Central Intrave nous Therapy

Venous Access Device Adverse Events

CHAPTER 5 Central Intrave nous Therapy

"

Ace ... d<vic .. rooy boc:omo: oo, . . ",11\OIN """ d"'B ... as

".<1"

fOl bIood_

borne poII>op:n .. TI". """"" 1I>0oI commOIIly iflhe

<Itt ..

,,,! he,,,,,",, soilrd '" "'<1 '" if tho 1.V. almm", . . i<on II". ""up he,,,,,, .. d_1>OC1ed """ """l2tninolrd.

Ccnwni_ of tho .... i« Il'1O)' ,..,..,M ift ><pOi. lhat is ov~ .y.,<mkally by rev« (or • low

I<mp<n''''''

ⁱⁿ

pM""'''

,,1'110 ..., i~ dliU .. rip.

ODd Ieu~ ..

,v. on

i"" ...

,n

bond:o ^Oil 1h< "hI(" blood ~'" ilill" ....

...w.

DrI:vi<e-....",i.oo<d _ """" . - . coontnOIlly "'o\h _ of ",nlrld ~ ..,....

_ ",lI!

p<np/IenI ~

. - s.

ConlMnoUlIOll of Ih< .... "'" abo "'"l' he impIic:oIrd im ~"! pIIIcbiu .... 'hO:tt may he ... ~ by rodneu. .~m . . ODd paio "" p<dpoIiom of tho ...u.o .. tc. A p"ipoN< <ord .... y he rok .. tho ... """

t-U1rnl1hi .... "'"l' he ... .

M ... r ... of't. ... , ... oeftd 10 DlOITOIlhoJc oIpIold><" .. but thoundrrlyill,

a u < is Iliff ... Wbm

"o ...

",b", .. 0<aJtlI. I d., hao

r."".... ..

tho 00CnII"~

This

ill.,... . - ,"', .. , ....

^{1Iy by} on i""""pIiOIo .. del""<'Y 01 I. V .

...au""" '"

^by

;'np"",tlyllDhi,.. tho I.V """""'"..., he\ .. ^ftIO 1h< deh....,. 01 .-....; ...

boI ... infu.o.-. In

,.nmd.

"",,,,,,,I

",,-...-eu

^{~ ~.-. prone} 10 ronnlng Ihrombi than ..., pmpbrnol _ _ 1oOt"eO . . . " " ' • .",,.,.. ... IbromIIu< f"""",;""

""'y _

<_

probkm ... " emboli "'hen!hey ~ kntcd UI poriph<nl-=><l .. !hey can boc:omo: lethal .... I"""'"'Y emboli if !hey ~ puen' ,n ",nlnll ,,.. .. 1 ..

Ai. emboli .... y foom if oi. is '"~ ,nIO • ",nlnll -=><l. from ... bubi>I<o lhat <ilion ..., mfU>Cd .. ilb tho I, V. inf.""" '" ... ~ rrom d,"""""",;"" of tho l.V.

almini.tnI;"" Ii ... ><t, 'Tbtoo ... <mboli can , .... 1h< _ kdul ~...".. ..

tllrombi that di.Jodl!" and boc:omo: clOllood,mboI, and tw .. 1"'1""""")' emboli ...

">pin'ory di.,,,,,,, and p<>Mibly .... pirsl<>ly fail ... .

P:ali,nl> .. ;tII «on""lIy .c<e.0C<I «nlralI.V, Ii .... ~ II ri.k r,.. the p"'.nli.olly ktIW odvcrx cvc,", of ... """"""'. and he",,~hon. during lhe ""'" ,hal tho Ii ...

i.

;n .. nod, n..",

0<Iva'><

",n" ^may

^he

^{manir ..}

^lt<l

by dy ...

",.piratory di ... hYI"',emi •• and <>'<:nlu.1 cordiopuln ....

"'Y

f.,I.",.

