Transcript IV solutions

NUR 1021
MARION TECHNICAL COLLEGE
SPRING SEMESTER 2016
INTRAVENOUS THERAPY
I. INTRODUCTION TO IV THERAPY
•
INDICATIONS FOR IV THERAPY
• TO PROVIDE WATER, ELECTROLYTES,
AND NUTRIENTS TO MEET DAILY
REQUIREMENTS
• TO REPLACE WATER AND CORRECT
ELECTROLYTE DEFICITS
• TO ADMINISTER MEDICATIONS AND
BLOOD PRODUCTS
WHAT DO IV SOLUTIONS CONSIST OF?
• IV SOLUTIONS CONTAIN
• DEXTROSE OR ELECTROLYTES MIXED IN VARIOUS
PROPORTIONS WITH WATER
• CAN ELECTROLYTE-FREE WATER CAN BE ADMINISTERED BY
IV?
• NOO! IT RAPIDLY ENTERS RED BLOOD CELLS AND CAUSES
THEM TO RUPTURE
IV SOLUTIONS
• THERE ARE SEVERAL TYPES OF IV FLUIDS
• TYPE OF FLUID USED SELECTED ACCORDING TO THE
CLIENT AND THE REASON FOR ITS USE
• IV SOLUTIONS ARE CLEARLY LABELED WITH THE EXACT
COMPONENTS AND AMOUNT OF SOLUTION
• IV SOLUTIONS ORDERS – OFTEN WRITTEN WITH
ABBREVIATIONS
REMEMBER THE ABBREVIATIONS!
• “D” IS FOR DEXTROSE
• “W” IS FOR WATER
• “S” IS FOR SALINE
• “NS” IS FOR NORMAL SALINE
• RINGER LACTATE (LACTATED RINGER)- COMMONLY USED
ELECTROLYTE SOLUTION
• ABBREVIATED “RL” OR “LR”
SOLUTION STRENGTH
• IV’S OFTEN IDENTIFIED WITH ABBREVIATION LETTERS
• THESE INDICATE THE COMPONENTS IN THE IV SOLUTION
• THE NUMBERS INDICATE THE SOLUTION STRENGTH OR
CONCENTRATION OF COMPONENTS IN THE IV FLUID
• NUMBERS WRITTEN AS SUBSCRIPTS
• FOR EXAMPLE, D5W (DEXTROSE 5% IN WATER).
LET’S PRACTICE:
• WHAT IS THE FULL NAME OF THE IV’S FROM THESE
ABBREVIATIONS?
• NS = SODIUM CHLORIDE 0.9%
• D5W = DEXTROSE 5% IN WATER
• RL = LACTATED RINGER SOLUTION (ELECTROLYTES)
• D5 AND ½ NS (0.45%) = DEXTROSE 5% IN 0.45% SODIUM CHLORIDE
COMPONENTS OF IV SOLUTIONS
D5W- EACH 100 ML OF
SOLUTION CONTAINS 5 G
DEXTROSE
D5W/0.9NS - SOLUTION
CONTAINS 5 G OF DEXTROSE
& 0.9 G (OR 900 MG) OF NACL
PER 100 ML SOLUTION
D5W/0.45NS - SOLUTION
CONTAINS 5 G OF DEXTROSE
& 0.45 G (OR 450 MG) OF
NACL PER 100 ML SOLUTION
IV SOLUTION ADDITIVES- POTASSIUM
• POTASSIUM CHLORIDE (KCL) –
• COMMON ADDITIVE TO IV FLUIDS
• POTASSIUM CHLORIDE- MEASURED
IN MILLIEQUIVALENTS (MEQ)
• ORDER USUALLY WRITTEN TO
INDICATE THE AMOUNT OF
MILLIEQUIVALENTS PER LITER
• IV SOLUTIONS ARE OFTEN AVAILABLE
WITH POTASSIUM PREMIXED IN THEM
SAFETY ALERT!
REMEMBER THE FOLLOWING WHEN ADDING
POTASSIUM TO AN IV:
• IT SHOULD BE COMPATIBLE WITH THE SOLUTION AND WELL-DILUTED
• MONITOR CLIENT DURING INFUSION, RAPID INFUSION OF POTASSIUM CAN CAUSE DEATH
DUE TO CARDIAC DEPRESSION, ARRHYTHMIAS, AND ARREST.
