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Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy
Elastomeric Infusion Pump
Table of Contents
Free Topics
About
Acid-Base Balance
Acknowledgments
Age-Related Considerations - Fundamentals of Fluid and Electrolyte Balance
Antigens (Agglutinogens)
Blood Preservatives
Calculator - Body Surface Area (BSA) - Calculator
Consultants
Crystalloid Solutions
Endocrine System
Figure - 0.2 Micron Air-Eliminating Filter Set
Figure - Acid-Base Scale
Fundamentals of Fluid and Electrolyte Balance
Glossary - Transfusion Therapy
Implementation of Interventions/Nursing Actions
Major Acid-Base Imbalances
Midline Catheters
Needle Protection: Active and Passive Sharps Safety
Preface
Renal Regulation
Reviewers
Step 3: Pretransfusion
Table - ABO Blood Grouping Chart
Table - ABO Compatibilities for Red Blood Cell Components
1. Professional Practice Concepts for Infusion Therapy
1. Professional Practice Concepts for Infusion Therapy
Delivery of Quality Care
Clinical Competency
Delivery of Quality Care
Evidence-Based Practice
Value of Certification
Glossary
Introduction
Learning Objectives
Legal and Ethical Issues in Infusion Therapy
Chapter Highlights
Ethical Issues Related to Infusion Therapy
Home Care Issues
Legal and Ethical Issues in Infusion Therapy
Legal Causes of Action Related to Nursing Practice
Legal Terms
Patient Education
Reducing the Risk for Malpractice
Sources of Law
The Infusion Nurse's Role as Expert Witness
Nursing Process Related to Infusion Therapy
Assessment
Diagnosis
Evaluation
Implementation of Interventions/Nursing Actions
Nursing Process Related to Infusion Therapy
Outcomes Identification
Planning
Quality Management
Additional Strategies in Quality Management
Performance Improvement
Quality Assessment/Quality Improvement
Quality Management
Standards
Standards as Domains of Organizational Structure
Total Quality Management
Risk Management and Risk Assessment
Documentation
Informed Consent
Infusion Medication Safety
Risk Management and Risk Assessment
Sentinel Events
Unusual Occurrence Reports
Table(s)
1-1. Assessing Competency
1-2. Sources of Evidence
1-3. Two Examples of Evidence Rating Scales
1-4. Elements of Informed Consent
1-5. Most Frequently Reviewed Sentinel Event Categories in 2012
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study
2. Infection Prevention and Occupational Risks
2. Infection Prevention and Occupational Risks
Age-Related Considerations
Age-Related Considerations
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Patient
Basic Principles of Epidemiology
Basic Principles of Epidemiology
Chain of Infection
Classification of Infections
Figure(s)
2-1. Chain of Infection
2-2. Sources of I.V. Cannula-Related Infections
2-3. Curos[®] Alcohol Disinfection Cap
2-4. Centers for Disease Control and Prevention (CDC) Injection Safety Checklist
2-5. Biopatch[®]
2-6. Chlorhexidine (CHG) Transparent Semipermeable Dressing
2-7. Aquaguard
2-8. Transparent Dressing over a Peripherally Inserted Central Catheter with Stabilization DeviceâStatLock[®]
Glossary
Health-Care-Associated Infections
Central Line-Associated Bloodstream Infection Surveillance and Public Reporting
Diagnosing Infection: Culturing Techniques
Health-Care-Associated Infections
Intrinsic Versus Extrinsic Causes of Bloodstream Infection
Pathogenesis of Vascular Access Device-Related Infections
Vascular Access Device-Related Infections: Scope and Terminology
Immune System Function
Immune System Disorders
Immune System Function
Impaired Host Resistance
Mechanisms of Defense
Introduction
Learning Objectives
Occupational Hazards
Bloodborne Pathogens
Hazardous Drugs
Latex Allergy
Occupational Hazards
Procedures Display(s)
2-1. Steps in Culturing Catheter-Skin Junction, Catheter, Infusate, and Blood
