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Brenda McLoud BSN, RN, CGRN Learning Objectives Describe the Nurse’s role in IV therapy care Explain IV supplies, type of vascular access devices, and administration of IV therapy GI nurse’s role in IV therapy Assessment Planning Implementation Evaluation. Competencies in IV Therapy for the GI Nurse Knowledge of Vascular Access Devices (VAD) used Skill in performing procedure competently & safely Skill in inspecting insertion site Ability to problem solve Knowledge to monitor patient’s condition & report changes Proper documentation and record-keeping skills Basic Principles of Fluid & Electrolytes Water is 60% of the average adult’s total body weight In infants, body water represents about 80% of total body weight Solutions – liquids (solvents) containing dissolved substances (solutes) – are classified according to their concentration or tonicity and include Isotonic Solutions Hypotonic Solutions Hypertonic Solutions Body fluids are isotonic solutions Basic Principles of Fluid & Electrolytes Body water is contained in two major body compartments Intracellular fluid (ICF) Extracellular fluid (ECF) Fluid balance is maintained when water intake equals water output Solutes are substances dissolved in a solution Basic Principles of Fluid & Electrolytes Solutes are classified as Nonelectrolytes Electrolytes Cations Na, K, Ca, Mg, H Anions Cl, P, HCO3 Electrolytes perform four essential functions Promote neuromuscular irritability Maintain body fluid osmolality Regulate acid-base balance Regulate distribution of body fluids among body fluid compartments Fluid & Electrolyte imbalances Imbalances may result from Vomiting, diarrhea, suction, draining wounds, intestinal obstructions, draining fistulas, hemorrhage, infections, fever or prolonged use of enemas & Infants are more vulnerable because of their higher proportion of body fluid, immature kidneys, increased heat production & rapid growth Excessive loss of body water can lead to dehydration Administration of Fluids & Electrolytes All IV solutions are considered medications Requires a Dr.’s order Types of Solutions Isotonic Solutions 0.9% NS or LR Hypotonic Solutions 0.45% NaCl Hypertonic Solutions 3% NaCl or 10%Dextrose Risks for the GI Nurse Primary risks due to needlesticks Injury Disease transmission Spills Splashes Because universal precautions require use of gloves when dealing with blood and body fluids, development of latex allergies pose a concern for health care workers and patients Latex allergies Individuals who develop burning or tingling around mouth after blowing up latex balloons Known allergy to Bananas Avocados Potatoes Tomatoes Poinsettias History of contact dermatitis History of asthma History of eczema Vascular Access Devices (VAD) Steel winged infusion set (butterfly winged device) Peripheral short IV catheters Peripheral long or midline catheters Peripherally inserted central catheters (PICC) Nontunneled central venous catheters (CVC’s) Tunneled central venous catheters Totally implanted devices or ports IV Insertion sites Preferred sites Dorsum of hand Upper arm Avoid Extremities with Lymphedema, postop swelling, recent trauma, dialysis shunt, hematoma, axillary lymph node dissection, local infection or cellulitis, phlebitis or open wounds Best to begin with distal veins and proceed proximally towards the body Cannulation of lower extremities should be avoided in adults Complications Infiltration/extravasation Hematoma Phlebitis Pyrogenic reactions Air embolism Catheter embolism Pulmonary edema Speed shock/overload Nerve injury IV Medication Administration Techniques & routes of administration Appropriateness of the prescribed therapy Patient’s age and condition Any medication allergies Dose, route and rate of the medication ordered Medications Indications Actions Side effects Appropriate nursing interventions with adverse reactions Indications for IV meds in GI Moderate sedation/analgesia Control of variceal hemorrhage Treatment of opioid-induced respiratory depression Treatment of benzodiazepine-induced respiratory depression Treatment of cardiac dysrhythmias Reducing peristalsis or intestinal spasms Treatment for increased risk of infection Blood & Blood Components Whole blood Packed red blood cells Leukocyte-poor blood Platelets Fresh frozen plasma (FFP) Cryoprecipitates Factor VIII Factor IX Human albumin Autologous transfusion Adverse Reactions Circulatory overload Allergic reactions Hemolytic reactions Hepatitis B, hepatitis C and human immune deficiency viruses Other transfusion-related infectious agents Citrate toxicity When Adverse Reaction Occurs Stop the transfusion Keep vein open with normal saline Asses vital signs Notify Dr. Notify blood bank Send all transfusion containers & administration sets to blood bank Treat patient symptomatically & supportively Patient Education Documentation Review Salts that dissociate in solution into positive and negative ions are called: A. Anions B. Cations C. Electrolytes D. Colloids Review Drugs should never be added to blood transfusions because: A. They are incompatible. B. It complicates determination of the source of any adverse reaction. C. Drugs can cause clotting. D. The rate of infusion is too slow. Review The following may indicate a higher risk for latex allergy except, A. History of asthma. B. Use of powder-free gloves. C. Allergy to bananas D. History of multiple surgical procedures. Review Hemolytic reactions to blood transfusions usually occur : A. Immediately B. Within the first 5 to 15 minutes of the transfusion. C. Within 24 hours. D. As long as 6 months after the transfusion.
