Transcript IV Therapy
Intravenous Fluid Administration B260 Foundations of Nursing IV Fluid Administration: Objectives • Discuss purposes and procedures for initiation, maintenance and discontinuing an infusion. • Explain the importance of infection control in the management of intravenous solutions, tubing, and dressings. • Discuss the complications of intravenous therapy. • Discuss the procedure for initiating a blood transfusion and interventions to manage a transfusion reaction. Intravenous Therapy • • • • Goal: Correct or prevent fluids and electrolyte disturbances Allow direct access to the vascular system Requires close monitoring Knowledge required: solutions, equipment, procedures, regulating flow, maintenance, identifying and correcting problems, and how to discontinue Intravenous Therapy: Types of Solutions • • Isotonic: same concentration as body fluids including Blood, most common use for volume replacement (eg. after prolonged vomiting); NaCl 0.9% normal saline, D5W 5% Dextrose in water Hypotonic: concentration lower than body fluids Use to rehydrate the cells; 0.45% NaCl or ½ normal saline Hypertonic: concentration higher than body fluids Used to increase vascular volume, use with caution due to risk for fluid overload D5 0.45% NS D10W D5LR http://www.youtube.com/watch?feature=player_de tailpage&v=_slUL3kMZlU IV Solution Cheat Sheet Intravenous Therapy: Additives IV Fluids may contain additives: • Hyperalimentation or Total Parenteral Nutrition • Lactated Ringers, D5LR • Dextrose and saline combinations, with added KCL • KCL is commonly added to IV solutions when patients are NPO; body cannot conserve K • Never give KCL IV push directly as it may be fatal! • KCL: administer slowly over several hours and diluted Intravenous Therapy: Orders Should contain: • specific solution • additives • time schedule • Example: D5½ NS with 20 meq KCL Follow 7 rights of medication administration, same as with all medications Review: Seven Rights • • • • • • • Right Person Right Drug Right Dose Right Route Right Time Right Documentation Right to refuse IV Therapy: Equipment Intravenous Therapy: Equipment • Butterfly Angiocath • Saline lock IV Therapy: Peripheral IV Therapy: Peripheral Sites Feet not recommended for adults IV Therapy: Starting an IV • • • • • • Review order Get supplies Explain to patient Find best vein Start distally Perform venipuncture, secure, start fluids • Document • Dressing should be transparent IV Therapy: Angle of Entry IV Therapy: Insertion with Flashback http://www.youtube.com/watch?feature=pla yer_detailpage&v=DHuOIcxJTIY IV Therapy: Dressing Intravenous Therapy: Equipment Bottles, Bags IVPB Tubing IV Therapy: Administration Sets IV Therapy: Administration Sets Intravenous Therapy: Equipment Central lines PICC lines Implanted ports IV Therapy: Central Line IV Therapy: Central Line IV Therapy: Central Line Dressing IV Therapy: PICC Line IV Therapy: PICC Line IV Therapy: Implanted Ports IV Therapy: Implanted Ports IV Therapy: Implanted Ports IV Therapy: Hyperalimentation IV Therapy: Lipids IV Therapy: Assessment Important areas to assess: • Daily wt • I&0 • Labs=Na+, K+, Cl, glucose, BUN • Skin turgor • Breath sounds IV Therapy: Assessment • Psychological responses • Independence • Condition of vein and surrounding tissues • Infiltration • Phlebitis • Infection • Bleeding • Circulatory overload • Severe untoward reactions IV Therapy: Complications Extravasation IV Therapy: Complications Swelling-Edema from Infiltration IV Therapy: Complications Phlebitis This child's IV site was completely wrapped, preventing proper assessment. IV Therapy: Complications Redness and Swelling IV Therapy: Complications Phlebitis IV Therapy: Complications This child’s antibiotic infiltrate went untreated for a few days. IV Therapy: Complications Bruising Intravenous Therapy: Discontinue IV • • • • • • Review order Explain to patient Stop IV fluids, remove dressing Stabilize the cannula and clean site Cover with sterile gauze, gentle pressure and remove cannula Apply pressure 2-3 minutes and secure dressing Collaborative Learning • Jimmy Lewis is brought to the hospital emergency room by some friends. He had been vomiting for several days and was complaining of heart palpitations. Mr. Lewis is a 58-year-old white male who is homeless. He has not had any health