Intravenous therapy: Wikis

  

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IV bags on a pole connected to IV lines.
.Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein.^ Intravenous (IV) Within, or administered into, a vein.

^ Preterm or sick newborn infants are often fed with nutrients and fluids that are delivered directly into a vein.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

The word intravenous simply means "within a vein". .Therapies administered intravenously are often called specialty pharmaceuticals.^ Therapies administered intravenously are often called specialty pharmaceuticals .

^ Therapies administered intravenously are often called Peripheral IV lines specialty pharmaceuticals.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Therapies administered intravenously are often called specialty pharmaceuticals.
  • Intravenous Therapy - OrganizedWisdom Health 22 January 2010 20:18 UTC organizedwisdom.com [Source type: General]
  • Intravenous Therapy - Kosmix : Reference, Videos, Images, News, Shopping and more... 22 January 2010 20:18 UTC health.kosmix.com [Source type: Academic]

.It is commonly referred to as a drip because many systems of administration employ a drip chamber, which prevents air entering the blood stream (air embolism) and allows an estimate of flow rate.^ Macrodrip sets Allow 10 to 15 drops / mL into the drip chamber.

^ Microdrip sets Allow 60 drops (gtts) / mL through a small needle into the drip chamber.

^ Moreover, because the vena cava flow approximates 2 L of blood per minute, these medications dilute as soon as they enter the bloodstream ( Salim et al., 1995 ).
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

.Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body.^ Usual reasons for intravenous fluid administration .
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ Design of a prescription for intravenous fluid administration .
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ Intravenous and IM administration of an unspecified calcium salt temporarily inhibited severe anaphylactic reactions in two other patients.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

.Some medications, as well as blood transfusions and lethal injections, can only be given intravenously.^ Some medications, as well as blood transfusions and lethal injections, can only be given intravenously."
  • Intravenous (IV) & Infusion Drug Therapy Links on: The Nurse Friendly 22 January 2010 20:18 UTC www.nursefriendly.com [Source type: Academic]

^ A peripheral vein is Some medications, as well as blood transfusions any vein that is not in the chest or abdomen.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Some medications, as well as blood transfusions and lethal injections, can only be given intravenously.

Contents

Intravenous access devices

.These can all be used to obtain blood (e.g.^ Inserted in a peripheral vein in the antecubital fossa (usually the cephalic or basilic vein) and threaded into the SVC, PICC lines can be used for all therapies and for blood collection.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Improvements in these measures were comparable for all LVAD survivors, regardless of inotropic therapy use.
  • Left Ventricular Assist Device as Destination for Patients Undergoing Intravenous Inotropic Therapy: A Subset Analysis From REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure) -- Stevenson et al. 110 (8): 975 -- Circulation 22 January 2010 20:18 UTC circ.ahajournals.org [Source type: Academic]

^ However, these drugs are not restrictive, and the steroid drugs, antiallergics, and antihistaminics usually used in the field of dermatology can all be used.
  • CA Patent 2511209 - REMEDY FOR PEMPHIGOID 20 November 2009 7:21 UTC www.wikipatents.com [Source type: Academic]

for testing), also known as .phlebotomy as well as for the administration of medication/fluids.^ The designated hyperalimentation port should not be used for other purposes, such as administration of fluids, medications, blood, and blood products.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Category IB B. Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs ( 67,68 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Good for medication administration or pediatric fluid delivery .

Hypodermic needle

.The simplest form of intravenous access is by passing a hollow needle through the skin directly into the vein.^ Preterm or sick newborn infants are often fed with nutrients and fluids that are delivered directly into a vein.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ To access the port, a special noncoring needle, usually referred to as a Huber point needle, is inserted through the skin into the septum.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

.This needle can be connected directly to a syringe (used either to withdraw blood or deliver its contents into the bloodstream) or may be connected to a length of tubing and thence whichever collection or infusion system is desired.^ You get the needle in your arm, usually at the wrist, and the needle is connected through a long tube to a bottle of the EDTA solution, hanging on a movable "post."
  • The World Of Intravenous Chelation Therapy Is Crumbling! 22 January 2010 20:18 UTC www.oralchelation.com [Source type: General]

^ They are used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples (although not routinely, since the small diameter may damage blood cells).

^ Preterm or sick newborn infants are often fed with nutrients and fluids that are delivered directly into a vein.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

.The most convenient site is often the arm, especially the veins on the back of the hand, or the median cubital vein at the elbow, but any identifiable vein can be used.^ The word intravenous simply means "within a vein", but is most commonly used to refer to IV therapy.
  • Intravenous Therapy - Your resource for Intravenous Therapy, IV Therapy, Intravenous, Blood Therapy, Drug Therapy, Clinical Therapy, Therapists, Cancer Therapy, Renal Therapy, Pediatric Therapy 22 January 2010 20:18 UTC iv4.org [Source type: FILTERED WITH BAYES]

^ First, the presence of a local site complication in this study, unlike previous studies, most often required an objectively observed abnormality at least 3 cm from the catheter insertion site.
  • Arch Intern Med -- Prevention of Peripheral Venous Catheter Complications With an Intravenous Therapy Team: A Randomized Controlled Trial, March 9, 1998, Soifer et al. 158 (5): 473 22 January 2010 20:18 UTC archinte.ama-assn.org [Source type: Academic]

^ We had a practice in IV therapy back in September, my classmate used one of my veins.
  • Intravenous Therapy - Your resource for Intravenous Therapy, IV Therapy, Intravenous, Blood Therapy, Drug Therapy, Clinical Therapy, Therapists, Cancer Therapy, Renal Therapy, Pediatric Therapy 22 January 2010 20:18 UTC iv4.org [Source type: FILTERED WITH BAYES]

.Often it is necessary to use a tourniquet which restricts the venous drainage of the limb and makes the vein bulge.^ In cases where cats and smaller dogs are being treated intravenously b.i.d., there sometimes is a problem of collapsed veins making it impossible to use this route.
  • Megascorbic Prophylaxis and Megascorbic Therapy - A New Orthomolecular Modality inVeterinary Medicine 22 January 2010 20:18 UTC www.seanet.com [Source type: Academic]

.Once the needle is in place, it is common to draw back slightly on the syringe to aspirate blood, thus verifying that the needle is really in a vein.^ Implanted ports that are already accessed can have the needle left in place for antibiotic infusion and blood sampling.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Correct needle placement should be confirmed before infusion by aspiration of blood and slow injection of 5 mL saline.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ When properly placed, this needle makes contact with the back of the port and allows fluid to flow into the catheter.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

.The tourniquet should be removed before injecting to prevent extravasation of the medication.^ Patients should be counseled that the use of any over-the-counter or herbal medications should be discussed with a physician before the medications are used.
  • Practical Aspects of Continuous Intravenous Treprostinil Therapy -- Widlitz et al. 27 (2): 41 -- Critical Care Nurse 22 January 2010 20:18 UTC ccn.aacnjournals.org [Source type: Academic]

^ Catheter function always should be assessed completely before administering chemotherapy vesicants and the site should be examined for signs of previous extravasation.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Medications known to extravasate should be administered with caution.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

Peripheral Cannula

Peripheral IV in hand
A nurse attempting an insertion of an IV line
.This is the most common intravenous access method in both hospitals and pre-hospital services.^ Therefore, a method of intravenous heparin delivery that is least laborious, least likely to produce complications, and most likely to prevent recurrent episodes is optimal.
  • Validation of a Weight-Based Nomogram for the Use of Intravenous Heparin in Transient Ischemic Attack or Stroke -- Toth and Voll 33 (3): 670 -- Stroke 22 January 2010 20:18 UTC stroke.ahajournals.org [Source type: Academic]

^ He had already been in the hospital for 2 weeks, and his arms were sore after many peripheral intravenous (IV) accesses.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Bisphosphonates are most often administered orally, but unlike other bisphosphonates such as alendronate and risedronate, clodronate can be given both orally and intravenously.
  • Effect of cyclical intravenous clodronate therapy on bone mineral density and markers of bone turnover in patients receiving home parenteral nutrition -- Haderslev et al. 76 (2): 482 -- American Journal of Clinical Nutrition 22 January 2010 20:18 UTC www.ajcn.org [Source type: Academic]

.A peripheral IV line consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein (any vein that is not inside the chest or abdomen).^ Short peripheral catheters are used for most IV therapies.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Example: peripheral IV catheter.

^ An IV needle is inserted into your arm or hand allowing a drug called EDTA to drip into your bloodstream over a period of 1 1/2 to 3 hours.

