Infusion Equipment

After completing this chapter, the reader will be able to:

1.Define terminology related to infusion equipment.

2.Identify types and characteristics of solution containers.

3.Identify types and characteristics of administration sets.

4.Identify the three categories of peripheral IV catheters.

5.Discuss risk factors associated with the use of add-on devices including needleless connectors.

6.Describe the purpose of, and indications for, medication and solution filtration.

7.Discuss the rationale for and options for vascular access device securement.

8.Differentiate between site protection and joint protection.

9.Describe technologies used in vascular visualization.

10.Describe the use of infiltration detection technology.

11.Identify the different types of flow-control devices.

12.Describe the nurse's role in product selection, evaluation, and problem reporting.

Glossary ⬆ ⬇

Backcheck valve A device that functions to prevent retrograde solution flow
Cannula A flexible tube that may be inserted into a duct, cavity, or blood vessel to deliver medication or drain fluid. It may be guided by a sharp, pointed instrument (stylet); also called a catheter.
Drip chamber Area of the IV administration set usually found under the spike where the solution drips and collects before running through the IV tubing
Drop factor The number of drops needed to deliver 1 mL of fluid
Elastomeric pump A portable infusion device with a balloon (elastomeric reservoir) made of soft rubberized material that is inflated with medication to a predetermined volume; when the tubing is unclamped, positive pressure is exerted to deliver the infusion
Electronic infusion pump An infusion pump powered by electricity or battery; programmed to regulate the IV flow rate
Flow-control device Any instrument or method used to regulate the infusion rate
Filter A special porous device used for eliminating certain elements, as in particles of a certain size in a solution
Gauge Size of cannula opening; a standard of measurement
Hub Female connection point of an IV catheter where the IV administration set or syringe is attached
Infusate Refers to medications or solutions administered via an infusion
Lumen The space within a tubular structure, such as an artery, vein, or catheter
Luer-Lok A design that incorporates a threaded sleeve on a male Luer
Macrodrip In IV therapy, an administration set that delivers measured amounts of IV solutions at a specific flow rate based on the size of the drops of the solution
Microdrip An administration set that delivers the infusion with a drop factor of 60 drops/mL
Midline catheter A longer peripheral catheter that is placed in a peripheral vein, generally inserted about the antecubital fossa, with the catheter tip residing level at or near the level of the axilla and distal to the shoulder; in infants, a midline catheter may be placed in a scalp vein with the tip terminating in the jugular vein above the clavicle or in the leg with the tip below the inguinal crease
Multichannel pump Electronic infusion device that delivers multiple drugs or solutions simultaneously or intermittently from bags, bottles, or syringes
Needleless connector (NC) A device attached to the hub of the peripheral IV catheter or central vascular access device that allows the tip of a syringe or male Luer end of the IV administration set to be attached
Over-the-needle catheter A device that consists of a needle with a catheter sheath; the needle is removed, leaving a plastic catheter in place; the most common type of peripheral IV catheter
Patient-controlled analgesia (PCA) A drug delivery system that dispenses a preset intravascular dose of a narcotic analgesic when the patient pushes a switch on an electric cord
Port Point of entry
Primary administration set Device used for delivery of parenteral solutions
psi Pounds per square inch; a measurement of pressure: 1 psi equals ~ 50 mm Hg or ~ 70 cm H₂O
Radiopaque Material used in IV catheter that can be identified by radiographic examination
Secondary administration set Administration set that has short tubing used for delivery of 50 to 150 mL (or sometimes greater volumes of up to 500 mL) of infusion attached to primary administration set for intermittent delivery of medication or solutions
Stylet Needle or guide that is found inside a catheter; used for vein penetration and removed after catheter insertion
Syringe pump Piston-driven pumps that provide precise infusion by controlling the rate of drive speed and syringe size
Vascular access device (VAD) A catheter inserted into a vein or artery to administer fluids or medications or to measure pressure; includes peripheral and central vascular access devices and arterial catheters
VAD securement Refers to methods to reduce movement at the VAD insertion site.
Visualization technology The use of methods to visualize blood vessels and surrounding structures beneath the skin.

Introduction ⬆ ⬇

Infusion administration and vascular access device (VAD) care and management require a variety of supplies and equipment and often complex technology. Included are single-use devices, such as disposable solution containers, tubing, and VADs, and durable medical equipment including infusion pumps, IV poles, and visualization technology such as near infrared and ultrasound. Nurses must be well educated and competent in the clinical application and proper use of both supplies and equipment, and as end-users should be involved in the VAD and infusion product evaluation process (Gorski et al., 2021). Referring back to Chapter 2, remember that the U.S. Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen standard requires that staff have input into safe controls to reduce exposure. There is a relationship among the industry that develops and manufactures equipment, health-care providers, and patients that is collaborative and mutually dependent. The public holds industry, medical institutions, and professionals accountable for the safe and effective delivery of health care. Medical products and equipment are the collective responsibility of industry and medical professionals.

