Intravenous therapy (IV) is a therapy that provides a direct fluid to the blood vessels ( intra- ven - -ous ). Intravenous delivery route may be used for injection (with a syringe at higher pressure) or infusion (usually using only the pressure provided by gravity). Intravenous infusion is often referred to as drip . The intravenous route is the fastest way to give medicine and fluid replacement to the rest of the body, because the circulation takes them. Intravenous therapy may be used for fluid replacement (such as correcting dehydration), to correct electrolyte imbalances, to administer medications, and to blood transfusions.
Video Intravenous therapy
Access type
The intravenous system can be categorized by a type of blood vessel inserted tube, called a catheter, emptying intowards.
Peripheral line
Peripheral lines are used in peripheral veins (blood vessels in the arms, hands, feet, and legs). This is the most common type of IV therapy used.
Center line
The central IV line has a catheter passed through the vein and empty to the large central vein (the vein in the trunk), usually the superior cava vein, the inferior vena cava or even the right atrium of the heart. Because this vein has a larger diameter than the peripheral vein and has a faster blood flow, the central pathway is usually used to manage substances that can irritate the blood vessel lining, such as some chemotherapy drugs and total parenteral nutrition, whose high glucose content can damage blood vessels..
Another advantage is due to emptying near the heart, drugs can also be quickly distributed throughout the body. Since there is room for some parallel compartments (luminaires) inside the catheter, some drugs can be delivered at once, even if they will not be chemically compatible in one tube. It is generally believed that liquids can be pushed faster through the central line; however, the diameter of each lumen is often smaller than the diameter of the large peripheral cannula. Carers can also measure central venous pressure and other physiological variables through the central pathway. They are also longer and, as reflected in Poiseuille's law, require higher pressures to achieve the same flow, all other variables are equal.
Line IV is carrying the risk of bleeding, infection, gangrene, thromboembolism and gas embolism (see Risks below). They are often more difficult to include properly because the veins are unusually palpable and depend on experienced doctors to know the appropriate landmarks and/or use ultrasound probes to safely find and insert the veins. The surrounding structures such as the pleura and the carotid artery are also at risk of damage with potential pneumothorax or even arterial cannulation.
There are several types of central IV access, depending on which route the catheter takes from outside the body to the vein.
Centrally mounted central catheter
PICC lines are used when intravenous access is required for long periods of time or when the material to be infused will cause rapid damage and initial failure of the peripheral IV line and when conventional central lines may be too dangerous to try. Common uses for PICC include: long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition.
The PICC line is inserted through the veil to the peripheral veins occasionally using Seldinger techniques or modified Seldinger techniques, under ultrasound guidance, usually in the arm, and then carefully upward until the catheter is in the superior vena cava or right atrium. This is usually done by measuring the distance to an external landmark, such as a suprasternal notch, to estimate the optimal length. X-rays should be used to verify that the tip is in the right place when fluoroscopy is not used during insertion.
The PICC may have single tubes and connectors (one lumen), two (double-lumen) or three (triple-lumen) compartments, each with its own external connector. PICC power-syringe is now available as well. From the outside, a single-lumen PICC resembles a peripheral IV line, except that the tubing is slightly wider.
Insertion sites need better protection than peripheral IV lines, because the risk of a serious infection is higher if the bacteria walk up the catheter. However, PICCs have less risk of systemic infection than other central IV lines, since insertion sites are usually colder and drier than sites commonly used for other central routes. This helps slow down the growth of bacteria that can reach the bloodstream by walking under the skin along the outside of the catheter.
The main advantage of PICC against other types of central pathways is safer to include with the risk of uncontrolled bleeding and basically there is no risk of damage to the lungs or major blood vessels. Although special training is required, PICC does not require the level of expertise of a physician or surgeon. It is also externally unobtrusive, and with proper hygiene and care it can be left for months to years if necessary for patients requiring further treatment.
The main disadvantage is that it should be included and then travel through relatively small peripheral veins that can take a less predictable course on the way to the superior vena cava and are therefore somewhat more time consuming and more technically difficult to place on some patients. When the PICC goes through the axilla, it can also become bent, causing poor function.
The severed line
While some of the midline has a catheter passing through the skin and then directly into the blood vessels, another diameter called "catheter tunnel" inserts through the skin and then passes or "tunnel" a significant distance before entering into the blood vessels. This reduces the risk of infection, because bacteria from the skin surface can not travel directly to the vein. These catheters are often made of materials that resist infection and freezing. This includes the Hickman line or the Broviac catheter.