Strategies for Preventing Infection
1. Standard and Transmission-Based Precautions
2. Hand Hygiene
3. Aseptic Technique
4. Skin Antisepsis
5. Catheter Dressings
6. Catheter Stabilization
7. Antimicrobial/Antiseptic-Impregnated Catheters
8. Central Line Bundle
9. Other Aspects of Postinsertion Care
Strategies for Preventing Infection
Table(s)
2-1. Organs of the Immune System
2-2. Types and Functions of White Blood Cells
2-3. Factors Associated with Increased Central Line-Associated Bloodstream Infection (CLABSI) Risk
2-4. Microorganisms Most Frequently Encountered
2-5. Common Tests for Evaluating the Presence or Risk of Infusion-Related Infections
2-6. Sharps Safety Devices and Recommendations
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Infection Prevention and Occupational Risks
3. Fundamentals of Fluid and Electrolyte Balance
3. Fundamentals of Fluid and Electrolyte Balance
Acid-Base Balance
Acid-Base Balance
Renal Regulation
Respiratory Regulation
Age-Related Considerations
Age-Related Considerations - Fundamentals of Fluid and Electrolyte Balance
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Client
Basic Principles of Electrolyte Balance
Basic Principles of Electrolyte Balance
Calcium (Ca[2+])
Chloride (Cl[-])
Magnesium (Mg[2+])
Nursing Diagnosis and Electrolyte Imbalances
Phosphorus (HPO(4)[-])
Potassium (K[+])
Sodium (Na[+])
Body Fluid Composition
Disorders of Fluid Balance
Disorders of Fluid Balance
Fluid Volume Deficit (Hypovolemia)
Fluid Volume Excess (Hypervolemia)
Figure(s)
3-1. Percentages of Body Fluid
3-10. Positive Trousseauâs Sign
3-11. Positive Chvostekâs Sign, which Occurs after Tapping the Facial Nerve Approximately 2 cm Anterior to the Ear Lobe
3-12. Acid-Base Scale
3-2. Effects of Fluid Shifts in Hypotonic, Isotonic, and Hypertonic States
3-3. Tonicity Osmolarity Ranges of Solutions
3-4. Hand Vein Assessment
3-5. Jugular Venous Distention
3-6. Edema
3-7. Sodium and Cellular Fluid Relationship
3-8. Sample ECG Tracing Showing Hypokalemia
3-9. Sample ECG Tracing Showing Hyperkalemia
Fluid and Electrolyte Homeostatic Mechanisms
Cardiovascular System and Atrial Natriuretic Factor
Endocrine System
Fluid and Electrolyte Homeostatic Mechanisms
Kidneys
Lymphatic System
Respiratory System
Fluid Distribution
Fluid Function
Fluid Function
Fluid Transport
Tonicity of Solutions
Glossary
Learning Objectives
Major Acid-Base Imbalances
Major Acid-Base Imbalances
Metabolic Acid-Base Imbalances
Respiratory Acid-Base Imbalances
Physical Assessment of Fluid and Electrolyte Needs
Body Weight
Cardiovascular System
Laboratory Values
Neurological System/Focus on Level of Consciousness
Physical Assessment of Fluid and Electrolyte Needs
Respiratory System
Skin Appearance and Temperature
Special Senses
Table(s)
3-1. Percentages of Total Body Fluid in Relation to Age and Gender
3-10. Summary of Acute Acid-Base Imbalances
3-2. Regulators of Fluid Balance
3-3. Summary of Laboratory Evaluation for Fluid and Electrolyte Imbalances
3-4. Quick Assessment Guide for Fluid Imbalances
3-5. Comparison of Electrolyte Composition in Fluid Compartments
3-6. Critical Guidelines for Administration of Potassium
3-7. Critical Guidelines for Removal of Potassium
3-8. Critical Guidelines for Administration of Magnesium
3-9. Clinical Problems Associated with Electrolyte Imbalances
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Fundamentals of Fluid and Electrolyte Balance
4. Parenteral Solutions
4. Parenteral Solutions
Age-Related Considerations
Age-Related Considerations - Parenteral Solutions
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Client
Glossary
Key Elements in Parenteral Solutions
Amino Acids
Carbohydrates (Glucose)
Electrolytes
Key Elements in Parenteral Solutions
pH
Vitamins
Water
Learning Objectives
Osmolality and Osmolarity of Parenteral Solutions
