IV Therapy (week 10):
fascinating factoid per Dr Ambrose: scutellaria inhibits expression of IL6
governing Org: IV Nutrit Therapy
where we can get more training: www.ivnutritionaltherapy.com
Drs Paul Anderson, Dan Carter, Virginia Osborne
can take advanced IV or chelation class thru them, no more offered at NCNM
"the travelling IV therapy show" "they dance to their own drumbeat"
she also speaks of the
Center for Enhancement of Human Functioning
Riordan Clinic in Oklahoma
we lack gluconolactactone oxidase: can't make vit c from glucose, along with guinea pigs
vit C has a double bonded O where glucose has an OH, that's the only difference
high dose vitamin C in oncology
normal cells have catalase and can resist H2O2
cancer cells have only 10% catalase fx
assure renal, liver, cv fx before giving fluid, must give rapidly and large dose to be effective
use sterile water-->less osmolarity, easier on pt
cachexia formula: ca gluconate, mg, sulfate, se, KCl, ZnSO4, Mn, Mo, B6, B5, HydroxyB12, Bcomplex 100, more
FreAmine III for cachexic pts
**************
notes on PICC line chart
peripherally inserted central catheter
keep in in 6wks-1yr
tip into sup vena cava or other
flush with saline, do vit C, flush with saline, always end in heparin
* always use 10cc syringe
never force the flush against resistance
**************************
ON CENTRAL LINES
read this on our own
Central Lines Maintenance
Central venous lines - indwelling catheters surgically inserted
Vasculature ID picture - varying access into upper torso veins
Maintenance of various devices - flushing protocols
Procedure for Central line dressing change - frequency and Sterile to clean
technique
Criteria for Central venous Lines
Total parenteral Nutrition (TPN)
Cancer Therapy
Chemo Therapy
Limited Venous Access
Phlebogenic Infusates
Long term therapy
Home Intravenous Therapy
Advantages of Central Venous Lines
Ability to infuse phlebogenic infusates
Lower risk of infection
Massive fluid replacement needs
Monitoring Central Venous pressure
Frequent blood Draws d/t IV Therapy given
Ease of access when peripheral veins compromised
Types of Central Venous Lines
GROSHONG: Surgically inserted may have 1 - 3 access lumens
Duration: indefinitely (as long as there are no signs and symptoms of catheter
complications, e.g. length changes, clots)
Tip placement: Superior Vena Cava (SVC)
Exit Site: dressing over site until healed (gauze/transparency)
Dressing: gauze changed QD Opsite-3000 change weekly and prn
Sterile procedure until site is healed. At home pt. does
clean procedure observing clean concepts
Flushing: before and after each use with 5cc of NS using positive pressure
Labs: may draw labs, flush with 5cc NS, aspirate 5cc blood & discard,
Obtain labs, flush with 10cc NS using positive pressure
Complications: infection, clotting, and thrombus formation
HICKMAN: Surgically inserted may have 1 - 3 access lumens
Duration: indefinitely (as long as no catheter/ related complications)
Tip Placement: Superior Vena Cava (SVC)
Exit Site: Dressing over site until healed (gauze or transparency)
Dressing: gauze changed QD Opsite-3000 change weekly and prn
Sterile procedure until site is healed. At home pt. does clean
procedure observing clean concepts.
Flushing: Before using, clear the line with 3cc NS; infuse RX; clear the line
with 3cc NS; follow with 2.5 cc (10 units/cc - 100 units/cc) Heparin.
When not using, flush q8h with 2.5 cc (10units/cc -100 units/cc) Heparin
Labs: same as for Groshong: flush with 5cc NS, aspirate 5cc blood & discard,
Obtain labs, flush with 10cc NS using positive pressure
After the 10cc NS flush, follow with 2.5cc(10u/cc) heparin
Complications: infection, clotting, and thrombus formation
PICC (GROSHONG & PER-Q-CATH) May have more than on lumen or site
Duration: 6 weeks to a year
Tip placement: mostly Superior Vena Cava (SVC) but can be deep vein or
midline
Exit site: inserted as peripheral catheter technically not considered an exit site
Dressing: sterile procedure as an out patient (not Sutured)
Must measure the length of catheter extending outside the skin
Dressings changed weekly et prn.
