Transcript Chain of Survival and EMSC

Administering Intravenous Solutions
and Medications
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Lesson 36.1
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Theory
1) List four purposes for administering intravenous
(IV) therapy.
2) Evaluate the advantages and potential problems
of using an infusion pump to deliver fluids or
medications.
3) Summarize the possible complications that can
arise from the use of the IV route and the
corrective actions you should take for each one.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Clinical Practice
1) Prepare to give medications using each of the
following methods:
a. Using an infusion pump
b. Using a second IV line as a piggyback
c. Using a controlled-volume device
d. Using an intermittent IV or a PRN (as-needed) lock
e. Giving the medication as a bolus
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Slide 4

IVs are given to supply the body with:
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Drugs or substances that cannot be supplied by
other means (orally/rectally)
Fluids and electrolytes—for patients who do not
have adequate oral intake
Blood, plasma, and other blood components
Nutritional formulas containing glucose, amino
acids, and lipids
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Slide 5
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Slide 6
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
The average adult needs 1500 to 2000 mL of
fluids in each 24-hour period to replace those
eliminated by the body
Fluids are lost by:

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Hemorrhage
Severe or prolonged vomiting or diarrhea
Excessive wound drainage
Wounds (especially burn wounds)
Profuse perspiration
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Slide 7

Solutions most frequently used contain:
Glucose
 Saline
 Electrolytes
 Vitamins
 Amino acids
 Blood and blood products

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Slide 8
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Isotonic solutions
Have the same concentration, or osmolality, as blood
 Used to expand the fluid volume of the body
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Hypotonic solutions
Contain less solute than extravascular fluid
 May cause fluid to shift out of vascular compartment


Hypertonic solutions
Have a greater tonicity than blood
 Replace electrolytes; when given as concentrated dextrose
solutions, produce shift in fluid from intracellular to the
extracellular compartment

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Slide 9
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0.9% saline
0.45% saline
5% dextrose in water
10% dextrose in water
Hypertonic
5% dextrose in 0.9% saline
5% dextrose in 0.45% saline
5% dextrose in 0.225% saline
Ringer’s lactate
5% dextrose in Ringer’s lactate
Isotonic
Hypotonic
Isotonic
Hypertonic
Hypertonic
Isotonic
Isotonic
Hypertonic
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Slide 10
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Primary intravenous set
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Secondary or piggyback intravenous set
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Consists of bag of solution, regular tubing set,
needleless connector, and IV stand
Medications to be given intravenously often added
to an existing IV line by using the piggyback method
Parallel intravenous set

A Y-type administration set used to infuse certain
blood products
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Slide 11
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Slide 12
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Slide 13
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Slide 14
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Controlled-volume set
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Intermittent intravenous device (saline or PRN
lock)
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Infusion pump administers small volumes of fluid or
medication
Established by applying Luer-lock cap or an extension
set to the IV cannula
Filters

Trap small particles such as undissolved medication or
salts that have precipitated from solution
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Slide 15
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Slide 16
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Slide 17
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An added safety measure used in many agencies to
regulate the flow of routine IV fluids
Use is mandatory when patients receive total
parenteral nutrition or for medications that require
critical accuracy
Programmed infusion pumps more accurate and
provide better control over the amount of solution
being infused
Controllers reduce risk of infusing fluid too quickly
Patient-controlled analgesia pumps used in most
hospitals and in the home setting
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Slide 18
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Slide 19

Used in home IV therapy to administer pain
medication
Portable pumps: used at home to regulate TPN
 PCA pumps: used in hospitals to allow patient to
regulate administration of IV analgesics

 Patient receives a preset bolus of medication when the
button is pushed and/or a base amount of medication
each hour
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Slide 20

Intravenous needles and catheters

Winged-tip or butterfly needle
 Meant for short-term therapy
 Supplied in odd-numbered gauges (17, 19, 23, and 25)

Over-the-needle catheters
 Consist of a needle with a catheter sheath over it
 The needle is removed, leaving the flexible catheter in
the vein
 18-, 19-, 20- to 22-gauge needles

