Efnisyfirlit

• Cover
• Title page
• Copyright Page
• Dedication
• Foreword
• Contents
• 1 Introduction to infusion therapy
• A look at infusion therapy
• What is infusion therapy?
• Benefits of infusion therapy
• Risks of infusion therapy
• Strings attached
• No such thing as a free lunch—or infusion!
• Fluids, electrolytes, and infusion therapy
• We’re all wet (well, mostly)
• Of solvents and solutes
• Fluid functions
• Aim for the optimum
• Inside and outside
• The ABCs of ECF
• Balancing act
• You gain some, you lose some
• Hormones at work
• Thirst quencher
• Osmolality versus osmolarity: what’s the difference?
• Picking out the baseline
• Electrolytes
• You’ll get a charge outta this
• Understanding electrolytes
• Fluid and electrolyte balance
• Extra(cellular) credit
• Oh, osmosis
• Opposing forces
• Up against the capillary wall
• Opposing forces
• Reabsorption to the rescue
• May the force be with you
• Correcting imbalances
• Osmolarity at parity?
• When, why, and how to get hyper
• Flood warning
• Additional types of infusion therapy
• Parts of the whole
• It isn’t gourmet, but it has all you need…
• Infusion delivery
• Peripheral or central vein?
• Delivery methods
• Upside …
• …and downside
• On again, off again
• Start at the top—the solution container
• Administration sets
• Make the right connection
• Infusion flow rates
• Gravity flow rate calculation
• Regulating flow rates
• mL/hour or gtt/minute?
• Infusion orders
• Factor these in
• I’ll be back soon!
• Start at one end and work to the other
• Minor (not major) adjustments
• Infection prevention with ANTT
• Complex therapy requires comprehensive decisions
• Professional and legal standards
• Know your responsibility
• Follow the rules!
• Federal regulations
• Nurse Practice Acts (NPA)
• Know your legal limits
• Professional organizations
• Other organizations
• Facility policies and procedures
• Competency: getting it, keeping it, and documenting it
• Documentation
• Forms, forms, forms
• Documenting initiation of infusion therapy
• Label that dressing!
• Documenting infusion therapy maintenance
• Documenting discontinuation of infusion therapy
• Patient education
• Based on past experience
• The whole story
• Easing anxiety
• But did they get it?
• Don’t forget the paperwork
• Stay out of court!
• Quick quiz
• Scoring
• Suggested References
• 2 Infusion therapy using peripheral veins
• Understanding peripheral intravenous therapy
• Practice, practice, practice
• Basics of peripheral IV therapy
• Peripheral IV access
• Types of PIVCs
• Peripheral IV therapy concerns
• A mainstay and crucial contributor
• Preparing for venipuncture and infusion
• Preparing the patient
• Care + confidence = a relaxed, cooperative patient
• What goes on behind drawn curtains
• Selecting the equipment
• Add-on devices
• Back to basics
• Secondary piggyback
• Down to the milliliter
• In-line filters
• Keeping in line with in-line filters
• Preparing the equipment
• When in doubt, throw it out
• Basic training
• Secondary, but just as important, set
• What about a filter?
• Selecting the insertion site
• Superficial advice: try the hand and forearm
• Alternatives: upper arms, legs, and feet
• The lowdown on the upper arm
• You aren’t an artery, are you?
• Avoid valves
• Selecting the venous access device
• Let’s go over this needle
• Taking wing
• The down low on the IO (intraosseous access device)
• Subcutaneous infusion and access devices
• Performing venipuncture
• Patient identification, assessment, and education
• Dilating the vein
• Pretourniquet prep
• Intend to distend
• Top tourniquet technique
• Hidden from sight
• Preparing the access site
• Intradermal lidocaine
• Topical transdermal agents (creams)
• Frozen (not quite)
• Other options
• Preparing the venipuncture site
• Hold still, vein
• Insertion
• You need to know this
• Steady and direct
• Steady and indirect
• Don’t wing it, follow these steps…
• “Floating” in
• Protect the skin
• Stable and secure
• Dressing for success
• Stabilize the joint
• Finishing touches
• Intermittent infusion device
• Continuous infusion not required
• Can’t get a blood return from a peripheral catheter?
• Don’t go blindly
• Using a stretch net
• Collecting a blood sample
• Documenting the venipuncture
• Maintaining peripheral IV therapy
• Routine care
• Time to change
• Getting ready
• Changing the IV solution
• Complications of therapy
• Local trouble? It may become system wide…
• Infiltration or extravasation!
• Phlebitis and thrombophlebitis
• Other complications
• An ounce of prevention: it’s in your hands
• Think OPAL
• Always document: thoroughly document!
