basilic,cephalic veins drawing
    blood

  • bolus injections of
    medication

  • PICC
  • The saphena veins in legs and veins in dorsal
    feet are not the first choice because of the
    danger of thrombosis caused by the vein valve.
  • Veins in dorsal foot are commonly used for
    children,but are avoided in adults because of the
    danger of thrombophlebitis.
  • Veins in the Scalp for infants
  • Subclavian,External Jugularfor central venous
    access

25
peripheral intravenous infusion
  • Purposes
  • Preparation nurse
  • patient
  • environment
  • equipment
  • Procedures and Key Points
  • Evaluation
    VCD

26
Purposes
  • To correct or prevent fluid and electrolyte
    disturbances resulted from illnesses, altered
    fluid intake, or prolonged episodes of vomiting
    or diarrhea.
  • To increase the blood volume, maintain blood
    pressure following severe loss of blood, severe
    burns, or shock.
  • To supply medication to cure diseases for rapid
    effectiveness.
  • To supply nutrient substances to promote wound
    healing, weight gain and positive nitrogen
    balance for patients with chronic consuming
    illness, inability to intake, digest or absorb a
    diet.
  • To establish a lifeline for rapidly needed
    medications.

27
Preparation
  • Nurse
  • 1. Review the physicians order in patients
    record.
  • 2. Evaluate patients age and medical status.
    Evaluate patients renal status and other
    pertinent lab data (e.g., electrolyte, serum
    glucose ).
  • 3. Wash hands and wear mask.
  • patient
  • 1. Verify patients identity.
  • 2. Explain the procedure and purpose.Ask the
    patient to void.
  • 3. Position the patient for comfort and
    optimal visibility for skill performance.

28
Preparation
  • Environmentcleanness, commodiousness and
    brightness
  • equipment
  • Medical tray
  • Antiseptic solution Sterile
    swab
  • Tourniquet
    infusion Pad
  • Adhesive tape
    File and vial opener
  • IV solution and medication
    Bottle bag
  • Infusion set
    kidney-shaped tray

29
Procedures and Key Points
  • 1.Check and right
  • the bed number,the patients name,medication
    name, concentration, dosage, date and usage
  • the quality of solution(the cap of bottle, the
    expiration date , deposition,cloudiness, foreign
    matter, any cranny on the bottles body)
  • 2. Complete the medication label and stick it to
    the solution container

30
  • 3. Add medications into solution
  • 4.Insert the infusion set
  • 5. Prepare the equipment and
  • take them to the bedside.
  • Check again
  • 6. Discharge air

31
  • 7.Select the venipuncture site(pad , tourniquet )
  • 8.Sterilize the venipuncture site.Prepare
    adhesive tape.
  • 9.Check again.
  • 10. venipuncture

The wizened The obese The elderly The dropsical
(edema)
32
  • 11.fixation
  • 12. Regulate the flow rate
  • 13. Check again.
  • 14. Disposure after operation
  • (equipment,patient)
  • 15. Change bottles
  • 16. Disposure after infusion
  • (equipment,patient)

33
Cautions
  • 1. Follow the principles of asepsis and check
    system strictly to prevent infection and
    mistakes.
  • 2. Arrange the sequence of IV fluids rationally
    according to the patients need. Assign
    medications according to the therapeutic
    principles and the half life of medications.
  • 3. Protect and use veins reasonably (usually from
    small veins) to patients who need long-term IV
    infusion.

34
Cautions
  • 4. Prevent air embolism by ejecting air
    thoroughly in infusion set, changing fluid
    bottles and withdrawing the venipuncture needle
    in time.
  • 5. Assess for compatibility of medications.
    Ensure the needle have been inserted into vein
    before administration irritative or special
    medications.
  • 6. Master the flow rate strictly.
  • 7. Assess during infusion carefully in order to
    find the problems and settle the problems on
    time. Document the result after assessment.

35
Education
  • 1. Tell the patient dont regulate the flow rate
    optionally.
  • 2. Introduce the signs and symptoms of
    complications with IV reactions, ask patient call
    nurse in time when he find the signs of IV
    reaction.
  • 3. Instruct the patient to report any blood in
    the tube,a stoppage in the flow,or increased
    discomfort.
  • 4. Intensify mental nursing to patient who need
    long-term IV infusion.

