IVs

IV’s OVERVIEWIV’s OVERVIEW IV solutions are instilled through a vein. IV solutions are instilled through a vein.

Includes water, chemicals, blood, blood Includes water, chemicals, blood, blood products, and meds.products, and meds.

LPN’s are certified through their facility, each LPN’s are certified through their facility, each facility’s policies/procedures vary. facility’s policies/procedures vary.

ADVANTAGES/DISADVANTAGESADVANTAGES/DISADVANTAGES

ADVANTAGESADVANTAGES Drug or solutions enter bloodstream instantly and

circulate into the tissue. This can be considered a disadvantage also.

DISADVANTAGE Fluids cannot be retrieved in the event of an error. Extreme caution must be used. Needle or catheter must be used to provide entry. Materials must be sterile to prevent infection.

IV DRUGS ARE ADMINISTERED FORIV DRUGS ARE ADMINISTERED FOR::

Restoring fluid balance secondary to trauma, illness, or dehydration.Restoring fluid balance secondary to trauma, illness, or dehydration. Maintain fluid balance when pt is NPO.Maintain fluid balance when pt is NPO. Administer medication/electrolytes/vitamins.Administer medication/electrolytes/vitamins. Administer anesthesia.Administer anesthesia. Administer blood/blood products.Administer blood/blood products. Long-term pain management. (avoids multiple injections)Long-term pain management. (avoids multiple injections) Trauma.Trauma. Maintain blood levels of drugs.Maintain blood levels of drugs. Establish access to vascular system for Dialysis, etc.Establish access to vascular system for Dialysis, etc.

IV MEDICATIONS ARE ADMINISTERED THROUGH 2 TYPES OF VEINS:

•PERIPHERAL

•CENTRAL (requires sterile dressing changes.)

TYPES OF IV CATHETERSTYPES OF IV CATHETERS CENTRAL VENOUS:CENTRAL VENOUS: Extends to vena cava or right Extends to vena cava or right

atrium. Administers meds in a atrium. Administers meds in a large volume of blood. Used for large volume of blood. Used for long-term IV therapy or when long-term IV therapy or when meds are irritating to peripheral meds are irritating to peripheral veins. If catheter is multiple lumen, veins. If catheter is multiple lumen, meds incompatible w/each other meds incompatible w/each other can be administered can be administered simultaneously.simultaneously.

TUNNELED:TUNNELED: Inserted into central vein. Part of Inserted into central vein. Part of

the catheter is secured in the catheter is secured in subcutaneous tissue.subcutaneous tissue.

TYPES OF IV CATHETERS TYPES OF IV CATHETERS (CONT)(CONT)

PERCUTANEOUS:PERCUTANEOUS: Inserted into a peripheral vein. For short-term therapy. Inserted into a peripheral vein. For short-term therapy.

Sutured to the skin.Sutured to the skin. IMPLANTED:IMPLANTED: (Porta-Cath). Sealed beneath the skin. Greatest protection (Porta-Cath). Sealed beneath the skin. Greatest protection

against infection. Self-sealing port which is pierced through against infection. Self-sealing port which is pierced through the skin with a special needle. Local anesthetic can be applied the skin with a special needle. Local anesthetic can be applied prior. Can remain for several years. Flushed periodically with prior. Can remain for several years. Flushed periodically with Heparin.Heparin.

PICC LINE:PICC LINE: Peripherally inserted central catheter.

TYPES OF IV SOLUTIONTYPES OF IV SOLUTION

ISOTONIC: Maintains balance-

resembles body fluids. 0.9% NS (Sodium

Chloride). Fluid loss/rehydration.

D5W (Dextrose 5% in water). Hydration.

Lactated Ringers. Hydration, burns, acute blood loss, replace electrolytes.

TYPES OF IV SOLUTIONS TYPES OF IV SOLUTIONS (CONT)(CONT)

HYPOTONIC: Causes cellular hydration. Used for fluid loss secondary to

diarrhea/vomiting. Normal Saline 0.45%. Cellular hydration, electrolyte

replacement. Dextrose/Water (DW) 2.5%. Hydration. Dextrose 5% in Normal Saline 0.45% (D51/2NS). Hydration. Normosol M. Hydration, electrolyte replacement.


HYPERTONIC: Causes cell shrinkage. Used with extreme caution when

reducing cerebral edema or to expand circulatory volume rapidly. Can cause circulatory overload by increasing the circulatory volume too rapidly.

5% Dextrose in Normal Saline. Hydration and shock. 5% Dextrose in 0.45% Normal Saline. Diabetic Ketoacidosis. 5% Dextrose in Lactated Ringer’s. Hydration. 5% Dextrose in 0.33% Normal Saline. Hydration. 10% Dextrose in Water. Provides a small amount of

nutritional glucose.


TPN: Usually in Central Line. For nutrition if unable to eat or

consume fluids over a long period. Example: Cancer, trauma, inflammatory bowel disease.