• Discontinuing the infusion
• Supplies
• I’m no longer needed
• Quick quiz
• Scoring
• Suggested References
• 3 Infusion therapy requiring central venous access
• Understanding central intravenous therapy
• Bringing it on home
• Benefits of a CVAD
• Risks of CVADs
• Venous circulation
• Going down…
• …and coming up
• Getting to the point
• Taking a different route
• CVAD planning
• CVAD characteristics
• Types of CVADs
• PICC specifics
• PICC ups
• PICC problems
• Cuff link
• Tunnel tidbits
• Implanted port: out of sight
• CVAD use—what can go through them?
• CVAD removal
• Preparing for central venous therapy
• Selecting the insertion site
• Careful! It’s close to the common carotid
• Far from internal organs
• Vein pursuits
• Dilution dilemma
• Scar wars
• Tracheostomy treachery
• Look out for the lungs
• Be practical and alert
• Preparing the patient
• Getting all dressed up
• An important position
• This may sting
• Testing, testing
• Preparing the equipment for CVAD insertion
• Getting equipped
• Mask, gown, and gloves required for surgical ANTT
• Some assembly required
• Aseptic, air-free, secure, and sealed
• Performing CVAD insertion
• Gonna be sedated?
• Positioning the patient
• Visible and accessible
• On a roll
• Preparing the insertion site
• Sterile drape style
• Inserting the catheter
• Blood samples
• Patient participation
• Catheter inserted. Now what?
• Monitoring the patient
• Arrhythmia alert
• No suture in the future
• Where is the tip?
• Poor catheter positioning poses problems
• Documenting access device insertion
• A measure of dislodgment
• Maintaining central venous infusions
• Routine care
• Getting equipped
• A different brand of dressing
• Open air prevention
• Switching solutions
• Turning over the administration set
• How often? How much?
• Mismatched medications
• Flushing made simple
• Exception to the rule!
• Under cover
• Special care
• Catheter breakdown
• Working out the kinks
• Clear the way
• Across the generation gap
• Homework
• Insertion related: pneumothorax
• Sneaky signs and symptoms
• Let’s talk puncture at this juncture
• Rare but risky
• Sepsis is systemic and serious
• Phlebitis—mechanical, bacterial, or chemical?
• Deeds for those who bleed
• Tame the pain
• Spared of air (embolisms)?
• Malposition disposition
• Discontinuing central venous therapy
• Discontinue continuous, implement intermittent
• Patient preparation
• Getting equipped
• Note this
• Implanted port insertion and infusion
• When to tap a port
• On punctures and patients
• Selecting the equipment
• Material matters
• Noncoring needles needed
• Implanted port insertion
• It begins with an incision
• Pre-op pointers
• Obtaining consent
• Post-op pointers
• Site lines
• Implanted port infusion
• Clear the field
• Wash up and get started
• Maintaining implanted port infusions
• Getting equipped
• Ready, set, flush
• Special precautions
• A big exception for small patients
• Homework
• All the way back
• Recognizing risks
• Quick quiz
• Scoring
• Suggested References
• 4 Infusion fluids and medications
• The medication pathway
• The purpose of infusion fluids
• Peripheral or central vein for infusion?
• Understanding infusion fluids
• Bringing back the balance
• Isotonic solutions
• Hypertonic solutions
• Hypotonic solutions
• Fluid flow rates
• Infusion medications
• Rapid response
• Effective absorption
• Identifying and reducing risks
• Continuous or intermittent infusion
• Important issues with infusion medication
• Compounding or reconstituting sterile medication?
• Stability
• Compatibility
• Safe delivery
• Use appropriate resources
• Calculating infusion drug dosages
• Weighing in
• Coming to the surface
• Preparing the infusion medications
• Safety first
• Reconstituting powdered drugs
• Reconstituting procedure
• Next steps
• Check it out
• Liquid drugs: additional dilution or not?
• Labeling solution containers
• Administering the medication
• Selecting the right equipment
• Electronic infusion pump
• Filters
• A few final steps
• Medications through a continuous infusion
• Tangle proof
• Manual injection or push medications
• Medications through a locked VAD
• Primary intermittent medication
• Manual injection or push medications
• Flushing and locking the intermittent VAD
• Patient-controlled analgesia
• Picking patients for PCA therapy
• PCA “pluses”
• PCA “minuses”
• A complete order
• PCA by proxy
• Focusing on the features
• Managing PCA therapy
• Giving an added boost
• Not the controlling type? That’s okay
• Check the record first
• Explain and reassure
• Determining doses
• Looking into the lockout interval
• What to monitor (and be sure to record!)
• PCA complications
• A note about nausea
• Patient education
• Don’t keep it a secret
• Did it work?
• Preventing harm from fluids and medications
• High-alert medications
• The name game!
• What can go wrong?