36
Evaluation
  • Assess the status of the skin and dressing of IV
    site by observing whether there is
    heat,pain,redness,or swelling
  • Whether the IV flows smoothly and whether the
    flow rate is consistent with what is ordered
  • Check the information to ensure the right
    medication administered
  • Signs and symptoms of complications with
    intravenous infusion
  • Patients knowledge about medication and infusion
  • Ability to perform self-care activities.

37
Regulating the Infusion Flow Rate
  • Calculate the Flow Rate
  • Common Infusion Control Device

38
Calculate the Flow Rate
  • Total time of infusion (h)
  • Total infusion vo1ume (m1)drop factor
    (drops/m1)
  • Drops per minute60
  • Drops per minute
  • Total infusion vo1ume (m1)drop factor
    (drops/m1)
  • Total time of infusion (min)

39
Calculate the Flow Rate
  • Slow flow rate is suitable for
  • the elderly,infants and patients with diseases
    in heart, 1ungs,or kidney.
  • When hypertonic solutions,solutions containing
    potassium,or solutions containing medications for
    raising blood pressure are infused,the flow rate
    also should be slow.
  • When a patient with normal heart and lung
    function has severe dehydration,the flow rate
    should be rapid.

40
Common Infusion Control Device
  • Clampbe easy to operate not precise
  • Infusion Pump
  • exert positive pressure on the tubing or on the
    fluid to ensure measured amount of fluid is
    infused uniformly in a given time
  • has a drop sensor, and an alarm that will sound
    if drops are not detected at the appropriate rate
  • VCD

41
The Usage of Infusion Pump
42
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43
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44
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45
Assessing during infusion
  • The responsibilities of nurses in assessment are
  • keeping the system sterile
  • changing solution,tube,and dressings on time
  • assisting the patient with self-care activities
    so as not to disrupt the system
  • instruct the patient to report any blood in the
    tube,a stoppage in the flow,or increased
    discomfort.

46
Common Problems during Infusion and Methods to
Treat
  • Slow Flow Rate or No Infusion
  • Too Large Volume of Solution in Chamber
  • Too Small Volume of Solution in Chamber
  • The Surface of Liquid Fall down Automatically
  • assess the site and the infusion rate
  • at least once an hour

47
Slow Flow Rate or No Infusion
  • Infiltration
  • occlusion of the IV Needle or Catheter
  • hyperkinesia of Vein
  • Too Low Hydrostatic Pressure

48
Infiltration
  • Causethe needle dislodge from the vein and fluid
  • exude in the subcutaneous space
  • Signs insertion site becomes swollen,clammy, and
  • painful
  • Alternative nursing actions discontinue IV and
  • establish a new line at
    a new site

49
occlusion of the IV Needle
  • causes
  • there are clots at the tip of the needle
  • the needle tip is against the vein wall (flexed
    joint-wrist , elbow )
  • narrowing the tubing may exist too-tight IV
    dressing

  • a kink in the tubing
  • measures
  • assess lowering the IV container below the
    level of the IV insertion site, opening the
    roller clamp thoroughly, and observing for a
    blood return
  • Alternative nursing actions
  • inspect the area
    around the insertion site
  • loose the IV dressing
  • check the tubing
  • change the position of the needle
    handle or extremity

50
hyperkinesia of Vein
  • Causes
  • extremity is exposed in cold environment for a
    long time
  • the temperature of the fluid is too low
  • Alternative nursing action warm the extremity

51
Too Low Hydrostatic Pressure
  • Raise the solution container
  • increase hydrostatic pressure
  • increase the flow rate

52
Too Large Volume of Solution in Chamber
  • Causescompress the drip chamber too many times
    or too hard when discharging air from tubing
  • Alternative nursing actions (3 methods)

53
Too Small Volume of Solution in Chamber
  • Causes
  • compressing chamber with less force or fewer
    times
  • too late when changing the IV solution during
    continuous infusion
  • Alternative nursing actions

54
The Surface of Liquid Fall down Automatically
  • Causes
  • the tubing and chamber is not airtight
  • Alternative nursing actions
  • check the whole infusion set system to see if
    there is untight connection of every part or
    cranny in infusion set
  • if necessary,the tube system should be changed

55
Complications of Intravenous Therapy and
Intervention
  • Fever
  • Phlebitis,Thrombosis,and Thrombophlebitis
  • Circulatory overload reaction
  • Air Embolism
  • Infiltration
  • Local Allergic Reactions
  • Infection or Inflammation at the Insertion Site

56
Fever
  • Causes allergic reactions to a medication or
    IV fluid
  • impureness of the
    solution
  • incomplete
    sterilization of the equipment
  • no strict application
    of aseptic techniques
  • during starting
    an IV
  • Symptoms and signs feel cold,trembling and with
  • increased body temperature to 38? to 40?
    or higher.
  • Systematic reactions may be present,such
    as nausea,
  • vomiting,headache,and tachycardia.