BLOOD AND BLOOD PRODUCTS: Whole Blood-Massive blood loss, restores blood volume.

Raises HMG and HMCT count. Packed Cells-Cellular replacement. Extra volume not needed. Plasma-Replaces clotting factors.

ASSESSMENT OF SITEASSESSMENT OF SITE

What is the IV used for? What is the IV used for? Irritating substances, larger Irritating substances, larger volumes, thicker fluids volumes, thicker fluids require larger veins.require larger veins.

Use F/A and hand in adults. Use F/A and hand in adults. Legs used only with a Dr Legs used only with a Dr order. Scalps used for order. Scalps used for infants.infants.

Use non-dominant hand.Use non-dominant hand. Where is the surgery?Where is the surgery? Patient preference.Patient preference.

Do not use a compromised site. (bruising, swelling, previous IV, impaired circulation, rash, infection, amputation, etc.)

Choose a site good for 72 hours.

Use alternate sites. Try a warm compress for 10

minutes, BP cuff, have pt make a fist, tap skin, lower arm (promotes distal pooling).

INFUSION TECHNIQUESINFUSION TECHNIQUES

CONTINUOUS;CONTINUOUS; Administration of a drug over a

period of several hours.

INTERMITTENT:INTERMITTENT: Administration of medication in a

relatively short span.

BOLUS:BOLUS: Medication given all at one

time. Through an existing port or lock.

INFUSION TECHNIQUES (CONT)INFUSION TECHNIQUES (CONT)

SECONDARY INFUSION:SECONDARY INFUSION: Administration of a drug that has been diluted in a small volume of IV

solution, usually over 30-60minutes. (Piggyback) Hang higher than Primary.

VOLUME CONTROL SET:VOLUME CONTROL SET: Chamber in IV tubing that holds a portion of the solution from a larger

container. Avoids overloading Circulatory System. (Volutrol, Buretrol, Soluset.)

PRIMARY:Approx 110in. Spans the distance between solution and infusion site.

SECONDARY:Approx 37in. Used to administer small volumes of solution into a port within

the Primary Tubing.

VENTED:Draws air into the container. Used with glass container. Allows fluids to

flow.

NON-VENTED:Prevents air from entering container. Does not need air because plastic bag

collapses as fluid infuses.

TYPES OF TUBING (CONT)TYPES OF TUBING (CONT)

MICRODRIP: Used for slow infusing solutions.

MACRODRIP: Easier to count if infusing fast-flowing solutions.

FILTERED: Removes air bubbles as well as undissolved drugs, bacteria, and larger

substances. Used for: Parenteral nutrition, Pediatrics, High Infection Risk, Administering blood.

NEEDLELESS SYSTEM: Eliminates need for needle access.

IV COMPLICATIONSIV COMPLICATIONS CIRCULATORY CIRCULATORY

OVERLOADOVERLOAD

INFILTRATION INFILTRATION

THROMBUS THROMBUS

THROMBOPHLEBITISTHROMBOPHLEBITIS

INFECTIONINFECTION

PULMONARY PULMONARY EMBOLUSEMBOLUS

AIR EMBOLISMAIR EMBOLISM

COMPLICATIONSCOMPLICATIONS

CIRCULATORY OVERLOAD: Symptoms: Increased BP, SOB, Anxiety. Cause: Rapid infusion, reduced kidney function, impaired heart

contractions. Action: First action of nurse is to assess for Respiratory Distress

(VS), then Decrease Flow-Rate, Fowler’s position, call Physician.

INFILTRATION: Symptoms: Swelling at site, burning, color-pallor, coldness, slow or

no rate. Cause: Solution escaping into subcutaneous tissue. Action: Restart IV, elevate, warm compress X20 minutes.

COMPLICATIONS (CONT)COMPLICATIONS (CONT)

THROMBUS:THROMBUS: Symptoms: Pain, swelling. Cause: Cannula point traumatizes wall of vein. Thrombi form on

the vein and tip of cannula. Traps bacteria. Action: D/C site. Call physician.

THROMBOPHLEBITIS:THROMBOPHLEBITIS: Symptoms: Pain along length of vein. Vein becomes increasingly

painful and hard. Cause: Thrombus with inflammation, chemicals or irritation. Action: Watch for Septicemia and Acute bacterial endocarditis. D/C

IV, notify Physician.


INFECTION: Symptoms: Redness, puffiness. Purulent drainage. Temperature and

chills. Cause: Spread of bacteria. Action: D/C site. Notify physician. Culture if necessary.

PULMONARY EMBOLUS: Symptoms: SOB, Anxiety, Sudden Chest Pain, Rapid heart rate with

a drop in BP. Cause: Movement of previously stationary blood clot. Action: Stay with patient and call for assistance.


AIR EMBOLUS:AIR EMBOLUS:

Symptoms: Drop in BP, Tachycardia, Decreased LOC, Cyanosis. Cause: Air enters vein, disconnected tubing, running solutions

simultaneously, lethal amount unknown. Associated with Central Lines.