Nursing Process ⬆ ⬇

The nursing process is a six-step process for problem-solving to guide nursing action. Refer to Chapter 1 for details on the steps of the nursing process. The following table focuses on nursing diagnoses, nursing outcomes classification (NOC), and nursing interventions classification (NIC) for patients using infusion equipment. Nursing diagnoses should be patient specific and outcomes and interventions individualized. The NOC and NIC presented here are suggested directions for development of outcomes and interventions.

Nursing Diagnoses Related to Management of Infusion Equipment	Nursing Outcomes Classification (NOC)	Nursing Interventions Classification (NIC)
Anxiety (mild, moderate, or severe) related to: Unfamiliar situation, stressors (new equipment technology); role function; environment	Anxiety level, anxiety self-control, coping	Anxiety reduction; calming technique; coping enhancement
Deficient knowledge related to: Equipment: unfamiliarity with information resources, cognitive limitation, and information misinterpretation	Knowledge: Treatment procedure; treatment regimen (equipment use)	Teaching: Purpose of equipment; demonstrate equipment with return demonstration
Impaired physical mobility related to: Movement limitations due to presence of VAD/infusion administration	Ambulation; mobility	Ambulation; joint mobility; positioning
Injury, risk for related to: Physical barrier (e.g., IV tubing attached to infusion pump/pole)	Personal safety behaviour Safe home environment Knowledge: Fall prevention	Health education; environmental management; fall prevention

Source: Herdman et al., 2021; Ackley et al., 2020.

Chapter Highlights ⬆ ⬇

Solution containers include glass containers, plastic containers, syringes, and infusion pump-specific containers.
Administration sets include primary continuous and secondary sets and a variety of specialty sets for specific types of infusions (e.g., infusion pump specific, lipids, blood administration, nitroglycerin).
Categories of PIVCs include short and long PIVCs and midline catheters. These catheters may be placed via a variety of techniques, including the most common “over-the-needle” method and more complex techniques such as modified or accelerated Seldinger.
Add-on devices include extension sets, stopcocks, catheter connection devices (e.g., J loop), manifolds, filters, and NCs.
Needleless connector categories include negative displacement, positive displacement, neutral, and antireflux. It is important to apply the correct clamping sequence for the type of NC to reduce the risk for blood reflux and thus thrombotic occlusion. NCs must also be disinfected prior to each access to reduce the risk for intraluminal introduction of microbes.
Filters may be used to remove particulate matter, air, microorganisms, and endotoxins. They are routinely used in blood transfusions, intraspinal infusions, and with PN and lipid infusions.
Flow-control device refers to any instrument used to regulate infusion flow rate; the main categories include manual devices (e.g., roller clamp) and mechanical and electronic infusion pumps.
- Mechanical infusion devices: nonelectric methods such as mechanical flow devices and elastomeric infusion pumps.
- Electronic infusion pumps are used in IV infusions as well as with subcutaneous, arterial, and epidural infusions, providing an accurate flow rate and alarms that signal problems with the infusion.
- Multichannel pumps: pumps that can deliver several medications and fluids simultaneously.
- Ambulatory infusion pumps: pumps that can be carried in a pouch; used primarily in home infusion therapy.
- Smart pumps: pumps with an embedded computer system, including a drug library.
The nurse plays an important role in product selection and evaluation. Participation in product evaluation is an ongoing responsibility of nurses and other clinicians.
Nurses use many medical devices and are usually the primary reporters of device problems.
The Safe Medical Devices Act of 1990 imposed significant reporting requirements on the medical device industry and users of medical devices. Medical device reporting is the mechanism for the FDA to receive information about adverse events from manufacturers and user facilities (e.g., hospitals and nursing homes).

Thinking Critically: Case Study

A 45-year-old postoperative hysterectomy patient has an order to convert her continuous IV to a Luer-Lok needleless connector.

Case Study Questions

1.What are the steps in flushing this device? Note: Refer to Chapter 6 for procedure.

2.What infection prevention technique should be used prior to accessing the needleless connector with each catheter access?

Media Link: Chapter post tests and answers are provided on FADavis.com, along with case studies and critical thinking activities.

