Transcript INTRAVENOUS THERAPY

INTRAVENOUS
THERAPY
REVISED 6 JAN 05
Terminal Learning Objective
• Given a casualty in a combat
environment and the standard field
medical equipment and supplies,
perform procedures for intravenous
(IV) therapy to prevent further injury
or death. (FMST.04.18)
Enabling Learning Objective
• Without the aid of references, given
a description or list, identify medical
terminology associated with IV
therapy, per the student handout.
(FMST. 04.18a)
Enabling Learning Objective
• Without the aid of references, given
a description or list, identify the
characteristics of different types of
IV fluids, per the student handout.
(FMST.0418h)
Enabling Learning Objective
• Without the aid of references, given
a description or list, identify the use
for specific IV fluids, per the student
handout. (FMST. 04.18c)
Enabling Learning Objective
• Without the aid of reference, given
a description or list, identify the
indications for initiating IV therapy,
per student handout.
(FMST.04.18b)
Enabling Learning Objective
• Without the aid of reference, given
a description or list, identify the
contraindications for initiating IV
therapy, per student handout.
(FMST.04.18i)
Enabling Learning Objective
• Without the aid of references, given
a description or list, identify the
equipment required for IV therapy,
per the student handout.
(FMST.04.18d)
Enabling Learning Objective
• Without the aid of reference
materials, given a description or
list, identify the procedural
sequence for IV therapy, per the
student handout. (FMST. 04.18e)
Enabling Learning Objective
• Without the aid of reference, given
a description or list, identify
potential complications of IV
therapy, per the student handout
(FMST. 04.18f)
Enabling Learning Objective
• Without the aid of references, given
a simulated casualty and standard
field medical equipment and
supplies, perform procedures for IV
therapy, per the student handout.
(FMST. 04.18g)
Terms / Definitions
• Homeostasis
– Physiological equilibrium, a balance
of functions and chemical
composition within the body
Terms / Definitions
• Electrolyte
– Ions that carry electric current
– Vital to maintain homeostasis
– Fluids containing electrolytes are
called “Crystalloids”
Terms / Definitions
• Colloids
– Large molecules such as proteins
– Hypertonic Volume Expanders
– Blood plasma, serum albumin, etc.
• Total Body Water
– % of persons weight consisting of
H2O
Terms / Definitions
• Body Fluid Compartments
– Intra-cellular fluid (ICF)
• Fluid w/in the cell
• Essential to electrolyte balance
Terms / Definitions
• Body Fluid Compartments
– Extra-cellular fluid (ECF): Fluid in
the;
• Intravascular (IVF) spaces (Vessels)
• Interstitial spaces
Characteristics of IV Fluids
• Isotonic Solution:
– Triggers least amount of water
movement from IVF in/out of ICF
and Interstitial compartments
• NS (0.9%)
• Lactated Ringers
Characteristics of IV Fluids
• Hypotonic Solution:
– Causes water to leave IVF
compartment and enter ICF &
Interstitial space
• D5W
• All solutions containing only water
and dextrose
Characteristics of IV Fluids
• Hypertonic Solution:
– Draws water from the ICF and
interstitial spaces into the IVF
compartment
USES OF I.V.
SOLUTIONS
I.V. Solutions
•
•
•
•
Water and Glucose
Crystalloid
Colloid
Whole Blood or Blood Products
Crystalloids (Isotonic)
– Effective, short term, volume
replacement
– Do NOT have O2 carrying capacity
– Do NOT contain protein
Crystalloids (Isotonic)
– After 1 hour, only 1/3 remains in
cardiovascular system
– Most common crystalloids
• Normal saline
– Fluid of choice in combat
• Ringers lactate
– Most physiologically adaptable solution available
Crystalloids (Isotonic)
• Precautions
– Always consider fluid volume
overload
– Excessive infusion of electrolytes
may cause electrolyte imbalances
– DO NOT use in patient’s with
• Cardiac failure
• Liver disease
Water and Glucose
• These solutions are Hypotonic
• Most common concentrations:
– D5W – Fluid replacement and
caloric supplementation
– D50W – treats hypoglycemic (low
blood sugar) in adults
Water and Glucose
• Contraindications:
– DO NOT use in HEAD INJURIES
• Will cause cellular swelling
• Precautions:
– Volume overload
– Electrolyte imbalance
Whole Blood
• Available in combat, (ONLY in
higher echelons of emergency
care)
• Must be ordered by an M.O.