This is usually in the form of a cannula-over-needle device, in which a flexible plastic cannula comes mounted on a metal trocar. .Once the tip of the needle and cannula are located in the vein the trocar is withdrawn and discarded and the cannula advanced inside the vein to the appropriate position and secured.^ Otherwise, After entering the vein, advance the plastic catheter (which is over the needle) on into the vein while leaving the needle stationary.

^ Tip location in the vena cava is associated with diminished irritation to the vein's intima.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ NAVAN position paper: Tip location of peripherally inserted central catheters.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

Blood may be drawn at the time of insertion.
.Any accessible vein can be used although arm and hand veins are used most commonly, with leg and foot veins used to a much lesser extent.^ Although most clinical research has been done with magnesium sulfate, some experts prefer magnesium chloride for IV use because of its greater retention in the body.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

^ A procedure that may be used to deliver anticancer drugs directly to an arm or leg.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

^ PICC lines are placed in peripheral veins, most commonly the medial cubital or upper basilic.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

.On infants the scalp veins are sometimes used.^ Scalp veins are safe and nontraumatic for the infant but may be frightening to the parents who think the fluid is infusing into the baby's brain.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ In cases where cats and smaller dogs are being treated intravenously b.i.d., there sometimes is a problem of collapsed veins making it impossible to use this route.
  • Megascorbic Prophylaxis and Megascorbic Therapy - A New Orthomolecular Modality inVeterinary Medicine 22 January 2010 20:18 UTC www.seanet.com [Source type: Academic]

^ Scalp veins are generally reserved for infant IV access ( Frye, 2000 ).
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

.The caliber of cannula is commonly indicated in gauge, with 14 being a very large cannula (used in resuscitation settings) and 24-26 the smallest.^ Commonly used aminoglycosides in the home care setting include amikacin, gentamicin, and tobramycin.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Efficient correction of iron deficiency may produce a cost savings by optimizing ESA use ( 24 , 26 ), particularly in patients demonstrating ESA hyporesponsiveness in the setting of iron deficiency.
  • Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients -- Provenzano et al. 4 (2): 386 -- Clinical Journal of the American Society of Nephrology 22 January 2010 20:18 UTC cjasn.asnjournals.org [Source type: Academic]

^ Because once-daily dosing is potentially less toxic compared with multiple daily dosing schedules, it is commonly used for certain indications.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line).^ The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line).

^ The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20- gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line).
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Drawing bloods through IV line .
  • Infusion Nursing or Intravenous Nursing - Nursing for Nurses 22 January 2010 20:18 UTC allnurses.com [Source type: FILTERED WITH BAYES]

.12- and 14-gauge peripheral lines actually deliver equivalent volumes of fluid faster than central lines, accounting for their popularity in emergency medicine.^ Type of intravenous line (central; peripheral) 4.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ To deliver large amounts of fluid, you should select a large vein and use a 14 or 16-gauge catheter.

^ Therefore, a 22-gauge catheter is smaller than a 14-gauge catheter.

These lines are frequently called "large bores" or "trauma lines".
.The larger the cannula the more discomfort there is for the patient and it is sometimes kinder to give a small injection of local anaesthetic into the intended site of insertion of the larger (18G and above) cannula.^ The following morning, the patient was eating and was noticeably more active, temperature 103.2 F. Two more similar injections were given this day.
  • Megascorbic Prophylaxis and Megascorbic Therapy - A New Orthomolecular Modality inVeterinary Medicine 22 January 2010 20:18 UTC www.seanet.com [Source type: Academic]

^ Replace dressings used on tunneled or implanted CVC sites no more than once per week, until the insertion site has healed ( 211 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Patient complaints of pain or swelling distal to the insertion site of a CVAD should arouse suspicion of thrombus formation.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.To make the procedure more tolerable for children topical local anaesthetic (such as EMLA or Ametop) can be applied for about 45 minutes beforehand.^ Some patients may tolerate a more rapid rate of infusion, whereas others experience side effects such as headache or hypotension at lower rates.
  • The Nurse's Role in Administration of Intravenous Immunoglobulin Therapy 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ This is a 45-60 minute procedure which is also given intravenously.
  • Chelation Therapy, intravenous edta chelation therapy, medical information 22 January 2010 20:18 UTC www.medical-library.net [Source type: Academic]

^ A bypass surgery action will cost about $50,000 for a simple procedure -- more for a complicated quadruple bypass.
  • The World Of Intravenous Chelation Therapy Is Crumbling! 22 January 2010 20:18 UTC www.oralchelation.com [Source type: General]

.The part of the catheter that remains outside the skin is called the connecting hub; it can be connected to a syringe or an intravenous infusion line, or capped with a bung between treatments.^ Also called intravenous infusion.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

^ The influence of site on the risk for catheter infections is related in part to the risk for thrombophlebitis and density of local skin flora.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ One study showed no difference between the two approaches for keeping a baby's intravenous line open and working and one study showed an advantage for intermittent flushes.
  • Continuousinfusion versus intermittent flushing to prevent loss of function of peripheralintravenous catheters used for drug administration in newborn infants 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

.Ported cannulae have an injection port on the top that is often used to administer medicine.^ Systemic corticosteroids administered in high doses over prolonged periods of time can provide effective control of active disease and are often used for maintenance therapy.
  • Arch Dermatol -- Corticosteroid-Sparing Effect of Intravenous Immunoglobulin Therapy in Patients With Pemphigus Vulgaris, September 2002, Sami et al. 138 (9): 1158 22 January 2010 20:18 UTC archderm.ama-assn.org [Source type: Academic]

^ If a multilumen catheter is used to administer parenteral nutrition, a port for hyperalimentation should be designated and labeled.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Consequently, a 1-g therapeutic course of IV iron was administered using two rapid injections of ferumoxytol over an interval of less than 1 wk in CKD patients ( 20 ).
  • Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients -- Provenzano et al. 4 (2): 386 -- Clinical Journal of the American Society of Nephrology 22 January 2010 20:18 UTC cjasn.asnjournals.org [Source type: Academic]

Complications

.If the cannula is not sited correctly, or the vein is particularly fragile and ruptures blood may leak into the surrounding tissues, this situation is known as a "tissuing" or a "blown vein". Using this cannula to administer medications causes extravasation of the drug which can lead to edema, causing pain and tissue damage, and even necrosis depending on the medication.^ Medications known to extravasate should be administered with caution.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Many cytotoxic medications can lead to extravasation.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Extravasation results when these medications infiltrate into the skin, causing necrosis of the surrounding tissue and muscle.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

.The person attempting to obtain the access must find a new access site proximal to the "blown" area to prevent extravasation of medications through the damaged vein.^ Caution also should be exercised when veins of the anterior forearm are used because the radial and ulnar nerves weave through the area.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ You can find an I/V doctor in your area.  Immediately below is a section taken from the official web site of ACAM, The American Academy Of Advancement In Medicine.
  • Full Explanation Of Intravenous Chelation Therapy -- IV Chelation 22 January 2010 20:18 UTC www.oralchelation.com [Source type: FILTERED WITH BAYES]

^ Tunneled lines are long-term external catheters made of durable, medical-grade silicone that are "tunneled" subcutaneously between the vein insertion site and the skin exit site.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.For this reason it is advisable to site the first cannula at the most distal appropriate vein.^ First, the presence of a local site complication in this study, unlike previous studies, most often required an objectively observed abnormality at least 3 cm from the catheter insertion site.
  • Arch Intern Med -- Prevention of Peripheral Venous Catheter Complications With an Intravenous Therapy Team: A Randomized Controlled Trial, March 9, 1998, Soifer et al. 158 (5): 473 22 January 2010 20:18 UTC archinte.ama-assn.org [Source type: Academic]

^ The peripheral veins generally tolerate basic crystalloid fluids (e.g., D-5-W) and most antibiotics as long as catheter sites are routinely changed.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

