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IV Management

IV Management. Jan Bazner-Chandler RN, MSN, CNS, CPNP. Central Venous Catheter. Central Line Bundle. Hand Hygiene Maximal barrier precautions upon insertion Chlorhexidine skin antisepsis Optimal catheter site selection; subclavian vein is the preferred site for non-tunneled catheter

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IV Management

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  1. IV Management Jan Bazner-Chandler RN, MSN, CNS, CPNP

  2. Central Venous Catheter

  3. Central Line Bundle • Hand Hygiene • Maximal barrier precautions upon insertion • Chlorhexidine skin antisepsis • Optimal catheter site selection; subclavian vein is the preferred site for non-tunneled catheter • Daily review of line necessity with prompt removal of unnecessary lines

  4. CA-BSI • Central venous catheter-associated blood stream infection • Three criteria for diagnosis

  5. Criterion I • A recognized pathogen in the blood found from one or more blood cultures, and the pathogen is not related to an infection at another site.

  6. Criterion 2 • Patient has at least one of the following signs or symptoms: fever (over 100.4 F or 38 C, chills, hypotension and • Positive laboratory results not related to infection at another site • Common skin contaminant identified in two separate cultures taken within 48 hours of each other.

  7. Criterion 3 • A patient less than one year old has at least one of the following signs or symptoms: fever (over 100.4 F or 38 C) or hypothermia (under 98.6 F 37 C) apnea, or bradycardia and • Positive laboratory results not related to an infection at another site • Common skin contaminant found in two blood draws – within 48 hours

  8. Risk Factors • Three lumen catheters • TPN running through central line • Inexperienced physician inserting line • Low patient – nurse ratio • Long – term catheter • Special care units

  9. Total Parental Nutrition A tunneled catheter should have An occlusive dressing in place. Whaley & Wong

  10. TPN Therapy • TPN provides complete nutrition for children who cannot consume sufficient nutrients through gastrointestinal tact to meet and sustain metabolic requirements. • TPN solutions provide protein, carbohydrates, electrolytes, vitamins, minerals, trace elements and fats.

  11. TPN: care reminder caREminder: • The TPN infusion rate should remain fairly constant to avoid glucose overload. The infusion rate should never be abruptly increased or decreased. • Bag and tubing need to be changed every 24 hours.

  12. Complications of TPN • Sepsis: infection • Liver dysfunction • Respiratory distress from too –rapid infusion of fluids

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