Transcript NAII-Module 7 - Peripheral IV Fluids

1
• Purpose: The IV procedure involves inserting a
needle into a vein for the purpose of
administering fluids and medications
• A physician’s order is always necessary for this
procedure
• IV solutions are
always sterile
2
1. State 2 purposes for
administrating IV fluids
2. List 4 classes of IV solutions
and their major components
3. Identify information needed as
a part of preparing for IV fluid
administration
4. Discuss the delivery devices
for IV fluid administration
5. Identify equipment necessary
to set up intravenous fluids
Photo: https://www.google.com/search?q=setting+up+iv+fluids&biw=1280&bih=689&source=lnms&tbm=isch&sa=X&ei=12EVbmFE4uhNs3clfAO&sqi=2&ved=0CAgQ_AUoAw#imgrc=kHejrtVAxxAgiM%253A%3BZ6d4_Iq3YWb1iM%3Bhttp%253A%252F%252Fi.ytimg.c
om%252Fvi%252FaGbYoao7Ogw%252Fmaxresdefault.jpg%3Bhttp%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253DaGbYoao7O
gw%3B1280%3B720
Special Directions
• The NAII may assemble and flush tubing only as a non-direct
patient care activity which is done in preparation for the
licensed nurse. in The NAII does not connect any tubing of IV
fluids directly to the patient. If the IV needs to be disconnected
for patient activity, then the licensed Nurse would do this and
then reconnect the IV to the patient.
Information Needed as a Part Of Preparing for IV
Fluid Administration
•
•
•
•
•
•
Identification of patient
Nurse’s instructions
Body weight
Vital signs
Intake and Output Record
Verification of correct solution
https://commons.wikimedia.org/wiki/File:Nurse_poses_with_cancer_patient.jpg
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• Intravenous Solution
(determined by MD order)
• Basic Administration Setincludes the flexible,
plastic tubing through
which the solution flows
• Labels for bag and tubing
• IV pole or electronic pump
to measure drops
Photo: "Infuuszakjes" by Harmid http://commons.wikimedia.org/wiki/File:Infuuszakjes.jpg#/media/Fi
le:Infuuszakjes.jpg
6
Nutrient Solutions
Purpose is for energy and fluid replacement
Examples include:
• D5W-dextrose 5% in
water
• Dextrose 5% in 0.45 %
Sodium Chloride (5%
dextrose in halfstrength saline)
These are carbohydrates in
the form of sugar
http://www.acmhhosp.org/images/chem300.jpg
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Electrolyte Solutions:
• Maintain the body’s fluid balance and body functions
• Correct electrolyte imbalances
Examples include:
• 0.9% Sodium Chloride-normal saline
• 0.45 % Sodium Chloride with 20
meq Potassium Chloride (KCL)
• Lactated Ringer’s
• Ringer’s Solution (contains minerals,
i.e. Sodium, Chloride, Potassium)
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Blood/Blood Volume Expanders:
-Increase blood volume
-Treat hemorrhage (severe blood loss)
-Plasma loss (severe burns)
Examples include:
Whole Blood, Packed
Red Blood Cells,
Dextran, Hespan,
Albumin, and Plasma
9
Total Parenteral Nutrition (TPN):
For patients who cannot digest for two weeks of more and
have large caloric and nutrient needs
Disease Processes: Small Bowel Syndrome, Inflammatory
Disease, GI Fistulas, Severe Burns, and Cancer
Examples: Dextrose
10/50% with
electrolytes, minerals,
and lipids per
physician’s order
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• Never write directly
on the IV bag as the
ink may bleed into
the container
• Use a label
http://s3.amazonaws.com/ultracart/im/BPMED/3D6E48AD543741014
4D6DB8F07051600?AWSAccessKeyId=0P4TXH5AKGYC8WHDZFG2&Ex
pires=1430411678&Signature=vkY6OAbxrnOh8D7fOa6CKU00Jc0%3D
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The Leur slip at
the bottom
connects the
tubing to the IV
catheter
The piercing pin pierces
the plastic bag
It is sterile and covered
with a plastic cap
The slide clamp is a
plastic clamp used to
stop or regulate the
flow of fluid
http://www.emswebstore.com/iv/administr
ation-sets/83-i-v-administration-set-10-dropsper-ml.html
In textbook,
See Figure 7-2, page 129
Example of a
Smart Pump
http://www.hpnonline.com/i
nside/2013-04/1304/ORBaxter-BAX_10_Eugene.jpg
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NCBON Learning
Objectives
Part B: IV Fluid
Monitoring Flow Rate
•
•
•
•
State 2 observations necessary to insure appropriate IV flow
Identify one cause of an obstructed IV
Discuss the significance of a slowing in the IV rate
Describe additional important observations in the patient receiving
IV fluids
• Identify special considerations related to patient age
Photo: http://www.stkatherinessurgery.co.uk/clinics-and-services.aspx
Special Directions: Part B
http://commons.wikimedia.org/wiki/File:Intravenous_therapy_2007-SEP-13-Singapore.JPG
• Flow rate per nurse’s
instruction
• Periodically check the IV
flow rate and the infusion
site
• Check the IV each time
you are in the room
• Microdrip administration set delivers fluid
at 60 drops per mL