Hypertonic Fluids
Hypotonic Fluids
Isotonic or Iso-Osmolar Fluids
Osmolality and Osmolarity of Parenteral Solutions
Rationales and Objectives of Parenteral Therapy
Maintenance Therapy
Objectives of Delivery of Infusion Therapy
Rationales and Objectives of Parenteral Therapy
Replacement Therapy
Restoration: Providing Fluids and Electrolytes to Restore Ongoing Losses
Table(s)
4-1. Contents of Available Intravenous Fluids
4-2. Quick-Glance Chart of Common I.V. Fluids
4-3. Common Colloid Volume Expanders
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Parenteral Solutions
Types of Parenteral Solutions
Colloid Solutions
Crystalloid Solutions
Types of Parenteral Solutions
5. Infusion Equipment
5. Infusion Equipment
Add-On Devices
Add-On Devices
Catheter Connection Devices (or Catheter Extension Sets)
Catheter Stabilization Devices
Extension Sets
Filters
Needleless Connectors
Site Protection and Joint Stabilization Devices
Stopcocks
Administration Sets
Administration Sets
Basic Components of Administration Sets
Blood Component
Lipid
Primary Continuous
Primary Intermittent
Primary Y
Secondary
Specialty Sets: Pump/Medication Specific
Central Vascular Access Devices
Catheter Features
Central Vascular Access Devices
Implanted Vascular Access Ports
Nontunneled Cvads
Peripherally Inserted Central Catheters
Subcutaneously Tunneled Cvads
Developing and Participating in Product Evaluation
Chapter Highlights
Developing and Participating in Product Evaluation
Home Care Issues
Nursing Process
Patient Education
Product Problem Reporting
Product Selection and Evaluation
Figure(s)
5-1. Comparison of Glass and Plastic Infusion Delivery Systems
5-10. Volume Chamber Control Set for Intermittent Infusion
5-11. Diagram of Y Administration Set Used for Blood Administration
5-12. Extension Tubing Connected to Access Device and Hub of Catheter, with Slide Clamp
5-13. Power Injectable Extension Set
5-14. Split Septum Needleless Connectors
5-15. Example of a Complex Needleless Connector (NC)
5-16. Curos[®] Alcohol Disinfection Cap, which is Changed after Each Catheter Access
5-17. Posidyne[®] ELD 0.2-Micron Filter with 96-Hour Bacterial and Endotoxin Retention
5-18. Lipopor⢠TNA Filter Set for Total Nutrient Admixture Administration with 1.2-Micron Air- and Particle-Eliminating Filter
5-19. Neonatal Filter
5-2. Plastic Infusion System
5-20. StatLock[®] PICC Plus Catheter Stabilization Device
5-21. Catheter Stabilization Device, Securacath[®]
5-22. I.V. House Ultradressing[®], which Consists of Flexible Fabric with Thumb Holes and a Polyethylene Dome that Wraps around the Patientâs Hand after an I.V. is Started
5-23. Butterfly-Winged Scalp Vein Needle
5-24. Over-the-Needle Catheters
5-25. Transillumination Device Veinlite[®]
5-26. Near-Infrared Imaging to Visualize Vein Using Vuetekvein-Siteâ¢
5-27. View of Upper-Extremity Veins Seen with the Vuetek Veinsite
5-28. Bioflo PICC Made of a Thromboresistant Material
5-29. Power PICC Solo[®]2 Catheters, Single, Double, and Triple Lumen
5-3. I.V. Container Systems for Addition and Reconstitution of Drugs
5-30. Subcutaneously Tunneled Catheter
5-31. Example of an Implanted Venous Access Port
5-32. View of an Implanted Port Model Showing Noncoring Needle Access
5-33. A, Safestep[®] Huber Needle Set
5-34. Mechanical Controller: Rate Flow Regulator
5-35. Elastomeric Infusion Pump
5-36. Ambulatory Pump: 6000CMS Ambulatory Electronic Infusion Device
5-37. Perfusor[®] Space Syringe Pump
5-38. Alaris[®] PCA Pump with Spo(2) Monitoring
5-39. Alaris[®] Multichannel Pump
5-4. Basic Administration Set Components
5-5. Spiking an I.V. Container
5-6. Primary Administration Set
5-7. Primary Administration Set Package
5-8. Secondary Administration Set
5-9. Dual Cap Systemâ¢
Flow-Control Devices
Electronic Infusion Devices