Nu"in~

>Ir.iI'ez""

^{aimed ..} pre ... nll.g or.d '''''li''8 11>0 .. ad,' ... ~n" are di ... »ed in funhe. de";l ^In ClIapl« 6.

Discontinuing Central I.V. Therapy

Crntral I.V. cathckn ... 1d he ~"",,'rd "he ... , ... i1 ..

'""'f'<d<d

that.hey ~

conwninolrd .... """"'" '" irIf<CIiool ... 'he ... hey ore

<bmo,....

^{and ...} I>oD<Y<1"

i. is dctnmonood by tho ""' ... ph)"ici>ll lbol I. V .• i>tnpy ^{is no ...} ".. w _ _

PICCo"""

""",umdcd _ ~ ...

y

he d_,ru,oed by • nurv. "'heR»

.wooded =tlr2I <:ath<tcn or.d ",.u.ntcd potU ... he d • . . - ' ... ""Ikally.'

.. I.V. Therapy Demystified

n.e

"U"" , .. ked with "mo\'ing a PIOC Ii"" or a

""",""""Ied

""0,,,,1 I.V, Ii""

should be mindful

,ha,

air .mbolism fOf1n>.tKln i, tile mo<I se';oo. odv""se event that might occur during Ill;. proced ... , !'rio.- to removing either one of the><

c.lI>e10B. the nu"" "-'plain. the procedure to <he Illiie"~ 'IISW.,., any q"""ioIu that the patient m.y

ru. .. ,

ond .nays "ny .nxiety. Supplie. g.thered ifIClude the following:

A mask and ooo .... ril< gk",.e, A ,uture removal kit

Se>"""'] .,."ile 4 ~ ~ inch gauze pads.oo tape Antibiotic oiouneot

Ge""",1 procedur.ll guideli"", for ",,,,,,, .. I of. Pice or. """'""Deled centr.il c.tIle,.r include !he following:

n.e

[,V. pump i. ,um<d off or,be LV, line i. clamped if",lu,ion i. inf""ing cOIItin"""ily in'o II>< 1 V. deli>ery .ystem.

n.e

!",tient i .... i<tod to !he donol recumben, position and ash-d to tu,n hi, C4" her heod

'''''y

from ,he dressing >ile, 1he no,,", <Ioru • mad and ooo ... rile gk",.e, and carefully

Ie""''''

the d", .. in8

Any ."ture> ore ",,,,,,,..J "'ith ,he 5Oi ... and t ... ee .. n in the ... 'ure

",..." .. 1 lil

111< no,,", hold . ... erile gauze pad ">"rthe """" . . . ite ond in.truct> "'"

"",;"n, to pertO!1Jl the Yal .. l ... rnaM ... to p.",'<n' on .i, <mbolus from ""terin~ the open '..,"""SI.oo,,, .ite. This me .... that the pati<'" is in<tlUC1«l to forcefully .,hale .gain>! the closed glotti.,

n.e

lin< then i.

gently remo'ied.

If resi .. """" i. met Juring o>theter ",mo .. :Ii. the nu"" doe> DOl cOIItinoe to poll bot dre.",. the ~xposed c.lheter with. "<rile dressing .nd DOIifi •• the phy.i<i ... promptly. If the c.thetor C:iII he ",mo,'ed willloo, re.i""""". i, i. oomplctely poll«l oot. :unibioli< ointment i, .pplied "".,. the .it •. and •

>torile ocrl ... i", dre>Sing is ploced finnly over ,he .,",." •• i,o.

n.e

c>thele! i, cumined to <n,u", tim 'here i. 00 . . idene. of damoge, If there i. ony <racking Of om.r """,ble <larnoge. thi. is promptly "'pt>rt«l to the "","ufaCIurer, typic.lly 'hrough the hospital Of he.I,h c.re .geney·, risl

"""'"gemen' office,

n.e

remoyol ptocedure i, documented in the pa'iont'.

,ocont.

n.e

,ite is reex .... ined .. ory 24 hours '0 detonnine if he.:lin~ i. occurring.

