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;
♡hearts
lungs
brains
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.
I read your mention of cannula migration, what is that and wjat are its effect on the body? You also mentioned the practice of placing a heavy thick plastic bag over Covid patients in some nursing homes when there is need for CPR. Why is this done? I am thinking that the CPR will be done using the pump and not mouth to mouth. I am hoping that a definite cure for this virus would be found soon and one which has no side effects.
Sometimes it can cause problems, but if it is caught right away, the cannula embolism can be treated before complications worsen. The clot can stop oxygen flow and that leads to necrosis or tissue death. Some cases have resulted in a stroke or heart attack. Any time there is a piece of the material inside of a vein, the blood flow can risk occlusion. The risk of getting an infection is increased. It is very unusual for this to happen, but often preventable. The plastic is for infection barrier, I don’t understand and it has not been openly discussed but I am glad no codes were like that because it seems like a dreadful situation. I am hopeful for your idea an actual sensible solution and not a recurring nightmare with so many lateral problems for everyone who has to endure.
Thank you for sending a note,
Nurse Becca
Great post
This is an informative and comprehensive post on infusion reflection, it is an eye opener with useful information, i gained lots of insight reading it, this pandemic is something else, most people are suffering daily, thanks to our medical practitioners,they are really giving their best i never knew that many promising treatments for corona virus is intravenous..Also the steps you gave in maintaining perfect hygiene is really awesome including observing strict hand cleanliness and washing techniques…I will share to my nurse friends to also learn few things..Thanks for sharing
Hi there,
You are welcome, what a privilege. I appreciate your input and feedback. Yes, they are researching immunoglobulins for infusion to help people get better. There are large specialty pharmacies working on this right now, such as CSL Behring, Takeda Pharmaceuticals and others who are banding together for research against this worldwide viral plague. It gives me hope.
This post has been extremely informative for me, as well as thought-provoking and stimulating a lot of questions. I am very impressed by your professional background and skills. I’ve noticed that apart from being a registered infusion nurse (you’re clearly an expert, I really enjoyed learning about the infusion procedure) you’re also so many other things, including a skin expert. May I ask you a question related to that? My 38-year old sister has suddenly developed very dry, flaky, almost paper-like skin on her face. What would you suggest to improve this condition? Many thanks for your advice.
Hi Lucie!
Thank you so much, I am flattered with your kindness. The dryness might need dermatology to have a look. I actually did just find a great product that works for me for the dryness with wearing masks, the dry areas I tried out vitamin C Melaleuca serum. I’ll find a picture for you and try to figure out how much it was. Also, there is a great product called Biosilk. I gave it to 2 nurses whose skin was literally peeling off their hands and it worked phenomenally. It is about forty dollars and I got mine at Ulta beauty. The great part about the Biosilk is no greasy residue, so that helps with nurses who need to keep going and say they are too busy for luxury of lotion. Thin skin on the face can be other problems, so I’m not suggesting my advice is the entire answer. But if it were me, Id buy both for my sis. When the skin is very fragile, I call it friable. I think her skin maybe friable and because of that, I’d suggest perhaps trying on her hands first to make sure its soothing and doesn’t cause sensitivity. Just my thoughts. Thank you for reading our team blog, Andy and I had a lot of fun with it. When I became a skin expert, I didn’t realize it untill attorneys started saying that. First, I did the check4cancer campaign. Checking all the Hewlett Packard people for skin cancer, then I worked on a few cases with skin problems that all settled. I feel very humbled and glad to help with your question. Feel free to send an email, to Info@nursebeccaconsulting.com, I’d be really interested to know if this helps.
