IV THERAPY: NURSE’S ROLE Nutcharee Jungvanichar RN, MBA
IV THERAPY: NURSE’S ROLE
Nutcharee Jungvanichar RN, MBA
ความปลอดภยัในการบริหารสารน ้า
Free from particulate contamination and
micro-organisms including pyrogens.
The fluids and the accessories must be sterile and free of micro-organisms.
Microbial contamination can cause serious
impact (local infection, septic thrombophlebitis or primary bloodstream infection).
Infusion Equipment
Infusion Equipment
Add-on devices
Luer-locked design
Disinfect the port (using friction)
The use of stop cock is not recommended
Needleless connector
Nurse should be knowledgeable about the function
Nurse should be aware that the catheter hub is a know
source of infection
Infusion Equipment
Filters
Infusion Equipment
Flow - control device
Electronic infusion device with administration based ,
anti free flow mechanisms shall be used
Dose –error reduction system shall be considered in
selection and use of electronic infusion devices
The nurse should be involved in the evaluation and
selection of flow –control devices
Infusion Equipment
Tourniquets
The tourniquet should be single-patient use
Latex allergy should be assesses
Hand Hygiene
Site Care And Maintenance
Site Care And Maintenance
Set change:
IV: No more frequency than 96 hrs.
Parenteral Nutrition : should be routine change every
24 hrs
Blood and blood product: should be replace every 4
hrs
Site Care And Maintenance
Flushing and Locking
Single use system include single-dose vial and prefilled
syringe are the preferred choice of flushing
Infusion Therapy
Pharmacist
Nurse, infusion nurse
Nurse, infusion nurse
Nurse, infusion nurse
Types of IV Fluid Containers
There are generally three types of IV fluid containers in use globally.
Rigid containers which are made of glass, High Density Polyethylene (HDPE) or Polypropylene (PP)
Semi-rigid containers which are made of Polyethylene (PE) or Polypropylene (PP)
Flexible bags which are made of polyvinyl chloride (PVC), or Polyolefin laminate
Open Infusion System
Open Infusion Container –
Glass container with air filter. Open Infusion Container –
Semi-rigid container with air filter.
The chance of contamination in an open system is 10 times more than the closed system.
Any device which has tubes with one end inside the body and one outside can cause contamination. These include urinary catheters, IV fluid bags, endotracheal tube, etc. These should be closed systems so as to prevent contamination.
Open Infusion System
Closed Infusion Container-
Fully collapsible plastic container without air filter
Closed Infusion System
In North America, Europe and Australia, a closed IV system is the minimum acceptable standard.
It is dependent on the understanding of the inherent risks associated with open IV systems and the risks can be avoided by using a closed IV system.
Acceptance of closed Infusion System
The main reasons for acceptance of the closed IV
system are:
a) Patient safety and reduce infection risk.
b) Reduce costs of treatment as a result of patients
not prolonging their stay in hospitals.
c) Improved quality care delivery in hospitals.
d) Meeting regulatory authorities to ensure best
practices.
Acceptance of closed Infusion System
Results
CLABSI was significantly decreased
(81%) in the closed container
Should we use closed or open infusion containers for prevention of bloodstream infections?
Should we use closed or open infusion containers for prevention of bloodstream infections?
Central line Bundle
Hand Hygiene
Maximal Barrier Precautions
Chlorhexidine Skin Antisepsis
Optimal Catheter Site Selection
Assessment of Central Line Necessity
2012 Highlight
• Scrub the hub 15 seconds prior accessing the line
• Daily assessment
Scrub the hub
Scrub with friction 15 sec.
…We can not predict the future but we can create it… from INS 2012
Thank You for Your Attention