.If a patient needs frequent venous access, the veins may scar and narrow, making any future access extremely difficult or impossible.^ Additionally, the patient's venous access must be considered.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ This finding suggests that AIDS patients and home care providers who use these devices need frequent assessment of both CVAD care technique and CVAD care supplies.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Dosing frequency depends on the patient's renal function and drug tolerance, particular fungal infection being treated, and need for chronic vs intermittent therapy.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.A peripheral IV cannot be left in the vein indefinitely, because of the risk of insertion-site infection leading to phlebitis, cellulitis and sepsis.^ Phlebitis has long been recognized as a risk for infection.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Because phlebitis and catheter colonization have been associated with an increased risk for catheter-related infection, short peripheral catheter sites commonly are rotated at 72--96-hour intervals to reduce both the risk for infection and patient discomfort associated with phlebitis.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ If sites for venous access are limited and no evidence of phlebitis or infection is present, peripheral venous catheters can be left in place for longer periods, although the patient and the insertion sites should be closely monitored ( 66,128,246 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.The US Centers for Disease Control and Prevention updated their guidelines and now advise the cannula need to be replaced every 96 hours.^ Over-the-needle catheters have a recommended dwell time of 72 hours, a nursing standard supported by the Infusion Nursing Standards of Practice (2006: 51S) and the CDC's Guidelines for the Prevention of Intravascular Catheter-Related Infections ( Centers for Disease Control and Prevention, 2002 ).
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Because infusion therapy is a major cause of morbidity, the Centers for Disease Control and Prevention has established guidelines for IV catheter insertion and maintenance, 2 which have been updated recently.
  • Arch Intern Med -- Prevention of Peripheral Venous Catheter Complications With an Intravenous Therapy Team: A Randomized Controlled Trial, March 9, 1998, Soifer et al. 158 (5): 473 22 January 2010 20:18 UTC archinte.ama-assn.org [Source type: Academic]

^ In the study group, two filters (clear fluid and lipid) and intravenous sets were changed every 96 hours and the intravenous sets in the control group were changed daily.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

[1] .This was based on studies organised to identify causes of Methicillin-resistant Staphylococcus aureus MRSA infection in hospitals.^ Vancomycin is commonly used in AIDS patients to treat infections due to Staphylococcus aureus and methicillin-resistant staphylococci.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Netto dos Santos KR, de Souza Fonseca L, Gontijo Filho PP. Emergence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from Brazilian university hospitals.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Li JZ, Willke RJ, Rittenhouse BE, Rybak MJ. Effect of linezolid versus vancomycin on length of hospital stay in patients with complicated skin and soft tissue infections caused by known or suspected methicillin-resistant staphylococci: results from a randomized clinical trial.
  • Intravenous-to-Oral Switch Therapy: eMedicine Infectious Diseases 22 January 2010 20:18 UTC emedicine.medscape.com [Source type: Academic]

.In the United Kingdom, the UK Department of health published their finding about risk factors associated with increased MRSA infection, now include intravenous cannula, central venous catheters and urinary catheters as the main factors increasing the risk of spreading antibiotic resistant strain bacteria.^ Precautions necessary with central venous catheters.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ An epidemiologic study of the risks associated with peripheral intravenous catheters.
  • Arch Intern Med -- Prevention of Peripheral Venous Catheter Complications With an Intravenous Therapy Team: A Randomized Controlled Trial, March 9, 1998, Soifer et al. 158 (5): 473 22 January 2010 20:18 UTC archinte.ama-assn.org [Source type: Academic]
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Risk factors for infection differ for umbilical artery and umbilical vein catheters.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

Central IV lines

.Central IV lines flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart.^ By definition, a central venous catheter (CVC) enters the vena cava, with the tip residing in either the superior or inferior vena cava.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ The catheter is threaded along the vein, into the subclavian, and eventually into the vena cava, where the tip lies immediately above the right atrium.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ However, all 4 types of central lines terminate in the vena cava.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

This has several advantages over a peripheral IV:
.
  • It can deliver fluids and medications that would be overly irritating to peripheral veins because of their concentration or chemical composition.^ It can deliver fluids and medications that would be overly irritating to peripheral veins because of their concentration or chemical composition.

    ^ This is usually done by It can deliver fluids and medications that feel and estimation; an X-ray then verifies that • would be overly irritating to peripheral the tip is in the right place.
    • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

    ^ The type of solution --Hypertonic solutions and various medications can be chemically irritating to the vein.
    • Welcome to gulfMD.com - The world of Health, Progress and Hope 22 January 2010 20:18 UTC www.gulfmd.com [Source type: FILTERED WITH BAYES]

    These include some chemotherapy drugs and total parenteral nutrition.
  • Medications reach the heart immediately, and are quickly distributed to the rest of the body.
  • There is room for multiple parallel compartments (lumen) within the catheter, so that multiple medications can be delivered at once even if they would not be chemically compatible within a single tube.
  • Caregivers can measure central venous pressure and other physiological variables through the line.
.Central IV lines carry risks of bleeding, infection, gangrene, thromboembolism and gas embolism (see Risks below).^ All outpatient IV devices should be single lumen, if possible, to decrease risk of infection.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Additionally, infection risk increases with nursing staff reductions below a critical level ( 48 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.They are often more difficult to insert correctly as the veins are not usually palpable and rely on an experienced clinician knowing the appropriate landmarks and/or using an ultrasound probe to safely locate and enter the vein.^ Patients are encouraged to seek care from a pulmonary hypertension center for the treatment of PAH and for the appropriate and safe use of specialized medications such as IV treprostinil.
  • Practical Aspects of Continuous Intravenous Treprostinil Therapy -- Widlitz et al. 27 (2): 41 -- Critical Care Nurse 22 January 2010 20:18 UTC ccn.aacnjournals.org [Source type: Academic]

^ IV usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

^ However, patients treated by hospital clinicians were more often discharged with an unstable clinical variable.
  • Intravenous-to-Oral Switch Therapy: eMedicine Infectious Diseases 22 January 2010 20:18 UTC emedicine.medscape.com [Source type: Academic]

Surrounding structures, such as the pleura and carotid artery are also at risk of damage with the potential for pneumothorax or even cannulation of the artery.
.There are several types of central IVs, depending on the route that the catheter takes from the outside of the body to the vein.^ Are there different types of IV sedation?

^ There are several types of central IVs, depending on the route that the catheter takes from the outside of the body to the vein.

^ There are several types of catheters that take a more direct route into central veins.

Peripherally inserted central catheter

.PICC lines are used when intravenous access is required over a prolonged period of time or when the material to be infused would cause quick damage and early failure of a peripheral IV and when a conventional central line may be too dangerous to attempt.^ Type of intravenous line (central; peripheral) 4.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ Fluid and electrolyte deficits in HIV-infected patients may arise from prolonged periods of vomiting, diarrhea, or night sweats.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ National Institute of Health Confirms Vitamin C Effectiveness National Institute of Health / National Cancer Institute – “Early clinical [Cameron/Pauling] studies showed that high-dose - oral OR intravenous vitamin c iv, may improve symptoms and prolong life in patients with terminal cancer.
  • Alternative Cancer Treatments, Intravenous Vitamin C for Cancer Patients 22 January 2010 20:18 UTC www.alternative-cancer-care.com [Source type: Academic]

.Typical uses for a PICC include: long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition.^ Total parenteral nutrition .
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Progressive bone loss during long-term home total parenteral nutrition.
  • Effect of cyclical intravenous clodronate therapy on bone mineral density and markers of bone turnover in patients receiving home parenteral nutrition -- Haderslev et al. 76 (2): 482 -- American Journal of Clinical Nutrition 22 January 2010 20:18 UTC www.ajcn.org [Source type: Academic]

^ ABVD A chemotherapy regimen commonly used to treat Hodgkin's Disease .

.The PICC line is inserted through a sheath into a peripheral vein sometimes using the Seldinger technique under ultrasound guidance, usually in the arm, and then carefully advanced upward until the catheter is in the superior vena cava or the right atrium.^ Inserted in a peripheral vein in the antecubital fossa (usually the cephalic or basilic vein) and threaded into the SVC, PICC lines can be used for all therapies and for blood collection.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Category II I. Do not use guidewire techniques to replace catheters in patients suspected of having catheter-related infection ( 134,135 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Devices that are inappropriate for outpatient use include jugular vein catheters, percutaneously placed subclavian vein catheters, and femorally placed catheters.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.This is usually done by measuring the distance to an external landmark, such as the suprasternal notch, to estimate the optimal length.^ With each dressing change, the external length of the catheter should be measured and documented.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.An X-ray can be used to verify that the tip is in the right place.^ An X ray is required to verify the tip placement in the SVC before initiating IV therapy.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.A PICC may have a single (single-lumen) tube and connector, two(double-lumen) or three (triple-lumen) compartments, each with its own external connector.^ Yeung C, May J, Hughes R. Infection rate for single lumen v triple lumen subclavian catheters.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

Power-injectable PICCs are now available as well. .From the outside, a single-lumen PICC resembles a peripheral IV, except that the tubing is slightly wider.^ From the outside, a single-lumen PICC and are quickly distributed to the rest of resembles a peripheral IV, except that the tubing the body.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ From the outside, a single-lumen PICC resembles a peripheral IV, except that the tubing is slightly wider.