• Side effects
• Adverse drug reactions
• Documentation
• Quick quiz
• Scoring
• Suggested References
• 5 Transfusions
• Understanding transfusion therapy
• Purpose of transfusion therapy
• Blood composition
• Blood components
• Feed and protect me!
• Take it away!
• Bank on this!
• The corner drugstore…
• A word of caution…
• Compatibility
• The ABO system
• Rh system
• A pregnant pause
• Blood type compatibility
• Universally accepted!
• Plasma antibodies
• Human leukocyte antigen (HLA)
• Can blood and its components be changed?
• Administering transfusions
• Patient blood management (PBM)
• A license to order
• A license to transfuse
• Identifying the patient
• Do I have your permission to proceed?
• NS—you’re the only one for me!
• Ready to filter through some advice?
• Let’s jump to a pump
• The pressure’s on!
• When a blanket just won’t do
• Ahh, this is the life!
• I’ll second that
• A slow start is the healthy way to a safe finish
• Monitor the blood bag!
• Don’t forget to document
• Special considerations
• Terminating the transfusion
• Transfusion complications
• One last thing…
• Quick quiz
• Scoring
• Suggested References
• 6 Antineoplastic therapy
• Understanding cancer treatment
• Understanding IV antineoplastic agents
• Precision is part of the decision
• Which cell is well?
• How antineoplastic medications work
• Covering all the bases
• Let’s get specific … as well as nonspecific
• Calculating collateral cost
• The selection process
• Going in cycles
• Antineoplastic agents
• Alkylating agents
• Antimetabolites
• Antitumor antibiotics
• Nitrosoureas
• Plant alkaloids
• Miscellaneous antineoplastic agents
• Hormone therapy
• Combinations work best
• SAFE handling to protect you!
• Employer responsibility
• Your responsibilities for handling hazardous drugs
• Exposure effects
• Follow the guidelines
• Preparation for antineoplastic drug administration
• Drug compounding or reconstituting
• Protect the air when you prepare
• Transporting hazardous drugs
• Administering antineoplastic drugs
• Do the math!
• Involve the patient
• Check the prescribed protocol
• Which vascular access device? An essential component for safety
• Close to you
• The lowdown on gowns and gloves
• Laying the groundwork for safety
• Feeling exposed
• Better safe than sorry
• The spiel on spills
• Drug administration
• Performing a preadministration check
• Count on doing this
• Which drugs? Which route?
• Who’s on first?
• Confirm and verify
• Assessment of VAD site
• Giving drugs
• Administration variations
• Finish with a flush
• Investigating infiltration and extravasation
• Concluding treatment
• Complications of antineoplastic drug therapy
• Infusion-related complications
• Local or systemic
• Managing acute hypersensitivity infusion reactions
• What to give and when
• After the HSR
• Treatment-related complications
• GI toxicities
• Myelosuppression
• Cutaneous toxicities
• Long-term complications
• A devastating effect
• Teaching and documentation
• Building a strong chain of communication
• Quick quiz
• Scoring
• Suggested References
• 7 Biologic therapy
• Introduction to biologic therapy
• Drugs and biologics—what’s the difference?
• Know your immune system!
• The immune system
• Two lines of defense
• More jobs for B and T cells
• Acquired immunity by passive or active methods
• Cytokines
• Acute versus chronic inflammation
• Not foolproof!
• Clinical indications for biologic therapy
• Cancer
• Direct and indirect
• Immunotherapy
• Autoimmune diseases
• Inflammation gone awry
• Immunosuppress to impress
• Immunodeficiency diseases
• No resistance
• Immunoglobulins to the rescue
• Types of biologic agents
• Natural but still potentially hazardous
• Check your policies
• Interferons
• Interleukins
• Colony-stimulating factors
• Giving normal cells a boost
• Monoclonal antibodies
• Combining for effectiveness
• Immunoglobulin
• Making immunoglobulins
• Not interchangeable!
• Patient assessment prior to therapy
• Administration of biologic therapies
• Tips for success
• Adverse drug reactions of biologic agents
• Side effects
• Adverse drug reactions
• Managing infusion reactions
• Other adverse events
• Patient education
• Quick quiz
• Scoring
• Suggested References
• 8 Parenteral nutrition
• Parenteral nutrition (PN)—complex high-alert fluid!
• Nutritional needs
• Turning food into fuel
• Malnutrition
• How much do healthy people need?
• Nutrient inadequacies or deficiencies?
• Macronutrient deficiencies
• Micronutrient deficiencies
• Nutrition disorders
• Metabolic activity increases in the hospital
• DRM with inflammation
• DRM without inflammation
• Malnutrition without disease
• Age-related malnutrition
• Overnutrition or obesity
• Micronutrient abnormalities
• Refeeding syndrome
• Nutritional assessment
• Nutrition screening
• Malnutrition diagnosis
• Clinical history
• Dietary assessment
• Physical examination
• Anthropometric measurements
• Diagnostic studies
• Laboratory tests
• Body composition tests
• PN solutions
• It’s a good thing …
• . . .but risky
• Many other clinicians and decisions
• PN versus peripheral parenteral nutrition (PPN) versus supplemental parenteral nutrition (SPN)— what’s the difference?
