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IV THERAPYBy: 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 drugadminister the right drug to the right patient.Administer the right doseAdminister the right drug to the right routeAdminister the right drug to the right timeDocument each drug you administerTeach patient about the drugs he is
receiving
DOCUMENTATION OF IV THERAPY
Proper documentation provides:an accurate description of care that can
serve as legal protectiona mechanism for recording and retrieving
information
INFORMATION WRITTEN ON IV TAPE
size, type and length of cannula/ needlename of person who inserted the IV catheterdate and time of insertion
Label the IV solution specifying
type of IV fluidmedication additives and flow rateuse of any electronic infusion deviceduration 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 allergiesBe aware of potential drug to drug or drug
to food interactions. To protect your patients or your license.
TONICITY OF IV FLUIDS0.45% SALINE (1/2 NS) Hypotonic0.9% NS Isotonic5% dextrose in water D5W IsotonicD5 ¼ NS IsotonicLactated Ringer’s solution IsotonicD5LR HypertonicD5 ½ NS HypertonicD5 NSS HypertonicD10W 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 CannulasSteel 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 bonesInfiltration is more common
Plastic needleUse in short term therapyUse for rapid infusion and more comfortable for
the clientIn-needle catheter can cause catheter embolism
IV GAUGESGauge 14 – 25The smaller the gauge the larger the outside
diameterG14 -19 – for rapid fluid administration
(blood products or anesthetics)G20 - 21 – for peripheral fat infusionG22 - 24 – STD IV fluid and clear liquid
medicationG24 - 25 – for very small veins
IV CONTAINERS
Glass or plasticDo 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 tubingShorter secondary tubing – use for
piggyback solutions, connecting them to the injection site
DRIP CHAMBER
Microdrip Are used if fluid will be infused at 50cc/ hrUsed if solution contains potent medication that
needs to be titratedDelivers 60drops/ ml
Macrodrip Use if solution is thick or need to infuse rapidlyDelivers 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 1.2-um 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 hrsChange the IV dressing every 72 hrs
especially when wet and contaminatedChange the IV tubing every 24 to 72 hrsLabel the tubing, dressing and solution bags
indicating the date and time when changedBefore adding med or solutions, swab
access ports with 70% alcohol
COMPLICATIONS Infection – redness, swelling and drainage at
site; chills, fever, malaise, headacheTissue damage – skin color change,
sloughing of skin, discomfort at sitePhlebitis – heat, redness, tenderness, not
hard and swollenThrombophlebitis – 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 minnos. of hrs = volume in cc x DF gtts/ min x 60 mincc/ 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 Steps1. determine the amount of medication/ ml
2. determine the infusion rate or ml/ hrAmount of medication/ ml
med/ ml = known amount of medication total volume of diluent
Infusion rateml/ hr = dose per hour desired concentration per ml
CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR
PROBLEMOrder: continuous heparin Na by IV at 1000
units per hourAvailable: IV bag 500 ml D5W with 20,000
unit of heparin NaHow Many ml/hr are required to administer
the correct dose
ANSWER
Conc/ ml = 20, 000 units 500 ml =40 units/ ml
ml/ hr = 1000 unit 40 units =25 ml/ hr
Types of BLOOOD COMPONENTS
RBCWhole bloodPlateletsFFPAlbumincryoprecipitate
RBC
Used to replace erythrocytespRBC (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
500mlRarely use
Platelets
Use to treat thrombocytopenia and platelet dysfxn
X – matching is not required 50 – 70ml /unit or 200 – 400ml/ unitAdminister immediately and given for 5 –
30minEvaluated 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 possibleX- matching is neededPT 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 fibrinogenPrepared from FFPCan be stored for 1 year but once thawed,
the product must be used
TYPES OF BLOOD DONATION
AutologousBlood salvageDesignated 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 spacesBlood 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 identifiedUse to prevent transfusion rxnCrossmatching – the testing of donors blood
and the recipients for compatibility
COMPLICATIONS
Transfusion rxnCirculatory overloadSepticemia Iron overloadDisease transmission Hypocalcemia and citrate intoxicationHyperkalemia
NURSING INTERVENTIONA 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, bubblesBlood must be administered 20-30 minutes
from its being received from the blood bankNever refrigerate blood in refrigerator other
than blood bankMonitor 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 obtainedCheck the clients vital sign and medical
status
THANK YOU