• Macrodrip administration set delivers
fluid at 10-15 drops per mL
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IV Drip
Chamber
The drop orifice is
the entry to the
drip chamber. This
controls the size of
drops of fluid
One More Time: Microdrip
administration set delivers fluid at 60
drops per mL
Macrodrip administration set delivers
fluid at 10-15 drops per mL
http://commons.wikimedia.org/wiki/File:Druppelcilinder_%281%29.JPG
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IV Roller
Clamp
The flow control clamp is
a roller clamp used to
regulate the speed or
rate of fluid flow
"Infuusdebietregelaar" by Harmid - http://commons.wikimedia.org/wiki/File:Infuusdebietregelaar.jpg#/media/File:Infuusdebietre
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gelaar.jpg
• Sometimes an IV is administered
at a very slow rate, just enough
to keep the vein open
• This may be called KO (keep
open), TKO (to keep open), KVO
(keep vein open)
• When this rate is ordered, the
patient does not need fluid. The
site is used for emergencies
and/or for the administration of
medicines
Photo: http://slothed.com/2013/08/27/how-the-healthcare-industrymarks-up-saltwater-for-big-profits/iv-bag-pic/
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Used for patients who do not need continuous fluids via IV,
but do need a line for intravenous medications
• The heparin lock is a
cap that covers the
end or hub of the
catheter
• The lock must fit the
catheter with either
a male or female
adapter
http://www.givereport.com/medication-administration/intravenous-bolus-medicationadministration
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Med Lock Continued
• The RN will flush the lock
• Injectable heparin (an anticoagulant) or normal
saline is injected into the lock to keep it open
(patent)
• Heparin locks
are changed
every 96 hours
or per facility
policy
http://i.ytimg.com/vi/P2212yBCU-w/hqdefault.jpg
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Troubleshooting the IV
• If the IV stops dripping, confirm that fluid is
present in the container
• Check the IV site for possible infiltration
• Check the patient’s position
• Check the height of IV solution, should be 3036 inches above the insertion site
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Equipment Function Checks
• Check tubing for kinks, position,
and bubbles
• Check the clamps for
patency
• Check the pump/controller
for designated flow rate
• If you cannot find the problem,
notify the RN
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1.
2.
3.
4.
5.
Identify the most common site for venipuncture
Describe the appearance of a normal venipuncture site
Define phlebitis and infiltration
Recognize and report 2 signs each of phlebitis and infiltration
Discuss the care activities for the patient with an IV
https://ocg.cancer.gov/e-newsletter-section/target-program-highlight
• No redness, swelling, heat, pain, or foulsmelling drainage at insertion site
• Patient does not complain of pain or any
problems
Photo: http://www.hpnonline.com/inside/2013-01/1301-IP-IVsitecare.html
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Butterfly
Used for short-term IV therapy
https://commons.wikimedia.org/wiki/File:Butterfly_needle.png
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Over-the-Needle Catheters
flexible,
plastic, Teflon.
Used for short
or long-term
IV Therapy
https://commons.wikimedia.org/wiki/File:Intravenous_cannula_05.JPG
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Use:
• standard precautions
• strict aseptic
technique
• good handwashing
Some facilities attach in-line filters to the administration set;
they allow the fluid to pass, but trap particles
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Hematoma
A collection of blood outside of the
blood vessel
In the photo, the vein was
injured during venipuncture
Stop the procedure,
apply firm pressure,
and elevate the extremity
Photo: https://quizlet.com/37975611/phlebotmy-vocab-with-pictures-flash-cards/
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Infiltration
occurs when the catheter comes
out of the vein and fluid flows into
the surrounding tissue
• Monitor the insertion site for
swelling, cool skin temperature,
and white or pale skin color
• Report to nurse right away.
Probable next steps: Stop the IV
solution, remove the catheter,
and apply warm, moist
compresses
Photo courtesy of Catherine Noonan, RN, PNP, Children's
Hospital Boston.
Photo: http://news.nurse.com/apps/pbcs.dll/article?AID=2004407010305#.VT-NTJMYEsI
Phlebitis
irritation of the vein. May be
caused from the irritation of
the IV or medication
• More common in lower
extremity insertions
• Risk is reduced by using
aseptic technique, taping
the IV catheter securely
• Rotating of the IV site every 48-72 hours helps to reduce
irritation (per CDC)
• Avoid insertion in the distal vein of the phlebitis.