• A matter of access
• Price is a premium
• Indications for PN
• Element roll call
• Added features
• PN solutions
• The 3:1 solution
• Maintaining glucose balance without adding insulin
• PPN solutions
• Lipid emulsions
• Administering PN
• Open for service 24 hours
• Not-so-vicious cycle
• Administering PN
• The dilution solution
• Preparing the patient
• Taking PN home
• Be an adherence booster
• 60-minute warm-up
• Infusate inspection is imperative
• Handle with care
• A port of last resort
• Administering PPN
• Obtain the largest vein
• Insulin insight
• Patient reports
• Lipid letdowns
• Considering clearance
• Precautions and complications
• Patients with special needs
• An extra helping
• Factor these in
• Lipid liabilities in little ones
• What lies underneath?
• Complications
• Changing flow rate?
• Glucose: feast or famine
• S.O.S.! It’s HHS!
• Potassium: a plethora or pittance
• Magnesium mayhem
• Phosphate funk
• Calcium calamity
• Acid-base balance blues
• Last but not least, liver dysfunction
• The risk of rushing
• Particular PPN problems
• Lipid low points
• Discontinuing therapy
• When to wean and when not to wean
• Quick quiz
• Scoring
• Suggested References
• 9 Infusion therapy in pediatrics
• Delivering infusion therapy to children
• Why infusion therapy is needed?
• Maintaining fluid and electrolyte balance
• Dehydration double check
• Calculating fluid needs
• Daily fluid fill-up
• Replacement therapy
• Tally those losses, too
• A stickler for scheduling
• Dehydration demands diligence
• Timely weights and measures
• Count on calculating
• A whole lot o’ blood … and O2
• Portioned-out products
• A formula for success
• Peripherally compatible fluids and medications
• Quick and highly efficient
• Vascular access to administer infusion therapy
• Selecting a short peripheral IV catheter (PIVC) site
• Children can be a challenge …
• … or is it?
• Only the best will do
• Other veins can be gold mines, too
• Anti-antecubital
• For the mobile and inquisitive child
• Preparing for insertion of a short PIVC
• Tailored to size and need
• Forewarned and forearmed
• Restrain for safety’s sake
• Inserting the catheter
• Having a flashback to childhood
• Securing the site
• Finger-proof and protect
• Still stuck on stickers
• Assessment and management
• Around-the-clock assessments
• Check that pain!
• Flushed and duly noted
• Dealing with IV complications
• Infiltration and extravasation
• Give it a grade
• Cease and desist
• Heat or cold? But only dry
• Other treatments to reduce tissue damage
• Fluid overload
• Beware the ominous signs!
• Infection
• Taking the local or septic route
• Strictly ANTT
• Allergic reactions or not?
• Preventing and predicting occurrences
• Other vascular access methods
• Central vascular access devices
• Peripherally inserted central catheter
• PICC a peck of reasons
• Generally, good to go
• Intraosseous infusion
• Umbilical vessel catheter
• Arterial access
• Vote for venous
• Specialized equipment
• Administration sets
• Keeping it just right
• Electronic infusion pumps
• Quick quiz
• Scoring
• Suggested References
• 10 Infusion therapy in older adults
• The older adult
• Modify your technique
• The aging process and the immune system
• Bad apples in the basket
• Inflammaging is raging!
• Physiologic changes of aging
• The skinny on skin changes
• Slow to heal
• The incredible shrinking pupil
• Visual acuity
• Common visual problems
• Airway closed
• Fluid balance and aging
• Further fluid factors
• Mind your elders!
• Preserving skin integrity
• Administering infusion therapy
• Keen on assessment
• Subtle signals
• Subcutaneous infusion
• Intravenous infusion
• Integral site integrity
• Direct approach
• Indirect approach
• Skin barrier solution
• Applying the dressing
• Visualize the site
• Administration
• Controlling the flow
• Better safe than sorry
• Removing the catheter
• A little TLC won’t hurt
• Checking for complications
• The usual suspects
• Can’t feel the pain
• Patient education
• Mental capacity changes
• Have a chat
• Sensory losses
• Can you hear me now?
• A bright idea
• More info, please!
• End-of-life issues
• Documentation
• Quick quiz
• Scoring
• Suggested References
• Appendices and index
• Appendix 1: Practice makes perfect
• Appendix 2: Checklist for prevention of central line—associated bloodstream infections
• Appendix 3: Glossary
• Index