Implant Port
Ports (often called brand names such as Port-a-Cath or MediPort ) are central venous channels that do not have external connectors; Instead, it has a small reservoir covered with silicone rubber and implanted under the skin. The drug is administered intermittently by placing a small needle through the skin, piercing the silicon, into the reservoir. When the needle is withdrawn, the lid of the reservoir returns by itself. The cover can receive hundreds of needle bars during its lifetime. It is possible to leave the port in the patient's body for many years; if this is done, the port should be accessed monthly and rinsed with anti-coagulants, or risk-stuck patients. If plugged in, it becomes a danger because the thrombus will eventually form with the risk of embolization that accompanies it. Port removal is usually a simple outpatient procedure; but a more complex installation and a good implant simply depends on the skills of radiologists. The harbor causes less discomfort and has a lower risk of infection than PICC, and is therefore commonly used for patients undergoing long-term intermittent treatment.
Middle line catheter
The third type is the midline catheter inserted into the peripheral vein and progresses through the vein, unlike the peripheral IV line, but fails to enter the central vein.
Maps Intravenous therapy
Infuse type
Continuous infusion
Continuous infusion is mainly used to correct fluid and electrolyte imbalances. This is the opposite of an intermittent infusion, when a patient needs medication only at certain times, such as secondary IV and IV impulses.
Secondary IV
The tube from a given fluid bag that connects directly to the patient is called the main tube. Each additional infusion to be administered is connected to the primary tubing and is called the secondary IV piggyback, or IV; this is done rather than placing many catheters in the patient. When administering IV secondary medicine, the main sac is held lower than the secondary bag so that the secondary drug can flow into the primary tube, not the fluid from the main sac that flows into the secondary tubing. The fluid from the primary sac is required to help flush the remaining drug from the IV secondary from the tubing to the patient.
IV push
Some drugs are also given by IV "push" or bolus. The syringe containing the drug is connected to the access port in the primary tubing and the drug is given through the port. The syringe sprayer is pressed slowly, if possible irritate the veins or cause effects too quickly. Certain drugs, such as potassium, are never administered by IV infusion because the surges in the drug in the blood from IV impulse can be fatal. Once the drug has been injected into the liquid stream from IV tube, there must be some way to ensure that it comes from the tubing to the patient. Usually this is done by letting the flow of fluid flow normally and thereby bringing the drug into the bloodstream; However, a second fluid injection is sometimes used, "flush", following an injection to push the drug into the bloodstream more quickly.
Medical use
Intravenously infused substances include volume expander, blood-based products, blood substitutes, medicines and nutrients.
Volume multiplier
There are two main types of expander volume: crystalloids and colloids. Crystalloid is a solution of mineral salts or other water soluble molecules. Colloids contain larger insoluble molecules, such as gelatin. Blood is colloidal.
- The most commonly used crystalloid liquid is normal saline, a solution of sodium chloride at a concentration of 0.9%, which is close to the concentration in the blood (isotonic). Lactated Ringer's (also known as Ringer's lactate) and Ringer's acetate are closely related, are mild hypotonic solutions that are often used in those with significant burns.
- Colloid maintains high colloidal osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloid due to hemodilution. There seems to be no benefit in using colloids rather than crystalloids. Crystalloid is generally much cheaper than colloids (blood, albumin, plasma, etc.)
- Expander volume can be isotonic, hypotonic, or hypertonic. Hypotonic fluid is generally not recommended in children due to an increased risk of side effects.
The best way to determine if a person will benefit from the fluids is by doing passive leg lift followed by measuring the output of the heart.
Drugs
Drugs can be mixed into the aforesaid liquid. Compared to other delivery routes, such as oral medications, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Bioavailability of IV drugs is 100%, unlike oral medicines in which many drugs are lost in the digestion before entering the circulation. Certain types of drugs can only be given intravenously, such as when there is not enough taking by other administration routes such as enteral. Examples include intravenous immunoglobulin and propofol.
