-
Why IV’s
7 Uses of IV Therapy
Fluid Volume Maintenance
Fluid Volume Replacement
Medication Administration
- Blood and Blood Product
- Administration
Nutritional Supplementation
To keep vein open for emergency
Blood sampling for diagnostic tests
-
What are some advantages?
-
What are some Disadvantages?
Infection
Painful
Dangers:
overdose
sepsis
-
Some Terminology
Hematoma
Thrombosis
Phlebitis
Thrombophlebitis
- Infiltration
- Local
- Infection
-
-
What are 6 nursing responsibilities?
Assessment
- Five
- Rights of Medication Administration
Documentation
Teaching
Discontinuance
-
Considerations in Planning
- Maintain
- aseptic technique
- Choose
- tubing and needle appropriate for solution to provide optimal blood flow
- Attempt
- to enter vein at its lower end
- NEVER
- ATTEMPT TO RETHREAD A CATHETER
-
VENIPUNCTURE
- Use
- distal branches of a large vein
Forearm
Ankle
foot
-
Selecting a Vein
- Perform
- hand hygiene, apply gloves
- Apply
- tourniquet 3-5 inches below elbow
- Look
- for vein with largest diameter and fewest curves or junctions
-
Infusion Devices
- Scalp
- vein needle (butterfly)-wings allow for ease of insertion, not for long term
- use
- Over-the-needle
- catheter-easy to insert, patent longer, stable which allows greater patient
- mobility
- Inside-the-needle
- catheter-less likely to damage vein, permits insertion into superior vena cava,
- CVP monitoring, rarely used
-
Central Infusion Devices
- Infraclavicular
- approach-no tunneling
- May
- remain for a few days to several weeks
- Access
- to larger venous circulation
Examples:
Jugular
Femoral
Subclavian
-
Central Infusion Devices
- Broviac-90cm
- long, 1mm diameter silicone Silastic,
- used primarily in pediatric patients.
- Hickman-modified
- Broviac
- with larger diameter, tunneled subcutaneously.
- Groshong-thin-walled
- translucent silicone rubber catheter, similar to Hickman, allows both fluid
- administration and blood draw through same lumen.
-
Inserting the catheter
- Hold
- skin taut, insert catheter with bevel up
- Watch
- for backflow of blood, advance quarter inch
- Remove
- needle, slide catheter into vein
- Secure
- according to policy
-
Assessment of the IV Site
- No
- infiltration (cold, swelling)
- No
- leaking of blood or fluid
-
How often should you check the IV
- The
- Nurse should assess the site and
- the infusion rate at least every
- hour
-
-
Assessment of the Patient with IV
-
Documentation in nursing notes
- No
- s/s of infiltration or infection
- Where
- is it? What does it look like?
- What
- is the date marked on the dressing
-
Documentation upon initiation of IV site
- Where
- it is and What size catheter it is
- INT
- or Continuous IV Fluids
-
Commit to memory
- Once
- a medication is given intravenously, it’s
- given! You can’t
- take it back!
-
Maintenance
Therapy
- daily
- body fluid requirements
-
Replacement
Therapy
- for
- present deficits with acute distress
-
Restoration
Therapy
- for
- concurrent or continuing losses
-
Parenteral Supplements
- maintain
- or replenish body levels of essential chemicals
- Na+,
- K+, and Ca++ for normal nerve and muscle function
- Cl-
- and Bicarbonate buffer to correct acid base imbalance
- Sugars
- in concentrations less 10% carbohydrate
- calories
-
Types of Parenteral Fluids
Hypertonic
Isotonic
Hypotonic
Blood
-
Hypertonic Solutions
- Cause
- shift ECF from interstitial space to plasma
- Give
- slowly to prevent circulatory overload
- Examples:
- D5NS 0.45%, D5NS 0.9%, D5LR
-
Isotonic Solutions
- Expand
- extracellular fluid (ECF)
- No
- affect on intracellular and interstitial compartments
- Danger
- is circulatory overload
Examples:
- 0.9%
- sodium chloride Lactated Ringers
-
Hypotonic Solutions
- Hypotonic solutions cause fluid to
- shift out of vessels and into the interstitial and intracellular compartments.
- Hydrate cells while depleting
- circulatory system.
Don’t give with low blood pressure
Examples: 0.45% sodium chloride
-
Types of Parenteral Fluid
- Crystalloid
- Solutions-electrolyte solutions-hypotonic, isotonic, hypertonic. “True” solutions.