Flow-Control Devices
Infusion Pump Safety
Mechanical Infusion Devices
Nonelectric Disposable Pumps
Glossary
Infusion Therapy Equipment
Learning Objectives
Peripheral Intravenous Catheters
Catheter Features
Midline Catheters
Needle Protection: Active and Passive Sharps Safety
Over-the-Needle Catheters
Peripheral Intravenous Catheters
Ultrasound
Vein Illumination Devices
Solution Containers
Glass Containers
Infusion Pump Specific
Plastic Containers
Solution Containers
The Syringe as a Solution Container
Use-Activated Containers
Table(s)
5-1. Smart Pump Features
5-2. Infusion Pump Risk Reduction Strategies for Clinicians
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Infusion Equipment
6. Techniques for Initiation and Maintenance of Peripheral Infusion Therapy
6. Techniques for Initiation and Maintenance of Peripheral Infusion Therapy
Age-Related Considerations
Age-Related Considerations - Techniques for Initiation and Maintenance of Peripheral Infusion Therapy
Home Care Issues
Nursing Process
Patient Education
Pediatric Peripheral Infusion Therapy
Peripheral Infusion Therapy in the Older Adult
Anatomy and Physiology Related to I.V. Practice
Anatomy and Physiology Related to I.V. Practice
Sensory Receptors
Skin
Venous System
Approaches to Venipuncture: Phillips 16-Step Peripheral-Venipuncture Method
Approaches to Venipuncture: Phillips 16-Step Peripheral-Venipuncture Method
Cannulation
Postcannulation
Precannulation
Chapter Highlights
Chapter Highlights - Techniques for Initiation and Maintenance of Peripheral Infusion Therapy
Pediatric Infusion Therapy
The Older Adult
Thinking Critically: Case Study
Worksheet 6-1: Superficial Veins of the Upper Extremities
Figure(s)
6-1. Anatomy of Skin
6-10. Skin Antisepsis Prior to Peripheral Intravenous Catheter Placement
6-11. Application of Traction to the Skin
6-12. A, Insertion of Needle at a 30-Degree Angle through Skin
6-13. Steps in Insertion of an over-the-Needle Catheter Once through the Skin into the Vein
6-14. A, BD Insyte Autoguard Bc Shielded I.V. Catheter Provides Blood Control during Insertion; Needle Safety System Button
6-15. StatLock Stabilizing a Peripheral I.V. Catheter
6-16. I.V. House Ultradressing, which Consists of Flexible Fabric with Thumb Holes and a Polyethylene Dome that Wraps around the Patientâs Hand after an I.V. is Started
6-17. A and B, Steps in Applying Transparent Semipermeable Dressing Directly over the I.V. Catheter Hub and Insertion Site
6-18. Applying a Tegaderm CHG Dressing over a Peripheral Intravenous Catheter
6-19. Tamper-Proof Biohazard Containers
6-2. Anatomy of a Vein
6-20. Intermittent Infusion Device
6-21. A, Superficial Veins of Scalp
6-22. 0.2 Micron Air-Eliminating Filter Set
6-23. IV House Ultradressing Pediatric
6-24. Fragile Veins
6-3. Superficial Veins of the Dorsum of the Hand
6-4. Superficial Veins of the Forearm
6-5. A, Spiking
6-6. Phillips Tourniquet Technique
6-7. Transillumination Techniques
6-8. Near-Infrared Imaging to Visualize Vein Using Veinsite
6-9. Intradermal Lidocaine Administered Before Venipuncture Using 0.1 to 0.2 Ml of 1% Lidocaine and a Tuberculin Syringe Entering the Skin at a 15- to 25-Degree Angle
Glossary
Learning Objectives
Peripheral Infusion Site Care and Maintenance (Peripheral-Short and Midline Catheters)
Needleless Connectors
Peripheral Infusion Site Care and Maintenance (Peripheral-Short and Midline Catheters)
The Nursing Process for Patients Receiving Peripheral Infusion
Procedures Display(s)
6-1. Steps for Inserting a Peripheral-Short Over-the-Needle Catheter by Direct and Indirect Methods
6-2. Converting a Primary Line to Intermittent Device
6-3. Flushing a Peripheral-Short I.V. Catheter
6-4. Discontinuation of Peripheral-Short I.V. Catheter
Table(s)
6-1. Comparison of Artery and Vein
6-10. Summary of Steps in Initiating Peripheral I.V. Therapy