Blood products
Blood products (or blood products ) are blood components collected from donors for use in blood transfusions. Blood transfusions can save lives in some situations, such as massive blood loss due to trauma, or can be used to replace blood loss during surgery. Blood transfusions can also be used to treat severe anemia or thrombocytopenia caused by blood diseases. People with hemophilia usually require replacement of clotting factors, which are a small part of the whole blood. People with sickle cell disease may require frequent blood transfusions. Early blood transfusions consist of whole blood, but modern medical practice generally only uses blood components, such as fresh frozen plasma or cryoprecipitate.
Blood substitutes (also called artificial blood or blood substitutes ) are artificial substances that aim to provide an alternative to blood-based products obtained from donors. The major blood replacements used today are volume expansion such as crystalloid and colloid mentioned above. Also, substitutes for oxygen carriers are emerging.
Buffer solution
The buffer solution is used to correct acidosis or alkalosis. Ringer's Lactate solution also has some buffering effect. A more specific solution used for the purpose of buffering is intravenous sodium bicarbonate.
Nutrition
Parenteral nutrition feeds a person intravenously, through normal eating and digestion processes. The person receives a nutritional formula containing salt, glucose, amino acids, lipids, and supplemental vitamins.
Tools
A standard IV infusion set consists of a pre-filled container, a sterile (glass bottle, plastic bottle or plastic bag) of fluid with an attachment that allows fluid to flow one drop at a time, making it easy to see flow rates (and also reduce air bubbles); a long sterile tube with a clamp to adjust or stop the flow; connectors to be plugged into access devices; and Y-sets to allow "piggybacking" another infusion set to the same line, for example, adding a dose of antibiotics to a continuous fluid infusion.
Infusion pump
A infusion pump allows precise control over the flow rate and the total amount delivered. The volumes to be infused (VTBI) from the IV main line bag should normally be programmed to be about 50 milliliters less than the stated volume of the IV bag to avoid letting the drip or "dry" duct. The VTBI for a secondary bag or piggy bank should normally be programmed for 30 to 50 milliliters more than is stated in the IV drug bag, to ensure that in addition to the bag is emptied, all doses of the drug are watered through IV tubing of the main bag. Due to its design, the line of short and secondary infusions can not be dry. Thus, the registered nurse must program the IV pump for a 50-milliliter IV antibiotic bag "volumes to infuse" or VTBI for at least 80 milliliters. 100 milliliters of antibiotic pockets usually require VTBI about 140 milliliters. In cases where changes in the flow rate will have no serious consequences, or if the pump is not available, the infusion is often allowed to flow simply by placing the bag above the patient level and using a clamp to adjust the rate; this is gravitational droplet .
Hypodermic needle
The simplest intravenous form is to give a hollow needle through the skin directly into the vein. This needle can be connected directly to a syringe (used either to draw blood or transmit its contents into the bloodstream) or may be connected to the length of the tubing and from which the desired collection or intravenous system is required.
The most convenient place is the arm, especially the veins on the back of the hand, or the median cubital vein on the elbow, but the identifiable veins can be used. Often it is necessary to use a tourniquet that limits vein drainage of the extremities and makes venous bulges. Once the needle is in place, it is common to draw back a bit on the syringe to inhale the blood, thus verifying that the needle is actually in the blood vessels. The tourniquets must be removed before injecting to prevent drug extravasation.
Drip space
Many administrative systems use a drip room, which prevents air from entering the bloodstream (air embolism), and allows for estimation of flow rate.
Peripheral canula
A peripheral cannula is the most commonly used intravenous access method in both hospitals and pre-hospital services. The peripheral IV line (PVC or PIV) consists of a short catheter (several centimeters long) inserted through the skin to the peripheral veins (veins that are not located in the chest or abdomen). This is usually in the form of a cannula-over-needle device, in which a flexible plastic cannula is mounted on a metal trocar. After the needle and cannula are inserted into the vein via venipuncture, the cannula is inserted into the vein over the trocar to the appropriate position and secured, the trocar is then withdrawn and removed. Blood samples can be taken immediately after the initial IV cannula insertion.
The accessible vein can be used even though the arm and hand veins are most commonly used, with the leg and foot vein being used much less. In infants, scalp veins are sometimes used.
Caliber needles and catheters can be given in Birmingham size or French gauge. The size of Birmingham 14 is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge, 18- and 20-gauge (all-purpose lines for infusion and blood withdrawal), and 22-gauge (versatile pediatric line). Peripheral lines 12 and 14-gauge are able to transmit large fluid volumes very quickly, calculating their popularity in emergency medicine. These lines are often called "big drill" or "trauma lines".