• CHECK IV SITE FREQUENTLY, MEDICATION IS EXTREMELY IRRITATING.
• ADMINISTER IV USING AN INFUSION CONTROL DEVICE.
• NEVER ADMINISTER POTASSIUM CONCENTRATE IV PUSH.
• DO NOT ADD POTASSIUM TO AN IV BAG THAT IS ALREADY INFUSING
• THIS WOULD CAUSE THE MEDICATION TO CONCENTRATE IN THE LOWER PORTION OF IV BAG
• RESULTS IN CLIENT RECEIVING A CONCENTRATED MEDICATION SOLUTION- CAN BE HARMFUL.
IV FLUID
• 3 MAIN TYPES:
• ISOTONIC
• HYPOTONIC
• PROVIDES MORE WATER
THAN ELECTROLYTESDILUTING THE ECF
• HYPERTONIC
TYPES OF IV SOLUTIONS
Isotonic
Hypotonic
Hypertonic
0.9% Sodium Chloride =
Normal Saline
0.45% NaCl
D5/LR
Lactated Ringer’s (LR)
0.33% NaCl
D5/0.9%NS (D5/NS)
D5W
D5W- Glucose rapidly
metabolized = hypotonic
TPN
D5/0.45 %NS
Solutions containing
meds
ISOTONIC FLUIDS
• CLOSE TO THE SAME OSMOLARITY AS
SERUM
• ISOTONIC FLUIDS EXPAND THE ECF VOLUME
• EXPAND THE INTRAVASCULAR SPACE
WHAT IMPLICATIONS DOES THIS HAVE FOR A
PATIENT WITH HYPERTENSION OR HEART
FAILURE IF THEY RECEIVE ISOTONIC IV’S?
• RISK OF FLUID OVERLOAD
ISOTONIC SOLUTIONS
• PROVIDES BENEFITS OF:
• HYDRATION
• MAINTAIN ELECTROLYTES
• USED DURING AND AFTER SURGERY
D5/W -HELPFUL FOR:
• PROVIDES FREE WATER NECESSARY FOR
RENAL EXCRETION OF SOLUTES
• USED TO REPLACE WATER LOSSES AND
TREAT HYPERNATREMIA
• PROVIDES 170 CALORIES/L
• NCLEX PRACTICE:
• THE NURSE RECOGNIZES REQUIRES FLUID
REPLACEMENT WITH ISOTONIC SOLUTION. ONE OF
THE ISOTONIC SOLUTIONS THAT MAY BE ORDERED
BY THE HEALTH CARE PROVIDER IS:
• 1.
0.45% SALINE
• 2.
LACTATED RINGER’S
• 3.
5% DEXTROSE IN NORMAL SALINE
• 4.
5% DEXTROSE IN LACTATED RINGER’S
HYPOTONIC FLUIDS – PURPOSE
• REPLACE CELLULAR FLUID
• PROVIDES FREE WATER FOR EXCRETION OF
WASTES
• OFTEN USE 0.45% NS – RX HYPERNATREMIA
OR OTHER HYPEROSMOLAR CONDITIONS
• LESS OSMOLARITY THAN SERUM
• DILUTES THE SERUM
EXCESSIVE USE OF HYPOTONIC SOLUTIONS
• LEADS TO INTRAVASCULAR FLUID DEPLETION
• DECREASED BLOOD PRESSURE
• CELLULAR EDEMA
0.45% NS - HYPOTONIC
• PROVIDES FREE WATER IN ADDITION TO NA+ AND CL–
• USED TO REPLACE HYPOTONIC FLUID LOSSES
• USED AS MAINTENANCE SOLUTION
• DOES NOT REPLACE DAILY LOSSES OF OTHER ELECTROLYTES
• PROVIDES NO CALORIES
• A HYPOTONIC SOLUTION THAT PROVIDES NA+, CL−, & FREE WATER
• USED AS A BASIC FLUID FOR MAINTENANCE NEEDS
HELPFUL FOR:
• CELLULAR DEHYDRATION:
• FLUID SHIFTS OUT OF BLOOD VESSEL (LESS
CONCENTRATED) TO THE TISSUE CELLS
(MORE CONCENTRATED)
• EX: DRY MUCOUS MEMBRANES
• HYPERGLYCEMIC CONDITIONS:
• DIABETIC KETOACIDOSIS
CAN BE HARMFUL:
• SUDDEN SHIFT OF FLUID FROM BLOOD VESSEL TO THE
CELLS – CARDIOVASCULAR COLLAPSE
• HYPOTONIC SOLUTIONS - POTENTIAL TO CAUSE
CELLULAR SWELLING
• MONITOR FOR CHANGES IN MENTATION →INDICATE
CEREBRAL EDEMA
• EXAMPLES- HYPOTONIC IV SOLUTIONS
• D5NS.45 (5% DEXTROSE IN ½ NORMAL SALINE)
• 5% DEXTROSE AND WATER (D5W)- PROVIDES
CALORIES AND WATER
• NCLEX PRACTICE:
• A CLIENT EXPERIENCES A LOSS OF INTRACELLULAR FLUID.