6-11. Components of the Pediatric Physical Assessment
6-12. Pediatric Infusion Sites
6-13. Flushing Guidelines for Pediatric Patients
6-14. Tips for the Older Adult with Fragile Veins
6-2. Selecting an Insertion Site for Superficial Veins of Dorsum of Hand and Arm
6-3. Phillips 16-Step Peripheral-Venipuncture Method
6-4. Tips for Selecting Veins
6-5. Phillips Multiple Tourniquet Technique
6-6. Transillumination
6-7. Techniques to Assist with Difficult Venous Access
6-8. Recommended Gauges
6-9. Conversion Chart: Rate Calculation
Worksheet 6-2: Basic Calculation of Primary Infusions
Post-Test
References
Worksheet 6-2: Basic Calculation of Primary Infusions
7. Phlebotomy Techniques
7. Phlebotomy Techniques
Age-Related Considerations
Age-Related Considerations - Phlebotomy Techniques
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Client
Blood Collection Procedure
Assessment and Identification
Blood Collection Procedure
Disposal of Equipment
Drawing Station
Equipment Preparation and Venipuncture Technique
Fill and Mix of Tubes
Hand Hygiene/Gloving
Key Nursing/Phlebotomist Interventions
Order of Tube Collection
Postprocedure Patient Care
Preparation of the Venipuncture Site
Specimen Identification and Labeling
Test Requisition
Transport of the Specimen to the Laboratory
Venipuncture Site Selection
Complications
Complications
Hematoma
Equipment for Blood Collection
Color Coding
Equipment for Blood Collection
Evacuated Tube Types
Expiration Dates
Microcollection Equipment
Needles
Supplies for Venipuncture
Syringe Systems
Vacuum (Evacuated) Tube Systems
Winged Infusion Set
Figure(s)
7-1. Traditional Components of an Evacuated Tube System
7-10. Proper Insertion of Needle into Vacutainer Holder
7-11. Insertion of Winged Needle into ETS Holder
7-12. Vacutainer Push-Button Winged Needle Blood Collection Set Steps
7-13. Hematoma Resulting from Multiple Attempts at Blood Draw
7-14. Appropriate Site for Heel Puncture on Infant
7-2. BD Vacutainer Eclipse⢠Blood Collection Safety Needle
7-3. BD Vacutainer⢠Plastic Tubes
7-4. Blood Collection Tube Top Guide
7-5. BD Vacutainer Push Button Blood Collection Set
7-6. BD Quikheel⢠Microcollection Lancet
7-7. Blood Drawing Chair
7-8. Sample Barcode
7-9. Best Sites for Venipuncture
Glossary
Introduction to Phlebotomy
Health-Care Worker Preparation
Introduction to Phlebotomy
Professional Competencies
Purpose of Phlebotomy
Learning Objectives
Procedures Display(s)
7-1. Collection of Blood in Evacuated Tube System
7-2. Collection of Blood Using a Winged or Butterfly Collection Set
7-3. Collection of Blood Using the Syringe Method
Table(s)
7-1. Duties of the Nurse or Phlebotomist
7-2. Blood Collection Tray Contents
7-3. Order of Draw for Multiple Tube Collections
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Phlebotomy Techniques
8. Techniques for Initiation and Maintenance of Central Vascular Access
8. Techniques for Initiation and Maintenance of Central Vascular Access
Age-Related Considerations
Age-Related Considerations - Techniques for Initiation and Maintenance of Central Vascular Access
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Patient
Anatomy of the Vascular System
Anatomy of the Vascular System
Venous Structures of the Arm
Venous Structures of the Chest
Assessment and Device Selection
Antimicrobial Catheters
Assessment and Device Selection
Catheter Gauge
Catheter Materials
Catheter Valves
Conditions that Limit Central Vascular Access Device Placement
Multilumen Central Vascular Access Devices
Power Injectable Central Vascular Access Devices
Vascular Access Teams
Care and Maintenance
Administration Set Changes
Assessment
Blood Sampling
Care and Maintenance
Catheter Repair
Discontinuation of Therapy
Flushing and Locking
Needleless Connectors
Site Care and Dressing Changes
