1
Q
Infusion Nursing
A
- nursing process relateing to technical and clinical application of fluids, electrolytes, infection control, oncology, pediatrics, pharmacology, quality assurance, tehcnology, clinical application, parenteral nutrition, transfusion therapy
2
Q
evidence based practice
A
- evidence from research/evidence-based theories and opinion
- evidence from assessment of patient history, physical exam, availability of health care resources
- clinical expertise
- information about patient preferences and values
3
Q
Iv therapy risk management
A
- IV therapy is a high-risk technical area
- if an act of malpractice does not do harm then legal action cannot be innitiated
- coercion of a rational adult to place an iv catheter constitutes assault and battery
- if pt refuses IV, document and call provider
- practice of using verbal orders rather than written orders potentially places nurses at high liability risks
- repeat back order, clarify dosage, check for similar sounding names
4
Q
criminal law
A
an offense against the general public caused by the potential harmful effect to society as a whole
5
Q
civil law
A
effect the legal rights of private persons and corportations. contract law and tort law are most appicable to nursing practice
6
Q
negligence
A
failture to do something that a reasonable person would do
7
Q
malpractice
A
subset of negligence, commited by a person in a professional capacity (nonadherance to the accepted standard of care)
8
Q
4 components needed to prove liability for malpractice
A
1) it must be established that the nurse had a duty to the patient
2) a breach of standards of care or failure to carr out the duty must be proven
3) pt must suffer actual harm or injury (including emotional)
4) there must be a causal relationshio between the breech of duty and the injury suffered
9
Q
breach of duty
A
- nurse must be aware at all time sthat failure to observe, failture to intervene, and verbal rather than written orders are potential risks
10
Q
legal perils related to infusion therapy practice
A
1) failure to monitor and assess clinical status
2) failure to prevent infection
3) failure to use equipment properly
4) failure to protect the patient from avoidable injury
11
Q
rule of personal liability
A
- every person is liable for his own tortous conduct (wrongdoing)
12
Q
common causes for legal action in nursing
A
1) unprofessional practice: conduct that is a departure from or failure to conform to the minimal standards of care
2) professional malpractice: professional misconduct or unreasonable lack of skill that results in harm
13
Q
ethics
A
- acknowledges the acceptance by a profession of the responsibilities and trust that society has conferred and recognizes the duties and obligations in that trust
14
Q
infusion nursing code of ethics
A
- autonomy: right to self determination, independence
- beneficence: doing good for patients
- nonmaleficence: doing no harm to patients
- veracity: truthfulness
- fidelity: obligation to be faithful
- justice: obligation to be fair to all people
15
Q
standards of care
A
- describes the results or outcomes of care and focus on the patient
- developed within organizations to measure qualiy based on expectations
- voluntary or mandated by legislation
16
Q
standards of practice
A
- focus on the provider of care
- represent acceptable levels of practice in patient care delivery
- define nursing accountability
- provide a framework for evaluating professional competency
17
Q
medication safety
A
- medication error is the most common type of error affecting patient safety
- preventable adverse drug events (ADEs) are associated with one of every five injuries or deaths occuring in the healthcare system
18
Q
medicaiton errors
A
- lack of awareness: 44k-98k deaths annually
- 2.5 mil nurses and 900k physicians pracicing in 7500 hospitals across us
- complex enbvironment: making clear communication even more important; end of shift reports
- 80% of nurses calculate doses 10% of the time
- 40% of nurses make mistakes more than 30% of the time
- 42% of nursing students could not calculate IV meds and flow rate with 90% accuracy
19
Q
active errors
A
- errors at the sharp end of healtcare; occur at the point of interaction between the person (nurse) and a larger system (medication cart)
- during the med fill
20
Q
latent error
A
- errors at the blunt end of health care; error gives rise to the active error and is not necessarily apparent when it happens
- wrong med may become apparent hours/days later
21
Q
reasons for errors
A
- interruptions
- fatigue
- time pressure
- hand offs
- med terminology
- standardization
- knowledge
- paradigm shift (expectations are changing, roles are changing)
22
Q
risk management strategies
A
- informed consent: something an RN can do
- unusual occurance report: med error
- sentinel events: unexpected death
- documentation: critical
- professional liability insurance: nurse service organization
- relationship based care: less likely to sue or take action against you
- quality management
23
Q
documentation
A
- provides legal accountability, communicates information, provides info for reimbursement, assists with outcomes monitoring
- accurate, timely, complete written account of the care rendered to the patient
24
Q
quality management
A
- systemic process to ensure desired patient outcomes
25
doing the right thing well includes:
1) availability of a needed test, procedure, treatment, or service to the client who needs it
2) timeliness with which a needed test, procedure, treatment or service is provided to client
3) effectiveness with which tests, procedures, treatments, and services are provided
26
occupational risks of IV therapy
- biological exposure to bloodborne pathogens
- needlestick injuries
- chemical exposure (chemo)
- latex allergy
27
veins of hand
- basilic and cephalic are most common
28
advantages of peripheral IV therapy
1) provides a route for immediate availability to systemic circulation
2) drug absorption is more predictable
3) blood levels of the drug can be maintained for even distribution and titrated according to the pt needs
4) provides reliable route for emergency conditions
5) ideal for drugs that cannot be given orally due to poor absorption and failure to reach general circulation
6) provides a route for drugs that cannot be given any other way
7) often the only available route for unconscious or uncooperative pt
8) ideal for pts who are nauseated, vomiting, have GI issues
9) less discomfort becayse it can be used for 72 hours and no more pokes
29
disadvantages to peripheral IV therapy
1) greated possibility of allergic rxn, rapid administration, cannot be retrieved once administered
