VENOCLYSIS: WHAT IS IT FOR, TYPES, MATERIALS, PROCEDURE - MEDICINE - 2025

The infusion is the method by which liquid, nutrients or medicaments are administered directly in the blood of a patient. To do this, it is necessary to catheterize a vein through which the infusion to be administered to the patient will be placed.

Infusion is a very common procedure, especially among hospitalized patients. This is because it is the fastest and most effective way to administer liquids and drugs, as well as nutrients, in the case of people who cannot ingest them on their own.

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There are different types of venoclysis depending on the type of venous access to be used (central or peripheral access), as well as according to its purpose. For example, there are infusion processes for hydration, nutrition, and drug administration.

In general, venous accesses are maintained for several days, although sometimes they can be used for only a short period of time. This happens for example in outpatient sedation procedures, where the venous access is removed shortly after the procedure is completed.

What is the infusion for?

Medicine administration

Infusion is very useful when medications need to be administered directly into the patient's bloodstream, in order to achieve therapeutic concentrations as quickly as possible.

When a drug is administered orally, transcutaneously, or even by intramuscular injection, it needs to be absorbed from the site of administration into the bloodstream. This process can take from a few minutes to several hours, and even days, depending on the formulation of the medicine.

In contrast, by administering the drug directly into the bloodstream, it does not need to be absorbed. In this way, therapeutic plasma concentrations of the drug are reached almost immediately.

This is very useful in emergency situations, as well as in those cases where strict dose-response control is necessary, such as during general anesthesia.

Fluid management

In addition to the administration of medications, infusion is very useful for the administration of fluids and electrolytes quickly and safely. In fact, if there were no infusion, it would be impossible to carry out transfusions of blood and blood products.

Once again, by infusing fluids by infusion, the absorption process is avoided, so that the fluids administered go directly to the intravascular space. This is especially helpful in seriously ill patients, where fluid resuscitation must be carried out effectively and quickly.

Nutrient management

Finally, in the cases of patients unable to nourish themselves orally, infusion allows the administration not only of fluids but also of nutrients such as carbohydrates, lipids and even amino acids.

This modality of nutrition, known as parenteral nutrition, is frequently used in intensive care units (ICU), where many patients cannot be nourished through the digestive tract due to various causes.

Types of infusion

There are two types of venoclysis according to the type of venous access used: peripheral infusion and central infusion. For its part, according to the purpose of the infusion, this procedure can be divided into:

- Venocolysis for drug administration.

- Venocysis for parenteral hydration.

- Venocolysis for parenteral nutrition.

Each of these types of infusion has particular characteristics, so it is not recommended to administer drugs following the same procedure by which nutrition is administered. At the same time, certain types of hydration must be kept separate from infusions of drugs, blood products, or other compounds.

Peripheral venoclysis

An infusion process is considered peripheral when the catheters through which the intravenous infusion is administered (some authors use the term “intravenous”) are located in small-caliber veins of the forearm or hand.

In these cases, the infusion rate is limited by the diameter of the catheterized vein, so the smaller the vessel, the slower the infusion rate.

On the other hand, certain highly concentrated or irritating solutions (such as solutions with potassium, parenteral nutrition or chemotherapy) cannot be administered by peripheral infusion since the volume of blood in which the drug is diluted is very small and complications occur. like phlebitis.

Peripheral infusions are usually used for relatively short periods of time, ranging from a few minutes to a few days (usually no more than 3 or 4).

Central venoclysis

When large-bore lines located in the neck or chest (internal jugular, subclavian) as well as the legs (femoral veins) are catheterized, a central venous access is said to be used for infusion.

These veins are characterized by being large and handling a considerable volume of blood. They are also a direct route to the heart, since the tip of the catheter is very close to the mouth of the superior vena cava in the right atrium (venous accesses in the internal jugular and subclavian veins) or directly within the inferior cava (femoral catheters).

Central infusions are very useful to pass large volumes of liquid in a short time, since the diameter of the vessel allows it. In addition, through them it is possible to administer highly concentrated or irritating solutions, since they are immediately diluted in a considerable volume of blood, pass quickly to the heart and from there they are dispersed in the general circulation.

Because thicker and longer catheters are used, central venous infusions tend to last longer, from several days to weeks or even months, as is the case with long-term chemotherapy catheters.

Venoclysis for drug administration

The infusion for drug administration is, as its name implies, one used to deliver drugs and other therapeutic agents directly into the bloodstream.

It is important to note that not any drug can be administered this way, so it is necessary to have specific formulations for intravenous use. Otherwise serious harm to the patient could be done.

The infusions for drug administration can be both peripheral and central. The most used for this purpose are the peripheral ones, although in certain cases such as chemotherapy central venous accesses are used.

Venoclysis for parenteral hydration

In cases where it is necessary to hydrate or rehydrate a patient without using the digestive tract, infusion can be used for parenteral hydration.

For these cases, health professionals have sterile solutions prepared for this purpose, which can be administered directly into the patient's vein to provide fluid and electrolytes.

Most intravenous hydration solutions can be administered by peripheral routes (peripheral venoclysis), this being the route of choice in more than 60% of cases.

However, in special cases such as large-scale surgeries, massive trauma, cancer patients and people admitted to the ICU, use of central venous access can be used to administer parenteral hydration.

Venoclysis for parenteral nutrition

The infusion for parenteral nutrition is one that is used to deliver nutrients directly into the bloodstream without having to pass through the digestive tract. In these cases, central venous access is preferred, since the concentration and volume of parenteral nutrition is not tolerated by the peripheral routes.

