Download 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
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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
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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
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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
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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
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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
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“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
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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
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Signs & Sx: anxiety, itching, wheezing,
cyanosis, shock, etc.
Circulatory Overload: fluid administered
faster than the circulation can accommodate
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Signs & Sx: cough, dyspnea, pulmonary
congestion, headache, hypertension,
tachycardia, distended neck veins
Sepsis: contaminated blood
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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)