- Colloid
- Solutions-do not dissolve-blood and blood products
-
Types of Parenteral Fluid
- Dextrose
- and Water Fluids-hydrate interstitium more
- than intravascular space. Difficult to
- get total calories needed. More than 20%
- cause vein damage. Don’t mix
- with blood.
- Sodium
- Chloride Fluids-provides ECF replacement, treats metabolic alkalosis, used with
- blood transfusions
-
Types of Parenteral Fluid
- Dextrose
- & Sodium Chloride-replaces nutrient and electrolytes, temporarily treats
- circulatory insufficiency & shock.
- Hydrating
- Fluids-assess status of kidneys, use cautiously in edematous patients, hydrates
- medical and surgical patients
-
Types of Parenteral Fluid
- Multiple
- Electrolyte Fluids-may be balanced hypotonic or isotonic maintenance and
- replacement solutions.
- Normosol R,
- Lactated Ringers, Isolyte E.
- Ringer’s
- Fluids-fluid & electrolyte content similar to plasma-short time replacement
- for blood, substitute potassium and calcium for sodium.
-
Types of Parenteral Fluid
- Lactated
- Ringer’s-less
- sodium, calcium, & chloride, adds bicarbonate precursor-assist in acidotic
- states.
- Plasma
- Expanders-increase blood volume.
- Alkalizing
- & Acidifying-bicarbonate levels increased or decreased-lactate or ammonium
- chloride.
-
Total Parenteral Nutrition (TPN
- preparations
- containing concentrated sugars, amino acids, and lipid.
- Nutrients
- administered IV replace those that normally would be absorbed from the GI tract
-
Who gets TPN?
- cachectic
- or debilitated persons
- who
- cannot take adequate oral nutrition
- severe
- intestinal malfunction
- temporary
- measure to improve the prognosis
- long
- term measure for maintaining clients with chronic malfunction
-
How does one administer TPN?
- parenteral
- formulas containing sugars and amino acids are concentrated and cannot be
- infused into peripheral veins
- high
- osmotic tonicity would damage erythrocytes, other cells, and vessels
- rapid
- dilution to normal tonicity is achieved by directly infusing into the largest
- veins the vena cava, subclavian or
- jugular
-
Are there dangers associated with
TPN?
- protein
- aggregation embolism
hyperglycemia
hyperammonemia
-
More Dangers associated with TPN
-
Hematocrit
- The
- volume of red blood cells found in a 100ml of blood, expressed as a percentage
- Dehydration
- or hypovolemia
-
Hemoglobin is a protein substance
found in Red Blood Cells. It is composed
of iron and carries oxygen
-
Low hemoglobin
- anemia-
- iron deficiency, aplastic,
-
too high hemoglobin
Dehydration
Polycythemia
COPD
CHF
-
-
Why the need for a Blood
Transfusion
Hemorrhage
- Temporary
- correction for deficiencies
Hemolysis
- At
- this time, there is no synthetic blood substitutes
-
What are the Problems with Blood
Transfusions?
Hemolysis
disrupts circulation
- damages
- organs- especially kidneys.
Hyperkalemia and Hypocalemia
-
Blood Compatibility
As easy as A B O
- A
- Blood Type presence of A antigen
- B
- Blood Type presence of B antigen
- AB
- Blood Type both antigens
- Antigens-substance
- capable of producing a immunological response
-
A
serum mixed with B
serum will clump as a result of the
Antigen-Antibody reaction.
Give
A or O blood to A group
Give
B or O blood to the B group
Give
A, B, AB, or O blood to the AB group
Give
O blood to the O group
-
Rh Factor
Rh+ (D antigen)
Rh- absence of the antigen
Rh+ presence of the antigen
- An Rh- person must only be transfused
- with Rh-
- blood to avoid the formation of antibodies to Rh+ blood
- The
- Rh+ patient may receive Rh+
- or Rh-
-
Transfusion Reactions
anxiety
restlessness
flushing
- increased
- pulse +/or respirations
- shaking,
- chills, fever, and cyanosis
-
If you suspect a Blood Transfusion
Reaction
- STOP
- THE INFUSION IMMEDIATELY
-
Lab Values
Hemoglobin w12-16 g/dl M 14-18
Hematocrit w39-47% M44-52
- Serum 60-110 mg/dl
- Glucose
BUN 8-25mg/dl
Creatinine .6 - 1.5 mg/dl
-
IV CALCULATIONS
Order-1000ml. D5W every 12 hr.
-
DRIP RATES
How many gtts. per minute?
83.3ml./ hr., 1.39ml./min.
60 gtts. /ml drop factor
- 60 gtt. = X gtt
- 1ml. 1.39 ml/min
X=83.4 gtts./min.
|
|