^ However, a PICC single tube.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

.The insertion site needs to be better protected, than what is required for a peripheral IV, due to the higher risk of serious infection if bacteria travel up the catheter.^ The risk of infection is higher for nontunneled catheters than for any other central catheter design.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ For short peripheral catheters, good hand hygiene before catheter insertion or maintenance, combined with proper aseptic technique during catheter manipulation, provides protection against infection.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ The influence of site on the risk for catheter infections is related in part to the risk for thrombophlebitis and density of local skin flora.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.However, a PICC poses less of a systemic infection risk than other central IVs, because the insertion site is usually cooler and dryer than the sites typically used for other central lines.^ The risk of infection is higher for nontunneled catheters than for any other central catheter design.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein ( 22,53,54 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Insertion- or exit-site infections usually present with inflammation with or without purulent discharge from the catheter insertion or exit site.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.This helps to slow the growth of bacteria which could reach the bloodstream by traveling under the skin along the outside of the catheter.^ During reactivation, virus replicates at the sensory ganglion and travels peripherally along sensory nerves to reach the mucocutaneous surface.
  • Varicella-Zoster Virus and HIV 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Usually, the tip of the catheter is advanced into the SVC. A Dacron cuff is attached proximal to the exiting end of the catheter and placed within the tunnel under the skin.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.The chief advantage of a PICC over other types of central lines is that it is safer to insert with a relatively low risk of uncontrollable bleeding and essentially no risks of damage to the lungs or major blood vessels.^ Type of intravenous line (central; peripheral) 4.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ Neutropenia A low number of neutrophils or white blood cells (WBC's); may increase the risk of infection depending how low the wbc count is and for how long it has been low.

^ The literature also reflects a lack of consensus on recommendations for catheter exit-site care and type of central line dressings.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.Although special training is required, a PICC does not require the skill level of a physician or surgeon.^ Although once-daily IV aminoglycosides may not require monitoring of serum peak levels, serum trough levels should be checked once or twice during the course of treatment.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ It seems incongruous that having demonstrated the required learning and skill, and having passed the examination and obtained a license, a physician should not be permitted to exercise the judgment developed from his experience.
  • Legal Status of Intravenous Disodium EDTA Chelation Therapy 22 January 2010 20:18 UTC www.drcranton.com [Source type: Academic]

.It is also externally unobtrusive, and with proper hygiene, care, and some good luck, can be left in place for months to years if needed for patients who require extended treatment.^ While under treatment at the clinic of the doctor I met and talked with many patients who told me they were advised to undergo double and triple by-pass surgery which they refused.
  • Full Explanation Of Intravenous Chelation Therapy -- IV Chelation 22 January 2010 20:18 UTC www.oralchelation.com [Source type: FILTERED WITH BAYES]

^ It has been the author's impression (and that of other clinicians) that some patients who respond to IM vitamin B12 injections do not experience the same benefit when vitamin B12 is given as part of the Myers'.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

^ Management of VZV infections in HIV-infected patients often requires the administration of specific antiviral chemotherapy; hospitalization may be necessary in some cases.
  • Varicella-Zoster Virus and HIV 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.The chief disadvantage is that it must be inserted and then travel through a relatively small peripheral vein which can take a less predictable course on the way to the superior vena cava and is therefore somewhat more time consuming and more techically difficult to place in some patients.^ Can cause peripheral neuropathy in some patients.

^ Therefore, for some patients receiving IV nutrient therapy, the vitamin B12 is given IM in a separate syringe.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

^ Nutrients taken up by cells after an IV infusion may eventually leak out again, but perhaps some healing takes place before they do.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

.Also, as a PICC travels through the axilla, it can become kinked causing poor function.^ Aplastic Anemia (AA) A deficiency of certain types of blood cells caused by poor bone marrow function.

Central venous lines

.There are several types of catheters that take a more direct route into central veins.^ There are several types of central IVs, depending on the route that the catheter takes from the outside of the body to the vein.

^ There are several types of catheters that take a more direct route into central veins.

^ Another type of central line, called a Hickman line or Broviac catheter, is inserted into the target vein and then "tunneled" under the skin to emerge a short distance away.

.These are collectively called central venous lines.^ Robinson JF, Robinson WA, Cohn A, Garg K, Armstrong JD. Perforation of the great vessels during central venous line placement.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Pierce CM, Wade A, Mok Q. Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Hoogen A, Krediet TG, Uiterwaal C, Bolenius J, Gerards LJ, Fleer A. In-line filters in central venous catheters in a neonatal intensive care unit.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

.In the simplest type of central venous access, a catheter is inserted into a subclavian, internal jugular, or (less commonly) a femoral vein and advanced toward the heart until it reaches the superior vena cava or right atrium.^ Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein ( 22,53,54 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Shapiro CL. Central venous access catheters.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ IV fluids via an umbilical or percutaneous central venous catheter or a catheter inserted in the subclavian or femoral vein (CVC) .
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

.Because all of these veins are larger than peripheral veins there is greater blood flow past the tip of the catheter meaning irritant drugs are more rapidly diluted with less chance of extravasation.^ A peripheral angiogram revealed complete occlusion of both femoral-popliteal arteries, with no detectable blood flow to the distal extremities.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

^ Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein ( 22,53,54 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ For all of these reasons, an IV team may save more than it costs, 13 but this is difficult to prove.
  • Arch Intern Med -- Prevention of Peripheral Venous Catheter Complications With an Intravenous Therapy Team: A Randomized Controlled Trial, March 9, 1998, Soifer et al. 158 (5): 473 22 January 2010 20:18 UTC archinte.ama-assn.org [Source type: Academic]

.It is commonly believed that fluid can be pushed faster through a central venous catheter but as they are often divided into multiple lumens then the internal diameter is less than that of a large-bore peripheral cannula.^ Central venous catheters can be tunneled or nontunneled.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Preterm or sick newborn infants are often fed with nutrients and fluids that are delivered directly into a vein.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein ( 22,53,54 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.They are also longer, which as reflected in Poiseuille's law, requires higher pressure to achieve the same flow, all other variables being equal.^ Other treatment protocols are being explored, including a single dose of intravenous antibiotic prior to the oral switch and all-oral regimens using the newer fluoroquinolones.
  • Intravenous-to-Oral Switch Therapy: eMedicine Infectious Diseases 22 January 2010 20:18 UTC emedicine.medscape.com [Source type: Academic]

^ Levine and colleagues note that all three patients survived for longer than expected for the types and stages of cancers that they had.
  • Alternative Cancer Treatments, Intravenous Vitamin C for Cancer Patients 22 January 2010 20:18 UTC www.alternative-cancer-care.com [Source type: Academic]

^ On the other hand, we found that the average baseline levels of plasma lipid peroxides of all three groups of patients were significantly higher than that of the controls.
  • Enhanced oxidative stress in haemodialysis patients receiving intravenous iron therapy -- Lim et al. 14 (11): 2680 -- Nephrology Dialysis Transplantation 22 January 2010 20:18 UTC ndt.oxfordjournals.org [Source type: Academic]

Tunnelled Lines

.Another type of central line, called a Hickman line or Broviac catheter, is inserted into the target vein and then "tunneled" under the skin to emerge a short distance away.^ Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein ( 22,53,54 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ The literature also reflects a lack of consensus on recommendations for catheter exit-site care and type of central line dressings.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Port A small plastic or metal container surgically placed under the skin and attached to a central venous catheter inside the body.

.This reduces the risk of infection, since bacteria from the skin surface are not able to travel directly into the vein; these catheters are also made of materials that resist infection and clotting.^ This reduces the risk of infection, since bacteria from the skin surface are not able to travel directly into the vein; these catheters are also made of materials that resist infection and clotting.

^ Do not routinely replace midline catheters to reduce the risk for infection ( 131 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ This reduces the The most commonly used crystalloid fluid is risk of infection, since bacteria from the skin normal saline, a solution of sodium chloride at surface are not able to travel directly into the 0.9% concentration, which is close to the vein; these catheters are also made of materials concentration in the blood (isotonic).
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

Implantable ports

.A port (often referred to by brand names such as Port-a-Cath or MediPort) is a central venous line that does not have an external connector; instead, it has a small reservoir that is covered with silicone rubber and is implanted under the skin.^ Appropriate outpatient devices include peripherally inserted central catheters (PICCs), tunneled central venous catheters such as the Hickman and Groshong devices, and subcutaneous implanted ports such as MediPort and Port-A-Cath.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Port A small plastic or metal container surgically placed under the skin and attached to a central venous catheter inside the body.