Flushing: PICC Groshong same as for tunneled Groshong
PICC PER-Q-CATH same as for tunneled Hickman
Labs: only on the PICC Groshong if it has 2 lumens: same as Groshong: flush
with 5cc NS, aspirate 5cc blood and discard,
Obtain labs, flush with 10cc NS using positive pressure
Complications: infection, phlebitis, clotting, and thrombus formation
IMPLANTED PORTS - single site access
Tip Placement: Superior Vena Cava (SVC)
Exit Site: This type of port is sub dermis with no external exit site
Special Needle considerations: Huber needle, a 90o - angled needle in a butterfly
type set. Flush needle set up first. When inserting the needle, make sure you are in middle of the
implanted port. Do not attempt this if not instructed on the procedure.
Dressing: not necessary when not being used. Sterile dressing procedure when
Site is accessed. May need to pad under Huber needle
Flushing: Done with 3-5cc Heparin 100u/cc and NS.
Flush with heparin first.
Always clear the heparin with 10cc NS prior to infusing RX
Always clear the line with 10 cc NS after infusing RX,
Follow with 5 cc heparin
Labs: may obtain labs, same as for Hickman: same as for Groshong: flush with
5cc NS, aspirate 5cc blood and discard, Obtain labs, flush with 10cc NS
using positive pressure. After the 10cc NS flush, follow with Heparin dose as
as noted above.
Complications: infection, clotting, thrombus formation, rejection of implant
Erosion of portal catheter through the skin or vessel.
Other venous access devices such as Quinton cath, Cook cath and Shunts are placed by a surgeon with the sole purpose of dialysis and plasmapheresis therapy. These are not meant to be used for IV therapy.
governing Org: IV Nutrit Therapy
where we can get more training: www.ivnutritionaltherapy.com
Drs Paul Anderson, Dan Carter, Virginia Osborne
can take advanced IV or chelation class thru them, no more offered at NCNM
"the travelling IV therapy show" "they dance to their own drumbeat"
she also speaks of the
Center for Enhancement of Human Functioning
Riordan Clinic in Oklahoma
we lack gluconolactactone oxidase: can't make vit c from glucose, along with guinea pigs
vit C has a double bonded O where glucose has an OH, that's the only difference
high dose vitamin C in oncology
normal cells have catalase and can resist H2O2
cancer cells have only 10% catalase fx
assure renal, liver, cv fx before giving fluid, must give rapidly and large dose to be effective
use sterile water-->less osmolarity, easier on pt
cachexia formula: ca gluconate, mg, sulfate, se, KCl, ZnSO4, Mn, Mo, B6, B5, HydroxyB12, Bcomplex 100, more
FreAmine III for cachexic pts
**************
notes on PICC line chart
peripherally inserted central catheter
keep in in 6wks-1yr
tip into sup vena cava or other
flush with saline, do vit C, flush with saline, always end in heparin
* always use 10cc syringe
never force the flush against resistance
**************************
ON CENTRAL LINES
read this on our own
Central Lines Maintenance
Central venous lines - indwelling catheters surgically inserted
Vasculature ID picture - varying access into upper torso veins
Maintenance of various devices - flushing protocols
Procedure for Central line dressing change - frequency and Sterile to clean
technique
Criteria for Central venous Lines
Total parenteral Nutrition (TPN)
Cancer Therapy
Chemo Therapy
Limited Venous Access
Phlebogenic Infusates
Long term therapy
Home Intravenous Therapy
Advantages of Central Venous Lines
Ability to infuse phlebogenic infusates
Lower risk of infection
Massive fluid replacement needs
Monitoring Central Venous pressure
Frequent blood Draws d/t IV Therapy given
Ease of access when peripheral veins compromised
