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

1

Septicemia (CRSI) Fluid overload & pulmonary edema Catheter embolism Air embolism Speed shock

2

Phlebitis ◦Mechanical or Chemical

Infiltration/ Extravasation Local infection Hematoma/ecchymosis Thrombophlebitis Thrombosis (catheter) Venous spasm

3

4

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

Infiltration Extravasation

Inadvertent administration of a nonvesicant solution into surrounding tissues.

The inadvertent administration of a visicant solution into surrounding tissue.

5

IOM report CDC & INS standards

◦“follow your hospital policy” – Changing IV admin sets IV dressings

◦How does this contribute to patient safety?

6

Change IV administration sets Dressing changes Changing NAP Cleanse access port with new alcohol swab

for 15 seconds.

7

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!!!

8

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

9

TSM = transparent semipermeable membrane◦ Tegaderm is one brand out of many◦ Change ________

Gauze dressing Procedure:

10

When:◦ Leaking, infiltration, pain, phlebitis, Dr. order

Supplies: gloves, 2x2 gauze, bandaid How: Phillips, Procedure 6-4 Greatest risk: catheter embolism

11

Power switch “enter” Numbers keyboard

◦ Set rate (in ml/hr)◦ Set volume to be infused (VTBI)

Check volume infused hold/run button

12

Run/hold indicator display screen alarms door to put in tubing Safety mechanism when door shut Visual -battery, or electrical power. Alarm Cause

13

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

14

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

15

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

16

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)

17