^ This formula is often referred to as oral chelation -- taking its name from the earlier treatment called intravenous chelation therapy.
  • Full Explanation Of Intravenous Chelation Therapy -- IV Chelation 22 January 2010 20:18 UTC www.oralchelation.com [Source type: FILTERED WITH BAYES]

.Medication is administered intermittently by placing a small needle through the skin, piercing the silicone, into the reservoir.^ Administer continuous or intermittent medication .

^ Medication is administered depend on the chemical properties of the intermittently by placing a small needle through medications being given.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Medication is administered intermittently by placing a small needle through the skin into the reservoir.

When the needle is withdrawn the reservoir cover reseals itself. The cover can accept hundreds of needle sticks during its lifetime. .It is possible to leave the ports in the patient's body for years; if this is done however, the port must be accessed monthly and flushed with an anti-coagulant, or the patient risks it getting plugged up.^ Patients with life-long infusion needs may benefit from early placement of permanent central venous access, like a subcutaneous infusion port.
  • ResourceNurse.com Intravenous Immunoglobulin 22 January 2010 20:18 UTC www.resourcenurse.com [Source type: Academic]

^ Twenty three patients (28 eyes) had completed two years of follow-up and were included for statistical analysis.
  • Visual outcome after intravenous dexamethasone therapy for idiopathic optic neuritis in an Indian population: A clinical case series Sethi HS, Menon V, Sharma P, Khokhar S, Tandon R - Indian J Ophthalmol 22 January 2010 20:18 UTC www.ijo.in [Source type: Academic]

^ Patient 9 had an excellent response to therapy after 8 pulse doses of IV cyclophosphamide and remained clear of disease for 1 year; however, the patient's disease recently began to flare, prompting a resumption of pulse cyclophosphamide therapy.
  • Arch Dermatol -- Pulse Intravenous Cyclophosphamide Therapy in Pemphigus, January 1999, Fleischli et al. 135 (1): 57 22 January 2010 20:18 UTC archderm.ama-assn.org [Source type: Academic]

If it is plugged it becomes a hazard as a thrombus will eventually form with an accompanying risk of embolisation. .Removal of a port is usually a simple outpatient procedure; however, installation is more complex and a good implant is fairly dependent on the skill of the radiologist.^ However, plasmapheresis is almost as expensive as IVIg therapy, is more cumbersome to administer, is not readily available, and usually has more adverse effects.
  • Intravenous Immune Globulin Therapy for Neurologic Diseases — Ann Intern Med 22 January 2010 20:18 UTC www.annals.org [Source type: Academic]

^ Ports are placed in surgery usually using local anesthesia and removed in surgery as well.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Tunnel, tract, or pocket infections are more difficult to treat with antibiotics and usually require device removal, especially in pseudomonal infections.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.Ports cause less inconvenience and have a lower risk of infection than PICCs, and are therefore commonly used for patients on long-term intermittent treatment.^ PICCs, and are therefore commonly used for patients on long-term intermittent treatment.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Ports cause less inconvenience and have a lower risk of infection Intravenous fluids must always be sterile.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Phlebitis has long been recognized as a risk for infection.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

Forms of intravenous therapy

Intravenous drip

.An intravenous drip is the continuous infusion of fluids, with or without medications, through an IV access device.^ IV access device.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ For all IV access devices: .
  • 201 KAR 20:490. Licensed practical nurse intravenous therapy scope ofpractice. 22 January 2010 20:18 UTC www.lrc.ky.gov [Source type: Academic]

^ Intravenous access devices .
  • Intravenous.eu 22 January 2010 20:18 UTC intravenous.eu [Source type: FILTERED WITH BAYES]

.This may be to correct dehydration or an electrolyte imbalance, to deliver medications, or for blood transfusion.^ IVT is associated with complications related to rapid over-correction of electrolyte imbalances [ 13 ], extravasation of infused solutions into surrounding tissues [ 14 ], and infection or inflammation [ 14 ].
  • BioMed Central | Full text | Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials 22 January 2010 20:18 UTC www.biomedcentral.com [Source type: Academic]
  • Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials 22 January 2010 20:18 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Iron overload may be inherited, or it may be caused by blood transfusions.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

IV fluids

.There are two types of fluids that are used for intravenous drips; crystalloids and colloids.^ There are two types of fluids that are used for intravenous drips; crystalloids and colloids.

^ There are three main types of fluids: .

^ Type of intravenous infusion set used to maintain body fluids in a ...
  • Intravenous Clipart Illustrations. 85 Intravenous clip art vector EPS drawings available to search from over 15 royalty free illustration publishers. 20 November 2009 7:21 UTC www.fotosearch.com [Source type: General]

.Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules.^ Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules.

^ Very weak, very pure Hydrogen Peroxide (0.0375% or less concentrations) are added to a sugar or salt water solution, the same used for intravenous feeding in hospitals.
  • The Whole Health Center - Oxidative Therapy 22 January 2010 20:18 UTC www.drmanso.com [Source type: FILTERED WITH BAYES]

^ Additional mineral salts such as potassium and calcium, vitamins , or medications can be added to the IV solution by injecting them into the bottle or bag with a needle or injected directly into the IV line.
  • Intravenous Rehydration - Definition, Purpose, Description, Risks, Parental concerns, Resources 29 September 2009 18:22 UTC www.healthofchildren.com [Source type: Academic]

.Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid.^ There are two main IV filter pore sizes; the 0.22 micron filter is used for aqueous solutions, and the 1.2 micron filter is recommended for larger molecule solutions such as lipids.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

.Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution.^ Reduced high blood pressure e.

^ The vacuum blood-collection system should be avoided because it generates extremely high pressure and can rupture the catheters.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Impotence can be caused by decreased blood flow to the penis due to clogged arterioles.
  • Chelation Therapy, intravenous edta chelation therapy, medical information 22 January 2010 20:18 UTC www.medical-library.net [Source type: Academic]

.[2] However, there is still controversy to the actual difference in efficacy by this difference.^ There were no clinically important differences between ORT and IVT in terms of efficacy and safety.
  • BioMed Central | Full text | Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials 22 January 2010 20:18 UTC www.biomedcentral.com [Source type: Academic]

[2] .Another difference is that crystalloids generally are much cheaper than colloids.^ In our experiments, the steady-state plasma concentration of IgA was much lower than that of IgG1, which is in accordance with the reported difference in clearance rates.
  • Blood -- Accelerated autoantibody clearance by intravenous immunoglobulin therapy: st... 22 January 2010 20:18 UTC bloodjournal.hematologylibrary.org [Source type: Academic]

[2]
.The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic).^ The medication was added to 250 mL of isotonic sodium chloride solution and infused over 1 hour.
  • Arch Dermatol -- Pulse Intravenous Cyclophosphamide Therapy in Pemphigus, January 1999, Fleischli et al. 135 (1): 57 22 January 2010 20:18 UTC archderm.ama-assn.org [Source type: Academic]

^ Clodronate (1500 mg) was dissolved in 1500 mL isotonic sodium chloride solution and administered intravenously over 6 h.
  • Effect of cyclical intravenous clodronate therapy on bone mineral density and markers of bone turnover in patients receiving home parenteral nutrition -- Haderslev et al. 76 (2): 482 -- American Journal of Clinical Nutrition 22 January 2010 20:18 UTC www.ajcn.org [Source type: Academic]

^ The designated hyperalimentation port should not be used for other purposes, such as administration of fluids, medications, blood, and blood products.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.Ringer's lactate or Ringer's acetate is another isotonic solution often used for large-volume fluid replacement.^ Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

^ If this fluid contains osmoles such as sorbitol or mannitol that remain extracellularly, the ECF volume will be expanded by an iso-osmotic, Na + -free solution.
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ The volume and/or the composition of fluids used for intravenous therapy often contribute to the development of acute hyponatraemia.
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

.A solution of 5% dextrose in water, sometimes called D5W, is often used instead if the patient is at risk for having low blood sugar or high sodium.^ Category II I. Do not use guidewire techniques to replace catheters in patients suspected of having catheter-related infection ( 134,135 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Instead, we divided the trials into low osmolarity (range 208 to 270 mOsmol/L) and high osmolarity (range 299 to 331 mOsmol/L) subgroups; these cut-offs were similar to those used by Hahn et al [ 41 ].
  • BioMed Central | Full text | Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials 22 January 2010 20:18 UTC www.biomedcentral.com [Source type: Academic]

^ Neutropenia A low number of neutrophils or white blood cells (WBC's); may increase the risk of infection depending how low the wbc count is and for how long it has been low.

