Infusion Therapy and Vascular Access
Domain 7 tests infusion therapy and vascular access: peripheral and central line care, calculations, compatibility, and recognition of complications. Safety depends on aseptic technique, correct rate, and early detection of infiltration or infection.
Core rules
- Use aseptic technique for insertion and access; scrub the hub and allow drying.
- Choose the smallest gauge that meets therapy needs; assess site and limb for pain, swelling, coolness, or redness.
- Use a pump for maintenance fluids and high-risk infusions; calculate hourly rate and verify programming.
- Maintenance fluids: 4-2-1 rule (4 mL/kg/hr for first 10 kg, 2 for next 10, 1 for each kg after).
- Central lines: follow CLABSI bundle, secure dressing, limit lumen access, and never force a blocked line.
- Blood products: use 0.9% sodium chloride only; never add medications to the bag.
Worked example
A 14-kg child needs maintenance fluids. Hourly rate = 4 × 10 + 2 × 4 = 48 mL/hr. If the order is 500 mL over 8 hours, the rate is 62.5 mL/hr; clarify which order is intended. Program the pump, verify the line and site, and document. For a peripheral vesicant, confirm patency and stop immediately if pain or swelling occurs.
Traps
Ignoring pain at a peripheral site, using a household teaspoon for oral meds, and mixing incompatible drugs in one line. Also avoid infusing blood with lactated Ringer’s, and do not skip site assessment because the pump is running.