When is iv therapy indicated

Repair should only be completed by a trained CVC specialist. Catheter migration Patient may experience dysrhythmias caused by tip of the catheter moving from original position to an unwanted position. Migration may occur due to increased intrathoracic pressure due to coughing, change in body position, or physical movement of the arms , sneezing, or weightlifting. Call physician and stop all fluid infusions. You may need to pull back on tubing and X-ray CVC again for placement confirmation. Do not pull on central lines; prevent IV lines from being caught on other equipment.

Data source: Baskin et al. Name three advantages and three disadvantages of a central line. Previous: 8. Skip to content Chapter 8. Intravenous Therapy. What is the difference between a non-tunnelled percutaneous catheter and a tunnelled catheter? Next: 8. Share This Book Share on Twitter. Signs, Symptoms, and Treatment. Clinical indications are localized redness, pain, heat, and swelling, which can track up the vein leading to a palpable venous cord.

Infiltration occurs when a non-vesicant solution IV solution is inadvertently administered into surrounding tissue. Extravasation occurs when vesicant solution medication is administered and inadvertently leaks into surrounding tissue, causing damage to surrounding tissue.

Hemorrhage is defined as bleeding from the puncture site. Local infection is indicated by purulent drainage from site, usually two to three days after an IV site is started.

Safety considerations: Cardiac and renal patients have increased risk of systemic complications. Pediatric patients, neonates, and elderly people have increased risk of systemic complications. Signs, Symptoms and Treatment. Pulmonary edema , also known as fluid overload or circulatory overload, is a condition caused by excess fluid accumulation in the lungs, due to excessive fluid in the circulatory system. It is characterized by decreased oxygen saturation, increased respiratory rate, fine or coarse crackles at lung bases, restlessness, breathlessness, dyspnea, and coughing up pinky frothy sputum.

Pulmonary edema requires prompt medical attention and treatment. If pulmonary edema is suspected, raise the head of the bed, apply oxygen, take vital signs, complete a cardiovascular assessment, and notify the physician. An air embolism is reported to occur more frequently during catheter removal than during insertion, and the administration of up to 10 ml of air has been proven to have serious and fatal effects. Small air bubbles are tolerated by most patients.

A catheter embolism occurs when a small part of the cannula breaks off and flows into the vascular system. Safety considerations: CVC care and maintenance requires specialized training to prevent complications. Central lines heighten the risk for patients to develop a nosocomial infection. Strict adherence to aseptic technique is required for all CVC care.

Tip location: The tip of the catheter is located in the SVC. The entry site is the exit site. Central venous catheters Internal jugular venous catheter upper CVC.

Tip location: The tip is located in the SVC. PICC line inserted in the upper arm through the basilic vein. Subcutaneous or tunnelled central venous catheter. A tunnelled CVC , also known as a Hickman, Broviac, or Groshong, is a long-term CVC with a proximal end tunnelled subcutaneously from the insertion site and brought out through the skin at an exit site.

Insertion is a surgical procedure, in which the catheter is tunnelled subcutaneously under the skin in the chest area before it enters the SVC.

IV fluid rehydration may be required for children with severe dehydration or those who cannot tolerate enteral intake. If electrolytes are deranged, consult senior clinician and relevant guideline, and consider slower replacement of deficit. Gastrointestinal tract losses are commonly replaced with sodium chloride 0.

Full maintenance fluid rates may be calculated using the table below as a starting point. This calculation applies for well children only. Fluid rates need to be adjusted for ALL unwell children. The maintenance fluid requirement calculation in this table applies to all ages including young infants.

Fluids can accumulate into spaces that normally contain minimal fluid volumes eg, the peritoneal or pleural cavities during surgery, anaesthesia or as a result of inflammatory conditions eg, sepsis. This breakdown of normal compartment integrity can result in loss of circulating intravascular volume. Causes of dehydration include preoperative fasting, ongoing gastrointestinal illness and self-neglect following acute confusion.

Knowing a detailed diagnosis is vital to gain information on the likely composition of the fluid lost. Practitioners also need to be aware of any concurrent conditions that can alter fluid distribution or make patients more susceptible to adverse effects from fluid therapy eg, a history of heart failure.

If a patient is suffering from fluid volume depletion, then his or her heart rate will increase to improve cardiac output and raise blood pressure, hereby maintaining tissue oxygenation. Blood pressure only falls after the intravascular volume has dropped by 20—30 per cent. Urine becomes concentrated in cases of volume depletion — more severe cases result in a fall in urine output.

Signs and symptoms need to be evaluated as a whole, since their specificity in isolation is limited. It should be borne in mind that co-existing conditions may alter results eg, tachycardia may be suppressed by concurrent drug therapy.

An accurately monitored fluid balance of overall intake and output is vital to tailor fluid administration. Losses via urine, drains, stoma or nasogastric aspirates should be documented. Some pathological conditions require special consideration. Patients with major burns require copious amounts of intravenous fluids, calculated according to body weight and percentage of body surface area affected.

In traumatic brain injury, fluid volume may be adjusted according to mean arterial pressure because this is related to cerebral perfusion pressure. Large amounts of IV fluids are also often required following trauma or septic peritonitis.

Fluid administration has to be particularly carefully balanced in individuals with heart failure, renal impairment or apparent respiratory failure. Similarly to any drug treatment, IV fluid administration requires monitoring for clinical response and adverse effects to ensure its safety and efficacy.

While dehydration will lead to malperfusion, kidney failure and eventually cell death, excessive administration of fluid is also associated with complications. Various studies have shown that outcomes for post-surgical and critical care patients can be improved with targeted, and even restrictive, fluid therapy — rather than administering fluids according to a set recipe of millilitres per kilogram of body weight. These findings may be absent if masked by other factors. For example, urine output can remain low for 24 hours after surgery, as part of the normal response to injury, even in patients receiving adequate fluid input.