.The choice of fluids may also depend on the chemical properties of the medications being given.^ The choice of fluids may also the skin.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ The choice of fluids may also depend on the chemical properties of the medications being given.

^ Medication is administered depend on the chemical properties of the intermittently by placing a small needle through medications being given.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

Intravenous fluids must always be sterile.
Composition of common crystalloid solutions
Solution Other Name [Na+](mmol/L) [Cl-](mmol/L) [Glucose](mmol/L) [Glucose](mg/dl)
D5W 5% Dextrose 0 0 278 5000
2/3D & 1/3S 3.3% Dextrose / 0.3% saline 51 51 185 3333
Half-normal saline 0.45% NaCl 77 77 0 0
Normal saline 0.9% NaCl 154 154 0 0
Ringer's lactate Lactated Ringer 130 109 0 0
D5NS 5% Dextrose, Normal Saline 154 154 278 5000
Ringer's lactate also has 28 mmol/L lactate, 4 mmol/L K+ and 3 mmol/L Ca2+. Ringer's acetate also has 28 mmol/L acetate, 4 mmol/L K+ and 3 mmol/L Ca2+.
Effect of adding one litre
Solution Change in ECF Change in ICF
D5W 333 mL 667 mL
2/3D & 1/3S 556 mL 444 mL
Half-normal saline 667 mL 333 mL
Normal saline 1000 mL 0 mL
Ringer's lactate 900 mL 100 mL

Infusion equipment

An infusion pump suitable for a single IV line
.A standard IV infusion set consists of a pre-filled, sterile container (glass bottle, plastic bottle or plastic bag) of fluids with an attachment that allows the fluid to flow one drop at a time, making it easy to see the flow rate (and also reducing air bubbles); a long sterile tube with a clamp to regulate or stop the flow; a connector to attach to the access device; and connectors to allow "piggybacking" of another infusion set onto the same line, e.g., adding a dose of antibiotics to a continuous fluid drip.^ IV fluid bags.
  • Intravenous fluid Stock Photos and Images. 80 Intravenous fluid pictures and royalty free photography available to search from over 100 stock photo brands. 29 September 2009 18:22 UTC www.fotosearch.com [Source type: General]

^ An intravenous drip filled with red fluid .
  • Intravenous fluid Stock Photos and Images. 80 Intravenous fluid pictures and royalty free photography available to search from over 100 stock photo brands. 29 September 2009 18:22 UTC www.fotosearch.com [Source type: General]

^ The intravenous and oral formulations of levofloxacin have same-dose bioequivalence, allowing for switch or step-down therapy from parenteral to oral formulations of the same agent at the same dose.
  • Intravenous-to-Oral Switch Therapy: eMedicine Infectious Diseases 22 January 2010 20:18 UTC emedicine.medscape.com [Source type: Academic]

.An infusion pump allows precise control over the flow rate and total amount delivered, but in cases where a change in the flow rate would not have serious consequences, or if pumps are not available, the drip is often left to flow simply by placing the bag above the level of the patient and using the clamp to regulate the rate; this is a gravity drip.^ High-dose IVIG down-regulates the activated levels of inflammatory indices (except erythrocyte sedimentation rate) in the acute stage of Kawasaki disease.
  • Intravenous Immunoglobulin: eMedicine Hematology 22 January 2010 20:18 UTC emedicine.medscape.com [Source type: Academic]

^ The patient is instructed to set the initial pump flow rate at 180 mL/hour, thus providing 1,800 mL over a 10-hour period.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Intravenous immunoglobulin (IVIg) and plasma exchange are often used as treatments in this patient group.
  • Immune Globulin Therapy* 22 January 2010 20:18 UTC www.wellmark.com [Source type: Academic]

.A rapid infuser can be used if the patient requires a high flow rate and the IV access device is of a large enough diameter to accommodate it.^ IV access device.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Formulas used to calculate flow rate; .
  • Lawriter - OAC - Chapter 4723-17 Intravenous Therapy Courses for Licensed Practical Nurses 22 January 2010 20:18 UTC codes.ohio.gov [Source type: Reference]

^ Phlebitis A rapid infuser can be used if the patient requires Phlebitis is irritation of a vein that is not caused a high flow rate and the IV access device is of a by infection, but from the mere presence of a large enough diameter to accommodate it.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

.This is either an inflatable cuff placed around the fluid bag to force the fluid into the patient or a similar electrical device that may also heat the fluid being infused.^ Symptoms are swelling, bag to force the fluid into the patient or a similar pain, and redness around the vein.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ It does not electrical device that may also heat the fluid necessarily mean the IV device must be being infused.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ This is either an inflatable cuff placed around the fluid bag to force the fluid into the patient or a similar electrical device that may also heat the fluid being infused.

Intermittent infusion

.Intermittent infusion is used when a patient requires medications only at certain times, and does not require additional fluid.^ Intermittent infusion is used when a patient Due to frequent injections and recurring phlebitis, requires medications only at certain times, and the peripheral veins of intravenous drug addicts, does not require additional fluid.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Many of them require an intravenous line only for medications and not for fluid.
  • Continuousinfusion versus intermittent flushing to prevent loss of function of peripheralintravenous catheters used for drug administration in newborn infants 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ Intravenous infusions are used for introducing fluids, nutrition, blood or its products, and medications to patients.
  • Intravenous Fluids, IV Therapy, Direct Patient Care on: The Nurse Friendly 29 September 2009 18:22 UTC www.nursefriendly.com [Source type: FILTERED WITH BAYES]

.It can use the same techniques as an intravenous drip (pump or gravity drip), but after the complete dose of medication has been given, the tubing is disconnected from the IV access device.^ It can use the same techniques as an intravenous drip (pump or gravity drip), but after the complete dose of medication has been given, the tubing is disconnected from the IV access device.

^ Intravenous access devices .

^ An intravenous drip is the continuous infusion of fluids, with or without medications, through an IV access device.

.Some medications are also given by IV push or bolus, meaning that a syringe is connected to the IV access device and the medication is injected directly (slowly, if it might irritate the vein or cause a too-rapid effect).^ Therefore, for some patients receiving IV nutrient therapy, the vitamin B12 is given IM in a separate syringe.
  • Intravenous nutrient therapy: the "Myers' cocktail" -"Myers' Cocktail" 22 January 2010 20:18 UTC chantillyspecialists.com [Source type: Academic]

^ Prevention of catheter-related sepsis during parenteral nutrition: effect of a new connection device.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Most notable are potential adverse effects of administered medications and the possibility of thrombosis and infection related to IV catheters.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.Once a medicine has been injected into the fluid stream of the IV tubing there must be some means of ensuring that it gets from the tubing to the patient.^ Once a medicine has been injected into the fluid stream of the IV tubing there must be some means of ensuring that it gets from the tubing to the patient.

^ IV tubing It occurs frequently with peripheral IVs, and there must be some means of ensuring that it requires replacement of the IV at a different gets from the tubing to the patient.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Usually this is accomplished by allowing the fluid stream to flow normally and therby carry the medicine into the bloodstream; however, a second fluid injection is sometimes used, a "flush", following the injection to push the medicine into the bloodstream more quickly.

.Usually this is accomplished by allowing the fluid stream to flow normally and thereby carry the medicine into the bloodstream; however, a second fluid injection is sometimes used, a "flush", following the injection to push the medicine into the bloodstream more quickly.^ Usually this is accomplished by allowing the fluid stream to flow normally and therby carry the medicine into the bloodstream; however, a second fluid injection is sometimes used, a "flush", following the injection to push the medicine into the bloodstream more quickly.