Through-the-needle catheter
 Used for midline catheter insertion for long-term
peripheral use
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Slide 21
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Slide 22
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Slide 23
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May be left in place for 6 to 8 weeks
Positioned in right atrium or superior vena
cava
Some are tunneled long-term catheters such as
a Hickman or Broviac catheter
PICC lines are the first choice in home IV
therapy
Correct placement is verified by x-ray
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Slide 24
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When giving IV medications:
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Review the drug’s action before administration and
know possible side effects and nursing implications
Assess for allergies and check for possible drug
solution incompatibilities
Ensure that IV line is patent before attempting to
administer medication, and verify flow rate IV
solution
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 25
The average adult needs how many mL of fluids in
a 24-hour period to replace those eliminated by the
body?
1)
2)
3)
4)
500 to 750
750 to 1000
1000 to 1500
1500 to 2000
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Slide 26
Different types of tonicity are found in intravenous
therapy solutions. Ringer’s lactate and 5% dextrose
are what type of solution?
1)
2)
3)
4)
Hypotonic
Isotonic
Hypertonic
None of the above
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Slide 27
Richard is getting supplies ready to administer
blood to his patient. Which type of administration
set does he need?
1)
2)
3)
4)
Primary
Secondary
Y-type
Controlled-volume
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Slide 28
One difference between the peripherally inserted central
catheter (PICC) and a midline (ML) catheter is:
1)
2)
3)
4)
you can take a blood pressure on the arm that has a
midline.
only a PICC line can be used in children.
only a midline is placed in the patient under sterile
technique.
the ML sits inside the subclavian vessel; the PICC may
be advanced to the subclavian vessel.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Lesson 36.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Theory
3)
Summarize the possible complications that can arise
from the use of the IV route and the corrective actions
you should take for each one. (Continued)
4)
State at least seven guidelines related to IV therapy of
fluids or medications.
5)
Summarize special considerations for elderly patients
who need IV therapy.
6)
Recognize the signs and symptoms of a blood
transfusion reaction and describe the steps you should
take if one occurs.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 31
Clinical Practice
2)
Devise a care plan with patient-specific data for a
patient who needs IV fluid therapy.
3)
Calculate the rate of flow of IV fluids from various IV
orders.
4)
Initiate IV therapy by performing venipuncture with
an IV cannula (catheter over the stylet) using aseptic
technique, and starting the ordered infusion.
5)
Add a new bag of fluid to replace one from which the
solution has infused.
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Slide 32
Clinical Practice
6) Discontinue an IV infusion and evaluate the site
and surrounding tissue.
7) Safely monitor a patient receiving a blood
transfusion; document your actions and the
patient’s response to therapy.
8) Collect data on a patient who is receiving total
parenteral nutrition; document your findings and
the patient’s response to therapy.
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Slide 33
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Occurs when fluid or medication leaks out of
the vein into the tissue
Often there will be edema around the site and
the tissue will feel cool
Infusion is discontinued and another site is
initiated to continue therapy
Fluid that is in the tissue will usually reabsorb
within 24 hours
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Slide 34
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Caused by irritation of the vein by the needle,
catheter, medications, or additives in the IV
solution
Signs: erythema, warmth, swelling, tenderness
IV must be discontinued and another site
found
Warm compresses to the inflamed site will
decrease discomfort
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Slide 35
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Occurs when infectious pathogens introduced into
the bloodstream
May occur from breaks in sterile technique during
cannula insertion or any time the system is opened
to change the bag or tubing
Signs and symptoms: fever, chills, pain, headache,
nausea, vomiting, extreme fatigue
Blood cultures ordered and aggressive antibiotic
therapy is started
IV site is immediately discontinued
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Slide 36
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Catheter embolus
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Air embolus
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Occurs when a piece of the catheter breaks off and
travels in the vein until it lodges
Can occur when changing bags, or when opening the
line of a subclavian catheter
Speed shock
Occurs when fluids or medications given by
bolus are administered too rapidly
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Slide 37
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Risk for deficient fluid volume
Imbalanced Nutrition: Less than body
requirements, related to decreased oral intake
Ineffective tissue perfusion, related to loss of
red blood cells or volume
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Slide 38

Selection of the IV site

Consider:
 Accessibility of the vein, its general condition
 Type of fluid to be given
 Duration of IV therapy
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Veins preferred for infusions and intermittent doses
of medications are those distal to the antecubital area
Cephalic, basilic, and antebrachial veins of the lower
arm and the veins on the back of the hand are the
sites of choice for most adult patients
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Slide 39
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All medications are administered using the Six
Rights, with the addition of the right rate
Movement of the patient can affect the flow rate
Potassium is ALWAYS diluted and never given
as a bolus
Sterile technique is used when medications are
added to IV fluids
Most facilities require certification to administer
chemotherapy drugs
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Slide 40

To calculate drops/minute:

Amount of solution in mL x number of drops/mL /
time (in minutes)
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Slide 41
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Slide 42

Keeping the IV solution running
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Assess:
 The IV flow: the solution should drip into the chamber at

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
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regular intervals
The rate of the infusion
If a pump is used, check the programmed rate and
volume; the dripping in the chamber will occur
intermittently
The insertion site
Complaints from the patient
The level of the fluid remaining in the bag
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 43

Administering IV medications

Methods
 Adding medications to the primary bag of fluids
 Adding a secondary line or piggyback to the primary
line
 Using controlled-volume burettes
 Directly injecting the medication into the vein

All medications are administered following the Six
Rights and are documented on the medication
administration record (MAR)
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Slide 44
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Administering antineoplastic medications
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Many are very irritating to tissue
Special precautions are used in preparing and
administering these drugs
Discontinuing an IV infusion
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When an infusion is to be discontinued, the flow is
stopped and the catheter is removed
Discontinuation is documented on the IV flow sheet
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Slide 45

Administering blood and blood products
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A consent to receive blood must be signed by the
patient
If a reaction to the blood occurs with the Y
administration system, the blood should be instantly
shut off
 Start the saline (with fresh tubing) to keep the IV access
open, in case emergency drugs are needed
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Slide 46
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Total parenteral nutrition
Mainly given through a central line
The nutritional status of patients who are NPO and
on IV therapy must be assessed every day
IV solution contains dextrose but amount of
calories supplied is below the total daily
requirement
Lacks other essential nutrients and bulk
Supplemental calories may be provided by the use
of amino acids and fat emulsions
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Slide 47
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Constant assessment of the patient
Evaluation of the effect of IV therapy relates to the
reason it was given
If fluids are given to hydrate the patient, check for
good skin turgor, adequate urine output, and moist
mucous membranes
If TPN is given, assess patient’s weight gain and
monitor blood glucose level
When a blood product is administered, monitor the
blood count to see if values improve
Monitor for signs/symptoms of transfusion reaction
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Slide 48
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Documentation
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Documentation of IV medication is done on the
MAR
IV site is accessed every 1 to 2 hours according to
agency policy and observations are entered on a flow
sheet or in nurses’ notes
IV fluid counted as intake and recorded on I&O
sheet
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Slide 49
Which action by the nurse is incorrect when
hanging intravenous therapy?
1)
2)
3)
4)
Hang the solution to run first at the lowest
point.
Observe closely for transfusion reactions.
Keep the tubing free from air.
Keep IV fluids sterile.
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Slide 50