Set of activities performed by the nurse to the patient with a subcutaneous reservoir.
Objective:
– To maintain the permeable reservoir. – Prevent complications such as infection, extravasation, accidental needle removal, gas embolism, etc.
Equipment:
– Cure trolley or trolley. – Sterile drapes. – Equipment necessary for the puncture procedure. – Sharps container.
Material:
– 1 pair of sterile gloves. – Sterile gauze. – Antiseptic solution. – Sterile dressing. – Physiological saline solution. – 1 Syringe of 10-20 ml. – 1 Intravenous needle. – Needle with special bevel and extension cord. – 1 obturator. – Diluted sodium heparin (commercial preparation). – Hypoallergenic plaster. – Nursing records.
Procedure:
– Perform hand washing. – Prepare the necessary material. – Preserve the patient’s privacy. – Inform the patient of the procedure to be performed. – Ask for the patient’s cooperation. – Place the patient in supine position, with the head turned to the opposite side where the reservoir is implanted. – Assess the appearance of the skin covering the subcutaneous chamber (make sure there is no redness, edema, subcutaneous infiltration, ulceration or suppuration). – Put on sterile gloves. – Monitor every 24 hours for signs and symptoms of local or systemic infection. – Change the perfusion system every 48 hours, if parenteral nutrition every 24 hours. – Change the dressing every 48 hours or when it is wet, detached or stained. – The reservoir needle should be changed every 7 days.
HEPARINIZATION AND SEALING OF THE RESERVOIR:
a) Create the sterile field and place all the necessary material. b) Fill a 10 cc syringe with 5 ml of diluted sodium heparin (commercial preparation). c) Remove the obturator. d) Connect the syringe to the terminal of the needle. e) Declamp the system. f) Inject with the syringe loaded with diluted heparin, introduce the 5 ml of diluted heparin. g) Clamp the system. h) Screw a new sterile obturator. – Discard the sharps in the container provided for this purpose. – Collect the material. – Leave the patient in a comfortable position. – Remove gloves. – Wash hands. – Record in the nursing documentation: procedure, reason, date and time, incidences and patient’s response.
Observations:
– Never inject liquids through the reservoir with syringes of less than 10 ml, since the silicone of the chamber may crack and the medication may leak out. – Observe in the patient symptoms that warn of possible fragmentation or embolization of the catheter: dyspnea, chest pain or palpitations.
– Heparinization will be performed: 1. every 4 weeks in reservoirs that are not in use. After administration of intravenous medication. 3. 3. After blood collection. 4. After administration of blood products.
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