By Sue Carrington |
Recently, I shepherded my 92-year-old father through heart surgery at a leading medical center. He got through the surgery fine; the difficulties came before the operation.
Dad’s care team struggled to find the best entry points for his IVs – and the best artery in his leg for inserting the tube that would guide the artificial valve to his heart. These challenges resulted in bleeding, bruising, and a delay in the start of surgery. Clearly, when treating elderly patients, even the best-laid plans can go awry.
Dealing with fragile veins
Aging causes changes to the skin, vein walls, and circulation. The skin becomes paper thin, losing its normal tone and elasticity. Veins are more fragile and can be easily damaged. They are likely to wiggle and roll under the skin as the IV is inserted.
Bleeding under the skin can be prolonged and spread out over a larger area, reducing available sites for IV access. The risk is high for vein ruptures and infiltration. Extra precautions are needed in selecting the best access site, ensuring stability in IV insertion, and applying pressure to any bleeding.
Guarding against infection
Older patients are likely to have multiple medical problems and a weakened immune system – amplifying the chances of infection. Thin and dry skin can also increase an elderly patient’s susceptibility to infection. Care teams need to take preventive measures to avoid introducing bacteria into the bloodstream.
Maintaining proper fluid levels
Older people don’t have the fluid reserves they once did and can easily become dehydrated. They are also at risk of fluid overload. Signs of overload include elevated blood pressure, rapid breathing, and shortness of breath.
The medical team needs to closely monitor the amount of fluids an elderly patient receives each day. Too much fluid in the body can lead to kidney and heart injury or even death.
Following best practices
Best care practices for IV therapy in elderly patients include:
- Warming the arm with warm packs to bring the veins to the surface of the skin
- Not using a tourniquet, which increases pressure and the risk of tears
- Finding the largest vein and using the smallest catheter possible
- Keeping the skin taut
- Inserting the needle at a flat angle
- Securing the catheter with paper-type tape
- Applying cold wraps to any bruises
- Assessing the patient regularly for signs of infection, fluid overload, and infiltration
- Explaining the procedure carefully to the patient and family
Although IV therapy for seniors poses distinct risks, medical teams who understand the complexities of each elderly patient are well positioned to avoid complications and deliver the best care. To learn more about general IV complications, check out IV Complications: What Can Go Wrong?