Transcript Intravenous Therapy

Intravenous Therapy
General principles……….
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use strict aseptic technique
when initiating, changing bag,
changing tubing
direct access to circulatory
system
examine solution for type,
amount, expiration date,
character of solution and
integrity of container
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IV solutions should be at room
temperature
type of solution ordered by
physician
always close clamp when
changing bag, pt’s gown,
equipment etc.
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always close clamp when
removing from pump for any
reason!!!!
always check tubing from
patient to container at least q4h
NEVER PLAY “CATCH UP” IF
BEHIND SCHEDULE!!!!!
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check site at least q4h for signs
of complications
in general, if you get in the habit
of checking an IV infusion from
pt. (noting site/dressing
condition) to bag (noting rate,
proper solution etc.) q1h you will
stay on top of things!!!!
Types of solutions……….
Isotonic:
D5W - does not contain Na so
should not be used in large
volumes (dilutes Na in serum)
0.9% NaCl - provides only Na and
Cl so not desirable for long term
use either (also called normal
saline)
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Lactated Ringers - contains
electrolyes similar to plasma ,
used for burns, hypovolemia
2/3 &1/3 – contains 3.3% dextrose
and 0.3% NaCl
- one of most commonly used
solutions
Hypotonic:
0.33% NaCl - contains Na, Cl and
free water
- 1/3 strength normal saline
0.45% NaCl - similar to above
- 1/2 strength saline
- dilutes plasma Na
without letting it drop too much
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Hypertonic:
5% dextrose in 0.45% NaCl commonly used to treat
hypovolemia and maintain fluid
intake
D10W - high calorie count
- 10 % dextrose
5%D in 0.9% NaCl - replaces
nutrients and lytes,
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Site selection……...
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accessibility of vein
condition of vein
type of fluid being infused
duration of infusion
in general, use the smallest
catheter and the largest vein
available and practical
use site naturally splinted (back
of hand)
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keep site between damaged
vein and heart
Possible complications……...
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Infiltration : escape of fluid into
subcutaneous tissue due to
dislodged needle or penetration
of vessel wall
: swelling, pallour, coldness
or pain around site, decrease in
infusion rate
: check site frequently during
shift, discontinue IV if this
happens
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Sepsis at site : usually due to
poor insertion technique
: area will be red and tender
: pt. may have chills, fever,
malaise, other VS changes
: assess for this daily, notify
physician if noted, follow agency
policy re culturing site,
discontinuing etc.
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Phlebitis :inflammation of a vein
: may be due to mechanical
trauma from needle moving,
chemical trauma from
medications or sepsis
: will have local, acute
tenderness, redness, warmth
and slight edema of vein above
site
:d/c IV, apply warm, moist
compress to site, notify
physician
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Thrombus : blood clot formation
due to trauma of vessel
: s & s similar to phlebitis, IV
flow rate may stop if clot
blocking vessel
: dc infusion, notify physician,
apply warm compress to site
: DO NOT RUB OR MASSAGE
SITE!!!!!
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Fluid overload : too large
volume of fluid infused into
circulatory system
: engorged neck veins,
increased BP, dyspnea
: slow rate of infusion, notify
physician, monitor vital signs,
carefully monitor flow rate
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Air embolism : break in IV
system allowing air to enter
circulatory system as a bolus
: respiratory distress, increased
heart rate, cyanosis, decreased
BP, change in LOC
: pinch off catheter, place pt. In
left trendelenburg, monitor VS,
SaO2, call physician
Causes of
Obstruction/Decrease in Flow
Rate……….
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height of container in relation to
patient
patient’s blood pressure
patent’s position
height of bed
patency of IV catheter
infiltration
kink in tubing
Monitoring rate of
infusion…….
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rate is determined by amount of
fluid to be infused over one hour
this is called the “drip rate”
drop factor or “drops per mL” is
determined by the size of the
tubing
macrodrip = 10, 15 or 20 gtts/mL
microdrip = 60 drops per mL
blood tubing = 10 drops per mL
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usually using microdrip tubing
for small volumes
may use buretrol/pediatrol for
children
sometimes put tape strip on
tubing with amount to be infused
per hour
this is a guideline only and does
not replace hourly rate checks
Calculating drip rate……...
gtts/min = volume(mL) X drop factor (gtts/mL
time in minutes
eg. IV D5W 1000 mL over 10 hours (microdrip)
gtts/min = 1000 mL X 60
600 mins
= 100 gtts/min
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Alternate formula using mL/hr
gtts/min = mLs /hour X drop factor
time (60 mins)
ie. 1000 mL D5W over 10 hours (microdrip)
gtts/min = 100 X 60 = 6000 = 100 gtts/min
60
60
Setting up an IV……...
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gather equipment and bring to
bedside
check solution and additives
with order
wash hands
maintain aseptic technique
clamp tubing
insert spike into IV solution
squeeze chamber and allow to
fill 1/2 way
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remove cap at end of tubing
(keep sterile)
release clamp allowing fluid to
flow through tubing
expel all air from tubing (invert
and tap as necessary)
recap
label with meds added if
necessary
Electronic infusion control
devices…….
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many different types
know your equipment
DON’T ALWAYS TRUST THE
EQUIPMENT!!!!
check drip rate the “old
fashioned” way at least q4h to
validate
regulates drip rate and alarms if
error or bag empty
Dressing changes……...
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usually tubing is anchored with
tape and covered with
transparent dressing
should be changed q48-72
hours
depends on hospital policy
automatically change any
dressing that is soiled, damp or
loosened
USE STRICT ASEPTIC
TECHNIQUE
Discontinuing an IV
infusion…...
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clamp tubing
remove dressing and tape
withdraw catheter in line with
vein
apply pressure to site with
sterile gauze
don’t use alcohol wipe as this
burns and won’t stop bleeding
examine catheter to ensure
intact
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Document
date
time
reason for discontinuing
infusion
type of solution and amount
remaining
any adverse reactions
your name