^ If the fluids seem to flow slower than usual it is possible the IV tubing has been kinked or crushed by the stopper, and needs gently squeezing to return it to its normal cylindrical shape.
  • I.V. Catheters & Fluids 22 January 2010 20:18 UTC www.lbah.com [Source type: General]

^ The symptoms of pain and swelling are is accomplished by allowing the fluid stream to temporary and not dangerous, unless giving a flow normally and therby carry the medicine into highly irritating medication, such intravenous the bloodstream; however, a second fluid contrast or amiodarone.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

Risks of intravenous therapy

Infection

.Any break in the skin carries a risk of infection.^ The risk for infection increases whenever the skin is broken.
  • Welcome to gulfMD.com - The world of Health, Progress and Hope 22 January 2010 20:18 UTC www.gulfmd.com [Source type: FILTERED WITH BAYES]

^ If skin becomes cracked, punctured or begins to bleed will increases the risk of bacteria entering skin resulting in serious infections.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ The influence of site on the risk for catheter infections is related in part to the risk for thrombophlebitis and density of local skin flora.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.Although IV insertion is a aseptic procedure, skin-dwelling organisms such as Coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment.^ Although once-daily IV aminoglycosides may not require monitoring of serum peak levels, serum trough levels should be checked once or twice during the course of treatment.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Such negative correlation may be attributed to the increase of oxidative stress in the patients with higher iron stores.
  • Enhanced oxidative stress in haemodialysis patients receiving intravenous iron therapy -- Lim et al. 14 (11): 2680 -- Nephrology Dialysis Transplantation 22 January 2010 20:18 UTC ndt.oxfordjournals.org [Source type: Academic]

^ It is often possible to treat catheter-related infections without removing the device, particularly when they are caused by gram-positive, coagulase-negative staphylococci.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.Moisture introduced to unprotected IV sites through washing or bathing substantially increases the infection risks.^ However, a PICC poses less of a systemic infection risk than other central IVs, because bacteria would have to travel up the entire length of the narrow catheter before spreading through the bloodstream.

^ Neutropenia A low number of neutrophils or white blood cells (WBC's); may increase the risk of infection depending how low the wbc count is and for how long it has been low.

^ Additionally, infection risk increases with nursing staff reductions below a critical level ( 48 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.Infection of IV sites is usually local, causing easily visible swelling, redness, and fever.^ Fever, pain, redness at site.
  • Help HER - » For Health Professionals | Treatments | Nutritional Therapies | Parenteral (Intravenous) Nutrition 22 January 2010 20:18 UTC www.hyperemesis.org [Source type: Academic]

^ Infection of IV sites is usually local, causing An infusion pump allows precise control over the easily visible swelling, redness, and fever.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Insertion- or exit-site infections usually present with inflammation with or without purulent discharge from the catheter insertion or exit site.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.If bacteria do not remain in one area but spread through the bloodstream, the infection is called septicemia and can be rapid and life-threatening.^ One study suggested that sutureless securement devices reduced the catheter-related bloodstream infections rates when compared with suture securement.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Although systemic catheter-related infection is rare, it can be life threatening once it occurs, especially in immunocompromised patients.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Although the overall risk for extrinsic contamination of multidose vials is likely minimal ( 168 ), the consequences of contamination might result in life-threatening infection ( 169,170 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.An infected central IV poses a higher risk of septicemia, as it can deliver bacteria directly into the central circulation.^ An infected central IV poses a higher risk of placing the bag above the level of the patient and septicemia, as it can deliver bacteria directly into using the clamp to regulate the rate; this is a the central circulation.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Because all of IV fluids these veins are larger than peripheral veins, There are two types of fluids that are used for central lines can deliver a higher volume of fluid intravenous drips; crystalloids and colloids.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein ( 22,53,54 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

Phlebitis

.Phlebitis is irritation of a vein that may be caused by infection, the mere presence of a foreign body (the IV catheter) or the fluids or medication being given.^ Most notable are potential adverse effects of administered medications and the possibility of thrombosis and infection related to IV catheters.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Particulate matter may cause localized phlebitis ( Marshall 1987 ).
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

^ In PID patients, infections are frequent and may cause progressive tissue damage that can be severe and life threatening.
  • Immune Globulin Therapy* 22 January 2010 20:18 UTC www.wellmark.com [Source type: Academic]

.Symptoms are warmth, swelling, pain, and redness around the vein.^ Patients should be monitored for symptoms of thrombus, which include swelling or pain in the chest, shoulder, or cannulated arm.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ A drug that reduces pain, fever, swelling, and redness.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

^ Redness, swelling, pain, and/or a feeling of heat in an area of the body.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

.The IV device must be removed and if necessary re-inserted into another extremity.^ An IV needle is inserted into your arm or hand allowing a drug called EDTA to drip into your bloodstream over a period of 1 1/2 to 3 hours.

^ It does not electrical device that may also heat the fluid necessarily mean the IV device must be being infused.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Cleanse the access diaphragm of multidose vials with 70% alcohol before inserting a device into the vial ( 236 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

.Due to frequent injections and recurring phlebitis, scar tissue can build up along the vein.^ Within 7-10 days of catheter insertion, scar tissue grows onto the cuff, anchoring the catheter and preventing microorganisms from migrating up the tunnel.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Nevertheless, as the body ages, calcium builds up progressively in all tissues.
  • Chelation Therapy, intravenous edta chelation therapy, medical information 22 January 2010 20:18 UTC www.medical-library.net [Source type: Academic]

.The peripheral veins of intravenous drug addicts, and of cancer patients undergoing chemotherapy, become sclerotic and difficult to access over time, sometimes forming a hard “venous cord”.^ Peripheral Difficult Venous Access in Children Rauch et al.
  • Arch Pediatr Adolesc Med -- Enteral vs Intravenous Rehydration Therapy for Children With Gastroenteritis: A Meta-analysis of Randomized Controlled Trials, May 2004, Fonseca et al. 158 (5): 483 22 January 2010 20:18 UTC archpedi.ama-assn.org [Source type: Academic]

^ Peripheral access is difficult to attain.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

Infiltration

.Infiltration occurs when an IV fluid accidentally enters the surrounding tissue rather than the vein.^ Extravasation results when these medications infiltrate into the skin, causing necrosis of the surrounding tissue and muscle.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ Category IB B. Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs ( 67,68 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ However, the use of steel needles frequently is complicated by infiltration of intravenous (IV) fluids into the subcutaneous tissues, a potentially serious complication if the infused fluid is a vesicant ( 68 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

It is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is usually not painful. .It is treated by removing the intravenous access device and elevating the affected limb so that the collected fluids can drain away.^ Aspirate residual fluid from IV access device before its removal.
  • INTRAVENOUS/ARTERIAL 22 January 2010 20:18 UTC www.uiowa.edu [Source type: Academic]

^ Blood Intravenous access devices draws are typically taken with specialized IV access sets known as phlebotomy kits, and once Needle and syringe the draw is complete, the needle is removed and the site is not used again.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

^ Collect assessment data; Cannulate and perform dialysis treatment via an implanted subcutaneous vascular device, and/or peripheral access sites (AV fistulas and AV grafts).
  • Supply, Demand, and Use of Licensed Practical Nurses 22 January 2010 20:18 UTC bhpr.hrsa.gov [Source type: Academic]

.Infiltration is one of the most common adverse effects of IV therapy and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue, in which case the incident is known as extravasation.^ Foscarnet's most common serious adverse event is reversible nephrotoxicity.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ IVT is associated with complications related to rapid over-correction of electrolyte imbalances [ 13 ], extravasation of infused solutions into surrounding tissues [ 14 ], and infection or inflammation [ 14 ].
  • BioMed Central | Full text | Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials 22 January 2010 20:18 UTC www.biomedcentral.com [Source type: Academic]

^ There are no known adverse effects from the use of IV in-line filters.
  • Intravenous in-line filters for preventing morbidity and mortality in neonates 22 January 2010 20:18 UTC www.nichd.nih.gov [Source type: Academic]

Fluid overload

.This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete.^ This error is compounded by a perceived need to excrete a larger urine volume with a more ‘comfortable’ urine osmolality.
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ Hypertonic fluids Contain a higher number of molecules than serum so the fluid shifts from the interstitial space to the intravascular space (represented by the green arrows).

^ Therefore, if the fundamental problem is antidiuresis rather than natriuresis, the principle of treatment is to reduce fluid given rather than giving more salt.
  • NUS : Department of Paediatrics 22 January 2010 20:18 UTC www.med.nus.edu.sg [Source type: Academic]

.Possible consequences include hypertension, heart failure, and pulmonary edema.^ Other possibilities include lipid deposits or precipitates, catheter malposition, and mechanical failure.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

Electrolyte imbalance

.Administering a too-dilute or too-concentrated solution can disrupt the patient's balance of sodium, potassium, magnesium, and other electrolytes.^ Potassium and magnesium may be combined in IV solution at various concentrations.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ If it must be administered peripherally, foscarnet should be diluted with NS to a concentration of 12 mg/mL or less.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

^ Excretion of concentrated urine and extra renal work One reason proposed to infuse electrolyte-free water to hospitalized patients is to minimize the work of the kidney.
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

.Hospital patients usually receive blood tests to monitor these levels.^ Hospital patients usually receive blood tests to monitor these levels.

