Chapter 15: Concepts of Infusion Therapy

Infusion therapy represents a fundamental nursing intervention that delivers fluids, medications, blood products, and nutritional support through parenteral routes including intravenous, intraosseous, and subcutaneous access. This chapter systematically examines the principles, procedures, and evidence-based safety standards that govern infusion administration across diverse clinical settings. The chapter begins by categorizing vascular access devices according to their characteristics and appropriate clinical applications, including short peripheral catheters for temporary access, midline catheters for intermediate duration therapy, peripherally inserted central catheters for longer-term central venous access, tunneled and nontunneled central venous catheters, implanted ports for repeated access, and specialized hemodialysis catheters. Each device type requires specific insertion techniques, maintenance protocols, and dwell time considerations. A critical emphasis throughout is the prevention of central line-associated bloodstream infections through implementation of maximal sterile barrier precautions, chlorhexidine skin antisepsis, routine assessment of line necessity, and meticulous hub disinfection. Nurses must develop competence in recognizing and managing common infusion complications including infiltration, extravasation, phlebitis, thrombosis, catheter occlusion, infection, air embolism, and unintended catheter displacement. Early detection of clinical signs such as erythema, edema, fluid leakage, and patient discomfort is essential to prevent tissue damage and systemic complications. The chapter addresses the physiological basis for device selection by examining osmolarity and pH considerations, ensuring that vesicant agents and hypertonic solutions are delivered through appropriate central access rather than peripheral veins. Detailed coverage of infusion equipment includes discussion of solution classification systems, smart infusion pump technology, flow control devices, and inline filters that enhance delivery precision and reduce medication errors. Special attention is devoted to infusion therapy in vulnerable populations including older adults with compromised vascular integrity, patients with chronic kidney disease, individuals requiring long-term parenteral nutrition, and those receiving cytotoxic chemotherapy. The chapter reinforces that infusion therapy extends beyond technical skill execution to encompass clinical judgment, requiring nurses to integrate anatomical knowledge, aseptic technique mastery, continuous patient monitoring, interdisciplinary communication, and ethical responsibility in preventing harm and promoting therapeutic outcomes.