Transcript Part2LECTURE

Catherine Luksic BSN, RN
 Primary


infusion
“maintenance infusion”
“continuous infusion”


Via gravity
Via electronic pump
 Secondary


infusion
“piggyback”
“IVPB”

Usually via electronic pump
 Primary


IV administration set
Gravity infusion
Electronic pump infusion
 Secondary

IV administration set
“piggyback tubing”
 Blood
administration Y set
 Extension tubing
 Intermittent infusion lock

HL or SL
 Gravity





Drip
Manually set, regulated w/ roller clamp
Simplest method
Count drops manually
Macrodrip tubing - drop factor determined by
manufacturer
Can range from 10-20 gtts/mL (common 10gtts/mL)
standard primary tubing
 for rapid infusions


Microdrip tubing - 60gtts/mL

Used for peds, elderly, slower rates
 Advantages:
 Easy
 Does
not require power source or pump
 Can set-up quickly
 Disadvantages:
 Not
greatly accurate
 No free-flow prevention
 Room for error
 Volume

ordered to be infused
1000 ml or 1000 cc
 Drop
factor of tubing being used
 Rate
of infusion as per order

100 ml /hr (or 100 cc/hr)
**refer to IV calculations worksheets
 Check
physician orders !
 Gravity drip or electronic pump ?
 cc/hr = ml/hr
 KVO (10-20 ml/hr)
 TKO
 Check IV site & IV rate at least every hour
 Refer
to procedure
 Maintain sterility
 Remember to close the roller clamp 1st **
 ?? Invert all Y-sites and tap to remove air
 Demonstration
 Practice
 Height
of bag
 36 inches above heart
 Position
of roller clamp
 is it open or closed ?
 Patency
of tubing
 Check for kinks
 Check
rate - has it been changed?
 Check tubing - is it kinked?
 Check clamp(s) - are they open?
 Check site  is
cath or vein being compressed?
 ANY abnormality?
 Look for sign of infiltration
 Purpose
 Requires
 Deliver

– improve accuracy of delivery.
power source
a preset fluid rate over a specified period
Uses constant force
 Always
use pump w/ TPN, central lines, titrated
medications, blood products
Occlusion
Air-in
line
Infusion complete
Power
 SINGLE
CHANNEL
 MULTI-CHANNEL
 PCA
(Patient controlled analgesia)
 AMBULATORY

IV PUMPS
Home care use
 ASSESSMENT
 DIAGNOSIS
 PLANNING
 IMPLEMENTATION
 EVALUATION
FIRST STEP, AS ALWAYS
 chronic conditions
 use of long-term medications (anticoagulants)
 previous IV experiences/problems
 allergies (especially latex & antimicrobial
agents)
 hand dominance
 Skin

*Cultural considerations, communication
barriers, level of understanding
 Physical



exam
Neurological status – AAO, ability
to understand and cooperate
Cardiovascular status – color,
pulses, edema, appearance of
veins
Skin – bruising, rashes, lesions
 Examples:





Risk for injury related to (lack of knowledge
regarding equipment)
Knowledge deficit related to (new IV insertion)
AEB (pt verbalization …)
Impaired physical mobility related to
placement of peripheral IV AEB…
Anxiety related to (initiation of IV therapy)
AEB...
Alteration in comfort: Pain
 Patient
outcomes and goals - what do
you (and the patient!) expect.
 Ex:
Pt. will remain free of S/S of
complications related to IV therapy
 More specific – Pt. will remain free of
signs of phlebitis
 Nursing
Care:
Check site HOURLY for complications - redness, pain,
edema, infiltration
 Instruct pt. to call nurse immediately: pain, bleeding,
other concerns.
 Instruct pt. to call nurse if pump alarm sounds.
 Maintain correct infusion rate as ordered.
 Secure IV (to prevent accidental dislodging of catheter
during movement).
 Change tubing according to hospital policy
(usually q 72 hr.)
 Change IV site according to hospital policy
(usually q 72 hrs.)

 Nursing
Care:
 2011
Infusion Nurse Society
(recommendations)


Do not change IV tubing more frequently
than q 96 hrs.
If IVPB tubing is detached from continuous
tubing, change q 24 hrs.
 How
will you know if the
goal/outcome has been achieved?
 Assessment
 Patient
record
 Lab values
 Communication