2) possibility of fluid overload
3) potential for dangerous outcomes with errors is amplified
4) always possibility of infection or sepsis when skin barrier is broken
5) pain assocaited with IV and psychological issues
6) impaired mobikity depending on placement
7) potential for nerve or vessel damage
8) pain assocaited with administration of irritating drugs
9) tissue damage can occur with extravasation
10) always potential for phlebitis, thrombophlebitis, or embolization
30
anatomy of vein
- tunica adventitia: white fibrous connective tissue
- tunica media: external elastic tissue and circular smooth muscle
- tunica intima: internal elastic tissue and loose connective tissue and endothelium
31
veins to avoid
- start at the most distal point and work up; avoid going below the last IV site
- avoid back of hand
- phlebotic, infiltrated or bruised arms
- areas of flexion
- anticubital veins
- mastectomy and lymph node issue arms
- edema arm or one that has suffered 3rd degree burns
- extremity with an AV fistula
- feet or legs of walking people, more at risk for atheroscelrosis
32
phillips 15 step venipuncture method
1: checking the physician orders
2: hand hygeine
3: equipment preparation
4: patient assessment and psychological preparation
5: site selection and vein dilation
6: needle selection
7: gloving
8: site preparation
9: vein entry
10: catheter stabalization and dressing management - decreases infection
11: labeling - initials, date, gauge of needle
12: equipment disposal
13: patient education
14: rate calculations
15: monitoring and documentation
33
site selection and vein dilation
* type of solution
* condition of vein
* duration of thearpy
* patient presence
* presence of shunt, graft
* pt receiving anticoagulation thearpy
* pt allergies (latex, tape)
34
way to increase blood flow in the upper extremeties
- blood pressure: tight turniquites
- presence of valves
- sclerotic veins
- multiple previous IV sites
35
ways to dilate a vein
- gravity: arm below heart
- fist clenching: relax during stick
- tapping
- warm compress
- blood pressure cuff
- tourniquet
- transillumination
36
cannulation
- site must tolerate flow rate
- site must bapable of delivering meds ordered
- site must tolerate gauge of cannula
- when possible the pt should be comfortable with site chosen
- site must not impede pt ADLs
37
tips for selecting veins
- hard to stabalize veins in someone who recently lost weight
- pts taking corticosteroids have fragile veings that bruise easily
- scelrotic veins are common in narcotic addicts and elderly
-
38
9 rights of IV med administration
1) patient: confirm right patient and check ID
2) drug: confirm correctly prescribed and appropriate for patient
3) route: IV route suitable
4) dose: is the dose correct (weight, age)
5) time: is the time correct (late or early)
6) dilution/compatability: manufacture recommendation
7) flow rate: using PRRR (pump)
8) monitoring: crucial to ensure patient response and safety
9) documentation: record promptly and correctly
39
documentation
- date and time of insertion
- manufacturer brand and style of device, lot number
- gauge and length of device
- specific name and location of accessed vein, infused solution and flow rate
- infusing by gravity or pump
- how many times attempted
- condition of extremity prior to insertion
- pt comments related to procedure
- patient response
- signature
40
documentation of observation
- tenderness
- temperatures at and around site
- discoloration
- swelling
- draining
- actions taken by nurse
41
discontinuing an IV
1. gloves
2. obtain dry 2x2, avoid alcohol pads
3. loosen the tape and apply the gauze pad loosly over the site
4. remoce the cannula and transparent dressing as one unit without pressure over the site
5. after the catheter is removed, apply direct pressure iwth the sterile gauze
6. an adhesive bandage may be applied to the venipuncture site after bleeding is controlled
7. document site appearance, how tolerated, appearance of catheter
42
colonization
- the presence of a microorganism in or on a host, with growth and multiplication of the microorganisms with no clinical symptoms or detected immune response
43
dissemination
- the shedding of microorganisms into the immediate environment from a person carrying them
44
nosocomial infections
- developed within a hospital or produced by organisms acquired during hospitalization.
- now called hospital aquired infections
45
chain of infection
1) first link: causative agent - the ability of an organism to induce disease is called its VIRULENCE
2) second link: reservoir - the source of microorganisms; other humans, clients own microorganisms, plants, animals, or the general envrionment;. the place where the organism maintains the presence, metabolizes and replicates
46
chain of infection
1) first link: causative agent - the ability of an organism to induce disease is called its VIRULENCE
2) second link: reservoir - the source of microorganisms; other humans, clients own microorganisms, plants, animals, or the general envrionment;. the place where the organism maintains the presence, metabolizes and replicates
3) third link: portal of exit from resevoir - major portals of exit include respiratory tract, GI tract, skin, blood
4) fourth link: method of transmission - direct (person-to-person, touching, kissing, biting, intercourse) and indirect (vehicle-born: toys, handkerchiefs, solied linens, clothes; vector born: animal or flying or crawling insect)
5) fifth link: portal of entry to the susceptible host -
6) sixth link: susceptable host - any person who is at risk for infection (immunocompromised, elderly)
47
Breaking the chain of infection
- new microbiologic methods
- advancement of epidemiologic methods
- continuous quality improvement programs
- risk management
- antibiotic use: only give as necessary and specific to bug trying to kill
- pharmacoepidemiology: pharmacists are very involved in what patients are getting for meds now
- emporiatrics: study of disease in travelers
48
Infusion-related infections
-
49
Infusion-related infections
- 90% of injfections are related to CVAD (central venous access device)
- biofilm is found on all CVADs
50
Central venous line acquired blood stream infections
- CLABSI
* primary risk factors include:
- duration of catheterization
- multiple lines, increased risk with increased # of lines
- colonization of catheter insertion sit by skin organisms
- locationof catheter; subclavian vein and groin are las option for cathere and hard to keep clean
- aseptic insertion technique: total barrier precautions
IV Therapy
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