Assessment, Planning, and Patient Education
Build the assessment before you touch the device
Infusion assessment is layered. Start with the whole patient: diagnosis and treatment plan, comorbidities (diabetes, renal or cardiac disease, coagulopathy), current medications, allergies, laboratory values (CBC, coagulation studies, electrolytes, renal function), nutritional and fluid status, cognitive status, health literacy, and the patient's preferences and goals. Then narrow to the vascular access device (VAD): indication, type, insertion site and date, dwell time, dressing integrity, patency (ability to flush without resistance and to obtain a blood return), and the condition of the surrounding skin and limb.
Planning and the plan of care
A defensible plan links therapy to device: what is being infused, at what rate, for how long, and whether the solution is a vesicant, irritant, or has an extreme pH or osmolality. Include monitoring frequency, parameters for holding or escalating, and who to notify. Document findings and revisions to the plan - a plan that is not documented cannot be evaluated.
Education that actually lands
Use teach-back, not "do you understand?" Match materials to literacy, language, vision, and hearing. For a patient going home with a catheter, teach hand hygiene, dressing and cap care, what to do if the dressing lifts, signs of infection (redness, drainage, fever, chills), and when to call. Include the caregiver and confirm a return appointment.
Trap: questions that describe a patient nodding along and ask what the nurse should do next - the correct answer is almost always "verify understanding with teach-back" or "assess further," not "reinforce the earlier teaching."
Worked example: A patient with a new PICC says, "I've got it, I've watched this before." Best action: ask the patient to demonstrate flushing and dressing inspection while you observe, then document the return demonstration.