References ⬆

Advancement of Blood & Biotherapies (AABB). (2018). AABB primer of blood administration. Author.
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed). Elsevier.
Alexandrou, E. (2019). Right assessment and vein selection. In N.Moureau (Ed.), Vessel health and preservation: The right approach for vascular access. Springer Open. http://library.oapen.org/handle/20.500.12657/22906
Bardin-Spencer, A., & Spencer, T. R. (2020). Ultrasound-guided peripheral arterial catheter insertion by qualified vascular access specialists or other applicable healthcare clinicians. Journal of the Association of Vascular Access, 25(1), 48-50.
Boehne, M., Jack, T., Köditz, H., Deidemann, K., Schmidt, F., Abura, M., Bertram, H. & Sasse, M. (2013). In-line filtration minimizes organ dysfunction: New aspects from a prospective, randomized, controlled trial. BMC Pediatrics, 13, 21. doi: 10.1186/1471-2431-13-21
Çag˘lar, S., Büyükyılmaz, F., Bakog˘lu, I˙., I˙nal, S., & Salihog˘lu, Ö. (2019). Efficacy of vein visualization devices for peripheral intravenous catheter placement in preterm infants: A randomized clinical trial. The Journal of Perinatal & Neonatal Nursing, 33(1), 61-67. https://doi.org/10.1097/JPN.0000000000000385
Demir, D., & Inal, S. (2019). Does the use of a vein visualization device for peripheral venous catheter placement increase success rate in pediatric patients? Pediatric Emergency Care, 35(7), 474-479. https://doi.org/10.1097/PEC.0000000000001007
Doellman, D., & Rineair, S. (2019). The use of optical detection for continuous monitoring of pediatric IV sites. Journal of the Association for Vascular Access, 24(2), 44-47.
Forsberg, U., Jonsson, P., & Stegmayr, B. (2019). Air contamination during medical treatment results in deposits of microemboli in the lungs: An autopsy study. The International Journal of Artificial Organs, 42(9), 477-481. https://doi.org/10.1177/0391398819840363
Gahart, B. L., Nazareno, A. R., & Ortega, M. Q. (2021). Intravenous medications (37th ed.). Elsevier.
Gibson, S. M., & Primeaux, J. (2020). Do needleless connector manufacturer claims on bidirectional flow and reflux equate to in vitro quantification of fluid movement? Journal of the Association of Vascular Access, 25(4), 28-36.
Gorski, L. A. (2017). Fast facts for nurses about home infusion therapy: The expert's best practice guide in a nutshell. Springer Publishers.
Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharpe, E., & Alexander, M. (2021). Infusion therapy standards of practice, 8th edition. Journal of Infusion Nursing, 44(1S). https://doi.org/10.1097/nan.0000000000000396
Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (2021). NANDA International Inc. nursing diagnoses definitions and classification 2020-2023 (12th ed.). Thieme.
Hull, G. J., Moureau, N. L., & Sengupta, S. (2018). Quantitative assessment of reflux in commercially available needle-free IV connectors. The Journal of Vascular Access, 19(1), 12-22. https://doi.org/10.5301/jva.5000781
Institute for Safe Medication Practices (ISMP). (2020). 2020-2021 targeted medication safety best practices for hospitals. https://www.ismp.org/sites/default/files/attachments/2020-02/2020-2021%20TMSBP-%20FINAL_1.pdf
Kan, K., & Levine, W.C. (2021). Infusion pumps. In J.Ehrenwerth, J. B.Eisenkraft, & J. M.Berry (Eds.), Anesthesia equipment: Principles and applications (3rd ed., pp. 351-367). Elsevier.
Norris, A. H., Shrestha, N. K., Allison, G. M., Keller, S. C., Bhavan, K. P., Zurlo, J. J., Hersh, A. L., Gorski, L. A., Bosso, J. A., Rathore, M. H., Arrieta, A., Petrak, R. M., Shah, A., Brown, R. B., Knight, S. L., & Umscheid, C. A. (2019). 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clinical Infectious Diseases 68(1), e1-e35. https://doi.org/10.1093/cid/ciy745
Panza, G. A., Steere, L., & Steinberg, A. C. (2022). A new force-activated separation device for the prevention of peripheral intravenous restarts. Journal of Infusion Nursing, 45(2), 74-80. https://doi.org/10.1097/NAN.0000000000000455
Phelps, P. K. (2017). Smart infusion pumps: Implementation, management and drug libraries. American Society of Health-System Pharmacists.
Shah, N., & Jani, Y. (2020). Implementation of smart infusion pumps: A scoping review and case study discussion of the evidence of the role of the pharmacist. Pharmacy (Basel, Switzerland), 8(4), 239. https://doi.org/10.3390/pharmacy8040239
Spencer, T. R., & Bardin-Spencer, A. (2019). Ultrasound guidance for vascular access procedures by qualified vascular access specialists or other applicable healthcare clinicians. Journal of the Association of Vascular Access, 24(4), 18-22.
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Wilkins, R. G., & Unverdorben, M. (2012). Accidental intravenous infusion of air: A concise review. Journal of Infusion Nursing, 35(6), 404-408.

section name header

Learning Objectives ⬇

Glossary ⬆ ⬇

Introduction ⬆ ⬇

Nursing Process ⬆ ⬇

Chapter Highlights ⬆ ⬇

References ⬆