Transcript IV Therapy - Essex County College Nursing School

IV Therapy
NRS 108
Majuvy L. Sulse RN, MSN, CCRN
Objectives of IV therapy




Achieve & maintain normal fluid &
electrolyte balance
Achieve optimal nutritional status
Maintain homeostasis through blood &
blood products administration
Medication administration
Composition & Distribution of
body fluids

Component



Water
electrolytes
Distribution


IntracellularExtracellular



Interstitial-Lymph
Intravascular-plasma
Transcellular-CSF, pleural, peritoneal & synovial
Movement of body fluids




Osmosis
Diffusion
Filtration
Active transport
Osmolarity vs. Osmolality
& Tonicity
Osmolarity


Number of milliosmosles
in a liter of solution
 Volume
Normal osmolarity of
plasma and ECF
 270-300 MOS/L
Osmolality

Number of
milliosmoles in a
kilogram of
solution
Weight
Tonicity- ability of solution to cause
a change in water movement across a
membrane due to osmotic pressures
Hypertonic
Isotonic
Hypotonic
Osmolarity greater than Osmolarity equal to
body fluid
body fluid
Osmolarity is less than
body fluid
Shifts fluid into blood
plasma by moving fluid
from tissue cells
Keeps fluid in the
intravascular volume
Shifts fluid from
intravascular to the
tissue cells
Uses:
Hypovolemia
hyponatremia
Uses:
dehydration, KVO,
intravascular
compartment
expansion
Uses:
Expand and hydrate
cells in cellular
dehydration
Watch for:
Increase in BP
Fluid overload
Fluid overload
Low Hb/Hct levels
Monitor Na levels
Hypotension
Examples of IVF
Hypertonic
NaCl 3%-5%
D5 NaCl D5LR
D5.45 NaCl
Isotonic
0.9% NaCl
Hypotonic
LR
D5W
Albumin 5%
(colloid)
0.45% NaCl
0.33% NaCl
2.5% Dextrose
Colloids
Proteins/large molecules
Increased osmotic pressure-plasma
volume
expanders
Uses: burns, hemorrhage, surgery
Types:
dextran-40-70 (decreases blood viscosity &reduces
platelet adhesiveness)
albuminMannitol
Nurse Alert: Monitor for blood pressure
Crystalloids
Substances easily dissolved, pass
through semi permeable
membrane
Uses: replace fluid loss & promote urine
output
Types:
Dextrose solutions
sodium chloride solutions
multiple electrolyte solutions
IV Sites & Cannulas


Site-start from periphery, use vein on
non dominant side, avoid areas of
previous venipunctures, avoid areas of
flexion, veins on a
surgically/neurologically compromised
limb
Catheter gauge-amount of fluid and
how long it will infuse, viscosity of fluid,
size & condition of vein
Common IV sites
1-cephalic
2-basilic
3-median cubital
4- medial cutaneous
nerve of forearm
medial antebrachial
cutaneous n.
5-lateral cutaneous
nerve of forearm
lateral antebrachial
cutaneous n.
Standard intravenous catheter



Used for continuous fluid administration
Not considered for long term therapy
Flow rate regulated manually by clamp
or regulated by an automatic pump
Heparin Lock





Intermittent infusion lock
Used when fluid therapy is no longer
required
Used to administer intermittent
medication
Used to maintain venous access
Needs flushing to maintain patency
Medication Administration

Added to primary intravenous fluids-large volume
infusions



Added via piggyback-small amount IV fluid in a
secondary set connected to Y port


10 mEq KCL to D51/2 NS
1amp MVI to D51/2 NS
antibiotics
Given via IV -push-confirm placement of catheter
Lasix
Intravenous Therapy & Piggyback
Medication Administration


Preparation Always practice strict hand washing
Preparation for additives
 Vial or ampule- measure appropriate amount
 Powder- mix with diluents
Common complications-Local



Hematoma
Leakage of blood into surrounding insertion site
Causes:




Signs/symptoms


Perforation of opposite vein wall
Needle slips out of vein
Insufficient pressure after venipuncture is terminated
IMMEDIATE SWELLING, ECCHYMOSIS
Interventions

Immediate pressure, sterile dressing, cold compress over 24
hrs then warm compress
Common complications-Local





Infiltration
Leakage of fluid into surrounding insertion site
Causes:
 Needle dislodges and fluid infuses into the tissues
S/S
 Edema, area cool to touch, no blood return
Interventions
 D/c Iv, sterile dressing, warm compress, elevate
Common complications-Local


Tissue injury- may include necrosis and
sloughing, deprive patient of fluid, infection,
permanent damage
Causes


S/S


Infiltration of hypertonic, toxic, acidic or alkaline
solutions
Pain, swelling, color changes, sloughing
Interventions

Notify MD, follow treatment
Common complications-Local


Phlebitis-inflammation of vein
Causes:


S/S


Prolonged infusion, traumatic entry, fluid tonicity,
cannula size, improper securing at site, poor
sterile technique
Redness, warmth, swelling, burning pain, low flow
rate
Interventions

D/c IVF, warm compress
Common complications-Local




Thrombosis-formation of thrombose without
inflammation
Causes:
 Damage to intima of vein, deposition of fibrin, clot
occlusion
S/S
 Little to no pain, low/no flow rate
Interventions

D/c IV

DO NOT IRRIGATE
Common complications-Local




Thrombophlebitis-clot formation with inflammation of
vein
Causes:
 Damage to intima of vein, fibrin deposit, clot,
occlusion
S/S
 Pain, redness, warmth, swelling
Interventions
 D/C IV, do not irrigate, notify MD, warm compress,
elevate
Common complications-Local




Clotting of cannula
Causes:
 Empty IV or interrupted flow, kinked tubing,
failure to flush heparin lock
S/S
 IV flow stops, backflow of blood in IV tubing
Interventions
 Aspirate clot (do not use force) restore flow
Complications-Systemic



Infection
Causes: introduction of microorganism at
catheter insertion or during therapy,
contaminated equipments or solutions
S/S


Dependent upon the degree and the individual
Interventions

Notify the MD, supportive care
Complications-Systemic


Air embolism
Causes:


S/S


Introduction of air during insertion of central line,
administration tubing, solution run dry
Pallor, cyanosis, dyspnea, cough, tachycardia,
syncope, shock
Interventions

Place client on Left side, emergency supportive
care, notify MD
Complications-Systemic


Thrombolism- obstruction of blood vessel by
carried via the circulatory system
Causes:


S/S


Release of clot from the catheter tip via
manipulation or tubing
Depending upon size & location of clot
Interventions

Notify MD, monitor VS, supportive nursing care,
treat as per MD
Complications-Systemic


Allergic reaction- hypersensitivity to solution
or medication
Causes:


S/S




Antigen-Antibody reaction
Skin: rash, urticaria
Respiratory: dyspnea, stridor, wheezing
Non specific: nausea, vomiting, chest tightness
Interventions

Stop IV, change tubing, run KVO, notify MD
Complications-Systemic




Circulatory overload-infusion of excessive
fluids
Causes:
 Failure to monitor rate
S/S
 Edema, puffy eyelids, SOB, rales,
hypertension
Interventions
 Decrease Iv rate, raise of head of bed up,
monitor VS, notify MD, O2
Complications-Systemic


Speed shock-related to toxic concentration of
drug
Causes:


S/S


Rapid administration of IV drug
Tachycardia, hypotension, syncope, shock, cardiac
arrest
Interventions

Stop drug infusion, KVO fluids, Monitor VS, notify
MD
Vascular Access Devices






Short Peripheral catheters
Midline Catheters
PICC-peripherally inserted central
catheters
Nontunneled Percutaneous Central
Catheters
Implanted ports
Dialysis catheters
Catheter care & Maintenance








Educate client
Assessment
Securing& dressing the catheter
Changing administration sets
Controlling infusion pressure
Obtaining blood samples from catheter
Keeping catheter patent
Discontinuing catheter
IV Flow Rate Calculations


Know tubing
Macro drip





10gtts
15 gtts
20 gtts
All equals 1 cc
Micro drip

60 gtts= 1cc
IV Flow Rate Calculations

Must know

Total volume to be infused


Calibration of tubing
Time ordered for infusion
Formula
flow rate= volume x calibration
time in minutes

IV Flow Rate Calculations


Order: 1000 ml D5w TO INFUSE OVER
8 HOURS. Drip factor: 20 gtts/ml.
Calculate the correct gtt/min.
1000ml x 20gtt= 20,000=41.6gtts/min
8x60
480
IV Flow Rate Calculations

Ordered D5W to infuse at 83 ml/hr. The
drop factor is 10.
10 x 83= 1 x 83= 13.8 or 14gtts/min
1 hr x 60 min
6
Calculating drug doses




Formula: Dose= Rate x concentration
Dose= expressed in different units:
mg/hr, mg/min, units/hr, etc
Rate=always in ml/hr as IV pumps are
used to administer these drugs
Concentration=found on the label of the
drug which maybe in mg/ml, units/ml or
mcg/ml
Calculating drug doses

1) You need to administer 800 units of
heparin. The label states there are
25,000 Units/500 ml of fluid. calculate
the rate you will set on the pump


500ml
25,000 U
x
800 U= 40000 ml =16ml/hr
1 hr
25000
Calculating drug doses

At the beginning of your shift, you note
that Theophylline 1 gm/500ml is
infusing at 20 ml/hr. You have an order
to administer Theophylline at 40 mg/hr.
Is the rate correct?
500ml
x
1000mg
40 mg =20000 ml =20ml/hr
1 hr
1000hr