17.3 Circulatory Support Interventions

Circulatory support interventions are crucial in managing patients with cardiovascular issues. These techniques, including IV fluid therapy and blood transfusions, help maintain adequate blood flow and oxygen delivery throughout the body. Understanding these interventions is key to providing effective care for patients with circulatory problems.

Nurses play a vital role in implementing and monitoring these interventions. From inserting IV catheters to administering blood products, nurses must be skilled in various techniques. They also need to be vigilant in monitoring for complications and quick to respond to any adverse reactions, ensuring patient safety throughout the process.

Venipuncture and IV Catheter Insertion

Venipuncture Techniques and Considerations

• Venipuncture obtains venous blood samples or gains vascular access for intravenous therapy
• Select appropriate veins typically in the antecubital fossa or forearm
• Use anatomical landmarks and palpation techniques to identify suitable veins
• Knowledge of vein valves and branching patterns aids successful procedures
• Proper patient positioning and tourniquet use essential for vein distention and accessibility
  • Apply tourniquet for no more than 1-2 minutes to prevent hemoconcentration
• Potential complications include hematoma formation, nerve injury, arterial puncture, and phlebitis
  • Recognize and manage these complications promptly to ensure patient safety

Peripheral IV Catheter Insertion

• Requires strict aseptic technique to prevent infection
• Select appropriate catheter size based on patient needs and vein condition
• Procedure steps:
  1. Assess and select suitable vein
  2. Cleanse insertion site with antiseptic solution
  3. Insert catheter at appropriate angle
  4. Advance catheter into vein and remove needle
  5. Secure catheter and apply sterile dressing
• Potential complications mirror those of venipuncture with additional risks of infiltration and extravasation

Documentation and Patient Education

• Document procedure details including:
  • Site selection
  • Catheter size
  • Number of attempts
  • Patient response
• Provide patient education on:
  • Care of insertion site
  • Signs of complications to report (redness, swelling, pain)
  • Activity restrictions if applicable
• Educate patients on purpose of procedure and what to expect during and after

Circulatory Support Interventions

Intravenous Fluid Therapy

• Indications include fluid resuscitation, electrolyte imbalance correction, and medication administration
• Contraindications involve fluid overload states and certain electrolyte disturbances
• Potential complications:
  • Fluid overload leading to pulmonary edema
  • Electrolyte imbalances (hyponatremia, hyperkalemia)
  • Catheter-related infections
• Monitor for signs of complications:
  • Increased respiratory rate or difficulty breathing
  • Swelling in extremities or face
  • Changes in mental status

Blood Transfusions

• Indications include severe anemia, acute blood loss, and certain hematological disorders
• Contraindications involve religious objections and previous severe transfusion reactions
• Complications categorized as acute or delayed reactions:
  • Acute: allergic responses, febrile non-hemolytic reactions, acute hemolytic reactions
  • Delayed: alloimmunization, transfusion-associated graft-versus-host disease
• Patient-specific blood management strategies aim to minimize allogeneic blood transfusions
  • Preoperative anemia management (iron supplementation)
  • Intraoperative blood conservation techniques (cell salvage)

Blood Products and Administration

• Different types of blood products with specific indications:
  • Packed red blood cells (severe anemia)
  • Fresh frozen plasma (coagulation factor deficiencies)
  • Platelets (thrombocytopenia or platelet dysfunction)
• Appropriate administration techniques crucial for safe and effective transfusion therapy
  • Use blood warmers for rapid transfusions
  • Administer through dedicated IV line with appropriate filter
• Monitor vital signs closely before, during, and after transfusion

Intravenous Medication Administration

The '5 Rights' of Medication Administration

• Right patient: verify patient identity using two identifiers
• Right drug: check medication label against order
• Right dose: double-check calculations and dilutions
• Right route: confirm IV access is patent and appropriate for medication
• Right time: administer at prescribed time or within allowed time frame

IV Medication Considerations

• Knowledge required for safe administration:
  • Drug compatibility with IV fluids and other medications
  • Reconstitution techniques for powdered medications
  • Appropriate infusion rates (bolus, intermittent, continuous)
• Assess IV site patency and functionality before administration
  • Check for signs of infiltration or phlebitis
• Understand pharmacokinetics and pharmacodynamics specific to IV medications
  • Onset of action often faster than other routes
  • Potential for more immediate side effects

Medication Calculations and Documentation

• Accurate calculation essential for:
  • Drug dosages (mg/kg, mcg/kg/min)
  • Infusion rates (mL/hr)
  • Drip rates (drops/min)
• Proficiency in using infusion pumps and other delivery devices required
• Document medication administration details:
  • Time of administration
  • Dose and route
  • Patient response
  • Any adverse reactions observed

Circulatory Support Monitoring

Vital Signs and Physical Assessment

• Continuously assess vital signs:
  • Blood pressure (hypotension or hypertension)
  • Heart rate (tachycardia or bradycardia)
  • Respiratory rate (tachypnea)
  • Oxygen saturation (hypoxemia)
• Monitor for signs of fluid overload:
  • Increased jugular venous distension
  • Crackles on lung auscultation
  • Peripheral edema (pitting edema in extremities)

Transfusion Reaction Monitoring

• Vigilantly watch for signs of allergic reactions or anaphylaxis:
  • Urticaria (hives)
  • Dyspnea (shortness of breath)
  • Hypotension (sudden drop in blood pressure)
• Be prepared to implement emergency protocols:
  • Stop transfusion immediately
  • Notify healthcare provider
  • Administer emergency medications as ordered (epinephrine, antihistamines)

IV Site and Catheter Monitoring

• Regularly assess IV insertion sites for:
  • Signs of infection (redness, warmth, purulent drainage)
  • Infiltration (swelling, coolness of surrounding tissue)
  • Phlebitis (redness and pain along the vein)
• Early detection and intervention can prevent serious complications
  • Remove and replace catheter if complications arise
  • Document findings and interventions

Specialized Monitoring Techniques

• Understand specific monitoring requirements for different interventions:
  • Central venous pressure monitoring for fluid resuscitation
  • Hemodynamic monitoring in critically ill patients (cardiac output, stroke volume)
• Familiarize with institutional protocols for managing adverse reactions
  • Know when to notify healthcare provider
  • Be prepared to initiate emergency measures
• Proficiently document patient responses, adverse reactions, and effectiveness of nursing interventions
  • Ensure clear communication between healthcare team members
  • Maintain accurate legal record of patient care