Chapter Highlights
Care and Maintenance Issues
Chapter Highlights - Techniques for Initiation and Maintenance of Central Vascular Access
Figure(s)
8-1. Veins of the Arm and Chest
8-10. Subclavian Insertion Site for a Tunneled Catheter
8-11. Diagram of Creation of Subcutaneous Tunnel
8-12. Example of Port Placement in Chest
8-13. Example of an Implanted Venous Access Port
8-14. Examples of Implanted Vascular Access Ports
8-15. Accessing the Port Wearing Gloves
8-16. A, Example of a Dressing Kit
8-17. Tegaderm CHG Dressing over PICC
8-18. Sorbaview Shield Contour TSM Dressing over Nontunneled CVAD Placed Via Internal Jugular Vein
8-19. Sorbaview TSM Dressing over Accessed Implanted Vascular Access Port
8-2. Venous Access Device Selection Algorithm
8-20. Biopatch[®]-Impregnated Foam Dressing around a CVAD
8-3. Bioflo PICC Made of a Thromboresistant Material that is Blended into the Polyurethane and Resistant to Accumulation of Blood
8-4. Power PICC Solo[*]2 Catheters, Single, Double, and Triple Lumen; Valve Located in Catheter Hub
8-5. A, Injection Ports of the Triple-Lumen Catheter Include the Proximal Lumen Port, Distal Lumen Port, and Medial Lumen Port
8-6. Siterite Ultrasound System
8-7. Algorithm for a 'Stuck' Peripherally Inserted Central Catheter
8-8. Diagram of Subcutaneously Tunneled Catheter Placement
8-9. Subcutaneously Tunneled Catheter
General Overview of Central Vascular Access Devices
Glossary
Learning Objectives
Long-Term Central Vascular Access Devices
Implanted Ports
Long-Term Central Vascular Access Devices
Subcutaneously Tunneled Catheters
Nontunneled Central Vascular Access Devices and Peripherally Inserted Central Catheters
Catheter Removal
Key Nursing Interventions
Nontunneled Catheters
Nontunneled Central Vascular Access Devices and Peripherally Inserted Central Catheters
Peripherally Inserted Central Catheters
Risks and Complications
Procedures Display(s)
8-1. Central Vascular Access Device Dressing Change
8-2. Flushing a Central Venous Catheter
8-3. Blood Sampling from a Central Vascular Access Device (CVAD)
8-4. Discontinuation of a Short-Term Vascular Access Device (Nontunneled Catheter or Peripherally Inserted Central Catheter)
8-5. Accessing an Implanted Port
8-6. Deaccessing an Implanted Port
Table(s)
8-1. Measurements of Veins (Adult)
8-2. Conditions Affecting Vascular Access Device Site Placement
8-3. Flushing Protocols
8-4. Comparison of Central Venous Catheters
8-5. Summary of Care and Maintenance of Central Vascular Access Devices
8-6. Neonatal and Pediatric Flushing Protocols
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Techniques for Initiation and Maintenance of Central Vascular Access
9. Complications of Infusion Therapy: Peripheral and Central Vascular Access Devices
9. Complications of Infusion Therapy: Peripheral and Central Vascular Access Devices
Age-Related Considerations
Age-Related Considerations - Complications of Infusion Therapy: Peripheral and Central Vascular Access Devices
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Client
Central Vascular Access Device Complications
Catheter Occlusion
Catheter-Associated Venous Thrombosis
Central Vascular Access Device Complications
Central Vascular Access Device Malposition
Insertion-Related Complications
Pinch-Off Syndrome
Superior Vena Cava Syndrome
Figure(s)
9-1. Hematoma
9-2. Phlebitis
9-3. Infiltration of Vancomycin into Subcutaneous Tissue, Causing Blistering of Skin
9-4. Infiltration
9-5. Infiltration and Swelling below the I.V. Site Occurring after Hands Were Placed Underneath the Patient during Turning
9-6. Fibrin Sleeve
9-7. Intraluminal Occlusion
9-8. Portal Reservoir Occlusion
Glossary
Learning Objectives
Local Complications
Hematoma
Infiltration/Extravasation
Local Complications
Local Infection
Nerve Injury
