00213 Risk for vascular trauma

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00213 Risk for vascular trauma

Definition of the NANDA label

The Risk of vascular trauma is the probability of suffering an injury to a vein and surrounding tissues related to the presence of a catheter and / or infusion of solutions.

Below, risk factors, NIC and NOC of the NANDA diagnosis “ Risk of vascular trauma ” are detailed.

Susceptible to damage to vein and its surrounding tissues related to the presence of a catheter and/or infused solutions, which may compromise health.

Risk factors

• Type of catheter.
• Caliber of the catheter.
• Inability to visualize the insertion site.
• Inadequate fixation of the catheter.
• Rate of infusion.
• Insertion area.
• Duration of insertion.
• Composition of the solution (eg: concentration, chemical irritant, temperature, pH).

Associated condition

– Irritating solution
– Rapid infusion rate

NOC

• Adequate peripheral vascular perfusion.
• Risk control.
• Healthy behavior.

NIC

• Vascular monitoring.
• Monitoring of vital signs.
• Monitoring of the skin condition.
• Control of peripheral perfusions.

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