Transcript Iv therapy
Principle Concepts of
IV THERAPY
1
MULTIDISCIPLINARY FUNCTIONS
PCP:
Determine
IV Fluid
RN:
Monitor,
Set,
Regulate
Education:
Use of
Equipment
Pharmacy:
Preparation
2
PRIMARY VS SECONDARY LINES
Primary line
Larger
Continuous unless
secondary is active
Secondary line
Smaller volume
“Piggy-back”
Must not be introduced
in high-alert fluid lines!
3
PLACEMENT OF SECONDARY LINES
Injection ports
If pump is used, above the pump
If no pump, close to IV insertion site
Secondary infusion bags are always placed
higher than the primary solution bags
4
DRIP CHAMBER
Used to monitor flow by
observing drops
Squeeze chamber to fill
half-full with fluid
Allows drops to be observed
easily
Prevents air from entering system
5
IV CLAMPS
Roller clamps allow adjustment of flow
Auxiliary clamps can stop flow temporarily
without changing the rate set by the roller clamp
6
PORTS
May be for needle- or needleless system
Allow for injection of medication into the line
Allow for attachment of secondary line
Never puncture a needleless system port with a
needle!
7
NEEDLELESS SYSTEMS
Designed to limit needlestick injuries
Ease of disposal
Reduces potential bacteremia
8
IV FLUIDS AND GRAVITY
IV fluids flow by gravity
Must be above patient’s
heart level
3’ above the heart is the
desired height
As the patient’s position
changes, the IV bag height
must be adjusted
9
MONITORING FLOW RATE
At a minimum, every hour
After every position change
More frequently for pressors,
antiarrhythmics, and other
critical drugs and fluids
10
SECONDARY LINES
Infusion of medications
Intermittent
IVPBs hang higher than primary bag
Gives IVPB bag greater pressure
Causes IVPB to infuse first
IVPB set includes an extender to be used on the
primary bag
When IVPB complete, primary bag will begin its
flow automatically
11
PREPARATION OF IVPB
Prepackaged
Mixed by Pharmacy
Mixed by RN on unit
12
SAFETY CHECK COMPATIBILITY
13
USE OF VOLUME CONTROLLED BURETTE
Used for greater accuracy in
measuring smaller volumes
100-150 ml
Measured in microdrops
Chamber filled from primary IV
to desired amount
Medication injected into port
Desired rate set manually or through pump
14
USE OF VOLUMETRIC PUMPS
Can deliver volumes too small to
measure by drips (e.g., 0.1 ml per hour)
May be large volume (replacement
fluids) or small volume (insulin, hormones)
May come with several safety features (flow alarms,
air alarms, drug libraries)
Or, may flow even when
infiltration occurs
Never turn off an IV alarm!
15
IDENTIFYING COMMON COMPONENTS
OF IV FLUIDS
DEXTROSE: “D” May be in various percentages: D5, D10
WATER: “W” Refers to sterile water
SALINE: “S” May be Normal Saline (NS or 0.9%), ½ NS or ¼ NS
ELECTROLYTE SOLUTION: “LR” or “RL” or “RLS” Ringer’s lactate
Lactated Ringer’s
16
IV DROP SIZES
Drops per mL (gtt/mL) required to calculate any
flow rate
Will be identified on IV tubing packaging
“Microdrip” is always 60 gtt/mL
17
METHODS OF CALCULATING FLOW RATES
Ratio and proportion method
Dimensional analysis method
Formula and division method
Division factor method
Any of these methods is helpful if you understand
the principles behind it!
18
RATIO AND PROPORTION METHOD
First find the mL per min by dividing the mL per
hour by 60 (60 minutes in 1 hour):
125 mL ÷ 60 = 2 mL/ min
If we know we are to give 2 mL per minute, set
up a proportion using the known drops per mL
based on the type of tubing used (e.g., 10 gtt/mL):
10 gtt = x gtt = 20 gtt/min
1 ml
2 mL
19
DIMENSIONAL ANALYSIS METHOD
Must have rate in mL per hour
Your unknown is in gtt/min
Therefore, start with your drop factor to have gtts = gtts in
your answer:
gtt = 10 gtt
min 1 mL
Add the “desired” mL per hour rate: gtt = 10 gtt x 125 mL
min
1 mL
1 hr
Add neutral time value: 1 hr
60 min
Cancel repeating numerator/denominator values:
gtt = 10 gtt x 125 mL x 1 hr = 21 gtt/min
1 mL
1 hr
60 min
20
FORMULA AND DIVISION METHOD
Useful only in small volumes
Must be completed in less than 60 minutes
Flow rate = mL/hr Volume x set calibration
Time (60 min or less)
125 mL x 10 gtt/mL = 21 gtt/min
60 min
21
DIVISION FACTOR METHOD
Must have rate as mL/hr
Can similarly divide the mL per hour by the
constant drip factor
Drip factor is obtained by dividing set calibration
into 60:
60 ÷ 10 gtt/mL = 6
60 ÷ 15 gtt/mL = 4
60 ÷ 20 gtt/mL = 3
60 ÷ 60 gtt/mL = 1
22
EXAMPLE FACTOR METHOD
1
125 mL x 10 gtt/mL = 21 gtt/min
60 min
6
…is the same as:
125 ÷ 6 = 21 gtt/min
23