Coolness Usually accompanied with edemadue to decreasing blood supply to the

Coolness usually accompanied with edemadue to

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Coolness —Usually accompanied with edema—due to decreasing blood supply to the area. Warmness —Usually indicates inflammation/infection at the site. Infiltration —Occurs when IV fluids leak into the surrounding tissue around the venipuncture site. This is indicated by pain, swelling, coolness, and pallor around the site.
2 ASSESS Phlebitis —Inflammation of the vein occurs from IV solutions and drugs and type and position of the IV catheter. Inflammation is manifested by pain, redness, edema, and warm skin temperature around the IV site. Access Assessment Peripheral Intermittent peripheral infusion device (IPID): Saline well, heparin well, heparin lock, or saline lock IV catheter to a continuously infusing IV line
3 ASSESS Central Single, double, triple, quad—lumen central line Triple lumen central line 16 Ga distal 18 Ga medial 18 Ga proximal Proximal lumen Medial lumen Distal lumen
4 ASSESS Each lumen has its own pathway (see following below) and its own exit. The medications never meet in the catheter, thus providing the ability to give incompatible medications. Due to the large volume of blood in the vessel, any infused medication is quickly dispersed. Cross-sectional view of multiple lumen central lines 1 2 3 4 5 6 7 8
5 ASSESS Subcutaneous implanted vascular access port (also called Mediport) Mediport Mediports are indicated for patients who require long-term treatment and are available in single- and double-injection ports. They are surgically implanted under the skin, with the catheter typically positioned in the superior vena cava. No part of the device can be seen outside the body.
6 ASSESS Peripherally inserted central catheter (PICC line) View of insertion site and placement in the superior vena cava Clavicular head 2nd rib
7 ASSESS HOT TIP: When injecting medications or fluid via syringe into a PICC line, a syringe 10 cc or larger must be used to maintain a psi (pound per square inch) of nearly 7. A smaller syringe exerts too much psi, and the PICC catheter could burst. Infusion Assessment Primary infusion fluid —Fluid that is infusing continuously. Secondary infusion —Fluid that is infusing intermittently, usually in a 50-250 ml IV bag infusing over 15 minutes to 2 hours. Patient-controlled analgesia (PCA) pump —Infuses pain medi- cation and is usually connected to the primary line. Both the primary line and PCA pump infuse concurrently. HOT TIP: When assessing the infusions to check for incom- patibilities, the PCA pump can easily be overlooked!! Verify the type of medication in the PCA pump, and ensure it is compatible. Total parenteral nutrition (TPN)/Lipids —TPN usually infuses continuously over 24 hours. Lipids usually infuse over 8, 10, or 12 hours connected to the TPN IV line below the filter. HOT TIP: Due to the additional components/medications in the TPN solution, NO medication is to be given in the same line as the TPN or the lipids.

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