• Type O-Negative is supplied in
combat and can be given without
cross-typing
Whole Blood
• Indications
– Acute massive blood loss
– Will resolve symptoms of
hypovolemic shock and anemia
• Note: Whole Blood is not suited for
the following:
– Shock without hemorrhage (Burns)
INDICATIONS
for
I.V. THERAPY
Indications
• Primarily for treatment of a source
of hypovolemia
• Hemorrhage or Trauma
• Dehydration
• Burns
Indications
•
•
•
•
Diarrhea or Vomiting
Unable to tolerate fluids by mouth
Pass Medications
Maintain Nutrition
Contraindication
• Absence of Signs and symptoms of
Indications
I.V. THERAPY
EQUIPMENT
IV Equipment
EQUIPMENT
• Needle and catheter
– Large 16-18g for trauma patients
– 20g for non-traumatic fluid
replacement
• IV solution
• Administration set
EQUIPMENT
•
•
•
•
•
Tape
Constriction band
Alcohol/Betadine prep
2x2
IV pole
Procedural Steps
Procedure
• Make your decision
• Assemble and check gear
– Ensure sterility of your equipment
– Check all packaging for damage
• Prepare the administration set
– See following slides
Equipment Preparation
• Remove
tubing and
IV fluid from
their
protective
coverings
Equipment Preparation
• Remove the
protective tab
from the spike
port
Equipment Preparation
• Remove the
protective cover
from the spike
(over the
inspection bulb)
of the IV tubing
Equipment Preparation
• Close the tubing
by rotating the
thumb lock to the
closed position
Equipment Preparation
• Assemble the IV
tubing to the IV
fluid
– Insert spike
into spike port
– Puncture seal
with the spike
by using a
twisting,
pushing motion
until spike is
fully inserted
Equipment Preparation
• Fill drip chamber
• Remove air from tubing
VEIN SELECTION
VEIN SELECTION
• Vein should be stable and
accessible
• Select a large springy vein
• Work distal to proximal
Use constricting band for vein
dilation
Prepare site
• Alcohol swab
– Cleanse the
area with an
alcohol swab
three times if
able
– Dry area
• Don gloves
Prepare catheter
Insert Needle
• Apply traction to the
skin and vein to
make those areas
taught
• BEVEL UP
• Needle at 30 degree
angle
Procedure
• Check flashback
after the “pop”
• Lower needle to
10-15 degrees
and thread
catheter into vein
Advance catheter
• While maintaining
the grasp to the
catheter with one
hand, hold the
colored portion of
the catheter with
the index finger and
thumb
Attaching IV tubing
• Place thumb over
the end of the
catheter in the
vein and apply
pressure to stop
blood flow out of
the catheter
• Dispose of
Needle
Connect IV tubing
• Remove the
protective cap
from the end of
the IV tubing
and insert the
tubing end into
the hub of the
catheter
Remove Constriction Band
Adjust Drip Rate
Secure the IV
•
•
•
•
Tape catheter in place
Cover site with 2x2 and tegaderm
Loop tubing around hand
Consider splinting
Apply Tape Securely Around Hub
Discontinue the IV
• Peel back taping
• Place 2x2 over site
• Remove catheter with one quick
motion
• Apply pressure with 2x2 to stop
bleeding
• Apply bandaid
COMPLICATIONS
OF
IV THERAPY
Infiltration (local)
• Escape of fluid from vein into tissue
after catheter dislodges from the
vein
Infiltration (local)
• Symptoms
– Edema
– Localized pain
– Coolness to site
– Blanching at the site
– Flow stops or slows
Infiltration (local)
• Treatment
– Discontinue IV
– Select alternate site
– Apply heat to site
– Elevate limb
Infiltration (local)
• Prevention
– Secure catheter properly
– Limit limb movement
Phlebitis
• Inflammation of a vein due to
bacterial, chemical or mechanical
irritation
Phlebitis
• Symptoms
– Pain
– Redness
– Warmth along the area
– Vein feels hard
Phlebitis
• Treatment
– Discontinue IV
– Apply heat to site
– Antibiotics
Phlebitis
• Prevention
– Ensure aseptic technique
– Place date and time on tape
– Rotate sites based on local policy
Nerve Damage (local)
• Results from arm secured tightly,
compressing nerves
Nerve Damage (local)
• Symptoms
– Numbness to fingers
• Treatment
– Reposition or loosen arm board
• Prevention
– Ensure tape is not applied too tight
Circulatory Overload (systemic)
• Increased fluid volume leading to
heart failure and pulmonary edema.
• Results from infusing IV fluid too
rapidly
Circulatory Overload (systemic)
• SYMPTOMS
– Headache
– Venous
distention
– Dyspnea
– Increased B/P
– Cyanosis
– Anxiety
– Pulmonary
edema
Circulatory Overload (systemic)
• Treatment
– Slow down flow rate
– Place PT in high Fowlers position
• Prevention
– Monitor and control flow rate
Air Embolism
• Air introduced into the blood
through the IV tubing
Air Embolism (systemic)
• Symptoms
– Cyanosis
– Hypotension
– Weak and rapid pulse
– Shortness of breath
– Tachypnea
Air Embolism (systemic)
• Treatment
– Place PT in left side reverse
Trendelenberg
– Administer oxygen
– Notify MO
– Monitor V/S
Air Embolism (systemic)
• Prevention
– Flush line prior to insertion
– Monitor tubing during therapy
– Avoid introducing air into tubing
Systemic infection
• Bacterial contamination of IV tubing
and/or fluid due to poor insertion
technique or contaminated
equipment
Systemic Infection
• Symptoms
– Sudden rise in temp and pulse
– Chills and shaking
– Blood pressure changes
Systemic Infection
• Treatment
– Look for Sources of Infection
– DC IV
– Restart in other site
– Notify M.O.
Systemic Infection
• Prevention
– Use aseptic technique
– Date/Time on Catheter
– Rotate sites Q72° (or as local
policy)
Questions?
Review