CPD reflective account

SPL

Peripheral intravenous access can be problematic in older or debilitated patients, and a midline catheter may be more appropriate for administering antibiotics or fluid replacement. Fluid and nutrition can be administered via the nasogastric route. Hypodermoclysis, a method of infusing fluid into subcutaneous tissue for patients with mild to moderate dehydration, is ideal in palliative care or for older patients because it avoids frequent re-siting of cannulae.

Haematoma

Intravenous therapy A CPD article boosted Abby Morrow-Barnes’s knowledge of the insertion and use of cannulae in older patients Providing intravenous therapy for older people is associated with challenges, because of comorbidities and age-related changes to the skin and veins. Skin integrity is an important factor affecting venous access. The natural ageing process results in loss of subcutaneous fat and collagen. The epidermis becomes thinner and less elastic, resulting in a decreased rate of healing and compromised skin barrier. Ageing veins have increased peripheral resistance and so may be unsuitable for peripheral cannulation. Before cannulation, most transient flora can be removed from the skin with soap and water using mechanical friction. Chlorhexidine 2% has been shown to be the most effective agent for skin cleansing before inserting a cannula, and should be applied with back and forth friction for at least 30 seconds, and the skin allowed to air dry for 30-60 seconds. The CPD article described direct and indirect methods of cannulation. The direct method involves inserting the device

directly into the skin and then into a vein. The indirect method involves inserting the device into the skin, then relocating the vein and advancing the device. This is more suitable for older patients because it is less traumatic and avoids puncturing the posterior wall of the vein. It is important to anchor the veins of older patients firmly before cannulation, because with ageing the veins are more likely to roll. Nurses should be aware that the patient maybe anxious about the procedure, which might cause vasoconstriction, making cannulation more difficult for the practitioner and more painful for the patient.

This reflective account is based on NS714 Dougherty L (2013) Intravenous therapy in older patients. Nursing Standard. 28, 6, 50-58.

Complications resulting from inserting and using cannulae include haematoma, phlebitis, infiltration, circulatory overload and speed shock. In the event of a haematoma, the cannula should be removed immediately and pressure applied to the site for a few minutes. Phlebitis may be mechanical, chemical or bacterial, and the cannula site should be monitored daily using a scoring tool. Infiltration can result in local inflammatory reactions or compression of the surrounding tissues. If circulatory overload is detected early, the patient should be placed in an upright position to relieve dyspnoea and oedema. If speed shock occurs, the rate of infusion should be reduced or discontinued. After reading this article I know more about the issues involved in cannulating older patients NS Abby Morrow-Barnes is a staff nurse at Warwick Hospital, England

Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 51 for this week’s article and on page 62 you can find out how to present and submit your reflective account.

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Intravenous therapy.

Providing intravenous therapy for older people is associated with challenges, because of comorbidities and age-related changes to the skin and veins...
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