57
Fever
  • Preventions
  • inspect the quality of solutions,the package of
    intravenous set and date of sterilization
    carefully
  • Interventions
  • reduce the flow rate or stop infusion and notice
    the physician immediately
  • Give physical cold therapy to patient with Tgt 39?
  • Administer the antiallergic medication according
    to physicians order if necessary.
  • Keep the residual solution,medication,and
    equipment for the laboratory test.

58
Phlebitis,Thrombosis,and Thrombophlebitis
  • Causes irritation to the lining of blood vessels
  • chemical irritation to tissues by IV solutions
    or medications
  • mechanical irritation to tissues by the needle or
    catheter
  • localized allergic reaction to the indwelling
    catheter or
  • needle
  • local infection by undemanding sterile
    performance during initiating infusion

59
Phlebitis,Thrombosis,and Thrombophlebitis
  • Symptoms and Signs
  • feel pain in local site,with increased skin
    temperature
  • swelling over the vein
  • redness traveling along the path of the vein in
    some cases
  • systemic reactions may be present,such as
    fever,chill

60
Phlebitis,Thrombosis,and Thrombophlebitis
  • Preventions
  • To follow sterile principles strictly,and protect
    the 1ocal site from contamination.
  • Irritating medication should be diluted
    thoroughly and infused slowly.
  • The needle should be secured firmly to prevent
    the needle sliding out of the vein.

61
Phlebitis,Thrombosis,and Thrombophlebitis
  • Interventions
  • Discontinue infusion and start IV at another
    vein.
  • Apply warm compresses with 50 magnesium
    sulphate.
  • Use physical therapy of ultrashort wave on local
    site.
  • If there is infection,use antibiotics according
    to physicians order.

62
Circulatory overload reaction--acute pulmonary
edema
  • Causes
  • receive a too large volume and a too rapid
    administration of IV solutions a sudden
    increase of circulating blood volume and too
    heavy cardiac load

63
Circulatory overload reaction--acute pulmonary
edema
  • Symptoms and Signs chest pressed,shortness of
    breath,cough, frothy or pinkish sputum,facial
    paleness,diaphoresis,neck vein distention,rales
    in the lungs,rapid heart rate,arrhythmia,rapid
    weight gain,pitting edema,and tachycardia

64
Circulatory overload reaction--acute pulmonary
edema
  • Preventions
  • maintain the appropriate flow rate during the
    infusion, especially for the patient with heart
    failure,the elderly and children
  • Avoid rapid flow rate at night because of
    nocturnal decrease in renal function.

65
Circulatory overload reaction--acute pulmonary
edema
  • Interventions
  • slow the rate of infusion or stop the infusion
    immediately,notify the physician
  • assume a Folowers position with the feet
    dangling at the bedside if the patients
    condition is allowed
  • apply oxygen administration with greater flow
    rate, put 20 to 30 ethanol solution into
    humidified bottle
  • administer the sedative,vasodilators,antiasthma,di
    gitalis,and diuretics to the patient according to
    the physicians order
  • apply tourniquet to limbs of the patient in
    alternation in order to reduce the venous return
    if necessary

66
Air Embolism
  • Causes
  • did not eject air in infusion system thoroughly
    infusion set is not air tight, did not eject air
    in the tubing below the chamber on time after
    changing the solution container
  • do not alter the bottle or withdraw the needle on
    time when the patient receives pressure infusion
    or pressure blood infusion

67
Air Embolism
  • Symptoms and Signs
  • feel discomfort in chest or pain under the
    sternum,with the presence of decreased blood
    pressure,cyanopathy,tachycardia,increased venous
    pressure, and unconsciousness
  • Clear and continuous bubble sound can be
    auscultated.

68
Air Embolism
  • Preventions
  • inspect the quality of infusion set
  • connect every part tightly
  • ejecting air in tubing thoroughly
  • check the tubing below the chamber to make sure
    no air after changing the bottle of solution
  • appoint a nurse to watch the patient with press
    infusion
  • have patient place head below heart level or
    perform Valsalva maneuver while changing tubing
    on central venous lines

69
Air Embolism
  • Interventions
  • help the patient to turn on left side with head
    down
  • administer oxygen therapy with high flow rate for
    the patient
  • monitor vital signs and notify the physician

70
Local Allergic Reactions
  • Causes
  • Individuals may demonstrate sensitivity to
    antiseptic solutions,or tape used to secure the
    catheter.
  • Indwelling catheters and needles may also cause
    allergic reaction.
  • Preventions and Interventions
  • assess allergic history of the patient very
    carefully,change some supplies which can cause
    allergic reactions
  • administer antianaphylaxis medication based on
    the physician's order if necessary.

