ATI COMPREHENSIVE MEDS FOR CARDIAC

ATI COMPREHENSIVE MEDS FOR

CARDIAC

1.COMPLICATIONS ASSOCIATED WITH IV INFUSION

A.Infiltration i.Prevention 1.Use smallest catheter for prescribed therapy, stabilize port-access, assess blood return ii.Treatment 1.Stop infusion, remove peripheral catheters, apply cold compress, elevate extremity, insert new catheter in opposite extremity B.Extravasation i.Prevention 1.Know vesicant potential before giving medication ii.Treatment 1.Stop infusion, discontinue administration set, aspirate drug if possible, apply cold compress, document condition of site (may photograph) C.Phlebitis/thrombophlebitis i.Prevention 1.Rotate sites every 72 to 96 hours, secure catheter, use aseptic technique; for PICCs, avoid excessive activity with the extremity ii.Treatment 1.Stop infusion, remove peripheral IV catheters, apply heat compress, insert new catheter in opposite extremity D.Hematoma i.Prevention 1.Avoid veins not easily seen or palpated; obtain hemostasis after insertion ii.Treatment 1.Remove IV device and apply light pressure if bleeding; monitor for signs of phlebitis and treat E.Catheter embolus i.Prevention

1.Do not reinsert stylet needle into catheter ii.Treatment 1.Immediately apply tourniquet high on extremity to limit venous flow 2.Prepare for removal under x-ray

2.COMPLICATIONS ASSOCIATED WITH CENTRAL VENOUS

CATHETERS

A.Pneumothorax (during insertion) i.Prevention 1.Use ultrasound to locate veins, avoid subclavian insertion when possible ii.Treatment 1.Administer oxygen, assist provider with chest tube insertion B.Air embolism i.Prevention 1.Have client lie flat when changing administration set or needleless connectors, ask client to perform Valsalva maneuver if possible ii.Treatment 1.Place client in left lateral Trendelenburg, administer oxygen C.Lumen occlusion i.Prevention 1.Flush promptly with NS between, before, and after each medication ii.Treatment 1.Use 10 mL syringe with a pulsing motion D.Bloodstream infection i.Prevention 1.Maintain sterile technique ii.Treatment 1.Change entire infusion system, notify provider, obtain cultures, and administer antibiotics

3.COMPLICATIONS ASSOCIATED WITH PICC LINE

A.Catheter occlusions i.Prevent kinks, reposition arm, confirm blood return, flush catheter between medications, administer approved antithrombolytic B.Catheter dislodges 2

i.Assess blood return, discomfort in jaw, chest, or ear, contact provider C.Phlebitis i.Apply low degree heat, discontinue if not resolved D.Catheter embolism i.Secure catheter, avoid pulling, following safe practices for catheter removal E.Infection i.Use aseptic technique, keep dressing clean and dry, intervene immediately for any sign of infection.

4.TOTAL PARENTERAL NUTRITION (TPN)

A.Care and Maintenance of TPN i.Before administering, verify prescription and solution with another nurse ii.Administer via infusion pump iii.Monitor weight daily iv.Monitor and record I&O, noting fluid balance v.Monitor serum glucose levels every 4 to 6 hours vi.Monitor for signs of infection vii.Change dressing every 48 to 72 hours per facility protocol viii.Change IV tubing and fluid every 24 hours ix.If TPN solution is temporarily unavailable, administer dextrose 10% in water to prevent hypoglycemia

5.ANTIDOTE/REVERSAL AGENTS

A.Acetaminophen i.Acetylcysteine B.Benzodiazepine i.Flumazenil C.Curare i.Edrophonium D.Cyanide poisoning i.Methylene blue E.Digitalis i.Digoxin immune FAB F.Ethylene poisoning 3

i.Fomepizole G.Heparin and enoxaparin i.Protamine sulfate H.Iron i.Deferoxamine I.Lead i.Succimer J.Magnesium sulfate i.Calcium gluconate 10% K.Narcotics i.Naloxone L.Warfarin i.Phytonadione (vitamin k)

6.THERAPEUTIC DRUG LEVELS

A.Aminophylline i.10 to 20 mcg/mL B.Carbamazepine i.5 to 12 mcg/mL C.Digoxin i.0.8 to 2.0 ng/mL D.Gentamicin i.5 to 10 mcg/mL E.Lidocaine i.1.5 to 5.0 mcg/mL F.Lithium i.0.4 to 1.4 mEq/L G.Magnesium sulfate i.4 to 8 mg/dL H.Phenobarbital i.10 to 40 mcg/mL I.Phenytoin i.10 to 20 mcg/mL

ii.Salicylate: 100 to 250 mcg/mL

4