Nurse Becca Blog of Infusion Reflections, Inspired by Yuma City Bloggers-Andy Anderson
The list of potential infusion complications is the root of requiring ongoing education for registered nurses in clinical care. This discussion does not cover all possible problems related to infusions.
Hyperimmune therapy and convalescent plasma are having successful advances. Progress is being made! Many of the promising treatments for Coronavirus are intravenous, and carefully monitored with each person to ensure tolerance and treat any side effects.
Of course there is a big difference between side effects and adverse drug events versus an actual iatrogenic effect. Side effects still need to be addressed, but they can be an expected outcome of therapy. Some side effects are overcome with hydration and rest.
Several vaccines are in progress through FDA approval and the other portion of funding is geared toward the next runners up. Genetic testing for antibodies and digitalized tracking with technology is emerging with new hopeful results. Soon the next prediction of dexamethasone shortages maybe coming to the front lines for health care as an adjunct infusion therapy.
There are so many unknowns with best practice, some nursing homes are training staff to place a heavy thick plastic bag over patients before CPR, and no ventilation for CoVid suspect, as well as no entry to any room with known CoVid cases.
With increased needs for infusion from global pandemic 2020, the frontline healthcare staff experience shortages of equipment, running out of products and requiring innovation to achieve the highest level of wellness as possible under the circumstances. With a surge of infusions for CoVid patients, an open educative approach, some of the complications can be avoided.
The collaboration is also a pay it forward for the Open Education Project of Wealthy Affiliate Community.
Everyone has unique veins, and those who must get an IV started has to actively learn along years to get expertise at infusion skills.
The basics are explained by reviewing iv order, gathering your set of supplies – this can vary depending upon pharmacies and patient preference. You should have a sharps container available, or a sturdy plastic receptacle, assess the scene safety Pertaining to the Corona virus, anyone with a cough in the area or history of symptoms of illness are potentially an unsafe scene.
Think of the known and available patient info pertaining to the overall plan. Look for a vein and check pulses, vital signs if appropriate and able. It is a good idea to start peripherally, toward the hand or forearm. The last choice is the vein where the arm bends (antecubital), check all equipment prior to your approach, expiration dates of the sterile equipment such as gloves, IV start kit and cleansing material. Have soap, clean water and paper towels available, as well as hand sanitizer.
Observe strict hand cleanliness, and washing technique. Imitation fingernails are not best practice due to 100% pathogens in infectious quanity in a period of 72 hours. Hand washing can be replaced with hand sanitizer of no other invasive or unclean skills are performed. For example, in between steps for IV insertion and starting the infusion.
Review allergies. If there is chlorhexidine or iodine in the package, for example, this requires attention.
Ensure all supplies are accounted for, record the needed information-efficient documentation is required for licensure and ethics of health care providers. This training is not meant for medical or legal advice, in hopes to be helpful and offer something uplifting to learn.
Ensure the best comfort. Consider the fluid to be administered, and follow instructions for bringing to room temperature. Review medication taken or required for premed or after the infusion.
Sterile parts must remain sterile, and anything underneath a sheath for infusions is considered sterile. It must not come into contact with any other surface, including nonsterile gloves.
Search for recalls, and add to planning. With preparation and communication, you may be able to verify a manufacture or safety recall. This can prevent hazards, to remove from the supplies any expired or recalled material. Have discretion upon removing any supplies and notify if there is inventory shortage.
Choose the best tools for the job at hand, you can consider the product to be administered, the package insert of the prescribed product, as well as the person who receives the therapy.
Know signs of concern, and actions to alleviate. This requires the clinical judgement of a nurse. Prudence is required. For the reasonable level of detail for a blog article and dicussion, this is just an informational approach.
For 100 years, infusions have been used without much knowledge.
Today, a working knowledge of chemistry, intermediate pharmacology, medical math and human care are required for the practice of IV insertion.
One weekend the barbeque ended abruptly because a man who fell unconscious had a major stroke from IV cannula migration. The abrupt surgery saved his very life, but life as he knew it was forever changed. He could still perform most functions, and others with the same injury have suffered instant death by the drifted cannula interrupting the blood flow to vital organs, such as;
Clinical changes that can suggest thrombosis or embolism are, pain and numbness, warm or coolness to the extremity, change in vision, fainting or loss of consciousness, shortness of breath or sense of impending doom, sudden weakness or drooping of the extremity. Remember the acronymn FACE to know whether to request emergency transfer.
Keep a tourniquet available and remember posisioning. In the ultra rare event that an IV cannula piece was lost amok in the interior space of the vein, the blood flow and oxygen to any area of the body can be interrupted. It is important to act fast recalling human anatomy to prevent the migration of the cannula embolism into the blood stream.
Any time a migrated cannula is dislodged into the vein, any form of blood clots are a higher potential. It is a serious medical event. With the clotting issues that CoVid patients are facing, one less catheter piece enlodged in a vein is a celebration for health care progress.