71
Infection or Inflammation at the Insertion Site
  • Causes
  • Microorganisms gain access to the tissue and
    circulatory system through the tip of needle or
    cannula device inserted during venipuncture
  • Microorganisms enter later by migration along
    the interface between the catheter and tissue
  • Symptoms and Signs
  • the local tissue may have redness,edema,heat,pain,
    and perhaps exudation.The patient may have
    systemic reactions,such as fever

72
Infection or Inflammation at the Insertion Site
  • Preventions
  • Using aseptic technique for all IV-related care
    keeping dressing dry changing dressing on time
  • Interventions
  • remove IV to another site if necessary
  • apply cool compress to site as ordered by the
    physician
  • elevate limb,and observe for signs of sepsis

73
INTRAVENOUS INDWELLING NEEDLE INFUSION
  • Purposes
  • Preparation
  • Procedures
  • Cautions

74
Purposes
  • Apply to the patients that have difficult to
    puncture and need long-term IV infusion.
  • Provide an easy access for intermittent infusions
    or IV administration.
  • Protect patients veins from damnification of
    repeated venipuncture.

75
Preparation
  • Nurse
  • Review the physicians order in patients record.
  • Evaluate patients age and medical status.
    Evaluate patients renal status and other
    pertinent lab data (e.g., electrolyte, serum
    glucose ).
  • Wash hands and wear mask.
  • patient
  • Verify patients identity.
  • Explain the procedure and purpose.Ask the patient
    to void.
  • Position patient for comfort and optimal
    visibility for skill performance.

76
Preparation
  • Environmentcleaning, commodious, bright
  • Equipment Medical tray
  • Antiseptic solution
    Sterile swab
  • Tourniquet
    Pad
  • Crystal adhesive tape File
    and opener
  • IV solution and medication Medical
    card
  • Infusion set
    Bottle bag
  • Kidney-shaped tray
    Sterile gloves
  • Intravenous indwelling needle

77
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78
Procedures
  • 1. Check and right
  • 2. Complete the medication label
  • 3. Add medications into solution
  • 4. Insert the infusion set
  • 5. Prepare the equipment and take them to the
    bedside.Check again
  • 6. Discharge air

79
Procedures
  • 7. Wear gloves, prepare IV indwelling needle
  • Check the quality of the IV indwelling needle
  • take out the indwelling needle
  • sterile the heparin cap
  • insert spike of infusion set
  • into the heparin cap
  • discharge again
  • Close the clamp
  • protect the indwelling needle

80
Procedures
  • 8. Select the venipuncture site
  • (1) Place a pad under the extremity
  • (2) Apply a tourniquet firmly 10 to 15cm above
    the venipuncture site.
  • 9. Sterilize the venipuncture site.(gt10cm)
  • 10.Check again.

81
Procedures
  • 11.Intravenous injection
  • (1) Use the left hand to pull the skin taut
    against the vein, hold the needle with right
    hand, insert the needle and catheter through the
    skin and into the vein
  • (2) Once blood appears in the lumen of the
    catheter, reduce the angle of the needle until it
    is almost parallel to the skin,advance the needle
    0.2cm, then withdraw the needle 0.5cm, advance
    the catheter and needle until the whole catheter
    is in vein.Hold the catheter shaft steady,
    withdraw the needle.

82
Procedures
  • 12. Fixation
  • release fist, tourniquet,and clamp
  • Open the sterile adhesive tape bag, take out the
    crystal adhesive tape, and secure the injection
    site hermetically.
  • Loop the tubing near the site of entry,fix with
    adhesive tape, and write down the date of
    installation on the tape.
  • 13. Regulate the flow rate
  • 14. Check again.