Phlebitis/Thrombophlebitis
Venous Spasm
Systemic Complications
Bloodstream Infection
Circulatory Overload
Speed Shock
Systemic Complications
Venous Air Embolism
Table(s)
9-1. Types of Phlebitis
9-2. Factors Increasing Risk for Phlebitis
9-3. Phlebitis Scale
9-4. Infiltration Scale
9-5. Factors That Increase Risk for Extravasation Injury
9-6. Local and Systemic Complications of Peripheral Intravenous Therapy
9-7. Central Venous Catheter Bloodstream Infection Prevention
9-8. Summary of Complications of Central Venous Access
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Complications of Infusion Therapy: Peripheral and Central Vascular Access Devices
10. Infusion Medication Safety, Methods, and Routes
10. Infusion Medication Safety, Methods, and Routes
Age-Related Considerations
Age-Related Considerations - Infusion Medication Safety, Methods, and Routes
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
Pediatric Patients
The Older Adult
Drug Stability and Compatibility
Adsorption
Drug Incompatibility
Drug Stability
Drug Stability and Compatibility
Figure(s)
10-1. Methods of Delivery of Secondary Infusions
10-10. EZ-IO[®] Drill and Products
10-11. EZ-IO Steps
10-12. Ommaya Reservoir
10-13. A. Cross Sectional View of the Spinal Cord
10-14. Methods of Epidural Administration
10-15. Epidural Site Covered with Sorbaview[®] Shield Transparent Dressing
10-2. Administration of Medication Via a Volume-Controlled Chamber
10-3. Ambulatory PCA Pump: Painsmart Iod (Information on Demand)
10-4. Clearview⢠Ms: Multiple Site Subcutaneous Delivery Set
10-5. Aqua-C⢠Hydration Set for Hypodermoclysis and Clearview⢠Sub-Q
10-6. Aqua-C Subcutaneous Device with Two Needles; Used for Hypodermoclysis
10-7. Intraperitoneal Port Placement
10-8. Anatomy of a Long Bone
10-9. Sites for Intraosseous Infusions
Glossary
Infusion Medication Delivery
General Guidelines
Infusion Medication Delivery
Intravenous Medication Administration
Continuous I.V. Infusions
Intermittent I.V. Infusions
Intravenous Medication Administration
Intravenous Push
Patient-Controlled Analgesia
Learning Objectives
Other Infusion Medication Routes
Intraosseous
Intraperitoneal
Intraspinal
Other Infusion Medication Routes
Subcutaneous
Principles of Intravenous Medication Administration
Advantages
Principles of Intravenous Medication Administration
Risks
Procedures Display(s)
10-1. Administration of Medication by the Direct (I.V.) Push: Peripheral Catheter
10-2. Administration of Continuous Subcutaneous Medication Infusion
Safe Delivery of Infusion Therapy
Compounding of Medications
Orders
Safe Delivery of Infusion Therapy
Standards of Practice
Tubing and Catheter Misconnections
Table(s)
10-1. Advantages and Disadvantages of Intravenous Medication Administration
10-2. Patient Risk Factors for Oversedation and Respiratory Depression with Patient-Controlled Analgesia
10-3. Epidural and Intrathecal Medications
10-4. Monitoring Parameters for the Patient Receiving an Intraspinal Infusion
10-5. Eight Rights of Medication Administration
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Infusion Medication Safety, Methods, and Routes
11. Transfusion Therapy
11. Transfusion Therapy
Administration of Blood Components
Administration of Blood Components
Complications Associated with Blood Component Therapy
Step 1: Recipient Consent
Step 2: Verifying the Authorized Prescriber's Order
Step 3: Pretransfusion
Step 4: Vascular Access; Selecting and Preparing the Equipment
Step 5: Preparing the Patient
Step 6: Dispensing and Transportation of the Component
Step 7: Initiating the Transfusion
Step 8: Monitoring the Transfusion
Step 9: Completing the Transfusion
Age-Related Considerations
Age-Related Considerations - Transfusion Therapy
Chapter Highlights
Complication Prevention
Home Care Issues
Neonatal and Pediatric Patients