Types of Central Venous Lines
GROSHONG: Surgically inserted may have 1 - 3 access lumens
Duration: indefinitely (as long as there are no signs and symptoms of catheter
complications, e.g. length changes, clots)
Tip placement: Superior Vena Cava (SVC)
Exit Site: dressing over site until healed (gauze/transparency)
Dressing: gauze changed QD Opsite-3000 change weekly and prn
Sterile procedure until site is healed. At home pt. does
clean procedure observing clean concepts
Flushing: before and after each use with 5cc of NS using positive pressure
Labs: may draw labs, flush with 5cc NS, aspirate 5cc blood & discard,
Obtain labs, flush with 10cc NS using positive pressure
Complications: infection, clotting, and thrombus formation
HICKMAN: Surgically inserted may have 1 - 3 access lumens
Duration: indefinitely (as long as no catheter/ related complications)
Tip Placement: Superior Vena Cava (SVC)
Exit Site: Dressing over site until healed (gauze or transparency)
Dressing: gauze changed QD Opsite-3000 change weekly and prn
Sterile procedure until site is healed. At home pt. does clean
procedure observing clean concepts.
Flushing: Before using, clear the line with 3cc NS; infuse RX; clear the line
with 3cc NS; follow with 2.5 cc (10 units/cc - 100 units/cc) Heparin.
When not using, flush q8h with 2.5 cc (10units/cc -100 units/cc) Heparin
Labs: same as for Groshong: flush with 5cc NS, aspirate 5cc blood & discard,
Obtain labs, flush with 10cc NS using positive pressure
After the 10cc NS flush, follow with 2.5cc(10u/cc) heparin
Complications: infection, clotting, and thrombus formation
PICC (GROSHONG & PER-Q-CATH) May have more than on lumen or site
Duration: 6 weeks to a year
Tip placement: mostly Superior Vena Cava (SVC) but can be deep vein or
midline
Exit site: inserted as peripheral catheter technically not considered an exit site
Dressing: sterile procedure as an out patient (not Sutured)
Must measure the length of catheter extending outside the skin
Dressings changed weekly et prn.
Flushing: PICC Groshong same as for tunneled Groshong
PICC PER-Q-CATH same as for tunneled Hickman
Labs: only on the PICC Groshong if it has 2 lumens: same as Groshong: flush
with 5cc NS, aspirate 5cc blood and discard,
Obtain labs, flush with 10cc NS using positive pressure
Complications: infection, phlebitis, clotting, and thrombus formation
IMPLANTED PORTS - single site access
Tip Placement: Superior Vena Cava (SVC)
Exit Site: This type of port is sub dermis with no external exit site
Special Needle considerations: Huber needle, a 90o - angled needle in a butterfly
type set. Flush needle set up first. When inserting the needle, make sure you are in middle of the
implanted port. Do not attempt this if not instructed on the procedure.
Dressing: not necessary when not being used. Sterile dressing procedure when
Site is accessed. May need to pad under Huber needle
Flushing: Done with 3-5cc Heparin 100u/cc and NS.
Flush with heparin first.
Always clear the heparin with 10cc NS prior to infusing RX
Always clear the line with 10 cc NS after infusing RX,
Follow with 5 cc heparin
Labs: may obtain labs, same as for Hickman: same as for Groshong: flush with
5cc NS, aspirate 5cc blood and discard, Obtain labs, flush with 10cc NS
using positive pressure. After the 10cc NS flush, follow with Heparin dose as
as noted above.
Complications: infection, clotting, thrombus formation, rejection of implant
Erosion of portal catheter through the skin or vessel.
Other venous access devices such as Quinton cath, Cook cath and Shunts are placed by a surgeon with the sole purpose of dialysis and plasmapheresis therapy. These are not meant to be used for IV therapy.