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Coolness—Usually accompanied with edema—due to decreasingblood supply to the area.Warmness—Usually indicates inflammation/infection at the site.Infiltration—Occurs when IV fluids leak into the surroundingtissue around the venipuncture site. This is indicated by pain,swelling, coolness, and pallor around the site.
2ASSESSPhlebitis—Inflammation of the vein occurs from IV solutions anddrugs and type and position of the IV catheter. Inflammation ismanifested by pain, redness, edema, and warm skin temperaturearound the IV site.Access AssessmentPeripheral■Intermittent peripheral infusion device (IPID): Saline well,heparin well, heparin lock, or saline lock■IV catheter to a continuously infusing IV line
3ASSESSCentralSingle, double, triple, quad—lumen central lineTriple lumen central line16 Ga distal18 Ga medial18 Ga proximalProximallumenMediallumenDistallumen
4ASSESSEach lumen has its own pathway (see following below) and itsown exit. The medications never meet in the catheter, thusproviding the ability to give incompatible medications. Due tothe large volume of blood in the vessel, any infused medicationis quickly dispersed.Cross-sectional view of multiple lumen central lines12345678
5ASSESS■Subcutaneous implanted vascular access port (also calledMediport)MediportMediports are indicated for patients who require long-termtreatment and are available in single- and double-injection ports.They are surgically implanted under the skin, with the cathetertypically positioned in the superior vena cava. No part of thedevice can be seen outside the body.
6ASSESS■Peripherally inserted central catheter (PICC line)View of insertion site and placement in the superior vena cavaClavicularhead2nd rib
7ASSESSHOT TIP:When injecting medications or fluid via syringe into aPICC line, a syringe 10 cc or larger must be used to maintain apsi (pound per square inch) of nearly 7. A smaller syringeexerts too much psi, and the PICC catheter could burst.Infusion AssessmentPrimary infusion fluid—Fluid that is infusing continuously.Secondary infusion—Fluid that is infusing intermittently, usuallyin 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 theprimary line and PCA pump infuse concurrently.HOT TIP:When assessing the infusions to check for incom-patibilities, the PCA pump can easily be overlooked!! Verifythe type of medication in the PCA pump, and ensure it iscompatible.Total parenteral nutrition (TPN)/Lipids—TPN usually infusescontinuously 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 theTPN solution, NO medication is to be given in the same line asthe TPN or the lipids.