Iv Therapy

IV THERAPY By: Liezel A. Castillo

DEFINITION OF TERMS  Hypotonic

- solutions that have a lower osmolality than body fluids  Hypertonic - solutions that have a higher osmolality than body fluids  Isotonic - solutions that have the same osmolality as body fluids  Phlebitis – an inflammation of the vein that can result mechanical or chemical trauma or local infection  Infiltration – seepage of IVF out of the vein and into the surrounding interstitial space

DEFINITION OF TERMS  Air

embolism – obstruction caused by a bolus of air that enters the vein through an inadequately primed IV line, from a loose connection, or during tubing change or removal of IV line  Catheter embolism – obstruction that results from breakage of the tip of the catheter during IV line insertion

IV THERAPY  Intravenous

(iv) therapy is the insertion of a needle or catheter/cannula into a vein, based on the physician’s written prescription. The needle or catheter / cannula is attached to a sterile tubing and a fluid container to provide medication and fluids.

IV THERAPY  Is

used to sustain clients who are unable to take substance orally  Replaces water, electrolytes and nutrients more rapidly then oral administration  Provides immediate access to the vascular system for the rapid delivery of specific solutions  Provides a vascular route

TEN GOLDEN RULES FOR ADMINISTERING DRUG SAFELY  Administer

the right drug  administer the right drug to the right patient.  Administer the right dose  Administer the right drug to the right route  Administer the right drug to the right time  Document each drug you administer  Teach patient about the drugs he is receiving

DOCUMENTATION OF IV THERAPY  Proper

documentation provides:  an accurate description of care that can serve as legal protection  a mechanism for recording and retrieving information

INFORMATION WRITTEN ON IV TAPE  size,

type and length of cannula/ needle  name of person who inserted the IV catheter  date and time of insertion

Label the IV solution specifying  type

of IV fluid  medication additives and flow rate  use of any electronic infusion device  duration of therapy and the nurse’s name and signature

TEN GOLDEN RULES FOR ADMINISTERING DRUG SAFELY  Take

a complete patient drug history. (There is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks)  Find out if the patient has any drug allergies  Be aware of potential drug to drug or drug to food interactions. To protect your patients or your license.

TONICITY OF IV FLUIDS  0.45%

SALINE (1/2 NS)  0.9% NS  5% dextrose in water D5W  D5 ¼ NS  Lactated Ringer’s solution  D5LR  D5 ½ NS  D5 NSS  D10W

Hypotonic Isotonic Isotonic Isotonic Isotonic Hypertonic Hypertonic Hypertonic Hypertonic

TYPES OF SOLUTIONS  Hypotonic

- solutions that have a lower osmolality than body fluids  Hypertonic - solutions that have a higher osmolality than body fluids  Isotonic - solutions that have the same osmolality as body fluids  Crystalloids – solutions that contain electrolytes (fluid volume replacement)  Colloids/ plasma expanders – pull fluid from the interstitial compartment into the vascular compartment (hge or hypervolemia)

IV Cannulas  Steel

needle of butterfly sets

 Wing

tip needle with a metal cannula  Needle is 0.5 – 1.5 inches in length (G16 -26)  Use in small and fragile bones  Infiltration is more common  Plastic  Use

needle

in short term therapy  Use for rapid infusion and more comfortable for the client  In-needle catheter can cause catheter embolism

IV GAUGES  Gauge

14 – 25  The smaller the gauge the larger the outside diameter  G14 -19 – for rapid fluid administration (blood products or anesthetics)  G20 - 21 – for peripheral fat infusion  G22 - 24 – STD IV fluid and clear liquid medication  G24 - 25 – for very small veins

IV CONTAINERS  Glass

or plastic  Do not write the plastic IV bag with marker pen

IV TUBING  Contains

the spike end, drop chamber, roller clamp, Y – site and adapter end  Use of vented or non – vented tubing  Shorter secondary tubing – use for piggyback solutions, connecting them to the injection site

DRIP CHAMBER  Microdrip  Are

used if fluid will be infused at 50cc/ hr  Used if solution contains potent medication that needs to be titrated  Delivers 60drops/ ml  Macrodrip  Use

if solution is thick or need to infuse rapidly  Delivers 10 – 20drops/ ml

FILTERS  Filters

provide protection by preventing particles from entering the client’s veins  Filters are used in IV lines to trap small particles such as undissolved antibiotics or salt or medications that have precipitated in solution  Assess the agency policy regarding the use of filters  A 0.22-um filter is used for most solutions, a 1.2um for solutions containing lipids or albumin, and a special filter for blood components

NEEDLELESS SYSTEMS  Needleless

systems include recessed needles, plastic cannulas, and one-way valves; these systems decrease the exposure to contaminated needles  Do not administer total parenteral nutrition or blood products through a one-way valve

INTERMITTENT INFUSION SETS 

 



Intermittent sets are used when intravascular accessibility is desired for intermittent administration of medications by IV push or IV piggyback An IV lock is attached for intermittent infusion devices Patency is maintained by periodic flushing with normal saline solution (sodium chloride and normal saline are interchangeable names) When administering medication, flush with 1 to2 mL (depending on agency policy) of normal saline to confirm placement of the IV cannula; administer the prescribed medication, and then flush the cannula again with 1 to2 mL (depending on agency policy) of normal saline to maintain patency

SLECTION OF PERIPHERAL IV SITE  Veins

in the hand, forearm, antecubital fossa, scalp and feet  Assess the veins of both arms closely before selecting a site  Start IV infusion distally  Determine the clients dominant side  Bending the elbow on the arm with IV may obstruct the flow causing thrombophlebitis and infiltration  Use an armboard as needed in the area of flexion