Emotional Impacts can be a consideration, as often the events and treatment are unpleasant or painful. This can be a series of grief for the patient and/or families. Even health care providers would suffer from the event. There is always a small inherent risk of untoward outcome with treatments only a doctor can decide the benefits of infusion therapy outweight any risk factors and prescribe. This still comes with the caveat of following the procedures, understanding the mechanics and anatomy, as well as the art and science.
When starting the IV, the work area needs to remain free of contaminants. A tourniquet should be placed closer to the heart 2-4 inches. This requires some active adjustment depending upon the area of insertion. The vein is palpated, it should feel springy, bouncy or squishy.
Place the piddle pad or drop cloth aka chucks underneath to catch any drops which may spill, protect the furniture or pretty blouse.
Ensure IV line is primed with fluid as appropriate for the product to be given. If it is an immunoglobulin, expensive or specialty product, it maybe advisable to wait until the IV site is secure prior to opening, pooling or priming the liquid into the extension tubing.
The saline flush can be primed into the IV extension if available, and the product is compatible. Ensure the integrity of the leur lock seal, and absense of air in the IV line.
Cleanse the site and allow thorough drying time. Once the site and surrounding area is completely dry, reapply tourniquet. Instruct flexion and/or relaxing the muscles to get the vein primed.
This takes some practice to begin with, but generally, the bounce is a more official sign of a good start point because of the good blood supply and surface tension of the vein will work together to produce a quick splash of blood. This is the blood return.
The brisk blood return is reassuring, any sluggish or unexplained off color to blood should be promptly reported. Once the flash is verified, gently lower while advancing to anchor the cannula gently further in and upstream, pulling back to see the reassurance of blood return, then if safe push the normal.saline with care to ensure the placement. At this moment, it is imperative to observe the area surrounding to observe there is no swelling or discoloration.
For anyone aware who is going through the venipuncture procedure, staying as still as possible and reporting any change that feels important. It may feel like stinging, or if a nerve is brushed with the needle track, it could result in shooting nerve pain. If possible, try to limit movement despite discomfort.
Once an infusion is complete, the site should look pink and healthy, without abnormal bumps or bruising. The cannula should be the identical length as it was upon insertion, or follow assessment to appreciate any risk of cannula migration. Reverse trendelenberg, affix cuff, nothing by mouth, and alert their health care provider expediently. Any outcome that results in patient injury from an IV insertion or faulty product can be avoided in many cases by learning more in regard to this event incidence, prevention and obtaining the best quality of supplies.
There are several ways to run an infusion, with a programmable pump, by gravity or a mechanical pump. There are even spherical infusion bags which deflate for the prescribed therapy. Any area.or purpose for IV infusions may have different looking equipment for starting an infusion, and learning new devices or programs can take an ongoing effort by caregivers as well as supply chains.
Essentially, the majority of new products have enhanced safety features which retract to immediately prevent sharps injury with contaminated needles. This form of safety feature is beneficial to prevent reinsertion of a used needle into the cannula, that is a miniature fragile straw shaped piece of flexible tubing. If the safety latches, there is less potential for needles to be unsafely reused. Any questionable packaging, faded or illegible expiration and lot number should be disposed of.
When a product is recalled, it will be listed on the FDA website. The lot number and expiration date are used to identify anything that gets pulled off the market for safety.
The equipment should be inspected, clean and ready to use. The batteries or charging should be sufficient for the complete infusion to finish. If you have gravity flow, the drop factor and drip rate are calculated based on the weight, as well as the prescribed parameters.
When a needle is used even one time, the bevel can appear like barbed wire underneath a microscope. The microabrasions on your skin and within the tissues beneath can be preserved by remembering reuse of IV cannulas is not the way to go.
A safety check for fit on the cannula is required prior to venipuncture to make sure the integrity of the device is intact, and none of the material cracks as it is inserted. In nursing school, we learned something called a Chevron method for affixing the cannula to prevent migration if the patient needs to move during the infusion, such as going to the bathroom. This way of taping the site, known as chevron should only be attempted after practice.
Ensure a well-lighted pathway for walking to the bathroom, and remove anu fall hazards, such as a rug or chair that could catch the tubing or IV pole.
In the event intravenous thrombosis is suspected, treatment can range from heat and ice therapy, clarify instructions based on whether a cannula broken in the vein is suspected. Any complication should be communicated to the appropriate health care providers. A small amount of knowledge and prevention can work toward the goal of reducing the need for intravenous thrombosis treatment.
The doctor may prescribe heparin or coumarins. These have safety ranges to include prothrombin time for heparin or International Normalized Ratio for coumarin therapy. Aspirin is another medication that prevents blood cells from gathering together to form clots.
Maintaining good hydration and exercise as cleared per the physician can also help healing as well as prevent deep intravenous thrombosis treatment. Keep active within level of ability, to decrease risk of complications of IV therapy. Overall health and wellness will contribute greatly to reduce untoward outcomes. And education is a tool we can employ to make a difference for safety in health care.
See Andy’s Blog, Complications of IV Therapy to learn a patient’s perspective of IV cannula migration.