Transcript 3 layers of vessel walls

Do you know what you are really infusing into your patients’ veins?
Why not?
Abstract
It is well known that specific infusions may cause harm
when delivered through peripheral vascular devices.
Clinicians who prescribe or infuse these specific infusions
may be unaware and may place patients at risk of harm.
Whose job is it to say, “No, not that vascular device?” Risk
factors such as thrombosis, infiltrations, phlebitis, and
extravasations may occur when these infusions are
delivered through a peripheral vein. With the drive to
reduce central lines, we have put our patients at risk of
vascular injury from infusions delivered through peripheral
vascular devices.
Much research has focused on the prevention of
infections, complications, and vascular access devices,
and less on matching infusions with proper vascular
devices to prevent patient complications. Concern for
patient care plus the rise in lawsuits from patient
complications, means this issue demands the attention of
health professionals.
Objectives
1. To increase awareness of the risk of peripheral
complications from infusions that really belong in
central vascular devices.
2. To prevent patient harm by educating nurses,
physicians, pharmacists, and the patients by making
correct choices in vascular access devices.
Blood is a Buffer
What we add to the blood
changes and affects the
vessels health. The rate,
flow, and frequency of these
infusions over time may
cause harm.
Flow of Potential Harm
Current Interdisciplinary Approach to
Correct Vascular Access Choices
• The patient requires antibiotics,
fluids or nutritional replacement,
chemotherapy, etc…
• The physician orders the infusion.
• The pharmacist checks the order
and sends the infusion to the
patient’s unit.
• The vascular access is previously or
newly obtained by IV team or staff
nurse.
• Primary nurse hangs the infusion.
• After the infusion is hung the
decisions are made as to the
correct vascular device closer to
discharge or after complications
have decreased available access.
Chemical Injury
Mast cells found in all connective tissues are granular cells whose
actions include being released with inflammation; such as when
chemical injury occurs from infusions,.
Infusions that May Cause Harm
Infusion
Amiodarone
Ampicillin
Ciprofloxacin
Dobutamine HCL
Dopamine HCL
Doxycycline
pH
4.1
8 – 10
3.3 – 4.6
3.5
3.3
1.8 – 3.3
Infusion
Gentamicin
Levofloxacin
Phenytoin
Sulfamethoxazole/Trimethoprim
Tobramycin
Vancomycin
pH
3 – 5.5
3.8 – 5.8
12
10
3 – 6.5
2.5 – 4.5
Osmolarity >
600
Imagine that
your hands
and the pot holder
are your vein.
How long could you
hold a very hot cast
iron pot until you
had to put it down
or risk burning your
hands?
Blood as a
buffer
Viscous
• Relationship with hospital pharmacists, physicians, and nursing to
discuss patient safety regarding infusions.
• Investigate the patient’s medical record and see the length of
expected stay.
• Speak directly to physicians ordering infusions and make them
aware of the risks involved when giving certain infusions via the
peripheral veins. Suggest the correct access.
• Educate primary nurses about the increased risk of certain
infusions helping them to better understand the rationale to check
peripheral vascular access sites frequently.
Where to Find Available
Infusion Information
pH > 9
•
•
•
•
Infusion package inserts
Pharmacological books
FDA
Websites
Who is checking the pH,
osmolarity, and viscosity of
these infusions?
Results
How many infusions before
the vein says, “too much?”
Our patients place trust in us that we are infusing
medication to get them well and not cause harm.
Size counts in variation
in blood flow rate
Suggested Interdisciplinary Approach
to Correct Vascular Access Choices
• Patient requires specific infusion. The patient might receive one or two
peripheral doses before team can meet.
• Physician, nurse, and pharmacists discuss the need and length of time for
the specific infusion as close to admission as possible.
• As soon as possible a better vascular device is placed for the specific
infusion based upon the expected length of admission, pH, osomolarity, and
vascular condition of the patient.
• Improved outcomes and benefits from evaluating vascular access early is
less delay of infusions, less complications, improved patient satisfaction,
and possible earlier discharge.
Methods to Make Change Happen
pH < 5
Hold a
Hot Pot
Sara Fort, RN , VA-BC
Blood Vessel Structure
3 layers of vessel walls:
• Tunica intima
• Tunica media
• Tunica advenitia
• Small vessels/capillaries
1ml/minute
• Medium vessels 16 ml/minute
• Large vessels 256 ml/minute
• Flow is dependent upon
gravitational pressure, venous
pressure and the health of the
vessels.
• No change will happen, unless the nurse speaks up.
• Change of process, such as using the correct vascular device,
depends on either the primary or vascular access nurse speaking up
in the situation, preventing patient harm.
• Physicians who answer, “We have always done it this way,” do not
have the right answer based upon possible risk to patient outcomes.
• No change will happen, unless the physician listens.
Conclusion
• Providing safer outcomes for patients through the education of
health professionals on vascular infusions and correct vascular
devices is the right thing to do.
• Lawsuits averaging $100,000 are on the rise from patients
receiving harm from peripheral vascular devices or complications
from infusions.
• It is up to every health care professional to know and question: Is
this infusion safe to go into a peripheral device?
• It is up to every healthcare individual develop an index or resources
of known infusions that place the patient at risk of potential harm
and be proactive in placing correct devices.
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Gahart BL, Nazareno AR. Vancomycin Hydrochloride. In Gahart BL, Nazareno AR. (editors) 2013 Intravenous Medications. 29th Edition, pages 1162-1166. Elsevier, Mosby: St. Louis, Missouri. 2013. • Hadaway LC. Anatomy and Physiology Related to Infusion Therapy. In Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R. (editors) Infusion Nursing: An Evidence-Based Approach.
3rd Edition, Chapter 10, pages 139-175. Elsevier, Saunders: St. Louis, Missouri. 2010. • Perucca R. Peripheral Venous Access Devices. In Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R. (editors) Infusion Nursing: An Evidence-Based Approach. 3rd Edition, Chapter 23, pages 456-479. Elsevier, Saunders: St. Louis, Missouri. 2010. • Stranz M. Adjusting pH and Osmolarity Levels
to Fit Standards and Practices. JVAD Fall 2002 • Stranz M. Understanding pH and Osmolarity of Infusion Solutions: What is Reasonable? Presented at the 15th Annual National Association of Vascular Access Networks Conference. January 19, 2002. Alexandria, Virginia Stranz M. Kastango ES. A Review of pH and Osmolarity. International Journal of Pharmaceutical Compounding.
2002 May-June;6(3):216-220. • Trissel LA. Vancomycin Hydrocloride. In Trissel LA. (author) Handbook of Injectable Drugs. 15th Edition, pages 1548-1562. ASHP: Bethesda, Maryland. 2009. • Turner MS, Hankins J. Pharmacology. In Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R. (editors) Infusion Nursing: An Evidence-Based Approach. 3rd Edition, Chapter 15, pages 263298. Elsevier, Saunders: St. Louis, Missouri. 2010. • Special thank you to Kim Carmel for designing this ePoster.