THE NURSE ANTICIPATES THAT THE INTRAVENOUS (IV)
THERAPY THAT WILL BE USED TO REPLACE THIS TYPE OF
LOSS IS:
• 1.
0.45% NORMAL SALINE (NS)
• 2.
10% DEXTROSE
• 3.
5% DEXTROSE IN LACTATED RINGER’S
• 4.
DEXTROSE 5% IN NS
HYPERTONIC (HYPER-OSMOLAR)
• HIGHER OSMOLARITY THAN SERUM
• PULLS FLUIDS AND ELECTROLYTES FROM
THE INTRACELLULAR & INTERSTITIAL
COMPARTMENTS INTO THE INTRAVASCULAR
COMPARTMENT
• EXAMPLES
• D5/0.9NS AND D5/0.45NS
• USE POSTOP WHEN SOME SODIUM IS NEEDED
• D5LR
HELPS TO:
• ↓ EDEMA
•  URINE OUTPUT
• STABILIZE BP
• USED TO MAINTAIN FLUID INTAKE
• CAN TEMPORARILY BE USED TO TREAT HYPOVOLEMIA IF
PLASMA EXPANDER IS NOT AVAILABLE
• SOLUTIONS WITH CONCENTRATIONS GREATER THAN 10%
MUST BE ADMINISTERED THROUGH A CENTRAL LINE
• ALLOWS ADEQUATE DILUTION TO PREVENT SHRINKAGE OF
RBCS
• A CLIENT IS PRESCRIBED 0.9% SODIUM CHLORIDE
(NORMAL SALINE), WHICH IS AN ISOTONIC SOLUTION. THE
NURSE RECOGNIZES THE PRIMARY GOAL OF SUCH
INTRAVENOUS THERAPY IS TO:
• 1.
EXPAND THE VOLUME OF FLUID IN THE VASCULAR
SYSTEM
• 2.
PULL FLUID FROM THE CELLS
• 3.
KEEP PROTEIN LEVELS NORMAL
• 4.
MOVE FLUID INTO THE CELLS
• A CLIENT IS PRESCRIBED 3% SODIUM CHLORIDE, WHICH
IS A HYPERTONIC SOLUTION. THE NURSE RECOGNIZES
THE PRIMARY GOAL OF SUCH INTRAVENOUS THERAPY IS
TO:
• 1.
EXPAND THE VOLUME OF FLUID IN THE VASCULAR
SYSTEM
• 2.
PULL FLUID FROM THE CELLS
• 3.
KEEP PROTEIN LEVELS NORMAL
• 4.
MOVE FLUID INTO THE CELLS
• A CLIENT IS PRESCRIBED 0.45% SODIUM CHLORIDE,
WHICH IS A HYPOTONIC SOLUTION. THE NURSE
RECOGNIZES THE PRIMARY GOAL OF SUCH INTRAVENOUS
THERAPY IS TO:
• 1.
EXPAND THE VOLUME OF FLUID IN THE VASCULAR
SYSTEM
• 2.
PULL FLUID FROM THE CELLS
• 3.
KEEP PROTEIN LEVELS NORMAL
• 4.
MOVE FLUID INTO THE CELLS
IV SITES
• PERIPHERAL
• SUPERFICIAL VEINS OF FOREARM, HAND, AND SCALP OF
CHILDREN
• ARM VEINS - COMMONLY USED
• RELATIVELY SAFE AND EASY TO ENTER
• CHOSE SITE - DOES NOT INTERFERE WITH MOBILITY
• USE MOST DISTAL SITE OF THE ARM OR HAND FIRST
• THIS PERMITS SUBSEQUENT IV ACCESS SITES TO BE
MOVED PROGRESSIVELY UPWARD
• IS THE ANTECUBITAL FOSSA A PREFERRED IV SITE?