Action: Trendelenberg position on L side. (air rises to R atrium, preventing it from entering the Pulmonary Artery.

CALL FOR ASSISTANCE

BLOOD TRANSFUSIONBLOOD TRANSFUSION Blood is dispensed in 500ml containers. It is very thick and viscous. A

pressure bag may be used to permit continuous drip. VS are closely monitored. Usually Q5minX3 then Q15min. Check with your facility policy. First sign of a reaction is usually within 5-15min. Patients will c/o a burning sensation, after this they will develop:

Tachycardia Hypotension Flushing DyspneaRestlessness Back Pain Mild Allergic Reaction: Hives Itching If the infusion continues: Fever Chills Change in body temp. Intervention: Stop the transfusion Do not remove needle Report observations Monitor VS Save tubing for analysis by Lab

SIGNS/SXS’S OF INFECTIONSIGNS/SXS’S OF INFECTION(LOCAL AND SYSTEMIC)(LOCAL AND SYSTEMIC)

ABDOMINAL PAINABDOMINAL PAIN

DIAPHORESISDIAPHORESIS

GLUCOSE INTOLERANCEGLUCOSE INTOLERANCE

NV/DIARRHEANV/DIARRHEA

ALTERED MENTAL STATUSALTERED MENTAL STATUS

FATIGUE, MUSCLE ACHES, WEAKNESSFATIGUE, MUSCLE ACHES, WEAKNESS

KEY POINTSKEY POINTS HL need to be flushed QS and HL need to be flushed QS and

after admin of med.after admin of med. Make sure flush is compatible Make sure flush is compatible

with medication being given and with medication being given and IV fluid.IV fluid.

Use filter needle when using Use filter needle when using ampules.ampules.

Cleanse site first.Cleanse site first. When giving antineoplastic drugs, When giving antineoplastic drugs,

wear long-sleeved, cuffed, low-wear long-sleeved, cuffed, low-permeable gown with closed front permeable gown with closed front and non-powdered gloves. Cover and non-powdered gloves. Cover drug preparation area with drug preparation area with disposable pad to absorb spills. disposable pad to absorb spills. Avoid inhalation of drug.Avoid inhalation of drug.

If IV is running too slowly, do not play catch-up. Assess patient for respiratory distress secondary to fluid overload.

IV fluids are considered medications and are ordered by the Physician. The Five Rights are strictly adhered to and are critical, as well as assessment of the patient and site.

The drug, rate, and volume must be included in the order.

ASSESSMENT/CARE OF THE IVASSESSMENT/CARE OF THE IV

ASSESSMENT:ASSESSMENT: Q1HOURQ1HOUR

SITESITE RATERATE TIME STRIPTIME STRIP NOTIFY MED NURSE IF NOTIFY MED NURSE IF

BAG RUNNING DRY.BAG RUNNING DRY.

CARE:CARE: MAY USE ARMBOARD FOR MAY USE ARMBOARD FOR

POSITIONINGPOSITIONING PROTECT NEEDLE PROTECT NEEDLE

SITE/STERILITY OF FLUIDSITE/STERILITY OF FLUID CHANGE DRESSING Q24-CHANGE DRESSING Q24-

72HR ACCORDING TO 72HR ACCORDING TO POLICYPOLICY

KEEP SITE CLEAN/DRYKEEP SITE CLEAN/DRY CHECK FOR BUBBLESCHECK FOR BUBBLES (wind tubing around pencil, milk (wind tubing around pencil, milk

tubing)tubing)

GENERAL INFORMATIONGENERAL INFORMATION The longer the duration of infusion, the more likely complication are to

occur. Solutions/meds are irritating to the vein. Cannula’s can irritate and pierce venous walls causing complications. Small veins are more likely to be irritated. Cannula can occlude vein and prevent blood flow. Veins in lower extremities are a factor when there is pooling or stagnant

blood. Poor technique can cause inflammation and infection. Phlebitis with sepsis is associated with technique. (like disconnecting a

gown) Infection is a risk. Skin must be thoroughly and properly cleansed to

maintain asepsis. Such as thorough handwashing.

TOTAL VOLUME IN MILLILITERSTOTAL VOLUME IN MILLILITERS TOTAL HOURSTOTAL HOURS

EXAMPLE: EXAMPLE: 1000ML GIVEN OVER 8HRS1000ML GIVEN OVER 8HRS 1000ML =1000ML =125ML/HR125ML/HR 8HOURS8HOURS

DROP RATE:

REGULAR: 15GTTS/ML

MACRO: 10GTTS/ML (BLOOD)

MICRO: 60GTTS/ML (INFANTS/PEDS)

EXAMPLE: 1000ML OVER 12 HRS (ADULT)

VOLUME X SIZE OF DROP

TIME (IN MINUTES)

1000x15 = 21GTTS/MIN

60MINx12HRS

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IVs