^ Reducing these influences helps to normalize the balance between prostacyclin levels and thromboxane, and reduce the risk of "sticky" platelets and blood clots that can block an artery.

^ Potassium is ordered when a doctor is diagnosing and evaluating high blood pressure (hypertension) and kidney disease and when monitoring a patient receiving dialysis, diuretic therapy , or intravenous therapy .
  • Intravenous Therapy - Kosmix : Reference, Videos, Images, News, Shopping and more... 22 January 2010 20:18 UTC health.kosmix.com [Source type: Academic]

Embolism

.A blood clot or other solid mass, as well as an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel; this is called embolism.^ Reducing these influences helps to normalize the balance between prostacyclin levels and thromboxane, and reduce the risk of "sticky" platelets and blood clots that can block an artery.

^ Blood flow and oxygenation definitely are improved with the use of EDTA and what we know now is that the smallest (microscopic) arterial vessels (called "arterioles") open up and provide a physiologic bypass around hard plaque.
  • Chelation Therapy, intravenous edta chelation therapy, medical information 22 January 2010 20:18 UTC www.medical-library.net [Source type: Academic]

^ Some CVADs have a 2-way valve on their distal ends that allows both blood drawing and IV infusion while preventing blood from entering the catheter when not in use.
  • Outpatient Administration of Intravenous Therapies in Patients with HIV Infection 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

.Peripheral IVs have a low risk of embolism, since large solid masses cannot travel through a narrow catheter, and it is nearly impossible to inject air through a peripheral IV at a dangerous rate.^ Peripheral IVs have a low risk of embolism, since large solid masses cannot travel through a narrow catheter, and it is nearly impossible to inject air through a peripheral IV at a dangerous rate.

^ Example: peripheral IV catheter.

^ This has several advantages usually in the arm, and then carefully advanced over a peripheral IV: upward until the catheter is in the superior vena cava or the right atrium.
  • Intravenous Therapy 22 January 2010 20:18 UTC www.slideshare.net [Source type: FILTERED WITH BAYES]

The risk is greater with a central IV.
.Air bubbles of less than 30 milliliters are thought to dissolve into the circulation harmlessly.^ Air bubbles of less than 30 milliliters generally dissolve into the circulation harmlessly.

^ A blood clot or other solid mass, or an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel; this is called embolism.

.Small volumes do not result in readily detectable symptoms, but ongoing studies hypothesize that these "micro-bubbles" may have some adverse effects.^ These adverse effects are occasionally fatal.
  • Arch Dermatol -- Corticosteroid-Sparing Effect of Intravenous Immunoglobulin Therapy in Patients With Pemphigus Vulgaris, September 2002, Sami et al. 138 (9): 1158 22 January 2010 20:18 UTC archderm.ama-assn.org [Source type: Academic]

^ Some of these studies have looked at the effects of stopping therapy.

^ Prospective study of the adverse effects of IV lignocaine in 106 patients with fibromyalgia; retrospective questionnaire study of the efficacy of IV lignocaine in 50 patients with fibromyalgia.
  • BioMed Central | Full text | Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome 22 January 2010 20:18 UTC www.biomedcentral.com [Source type: Academic]

.A larger amount of air, if delivered all at once, can cause life-threatening damage to pulmonary circulation, or, if extremely large (3-8 milliliters per kilogram of body weight), can stop the heart.^ To deliver large amounts of fluid, you should select a large vein and use a 14 or 16-gauge catheter.

^ The body gradually accumulates toxic metals and these metals do most of their damage because they cause extremely large quantities of free radicals to be produced in the body -- without themselves being "used up."
  • Full Explanation Of Intravenous Chelation Therapy -- IV Chelation 22 January 2010 20:18 UTC www.oralchelation.com [Source type: FILTERED WITH BAYES]
  • Chapter Eleven:  Intravenous Chelation Therapy.  Medicine's Modern Miracle! 22 January 2010 20:18 UTC www.oralchelation.net [Source type: FILTERED WITH BAYES]

^ This heat must be dissipated to avoid a life-threatening rise in body temperature.
  • How to select optimal maintenance intravenous fluid therapy -- Shafiee et al. 96 (8): 601 -- QJM 22 January 2010 20:18 UTC qjmed.oxfordjournals.org [Source type: Academic]

.One reason veins are preferred over arteries for intravascular administration is because the flow will pass through the lungs before passing through the body.^ Dissection of a vein or artery for insertion of a cannula or needle for the administration of intravenous fluids or medication, or for measurement of pressure.
  • Intravenous Fluid - Kosmix : Reference, Videos, Images, News, Shopping and more... 22 January 2010 20:18 UTC www.kosmix.com [Source type: General]

^ Caution also should be exercised when veins of the anterior forearm are used because the radial and ulnar nerves weave through the area.
  • Choosing the Right Intravenous Catheter 22 January 2010 20:18 UTC www.nursingcenter.com [Source type: Academic]

^ A surgical procedure during which the circulation of blood to the lungs is separated from the circulation of blood through the rest of the body, and a drug is delivered directly into the lung circulation.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

.Air bubbles can leave the blood through the lungs.^ Blood and fluids can enter or leave the body through the port using a special needle.

^ A surgical procedure during which the circulation of blood to the lungs is separated from the circulation of blood through the rest of the body, and a drug is delivered directly into the lung circulation.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

^ It also clears the lungs in cases of emphysema by producing oxygen bubbles in the alveoli (tiny air sacs in the lungs) and literally lifting the mucus deposits out so they can be coughed out.
  • Intravenous Hydrogen Peroxide Therapy 22 January 2010 20:18 UTC www.gordonresearch.com [Source type: FILTERED WITH BAYES]

.A patient with a heart defect causing a right-to-left shunt is vulnerable to embolism from smaller amounts of air.^ Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.
  • Left Ventricular Assist Device as Destination for Patients Undergoing Intravenous Inotropic Therapy: A Subset Analysis From REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure) -- Stevenson et al. 110 (8): 975 -- Circulation 22 January 2010 20:18 UTC circ.ahajournals.org [Source type: Academic]

^ The one way valve at the catheter tip will remain closed during the insertion and prevent air from flowing through the catheter and causing an air embolism.
  • Methods and apparatus for intravenous therapy and hyperalimentation - Patent 4431426 22 January 2010 20:18 UTC www.freepatentsonline.com [Source type: Reference]

^ So, generally, most people have the right amount of calcium in their arteries to keep the heart contracting properly.
  • Full Explanation Of Intravenous Chelation Therapy -- IV Chelation 22 January 2010 20:18 UTC www.oralchelation.com [Source type: FILTERED WITH BAYES]

.Fatality by air embolism is vanishingly rare, in part because it is also difficult to diagnose.^ Fatality by air embolism is vanishingly rare, in part because it is also difficult to diagnose.

Extravasation

.Extravasation is the accidental administration of IV infused medicinal drugs into the surrounding tissue which are caustic to these tissues, either by leakage (e.g.^ IVT is associated with complications related to rapid over-correction of electrolyte imbalances [ 13 ], extravasation of infused solutions into surrounding tissues [ 14 ], and infection or inflammation [ 14 ].
  • Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials 22 January 2010 20:18 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Category IB B. Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs ( 67,68 ).
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ IV usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein.
  • Dictionary of Cancer Terms - National Cancer Institute 22 January 2010 20:18 UTC www.cancer.gov [Source type: Academic]

because of brittle veins in very elderly patients), or directly (e.g. because the needle has punctured the vein and the infusion goes directly into the arm tissue). .This occurs more frequently with chemotherapeutic agents and people who have tuberculosis.^ In patients who continue to require hemodynamic monitoring, pulmonary artery catheters do not need to be changed more frequently than every 7 days.
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections 20 November 2009 7:21 UTC www.cdc.gov [Source type: Academic]

^ Encephalitis occurs more frequently with zoster in the ophthalmic distribution, and cerebellar findings are typical; prominent symptoms include ataxia, tremors, and dizziness.
  • Varicella-Zoster Virus and HIV 22 January 2010 20:18 UTC hivinsite.ucsf.edu [Source type: Academic]

See also

References

  1. ^ CDC Morbidity and Mortality Weekly Report Aug 2002. "Guidelines for the Prevention of Intravascular Catheter-Related Infections". http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm. Retrieved 2008-03-13. 
  2. ^ a b c An Update on Intravenous Fluids by Gregory S. Martin, MD, MSc

External links


Citable sentences

Up to date as of December 20, 2010

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