Nursing Process
Patient Education
The Older Adult
Transfusion Administration Issues
Alternatives to Blood Transfusions
Alternatives to Blood Transfusions
Augmentation of Volume with Colloid Solutions
Intraoperative Autologous Transfusion (Blood Recovery)
Red Blood Cell Substitutes
Basic Immunohematology
Antibodies (Agglutinins)
Antigens (Agglutinogens)
Basic Immunohematology
Blood Preservatives
Other Blood Group Systems
Pretransfusion Testing
Blood Component Therapy
Blood Component Therapy
Granulocytes
Immunoglobulins
Irradiated Blood Products
Plasma Derivatives
Platelets
Recombinant Factor Replacement Products
Red Blood Cells
Whole Blood
Blood Donor Collection Methods
Allogeneic/Homologous
Autologous Donors
Blood Donor Collection Methods
Designated or Directed Donors
Blood Management
Blood Management
Strategic Approach to Blood Management
Figure(s)
11-1. Correct Labeling of a Unit of Blood
11-2. Medication Deferral List
11-3. Designated Donor Unit
11-4. Derivation of Transfusible Blood Products
11-5. Hanging PRBCs with Y Administration Set
11-6. Platelets
11-7. Fresh Frozen Plasma
Glossary
Learning Objectives
Procedures Display(s)
11-1. Initiation of Transfusion
Table(s)
11-1. ABO Blood Grouping Chart
11-2. ABO Compatibilities for Red Blood Cell Components
11-3. ABO Compatibility for Fresh Frozen Plasma
11-4. Blood Types by Population
11-5. Blood Conservation Methods
11-6. Summary of Common Blood Components
11-7. Steps in the Administration of a Blood Component
11-8. Risks of Transfusion Therapy
11-9. Summary of Transfusion Reactions
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Transfusion Therapy
12. Parenteral Nutrition
12. Parenteral Nutrition
Age-Related Considerations
Age-Related Considerations - Parenteral Nutrition
Chapter Highlights
Home Care Issues
Nursing Process
Patient Education
The Older Adult
The Pediatric Patient
Complications Associated with Parenteral Nutrition
Complications Associated with Parenteral Nutrition
Discontinuation of Nutritional Support
Metabolic Complications
Nutritional Complications
Concepts of Nutrition
Concepts of Nutrition
Malnutrition
Nutritional Deficiency
Delivery of Nutritional Support
Delivery of Nutritional Support
Nutritional Support Candidates
Nutritional Support Delivery Methods
Parenteral Nutrition Orders
Figure(s)
12-1. Example of Fat Emulsion (Intralipid 30%)
12-2. Automated Method of Compounding Parenteral Nutrition
12-3. Body Protein Depletion
12-4. Routes to Deliver Nutritional Support to Adults
12-5. Multichamber PN Solution Container
12-6. Lipopor⢠TNA Filter Set for Total Nutrient Admixture Administration with 1.2 Micron Air- and Particle-Eliminating Filter
Glossary
Learning Objectives
Nutritional Requirements/Parenteral Formulations: Adults
Carbohydrates
Electrolytes
Fats
Fluid Requirements
Medication Administration with Parenteral Nutrition
Nutritional Requirements/Parenteral Formulations: Adults
Parenteral Nutrition Compounding
Proteins/Amino Acids
Trace Elements
Vitamins
Nutritional Screening
Anthropometric Measurements
Assessment
Energy Requirements
Laboratory Assessment
Nutritional Screening
Physical Examination
Nutritional Support
Parenteral Nutrition Administration
Medical Equipment
Parenteral Nutrition Administration
Practice Criteria for Administration of Parenteral Nutrition
Vascular Access
Table(s)
12-1. Components of a Nutritional Assessment
12-2. Physical Findings Associated with Deficiency States
12-3. Dextrose Solutions for Parenteral Nutrition
12-4. Components of Parenteral Nutrition Order Form
12-5. Complications Associated with PN
Thinking Critically: Case Study
Post-Test
References
Thinking Critically: Case Study - Parenteral Nutrition
Front Matter
Acknowledgments
Consultants
Preface
Reviewers
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