• Elevate the extremity and apply warm, moist compresses as
directed
Illustration:
http://www.nlm.nih.gov/medlineplus/ency/imagepages/18086.htm
Air Embolus—
occurs when air enters the vein, moving freely through
the system
Signs and Symptoms Include:
• SOB
• Cyanosis
• Weak, rapid pulse
• Decreased blood pressure
• Loss of consciousness
• Cardiac Arrest
Treatment:
• Stay in room with patient and call RN
• Turn patient onto left side
• RN will administer Oxygen and notify
the physician
Art credit: http://newsinhealth.nih.gov/2009/November/feature2.htm
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Catheter Breakage or Embolus-loss of part or all of catheter into the system
• Signs and symptoms similar to those of air
embolus
• The physician will order an X-ray and the
circulating catheter will be removed surgically
Cannula sheared
into 2 pieces during
IV insertion
http://www.fda.gov/MedicalDevices/Safety
/AlertsandNotices/TipsandArticlesonDevice
Safety/ucm070030.htm
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Infection
caused by contamination somewhere in the IV system or
improper insertion
Signs and Symptoms
• Redness, swelling, heat, and pain @ insertion site, foul smelling
discharge
• Systemic infection may include fever, chills, headache, and rapid
respirations; followed by
decreased blood pressure
• Notify RN immediately;
catheter will then be
removed
• Prevent by good
handwashing, standard
precautions, and aseptic
technique!!
https://www.healthtap.com/user_questions/259417 34
Fluid Overload
occurs when fluids infuse too rapidly
• This is a serious condition
• Elderly and Pediatric patients are at high risk
• Monitor IV rate frequently
Early Signs and Symptoms
• Rapid respirations
• SOB
• Rapid Pulse
• Increased BP
• Distended neck veins
Treatment
• Position patient in Fowler’s and stay with him/her
• Call for RN
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Patient Education
Teach the patient to
avoid:
• Pulling on, kinking, or
obstructing the IV
tubing
• Brushing teeth or
combing hair with the
affected arm
NOTE: Bennett Gamel (the little boy above) has Cystic Fibrosis.
http://bennettgamel.blogspot.com/2012/11/day-of-waiting.html
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Removing/Replacing
the Resident’s
Clothing
• When a resident is receiving IV
fluids, he/she should wear a patient
gown with snaps on the shoulders
for ease of gown changes.
• If he/she is wearing street clothing,
a nurse must maneuver the IV
during outfit changes.
Photo: http://i.ytimg.com/vi/WSa1qk_Ypwk/maxresdefault.jpg
IV Site Dressing Change
• Most facilities use a transparent film dressing to
cover the site
• Works well because the site can be easily visualized
• Do not use gauze dressings because you cannot see
the site
• The frequency of the
dressing change may vary
with facility
• Supplies include transparent
film, tape, gloves
• See Procedure 132 on page
139
https://www.youtube.com/watch?v=wpS2mtvApDo
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Ambulation of Patient with an IV
• Explain to the patient what you will be doing
• After easing the patient out of bed, move their IV pole
along with them; support the patient as needed
• Try to avoid sudden movements; do not allow tension
on the tubing
• Do not let the tubing drag on
the floor
• Do not tug on the tubing
• Keep the IV bag 30-36 inches
above the insertion site
• If anything unusual occurs
notify the nurse
http://princetonhcs.kramesonline.com/HealthSheets/3,S,87065
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NCBON Learning Objective:
Describe the process for
discontinuing an IV
http://nursing-skills.blogspot.com/2013/12/discontinuingperipheral-iv.html#.VT-odpMYEsI
• An IV is discontinued
upon a physician’s order
• Or if complications occur.
Then it is restarted by a
trained professional in
another area
• See Procedure 133 on
page 140
Be sure to document that catheter and fluids were discontinued,
appearance of site, dressing applied, whether or not the cannula
was intact, and condition of patient
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 not in NA2 scope of practice
 inserted into a vein in the shoulder or neck area
 used for long-term IV Therapy
 changing the dressing is a sterile procedure
Photo by John Campbell
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https://www.flickr.com/photos/104346167@N06/15259958079/in/photolist-ovpDxw-4LvBWC-oektxT-3hPjHF-owuBDg-pftgTv-oumMwy-dkinZv4nhVV8-4nn14C-7Gcm3Z-ouQTwu-qe6oAE
Image by Blausen Medical Communications
http://upload.wikimedia.org/wikipedia/commons/f/f1/Blausen_0193_Catheter_PICC.png
PICC Line: Peripherally Inserted Central Catheter
Photo: http://www.cs.cmu.edu/~pausch/news/PICCline.jpg
Hickman Catheter
Look carefully to see
catheter tunneled under
the skin
Insertion site is away
from the central line to
decrease the chances of
a blood infection
2 separate lumens so that
2 treatments can occur at
the same time
http://en.wikipedia.org/wiki/Hickman_line
Port-A-Cath
http://commons.wikimedia.org/wiki/File:Port-catheter.jpg