ADMINISTRATION OF IV SOLN  Check

the IV solution for the type amount, percent of solution and rate of flow  Assess the health status and medical disorders  Wash hands thoroughly and use sterile technique  Prime the tubing to remove air from the system

ADMINISTRATION OF IV SOLN  Change

the IV site every 48 – 72 hrs  Change the IV dressing every 72 hrs especially when wet and contaminated  Change the IV tubing every 24 to 72 hrs  Label the tubing, dressing and solution bags indicating the date and time when changed  Before adding med or solutions, swab access ports with 70% alcohol

COMPLICATIONS  Infection

– redness, swelling and drainage at site; chills, fever, malaise, headache  Tissue damage – skin color change, sloughing of skin, discomfort at site  Phlebitis – heat, redness, tenderness, not hard and swollen  Thrombophlebitis – heat, redness, tenderness, hard and cordlike vein  Infiltration – Edema, pain, and coolness at the site

COMPLICATIONS  Catheter

embolism – decrease BP, pain along vein, weak, rapid pulse, cyanosis of nail beds, loss of consciousness  Circulatory overload – increased BP, distended jugular veins, rapid breathing, dyspnea, moist cough and crackles  Electrolyte overload – signs depend on the specific electrolyte imbalance

COMPLICATIONS  Hematoma

– ecchymosis, immediate swelling and leakage of blood at the site, and hard painful lumps at the site  Air embolism – tachycardia, dyspnea, hypotension, cyanosis, decreased level of consciousness

COMPUTATIONS  gtts/min

= volume in cc x DF nos. of hrs x 60 min  nos. of hrs = volume in cc x DF gtts/ min x 60 min  cc/ hr = volume in cc number of hours  Infusion time = total volume to infuse ml/ hr being infused

CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR  Two

Steps 1. determine the amount of medication/ ml 2. determine the infusion rate or ml/ hr  Amount of medication/ ml  med/ 

ml = known amount of medication total volume of diluent

 Infusion  ml/ 

rate

hr = dose per hour desired concentration per ml

CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR  PROBLEM  Order:

continuous heparin Na by IV at 1000 units per hour  Available: IV bag 500 ml D5W with 20,000 unit of heparin Na  How Many ml/hr are required to administer the correct dose

ANSWER  Conc/

 ml/

ml = 20, 000 units 500 ml =40 units/ ml

hr = 1000 unit 40 units =25 ml/ hr

Types of BLOOOD COMPONENTS  RBC  Whole

blood  Platelets  FFP  Albumin  cryoprecipitate

RBC  Used

to replace erythrocytes  pRBC (250ml)  Increases the hemoglobin by 1g/dl and hematocrit by 2 - 3 %  Acute and chronic anemia

WHOLE BLOOD  Use

to resolve hypovolemic shock resulting from excessive bleeding  500ml  Rarely use

Platelets  Use

to treat thrombocytopenia and platelet dysfxn  X – matching is not required  50 – 70ml /unit or 200 – 400ml/ unit  Administer immediately and given for 5 – 30min  Evaluated after 1 hr and 24 hrs after transfusion

FFP  Use

to provide clotting factors or volume expansion  Infused within 6 hours of thawing  Infused as rapidly as possible  X- matching is needed  PT and aPTT

ALBUMIN  Use

to treat hypovolemic shock or hypoalbuminemia  Prepared from plasma and can be stored for 5 years  25g/100ml of albumin = 500ml of plasma

CRYOPRECIPITATES  Use

to replace factor VIII and fibrinogen  Prepared from FFP  Can be stored for 1 year but once thawed, the product must be used

TYPES OF BLOOD DONATION  Autologous  Blood

salvage  Designated donor

AUTOLOGOUS  Donation

of the clients own blood before the scheduled procedure  Reduces the risk of disease transmission and potential transmission complications  Can be made every 3 days as long as hemoglobin remains with in a safe range  Donation should be made within 5 weeks of the transfusion date and end at least 3 days before the date of transfusion

BLOOD SALVAGE  An

autologous donation  Involves suctioning of blood from body cavities, joint spaces  Blood may need to be washed by a special process that removes tissue debris before reinfusion

DESIGNATED DONOR  When

recipients select their own compatible donors  Does not reduce the risk of contracting infection but they feel comfortable

COMPATIBILITY  Rh

type and ABO type are identified  Use to prevent transfusion rxn  Crossmatching – the testing of donors blood and the recipients for compatibility

COMPLICATIONS  Transfusion

rxn  Circulatory overload  Septicemia  Iron overload  Disease transmission  Hypocalcemia and citrate intoxication  Hyperkalemia

NURSING INTERVENTION A

large volume of blood transfused rapidly through a central catheter into the ventricle of the heart will cause cardiac dysrhythmias  No solutions other than NS should be added on blood components  Infusion should not exceed more than 4 hrs  Medication are never added to blood components  Blood administration set should be changed every 4 - 6 hrs

NURSING INTERVENTION  Check

the date of expiration  Inspect he blood for abnormal color, leaks, clots, bubbles  Blood must be administered 20-30 minutes from its being received from the blood bank  Never refrigerate blood in refrigerator other than blood bank  Monitor vs and assess lung sounds

NURSING INTERVENTION 2

RN need to check the physicians order, clients identity, clients identification band  Check the blood bag tag, label and blood requisition form

CLIENT ASSESSMENT  Assess

for any cultural or religious beliefs  Informed consent has been obtained  Check the clients vital sign and medical status

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