Angelite Nurses

Purposes

1. Maintenance of fluid and electrolyte balance
2. Replacement of fluid and electrolyte loss
3. Provision of nutrients
4. Provision of a route for medications

Nursing Interventions

1. Select correct solution after checking physician's order.
2. Note clarity of solution.
3. Calculate flow rate (Intravenous Calculations, Unit 2). Time-tape bag to assist in monitoring flow rate.
4. Assess infusion rate and site at least hourly.
5. Use infusion pump if administering medications (e.g., aminophylline, heparin, insulin).
6. Maintain I&O record.
7. Provide tubing change and IV site change according to hospital policy. Intravenous Nurses Society standards recommend IV site and tubing change every 48 hours.
8. Discontinue IV if complications occur.

Complications of Intravenous Therapy
See Table 4.7.

Table 4.7 Complications of Intravenous Therapy

Central Lines


Uses

1. Administration of TPN
2. Measurement of central venous pressure (CVP)
3. IV therapy when suitable peripheral veins are not available
4. Long-term antibiotic therapy
5. Chemotherapy

Types

1. Nontunneled catheters: inserted into subclavian vein for short-term access
1. Subclavian catheters: single lumen
2. Multilumen catheters: double, triple, or quadruple lumens for simultaneous infusion of fluids or for blood drawing with fluid infusion.
2. Tunneled catheters: long, silicone catheter threaded through subcutaneous layer to prevent infection with long-term use; catheter tip is located in the superior vena cava.
1. Hickman/Broviac catheters: single- or double-lumen catheters with external presentation; need to be flushed daily with a heparinized saline solution and must be clamped when not in use; repair kit available.
2. Groshong catheters: similar to Hickman/ Broviac; difference is in valve at closed distal end of catheter that opens when used and remains closed at other times, preventing blood back-up into catheter; no clamping is necessary; flushing is done daily with saline in a vigorous manner.
3. Implantable ports: totally internal device consists of subcutaneous self-sealing injection port and a tunneled catheter; flushing is done with a heparinized saline solution every 28 days; access must be with a special noncoring needle.
4. Peripherally inserted central lines (PICC): short-term long lines that can be inserted by qualified nurses; inserted via a vessel in the antecubital fossa (median or cephalic); flushing is with a heparinized saline solution.

Care of the Client with a Central Venous Line

1. Assist physician with placement; catheters should initially be flushed with saline. Have fluids or cap and heparin flush ready.
2. Confirm placement in superior vena cava by x-ray prior to catheter use.
3. Institute nursing measures to prevent infection (particularly important with TPN since high concentration of glucose encourages growth of bacteria).
1. Change dressings
1. Usually 3 times/week and as needed (e.g., when loose or wet) but agency policies may vary
2. Use sterile technique and apply sterile occlusive dressing.
2. Monitor for signs of infection: redness, drainage, odor at site, or elevated temperature.
3. Do not piggyback anything into a TPN infusion line except intralipids.
4. Monitor for infiltration: check for swelling of neck, face, and shoulder, and pain in upper arm.
5. Prevent catheter occlusion.
1. Keep infusion continuous.
2. Use infusion pump.
3. Check for kinks in tubing.
4. Evaluate for catheter migration or dislodgment.
6. Prevent air embolism.
1. Tighten and tape all tubing connections to prevent accidental disconnection of tubing.
2. Clamp catheter (except Groshong) and instruct client to perform Valsalva maneuver when changing or detaching tubing.
3. Check tubing for cracks or perforations.
7. Maintain proper infusion rate.
1. Monitor rate closely to prevent clotting, fluid depletion, or fluid overload.
2. Never attempt to speed up or slow down infusion.
8. With a multilumen catheter, flush ports not being used to prevent clotting (per agency's protocol).
9. With Hickman/Broviac catheters, Groshongs, PICCs, and implanted port provide other specific care according to agency protocol.
10. If clotting occurs, try to aspirate or add a declotting agent according to agency protocol. Do not irrigate.
1. Streptokinase requires 1 hour waiting time.
2. Urokinase requires 10 minutes waiting time.
When drawing blood specimens, discard initial sample of 5-10 ml prior to drawing required volume for specimens. Flush with saline prior to flushing with heparinized saline solution or continuing fluids.