Sincerely,
Nurse Becca
-R. Nixon, RN, CLNC
https://nursebeccaconsulting.com/my-vitamin-c-serum-for-lucie/
hellloo Rebecca Nixon, thanks for sharing such an amazing and informative post with us all, i was actually doing some research online about the pandemic stats, when i came across your site.after going through your site my mind is really at ease knowning that people out there that are knownlegable are fighting the virus, and must say the point you listed here on how to maintain perfect hygiene is really amazing, your writing skills is really something to talk about, just looking at your words tells you are qualified. i am gratefull to be apart of your work thanks alot for the info
You melted my heart, and I thank you
Kind Regards,
Nurse Becca
ps you’re quite welcome of course
After reading your article, am I right that hyperimmune therapy and convalescent plasma, could help a lot with the global pandemic of Covid 19 ? That would be awesome. Do you have any references to this ? The medical world is evolving so much and so quickly, isn’t it amazing?! Stay healthy and keep us informed please 🙂
kind regards,
Lizzy
I think you are right, but I don’t think it’s as simple as that. I will look for more references & information, but what I got so far is from specialty pharmacy and nursing networks. The idea made me curious because I was administering immunoglobulins for people who have ultra rare genetic, neuromuscular and immune deficiency conditions.
Look up plasma donations for CoVid, I think they are testing this currently. Taking hyperimmune plasma risks into consideration, it could be a viable idea. If you look back at Rhesus monkey developments to treating Rh disease, it could be as simple as giving people a RhoGam shot but made for the coronavirus. With all of the politics involved, it’s hard to know what in the media is true or valid. These are just my thoughts.
I’ll be back with a couple of ideas for more reading on hyperimmune therapy and convalescent plasma. Last year I confess, I had started writing a fiction story before CoVid and I was the President Trump’s nurse giving him the hyperimmune infusion prior to travels where they are using a virus as biological warfare. At the time, I thought I better not publish afraid people would think I’m weird or strangely insane. It turns out it wasn’t so far from possible, and I continue writing.
Sincerely,
Nurse Becca
https://onlinelibrary.wiley.com/doi/abs/10.1111/vox.12973
Here is an article about the gaps in knowledge to determine whether hyperimmune convalescent plasma or immunoglobulins could be helpful for the global pandemic. There is still so much research needed. I do believe serum specific to the individual can help the cytokine storm associated with the respiratory failure in CoVid-19.
Many thanks to you for sharing with me a beautiful and informative article. The main content of the article is INFUSION REFLECTIONS FOR YUMA CITY BLOGGERS. The subject of your article is very important in the current epidemic because we need to know these things in order to stay healthy. Therapy that not only circulates the blood but also helps in good hydration.
Since your article is health informative, I would like to share it on my Facebook group so that everyone can learn a lot.
What a great deal of information that you have given out in this awesome and interesting article I must give you a big thumbs up… I encountered an article like this on the internet and it changed my knowledge about INFUSION REFLECTIONS and gave me a new system to approach it…Many nursing homes have no ingredients to prevent COVID 19, so thank you very much for providing a summary of how these nursing homes will treat patients with COVID..thanks a lot for sharing.
Hi Nurse Becca,
An insightful article on infusions. I came across it purely because I was checking up on how blood should be taken for blood tests and what is the safest way to do it.
Infusions are pretty much the same thing; only the other way. The area must be spotlessly clean and so must the hands of the nursing professionals. The comfort of the patient must always be the prime focus.
Good read.
Aparna
Hi there, Aparna,
I appreciate your feedback. Blood draws are similar. I just finished a clinical trial in which blood draws are required for people who have ultra rare conditions. Each type of test has its own requirements for centrifugation, storage, sending shipped on dry ice for plasma. Plasma extraction on site is needed to get an accurate account of blood levels for the scientists and doctors running the experiments. The whole thing must be coordinated just so. For example, agitating a blood specimen can pop the cells, allowing a false reading of potassium levels. If drawn or handled incorrectly, the potassium can read dangerously high. That is just one example of how precise the process is for blood studies. When I centrifuge, this is the spinning of the blood at a specific speed, like gold panning, the heavier elements spin to the bottom the gold in this analogy would be the packed red blood cells, a white buffy layer forms and on top is the clear plasma. A small pipette can be used to aliquot the plasma and freeze in dried ice. The plasma is more like diamonds to be microscopically mined. In this clear fluid are protein particles called immunoglobulins. These are what the body uses to modulate against infections. An immunoglobulin works in symphony in the body with the other blood components to contruct miraculously specific to pathogens attacking the body.