• NO - LIMITS MOBILITY
OTHER IV SITES TO BE CAUTIOUS OF:
• LEG VEINS SHOULD RARELY BE USED
• HIGH RISK OF THROMBOEMBOLISM
• AVOID VEIN ACCESS DISTAL TO A PREVIOUS IV INFILTRATION
• AVOID SCLEROSED OR THROMBOSED VEINS
• AVOID AN ARM WITH AN ARTERIOVENOUS SHUNT OR FISTULA
• AVOID ARM AFFECTED BY EDEMA, INFECTION OR BLOOD CLOT
• AVOID ARM ON THE SIDE OF A MASTECTOMY - IMPAIRED LYMPHATIC FLOW.
PICC LINE (PERIPHERALLY INSERTED CATHETER)
• CAN BE INSERTED BY NURSES WHO
HAVE HAD SPECIAL TRAINING
• LONG CATHETER INSERTED INTO
ANTECUBITAL VEIN WITH TIP
POSITIONED IN SUPERIOR VENA
CAVA
• USE FOR IV ANTIBIOTICS FOR
SEVERAL WEEKS OR TPN
• LESS RISK OF COMPLICATIONS
CENTRAL LINE IV THERAPY
• CENTRALLY INSERTED CATHETERS SPECIAL CATHETER INSERTED INTO
A LARGE VEIN IN THE NECK OR
CHEST (SUBCLAVIAN OR JUGULAR)
• THREADED THROUGH INTO THE
RIGHT ATRIUM
• TIP RESTS IN DISTAL END OF
SUPERIOR VENA CAVA
USE OF CVC’S (CENTRAL VENOUS CATHETERS)
Medication administration
•• Cancer
•• Chemotherapy- infuse irritating or vesicant
medications
•• Infection
•• Long-term administration of antibiotics
Nutritional replacement
•• Infusion of parenteral nutrition (PN)
•• Able to infuse higher dextrose solutions through
central line than peripheral line
ADMINISTRATION OF IV FLUIDS
• USE AN IV INFUSION SET
• A DRIP CHAMBER IS CONNECTED TO
THE IV BOTTLE OR BAG
• FLOW RATE IS ADJUSTED TO DROPS
PER MINUTE (GTT/MIN) WITH ROLLER
CLAMP
• INJECTION PORTS - LOCATED ON THE
IV TUBING & ON MOST IV SOLUTION
BAGS
• ALLOW FOR INJECTION OF
MEDICATIONS DIRECTLY INTO IV BAG
OR IV LINE
• INJECTION PORTS ALSO ALLOW FOR
ATTACHMENT OF SECONDARY IV LINES
FOR IVPB MEDICATIONS
COMMON COMPLICATIONS OF PERIPHERAL
IV THERAPY
PHLEBITIS : INFLAMMATION OF A VEIN
• SIGNS & SYMPTOMS OF PHLEBITIS
• REDNESS, SWELLING, PAIN, AND
EDEMA AT THE INSERTION SITE
AND/OR ALONG THE VEIN
• TREATMENT - REMOVAL OF
CATHETER & APPLICATION OF WARM
SOAKS
INFILTRATION : VENIPUNCTURE DEVICE IS
DISLODGED FROM THE VEIN
• S & S:
•
•
•
•
•
•
•
LOCAL EDEMA
SKIN BLANCHING
SKIN COOLNESS
LEAKAGE AT THE PUNCTURE SITE
PAIN & FEELINGS OF TIGHTNESS
BLANCHING AT THE SITE
ABSENT BACKFLOW OF BLOOD
• TREATMENT:
• DISCONTINUE THE IV & MONITOR SITE
WHICH IS IT?
• REDNESS
• EDEMA
• SWELLING
• SKIN BLANCHING
• PAIN AND EDEMA AT THE INSERTION SITE
AND/OR ALONG THE VEIN
• SKIN COOLNESS
• LEAKAGE AT THE PUNCTURE SITE
• ABSENT BACKFLOW OF BLOOD
• PHLEBITIS
• INFILTRATION
VARIETY OF WAYS FOR
IMPLEMENTING IV THERAPY