To make the procedure more tolerable for children, medical staff can apply topical local anesthesia (such as EMLA or Ametop) to the skin of the chosen venipuncture area about 45 minutes earlier.
The part of the catheter remaining outside the skin is called the connecting hub; it can be connected to a syringe or intravenous infusion, or covered with a heplock or saline key, a needle-free connection filled with a small amount of heparin or salt solution to prevent clotting, among the use of a catheter. Ported cannulae has an injection port at the top which is often used to deliver medications.
In cases of shock, central venous catheters, peripherally installed central catheters (PICCs), venous cuts or intraosseous infusions may be necessary.
If the cannula is not installed properly, or the vein is very fragile and broken, the blood may extravasate to surrounding tissue, this situation is known as artery b> or "tissue". Using this cannula to administer the drug causes extravasation of drugs that can cause edema, causing pain and tissue damage, and even necrosis depends on the drug. Persons attempting to gain access must find a new access site proximal to the "blown" area to prevent drug extravasation through damaged veins. For this reason, it is advisable to place the first cannula on the most distal veins.
If a patient needs frequent venous access, the veins may be grated and narrow, making future access extremely difficult or impossible.
Peripheral IV can not be left in the vein indefinitely, because of the risk of infection of the insertion site that causes phlebitis, cellulitis and sepsis. The US Centers for Disease Control and Prevention updated their guidelines and now recommend that the cannula need to be changed every 96 hours. This is based on research conducted to identify the cause of methicillin-resistant Staphylococcus aureus (MRSA) infection in hospitals. In the UK, the UK Department of Health published their findings on risk factors associated with an increase in MRSA infections, now including intravenous cannula, central venous catheters, and urine catheters as the main factors that increase the risk of spreading antibiotic resistant strain bacteria.
Sliding catheter is a very rare complication, but the danger is very real. The shear occurs when part of the catheter is cut by a sharp tilted edge of the trokar. The shaved part may be completely separated from the main body of the catheter, and becomes free-floating in the bloodstream. Most of the time, it's because of a bad technique, but rarely poorly produced catheters can rupture from a hub or slide. Infection, and foreign body embolus are two threats to the patient.
The pressure bag
Fast infusers can be used if the patient requires high flow rates and IV access devices have a diameter large enough to accommodate them. It is an inflatable cuff that is placed around a fluid bag to force fluid into a patient or similar electrical device that can also heat the infused fluid.
Adverse effects
Pain
Injections inherently cause pain when the skin is damaged and medically invasive. In cases where the choice between intravenous therapy and oral treatment can be done to achieve the same result, as in the case of mild or moderate dehydration treatment (assuming oral rehydration therapy is an option), one should avoid using intravenous therapy in less oral choice sites invasive. Children in the emergency department treated for dehydration in particular have better results with oral care because they do not cause pain or the risk of complications from injections.
Cold spray can reduce the pain because it is inserted into a drip.
Infection
Any breaks in the skin carry the risk of infection. Although IV insertion is an aseptic procedure, skin-dwelling organisms such as Coagulase-negative staphylococcus or Candida albicans may enter through insertion sites around the catheter, or bacteria may by mistake. introduced in the catheter from contaminated equipment. The moisture introduced to the IV without condom site through washing or bathing substantially increases the risk of infection.
IV site infections are usually localized, leading to swelling, redness, and fever that are easily visible. If bacteria do not live in one area but spread through the bloodstream, infection is called septicemia and can be rapid and life-threatening. An infected central IV carries a higher risk of septicemia, as it can deliver bacteria directly to the center of the circulation.
Phlebitis
Phlebitis is a venous inflammation that may be caused by an infection, only the presence of a foreign object (IV catheter) or fluid or a given drug. The symptoms are warmth, swelling, pain, and redness around the veins. Device IV should be removed and if necessary re-inserted into other extremities.
Because of frequent injections and recurrent phlebitis, scar tissue may form along the blood vessels. The peripheral veins of the intravenous drug addicts, and cancer patients undergoing chemotherapy, become sclerotic and difficult to access from time to time, sometimes forming a "hard and painful" vein.