~ the ,ite 1= "pparen,ly epithelializ«l. it ""'y be left open to

:U',-CHAPTER 5 Central Intravenous Therapy

"

Summary

Crntr:ol I.Y. Ii .... may be illdOted rot p""en •• ,,"" If< pttJ<"ribod I.Y. thonpy Ih>.

i • • UicipMe<110 lui

r ... """"

^{than 1 day •.} Key

n.u """""led ...

^'iII im<ttioo ~ mai .... rwoce oflJlOll1 of ih<M: ... ioco ;nclude ..

,e-mboI, ...

^~

...

^,oboW. 'nf..-tiom.

pD<IOmothoru. ~ hemothoru. Selmion of .... Iype of C<1IlrllI ^O<UD dn'~ ..

prMicaI..! on .... 'l1'" '" thonpy 110M .. pracribed (or .... pII>rnI. 10

J"ft<fllI.

\he I.Y. ac<oJ ... :oIId ...- '"

,'oli>-ery _

deI ... ned ho.wd "" .. ~i,,","I: \he rub _

bmom. '"

'h<nj>y.

Quiz

1. \\1»<h oJ .... fcol"",",", <:CftttaI1.V b ....

came.

\he Iooo"e>l n .... ' "

occns.-ouoci-.J

pneu.-u1

(I) PIa:

(10) Tun .. eI..!.,..,.. ...

(e) Impl ... table p""

(d) Pen:~"y imcn«l",bcl"',,,,"ne

2. Idrntify t .... van ill .. C<lUld bt .. 1<c1..! .. an "'""' .. ~ for. PIa: li .... 1 (I) 8 .. ili<

(10) Subel •• ·i ..

(e) Exlem" jusu',,-(d) Fm.,.,,1

3. Identify' .... vein iII.t pnr;idt,'he be>t occe ... i~ fot. o<n .... lly irue"..!

e<ontr.ol I. V. Ii ....

(0) 8 .. ili<

(10) Subel •• ·.."

(e) ExtemolJuJIII ..

(d) ~1f"<lnI

4. Which oJ .... (col ... '''' od'~ """" ... ..."plkoIOOM is a .... """ ...

OC<"M","","~..,iII «ntr:ol LV. Ii .... ' ... "",iII periphend I. V. I ... ? (I) Pneuonotbon:<

(10) Aor emboli ....

"

(c) [ofecti""

(d) [ofil,,,,,""

I.V. Therapy Demystified

~, Which of "'" following

>oJ,.., ....

eve,," 0< oomphcalioo. i. lhe ... , worriso .... in pat;"",. who are Msing !heir cen'",[ I.V,

Ii"",

discootinood?

(oj I'neumolhonx (b) Air .mboli.m (c) [ofecti""

(d) [061,,,,,000

CHAPTER 6

Intravenous Therapy and the Nursing Process

learning Objectives

Aftef oompl .. in~ this cmpkr. the

I.""""

^"'ill

Uode"und til< applic.bility of the nu"ing J>fOCe .. fo.- ",,'icn" ,,'he ... e prescribed 'n"' ... .,""'" (I. V.) the"'PY'

Identify the in'erplay

be,,,,,,,"

the 'aJlooomi •• oflh< North American "u"jng [)jag"""i. Associ .. ;"" (NANDA). the Nu"ing OuIcomes C1 ... ificatioo (NOC),.oo ,be Nu"ing [01<"",",;00, CI ... ificatioo (NIC).

Recognize rommoo oc,u,l and poI<n'ial "U"inS <li.S..." fC4" patienlS who are prescribed LV.lhc~.

PI"" oppcopriate care for • !",'ient ~i,'i"g I. V. Ihe",Py based OIl ",,",I 000 poIon,ial nur>ins di.gnose •.

" I.V. Thera py Demystified

r l Key T erm s

Nursing proce» Nunins Outcome. C1assific.tioo (NOC)

N .... ing Interwntioru CI».ir.c.bon (NIC) North American Nursing Di'g""';'

A>soci .. ion (NANDA)