Daily weighing is the simplest and most reliable means of monitoring fluid status, but it does not provide any information about the distribution of administered fluids. Invasive techniques can provide a more detailed picture of the intravascular volume status. The measurement of central venous pressure CVP via a central venous catheter is often used to assess intravascular volume. The use of this technique has recently come under question, 2 but it remains common in routine practice.

Similar results can be derived from cardiac output measurements, using a variety of techniques such as oesophageal Doppler or thermodilution. These methods will be restricted to use in critical care areas and, since values are influenced by several parameters eg, the use of vasoactive medicines , expert knowledge is required for their interpretation and application to clinical treatment.

Timing of fluid therapy can sometimes be more important than volume administered. It has been shown that by treating critically ill patients who require fluid resuscitation aggressively and early giving them most of their resuscitation fluids within six hours of their deterioration , they have better outcomes than those patients whose fluid resuscitation is delayed when most of it is administered more than six hours after they deteriorate.

Fluids can also be categorised according to their mechanism of distribution in the body or their electrolyte loads. The different types of fluid distribute into the various fluid compartments in different ways see Figure 1. In general, colloids remain in the intravascular space, while crystalloids distribute more readily into other tissues. Drugs administered via: Burette of an infusion set: to dilute the drug in a smaller volume via burette giving system, hang the bag of infusion fluid and gradually open the roller camp to allow appropriate amount of diluent into the burette.

Inject the prescribed drug into the burette via the additive port. Syringe driver: is recommended for children weighing less than 10 kg.

Draw up required volume of diluent in appropriate size syringe and then pull back the syringe plunger to enable you to inject the drug into the syringe using aseptic technique. Infusion bag: Clean the access port with disinfectant swab before injecting prepared drug into infusion fluid bag via the additive port.

Without contaminating the key part spike insert the spike on the administration set into the septum of the infusion bag.

Access PIVC only after cleaning the access port and scrub the hub. Administer blood product transfusions via a volumetric infusion pump or syringe driver to ensure accurate delivery. Use gravity sets only when rapid administration is required with diligent monitoring of volume.

Use a Neonatal transfusion set includes a to micron filter required for blood products and syringe driver for delivering small volumes of blood products. Using aseptic non touch technique, spike the blood product septum with the Neonatal transfusion set and attach an appropriate sized syringe for the transfusion to the 3 way tap.

Draw the required volume into the syringe and prime the rest of the neonatal transfusion set. Label the syringe with both patient and blood product identification details including expiry date and time of blood product. If rapid transfusion of small volumes is required, draw the required volume into a syringe through a to micron filter. Burettes should not be used for transfusion of blood products. Sterile 0. This must be prescribed as a medication.

The optimal volume used for intermittent injections or infusions is unclear. The literature suggests the volume of flush should equal at least twice the volume of the catheter and add on devices and a minimum of 2mL normal saline flush is recommended. Use 10ml syringe for flushing to avoid excessive pressure and catheter rupture. Syringes with an internal diameter smaller than that of a 10mL syringe can produce higher pressure in the lumen and rupture the catheter.

If resistance is felt during flushing and force is applied this may result in extravasation Use aseptic non touch techniques including cleaning the access port scrub the hub with a dual disinfectant agent e. Flush in a pulsatile push-pause motion. Flush catheters: Immediately after placement Prior to and after fluid infusion as an empty fluid container lacks infusion pressure and will allow blood reflux into the catheter lumen from normal venous pressure or injection.

Prior to and after blood drawing. The dressing must be kept secure, clean dry and intact. Indications for dressing change: when it becomes insecure or if there is blood or fluid leakage under the dressing. Determine the need for an assistant considering patient age, developmental level and family participation prior to the procedure.

If patient is allergic to transparent film dressings, use sterile film dressing to be used and changed daily. Carefully remove the old dressing, holding the cannula in place at all times Take the opportunity to thoroughly inspect the site of entry of the cannula for any sign of infection.

Cleanse the area around the catheter insertion site including under the hub using a pattern which will ensure entire area is covered. Allow skin preparation to air dry prior to applying any dressing, this allows the disinfectant to work. Consider placing a small piece of sterile cotton wool ball or gauze underneath the hub of the cannula to reduce pressure.

If desired, place sterile tape over the hub of the device before placing the transparent dressing. Cover the cannula insertion site with sterile transparent semipermeable, occlusive dressing e.

Tegadermtm, IV tm placed using an aseptic non touch technique over the catheter. This will allow continuous observation of the site and to help stabilise and secure the catheter. This will adequately immobilize the joint and minimise the risk of venous damage resulting from flexion. When using Splints, ensure these are positioned and strapped with the limb and digits in a neutral position to prevent injury from restricting blood or nerve supply and to prevent pressure sores Inspect the splint at least daily and change if soiled by blood or fluid leakage.

Cover with non-compression tubular bandage. Ensure there is a clear window where the cannula enters the skin- insertion site, so the site can be regularly viewed. In Summary, when dressing a peripheral IV cannula ensure: it is secure the site is visible the child can't injure themselves, or be injured by the connections the child can't remove or dislodge the cannula tapes are not too tight or restrictive.

Change of Extension sets Extension sets are to be changed when the access device is changed or immediately upon suspected contamination or when any break in integrity. Extension sets are to be primed and attached to the cannula at the time of IV insertion using an aseptic non touch technique When exiting the flushing of extension set you must use a positive pressure clamping technique.