Infiltration/extravasation
Infiltration occurs when a liquid or IV drug accidentally enters the surrounding tissue rather than a vein. This can happen when the blood vessels themselves are ruptured (parents are particularly susceptible to fragile veins due to lack of support tissue), when blood vessels are damaged during the insertion of intravascular access devices, when the device is improperly attached, from increased porosity or when the device enters in the blood vessels being the lowest resistance path (for example if the cannula is in the blood vessel for some time, the veins may be scarred and closed and the only way to leave the liquid is along the outside of the cannula where it enters the blood vessels). Infiltration is the unintentional administration of solution/non-invasive drugs into tissue, which often occurs when the tourniquet is not removed in a timely manner. Infiltration is characterized by coolness and pallor to the skin as well as localized swelling or edema. This is treated by removing the intravenous access device and lifting the affected limb so that the collected fluid can flow away. Sometimes hyaluronidase injections may be used to speed up the spread of fluids/drugs. Infiltration is one of the most common side effects of IV therapy and is usually not serious unless infiltrated fluid is a drug that damages surrounding tissue, most often vesikan or kemoterapeutik agents, in this case called extravasation and extensive necrosis can occur..
Excess fluid
This occurs when fluids are administered at a higher level or in larger volumes than systems that can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema.
Hypothermia
The human body is at risk of hypothermia by accident when large amounts of cold liquid are infused. Rapid temperature changes in the heart can trigger ventricular fibrillation.
Electrolyte imbalance
Administration of a solution that is too dilute or too dense may impair the balance of sodium, potassium, magnesium, and other electrolytes of the patient. Hospital patients usually receive blood tests to monitor this level. It is important to correct this imbalance if they occur, because they can cause clinical symptoms of electrolyte imbalance, which, if left untreated, can lead to acidosis/alkalosis, and ultimately death.
Embolisme
Blood clots or other dense mass, as well as air bubbles, can be sent to the circulation through an IV and end up blocking blood vessels; this is called embolism. It is almost impossible to inject air through peripheral IV at a dangerous level. The risk is greater with the central IV.
Air bubbles less than 30 microliters are considered to dissolve into the circulation harmlessly. The greater amount of air, if delivered at once, can cause life-threatening damage, or, if very large (3-8 milliliters per kilogram of body weight), can stop the heart.
One reason the veins are preferred is the arteries for intravascular administration because the flow passes through the lungs before passing through the body. Air bubbles can leave blood through the lungs. A patient with a right-to-left shunt is susceptible to emboli from a smaller amount of air. Death due to air embolism is rare, although this may be partly because it is very difficult to determine when this is the cause of death.
Glucose
Intravenous glucose is used in some Asian countries such as Korea as pick-me-up, for "energy," but it is not part of routine medical care in the United States where glucose solutions are prescription drugs. Asian immigrants to the United States are at risk if they seek intravenous glucose treatment. This may be in a storefront clinic serving Asian immigrants, but, although it does not have more effect than drinking sugar water, it raises medical risks such as the possibility of infection. It's called "ringing."
History
Intravenous technology originated from a study of cholera treatment in 1831 by Dr. Thomas Latta of Leith.
Intravenous therapy was developed further in 1930 by Hirschfeld, Hyman and Wanger but was not widely available until the 1950s.
Education
The knowledge and skills of intravenous therapy among health care providers vary widely. While the initial exposure to I.V. therapy usually through a formal nursing education program, I.V. Initial skills only evolved from a combination of theoretical instruction and work practices. However, employers typically expect potential employees to become proficient in this field of clinical practice before being employed. The gap between actual and expected knowledge and skills can be very broad, especially in I.V. therapy. Part of this gap comes from the lack of educational experience and/or inaccessibility of this offer. Although not widely offered, interactive multimedia I.V. education, such as hybrid courses that combine online theory with direct practice, can provide a way to narrow the gap in a fast and cost-effective way that will represent improvements in patient safety and treatment outcomes. Artificial intravenous solutions used for training purposes have only been produced; at least in one case, routing training solutions into standard medical settings has caused patients to experience side effects.
The Infusion Nurses Society offers comprehensive evidence-based education resources for its members. The Infusion Nurses Certification Corporation offers the only nationally recognized and accredited certification for infusion nurses through CRNIÃ,® credentials.
See also
References
Further reading
- Royal College of Nursing Standards for 3rd drip therapy. 2010 edition
External links
- IVTEAM.com
- IV-Terapi.net
- Intravenous therapy - atitesting.com
Source of the article : Wikipedia
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