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