All formulations for parenteral nutrition are specifically designed to be administered in this way. Parenteral nutrition is delicate and should be administered only by appropriately qualified professionals who have a detailed knowledge of each of the components of the compounds to be provided.

In some cases and for very short periods of time parenteral nutrition can be administered through the peripheral route. However, the amount of nutrients, the volume of infusion, the total administration time and the number of days it can be used are very limited.

materials

In general, few materials are required for an infusion. These include the following:

- Sterile gloves.

- Tourniquet.

- Gauze or cotton.

- Medical adhesive.

- Antiseptics (usually alcohol or povidone-iodine solution).

- Catheters for intravenous use (peripheral or central).

- Infusion equipment (macro dripper or micro dripper).

- Syringe (optional).

- Solutions for parenteral infusion.

- Bottles for preparation of solutions (optional).

- Infusion pump (optional).

- Shutters, three-way keys, connectors or track extenders (optional).

Each of these materials will be used to place an IV. In cases where it is indicated that it is optional, it is because they can be dispensed with without compromising the execution of the procedure, or because they are only needed in certain special cases.

Process

The procedure for administering an infusion is relatively simple, with the most delicate step being catheterization of the vein, especially in cases of central venous lines.

The standard procedure for peripheral infusion is described step-by-step below.

Patient information

Before starting with the infusion, the patient should be informed about the procedure to be carried out step by step, since this helps the patient feel more secure and, thereby, avoids increasing their anxiety or stress.

Handwashing

Before starting any sanitary procedure, it is necessary to get rid of the rings and other objects that adorn the hands and go to wash them. The typical procedure of washing palms, fingers, nails and thumb with soap and water or alcohol solution should be followed. Then they go to dry disposable.

Preparation

Before starting to work with the patient, the solution to be infused is prepared. The infusion set - also called the serum system - is then installed and purged to ensure there is no air in the system.

Once the equipment is prepared, a tourniquet is placed on the arm or forearm where the infusion is planned to be placed. By inspection and palpation, the ideal site for puncture of the vein is chosen. Ideally, it should be away from folds, in a straight vessel and dilated with the placement of the tourniquet.

Once the vein has been selected, the health worker must put on sterile gloves and proceed with the puncture.

Putting on gloves by the sanitary.

Puncture (or catheterization)

The next step is to prepare the area where the vein will be catheterized, cleaning it with antiseptic solution using gauze or cotton. This procedure should be carried out with a circular motion from the center of the area where the puncture is to be carried out outwards, and always with a single pass of the gauze or cotton on the skin.

Then, with an appropriate size catheter (either Teflon or butterfly type), the vein is catheterized.

Once it has been confirmed that it has been successfully catheterized, an obturator, three-way stopcock or extender (or extension) is placed on the free end of the catheter. If not available, the line can be connected directly to the infusion set. Finally, the peripheral line is secured with medical adhesive (tape).

Solution management

Once the catheter is secured, the solution can be administered by gravity or with the aid of an infusion pump. In some cases, the drug to be infused can be prepared directly into a 10 or 20 cc syringe and connected to the catheter to infuse the solution.

In the cases of central venous accesses, the steps are very similar, except that tourniquets are not used and the line must be catheterized according to the procedures designed for central venous accesses.

Once this is done, the procedure for administering fluids via the peripheral or central line is practically identical.

Subsequent hand washing

Once the infusion process is finished, the gloves are removed and the corresponding hand washing is carried out, applying the same technique that was used at the beginning of the procedure.

Precautions

Although it is a routine procedure that is performed hundreds of times a day in the hospital setting, infusion is not without complications. Therefore, certain precautions must be taken to minimize the possibility of failure or complications.

In this sense, it is very important that the operator is well trained, knows the anatomy and the procedure for the infusion. Likewise, you must have all the necessary material, which must be available and prepared at the time of starting the procedure, so that there are no problems due to lack of material.

The most important precaution is to strictly adhere to the rules of asepsis and antisepsis, since the bloodstream is being accessed directly. Thus, any bacteria that contaminate the catheter or the solution to be infused will go directly into the blood, with life-threatening consequences.

On the other hand, special care must be taken not to puncture the vein on its back, especially in cases of difficult venous access. If this happens, you must be prepared to limit bruising.

In cases of venous accesses, special caution should be exercised during puncture in order to avoid pneumothorax (subclavian accesses) and hematomas (all central accesses). For their part, the solutions to be infused must be handled with extreme care to avoid contamination. Any remainder must be discarded.

Finally, venous accesses should be inspected daily and the catheter removed at the first sign of complication (pain, redness, pus).

References

1. Stegeman, BH (1979). US Patent No. 4,142,523. Washington, DC: US ​​Patent and Trademark Office.
2. Barandun, S., Kistler, P., Jeunet, F., & Isliker, H. (1962). Intravenous administration of human γ-globulin. Vox sanguinis, 7 (2), 157-174.
3. Mitsunaga, M., & Yamamoto, Y. (2004). US Patent No. 6,788,885. Washington, DC: US ​​Patent and Trademark Office.
4. Ruschke, R. (1986). US Patent No. 4,573,974. Washington, DC: US ​​Patent and Trademark Office..
5. Reeves, WR, Defever, MG, & Little, TG (1994). US Patent No. 5,282,264. Washington, DC: US ​​Patent and Trademark Office.
6. Genese, JN, & Muetterties, AJ (1982). US Patent No. 4,316,460. Washington, DC: US ​​Patent and Trademark Office.
7. Kistner, TL, Kistner, DT, & Burrell, GC (2000). US Patent No. 6,139,528. Washington, DC: US ​​Patent and Trademark Office.