83
Procedures
  • 15. Disposure after operation
  • 16. Change bottles
  • 17. Disposure after infusion
  • After infusion,close the roller clamp,withdraw
    the needle from the heparin cap,
  • sterile the heparin cap and seal the catheter
    with 0.9NS in positive pressure
  • Close the Luer Lock of primed IV catheter set to
    peripheral cannula
  • Help the patient to have a comfortable position.
  • Record the volume of fluid infused and the time
    of the discontinuation
  • Dispose of the equipment in proper manner
  • Wash hands. Document relevant data

84
Cautions
  • 1. Follow the principles of asepsis and check
    system strictly to prevent infection and
    mistakes.
  • 2. Keep the injection site cleaning. Observe the
    injection site carefully in order to find the
    complications and settle them on time.
  • 3. Seal the catheter with positive pressure after
    infusion to prevent occlusion of the catheter or
    thrombophlebitis.
  • 4. The catheters indwelling time is commonly
    about 3 to 5 days
  • 5. Instruct the patient to take self-care. Avoid
    to energize and press excessive. Avoid the
    catheter to be pulled out when change clothes.

85
EXTERNAL JUGULAR VENOUS CATHETER INFUSION
  • Purposes
  • Preparation
  • Procedures
  • Cautions

86
Purposes
  • 1. Measurement of central venous pressure (CVP)
  • 2. Apply a venous access when no peripheral veins
    are available
  • 3. Administration of vasoactive medications which
    cannot be given peripherally
  • 4. Administration of hypertonic solutions
    including total parenteral nutrition.

87
Preparation
  • Nurse
  • Review the physicians order in patients record.
  • Evaluate patients age and medical status.
    Evaluate patients renal status and other
    pertinent lab data (e.g., electrolyte, serum
    glucose ).
  • Evaluate patients mental status and cooperation
    status.
  • Evaluate the venipuncture site.
  • Wash hands and wear mask.

88
Preparation
  • patient
  • Verify patients identity.
  • Explain the procedure and purpose to reduce the
    patients anxiety and tension.
  • Position patient for optimal visibility for skill
    performance.
  • Environment
  • must be cleaning, commodious and bright

89
Preparation
  • Equipment Medical tray
  • Antiseptic solution
    Sterile swab
  • Crystal adhesive tape File
    and opener
  • IV solution and medication Medical
    card
  • Infusion set
    Bottle bag
  • Kidney-shaped tray local
    anaesthetic
  • Sterile venipuncture package Sterile
    gloves

90
Procedures
  • Steps 1 to 6 are the same as described in
    Peripheral Intravenous Infusion
  • 7. Select the position
  • 8. Select insertion site and sterile the skin
  • 9. Open the sterile venipuncture package, wear
    sterile gloves, and drap the area
  • 10. Infiltrate the skin and deeper tissues with
    local anaesthetic
  • 11. Insert the catheter and cover with a sterile
    dressing
  • 12. Connect with infusion set

91
Procedures
  • 13. Regulate the flow rate
  • 14. Check again.
  • 15. Disposure after operation
  • 16. Change bottles
  • 17. Disposure after infusion
  • Seal the catheter with a small volume of dilute
    heparin ( 100 U/ml ) into the lumen.
  • Clamp catheter lumen using online slide clamp.
  • Stuff the needle hub hole with a sterile
    injection cap.
  • Catheter insertion site protection and
    stabilization are accomplished by regular
    antimicrobial cleaning and sterile dressing
    changes every day.

92
Procedures
  • 18. Infusion again
  • Remove the sterile injection cap, sterile the
    needle hub hole, connect with infusion set,
    unclamp lumen, then initiate IV infusion.
  • 19. Withdraw the catheter
  • The lumen of the catheter connect with a syringe,
    withdraw the catheter while pump the syringe,
    press the insertion site for several minutes.
  • Sterile the local skin with 75 ethanol solution,
    and cover it with sterile dressing.

93
Cautions
  • 1. Follow the principles of asepsis and check
    system strictly to prevent infection and
    mistakes.
  • 2. Select the insertion site carefully.
  • 3. Intensify evaluation during infusion. Flush
    the catheter with dilute heparin ( 100 U/ml ) if
    return blood appears in the catheter to prevent
    occlusion.

94
Cautions
  • 4. Seal the catheter with positive pressure after
    infusion to prevent occlusion of the catheter.
    Clot appears in the catheter should be sucked use
    a syringe to avoid to be pushed into blood
    circulation.
  • 5. To stabilize and protect catheter site to
    prevent contamination or dislodgement. Observe
    the injection site carefully in order to find the
    complications and settle them on time.

95
SUBCLAVIAN VENOUS CATHETER
INFUSION(self-study)
96
INFUSION PARTICLE CONTAMINATION (self-study)
97
  • END!
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