It can be another problem if the processing is delayed. Let’s say the ambient sample is lost in shipping and by the time it reached the lab it is not a viable specimen. If, for any reason, something goes wrong, the patient may endure additional blood draws. This can be a challenge to coordinate because of distance and reorganizing the series of events needing to take place in order to keep the trial on pace. Each test may also need a different speed of centrifugation, and order of drawing, number of times to invert each vial and a ton of other details. It differs from infusions in several ways, but the process for setting up and accessing the vein for collecting blood is very close to starting an IV.
In an infusion, the cannula migration rarely occurs. In venipuncture for blood draws, there is not a risk of cannula breaking off into a vein because the needle for blood collection does not have the plastic flexible miniature straw that remains in the vein for delivery of fluids or medication. A haematoma is a risk, that can be prevented by providing pressure if the site is swelling, and affixing an ice pack. I hope this helps better understand the difference.
I truly appreciate your discussion on the topic and interest in my work.
Warm Regards,
Nurse Becca
-R. Nixon, RN, CLNC
This is a very comprehensive and well researched article about infusion reflections. It is certainly a very technical procedure and you mention several medical terms and procedures involved. So what is the venipuncture procedure?
You also talk about the cannula that should be the identical length as it was upon insertion, but I am curious to know what cannula migration actually is?
Hi there,
Venipincture is the technique used to access a vein. It requires location, setup and aseptic technique, and must be done with a doctor order. In IV starts, a cannula is a flexible plastic sheath that encircles the needle and slides off once there is blood return. When the needle is reinserted into the cannula, or becomes friable (easy to break) due to extreme temperatures or other elements, the piece of plastic can get dislodged into the vein. After the cannula sheath is inserted and anchored into the vein, it should flow without swelling and when drawn back should have brisk blood return.
Sometimes, the process can be done incorrectly, for example if the nurse doesn’t know or handle the eqipment properly or an accident, such as a sneeze or jerk from braising a nerve with the needle. If the needle is removed from the cannula, it can’t be reinserted for vein hunting. That can cause the cannula to become dislodged into the vein because it is difficult to get the needle exactly realigned to go back into the cannula without hitting the inside and slicing a piece off. I thought about making visual aids to help envision this better. Does this explanation help a little bit?
Thank you for reading and replying to this article.
Kind Regards,
Nurse Becca
Wow! Very detailed information you have provided here and I must say that I really fancy all you have shared here. In all honesty, I must say that this infusion reflection topic here have really been enlightening especially knowing how much safety precautions are now out in place these days to ensure that things are worth while in the long run. Thanks
Hi Kimberly,
You’re quite welcome, of course. I added a picture of an expired 22 gauge IV cannula that is typically used for starting infusions. I made a video GIF, but couldn’t embed it into the post. Thank you for your visit and comment:)!
-Nurse Becca
This has been a very interesting read and I will share it with some at work. We have all been hit badly by COVID-19 but it’s a big relief to read good news in the midst of a see of uncertainty. I would like to highlight that I have seen over and over again COVID-19 patients clotting issues and one less catheter piece enlodged in a vein is indeed progress.
Yes, the technique is very important. Thank you for your interest and sharing my work.
Cordially,
Nurse Becca
-R. Nixon, RN, CLNC
I think that you have done a great deal of research to out this together and you are also very skilled at what you do because this that you have here is not something that we should take lightly. All the same, this is good stuff. I did not understand some of the terms you used though, they were behind me but I see that covid19 might well and truly be on its way away. What is the venipuncture procedure
Thank you so much for your interest. The venipuncture procedure is the way to access a vein in order to start an IV or draw blood specimens. There are special steps, during which aseptic technique is of utmost importance. I like to think of gathering supplies, setting up, performing task, then clean up and documentation. The process after set up is assess, confirm identity, orders, allergies, prepare patient providing for privacy and comfort, perform proper hand hygiene, plan the best vein by palpation, or feeling for the spot, warm area if needed with a heat pack, cleanse site allowing to air dry, apply tourniquet (sometimes the tourniquet is not needed or can use a partially inflated BP cuff, to expand the vein bevel up needle if appropriate, obtain flash back of blood return filling the needed vials, or flush for IV start. As you can tell, this is just a general idea but the details are in the specific task at hand and for whom.
I wrote a brother blog, infusion reflections for a little more info. Please let me know if this adequately answers your question.
Kind Regards,
Nurse Becca
-R. Nixon, RN, CLNC