care for at least 10 years. He is an alcoholic and drinks a quart of gin or vodka every day. He does not have a job, and his family is all out of state. The emergency physician does an initial assessment and transfers him to a hospitalist, who admits him to a medical-surgical unit for further evaluation and treatment. Collaborative Learning • Mr. Lewis has lab work drawn. His electrolytes are as follows: sodium 138 mEq/L, potassium 3.1 mEq/L (low), chloride 104 mEq/L, and magnesium 1.5 mEq/L (low). His arterial blood gas measurements are as follows: pH 7.48 (high), PaCO2 40 mm Hg, HCO3 29 (high). Jamie Taylor, a 22-year-old nursing student, is assigned to Mr. Lewis. She reviews Mr. Lewis medical record before going in to assess him. Discuss Discuss • Answer: A, B, E Rationale: The results of the lab tests reveal decreased potassium and magnesium. These deficits are related to vomiting and alcoholism. The fluid volume deficit is a result of decreased intake and increased output related to vomiting. Discuss • The hospitalist orders an IV of D5NS to run at 125 ml/hour. What type of fluid is this? A. Hypotonic B. Isotonic C. Hypertonic Discuss • Answer: B Rationale: Isotonic fluids replace extracellular volume and will hydrate the cells. Discuss • Two hours after the IV is started, Mr. Lewis complains of pain at the insertion site. Jamie assesses the site and notes that it is cool to the touch around the site and is edematous. She tries to obtain a blood return and does not get any return. This indicates what type of problem, and what action should she take? Discuss • Answer: This indicates infiltration of the IV, and Jamie should discontinue it, raise the extremity, and place a warm, moist towel over the area. Rationale: An IV is infiltrated when the fluid is entering the subcutaneous tissue around the venipuncture site. This causes swelling of the tissue and pallor and coolness due to decreased circulation around the site. Elevating the extremity promotes venous drainage, and the heat from the warm, moist towel will increase the blood flow. IV Therapy Blood Administration IV Therapy: Blood Administration Blood transfusion includes any of the following : • Whole blood • Packed RBC’s • Plasma • Platelets IV Therapy: Blood Products IV Therapy: Whole Blood IV Therapy: Blood Administration Purpose: 1. Increase blood volume 2. Treat anemia 3. Replace blood components (clotting factors, platelets, albumin) IV Therapy: Blood Administration Blood Grouping • • • • • “O” is universal donor AB is universal recipient A blood B blood Rh factor If mismatched, transfusion reaction may occur (mild severe) IV Therapy: Blood Transfusion Guidelines for Safe Blood Administration • • • • • • • Blood tubing has an in-line filter Prime with 0.9% normal saline Educate patient Assess patient for history of reaction Consent signed Checked by 2 RN’s Vital signs: baseline, 15 minutes after starting the infusion, when complete, and prn. IV Therapy: Blood Transfusion Guidelines for Safe Blood Administration • Stay with patient during first 15 minutes • IV gauge: 18-19 preferred, 20g or less. • Start blood within 30 minutes from blood bank • Administer slowly in first 15 min, then increase rate as ordered or within 2 - 4 hours. • Not longer than 4 hours - risk bacterial contamination • Use gloves to prepare and administer IV Therapy: Transfusion Reactions Acute Hemolytic: Incompatibility to antibodies causing RBC breakdown • Signs & Sx: chills, fever, pain, flushing, tachycardia, tachypnea, etc. Febrile nonhemolytic: • Sensitization to specific blood components • Signs & Sx: chills, fever, headache, flushing, etc. Mild allergic: sensitivity to plasma proteins • Signs and Sx: flushing, itching, hives IV Therapy: Transfusion Reactions Anaphylactic: reaction to blood proteins • Signs & Sx: anxiety, itching, wheezing, cyanosis, shock, etc. Circulatory Overload: fluid administered faster than the circulation can accommodate • Signs & Sx: cough, dyspnea, pulmonary congestion, headache, hypertension, tachycardia, distended neck veins Sepsis: contaminated blood • Signs & Sx: chills, high fever, vomiting, diarrhea, hypotension, shock IV Therapy: Transfusion Reactions Management: stop transfusion! keep IV line open with 0.9% normal saline notify provider stay with patient and monitor (vitals, observe and treat)