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INTRAVENOUS FLUID ADMINISTRATION IN THE NEWBORN May Baldemor, RN Senior Nurse, NICU Jordan Hospital, Amman

INTRAVENOUS FLUID ADMINISTRATION IN THE NEWBORN May Baldemor, RN Senior Nurse, NICU Jordan Hospital, Amman. PERIPHERAL INTRAVENOUS LINE . Purpose and Uses ?.

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INTRAVENOUS FLUID ADMINISTRATION IN THE NEWBORN May Baldemor, RN Senior Nurse, NICU Jordan Hospital, Amman

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  1. INTRAVENOUS FLUID ADMINISTRATION IN THE NEWBORNMay Baldemor, RNSenior Nurse, NICUJordan Hospital, Amman

  2. PERIPHERAL INTRAVENOUS LINE

  3. Purpose and Uses ? * Used to sustain clients who are unable to take substances orally. * Provides immediate access to the vascular system for the rapid delivery of specific solutions without the time required for gastrointestinal tract absorption. * Provide a vascular route for the administration of medications or blood components.

  4. Intravenous devices: IV cannula: a)Steel needles or butterfly needles. b)Plastic cannula- after vein puncture, it is guided through the needle into the vein and the needle is removed from the catheter.

  5. Precautions: 1- Wear gloves. 2- Avoid vessels across joints. 3- Take care to differentiate veins from arteries. 4- If limb requires warming prior to procedure, do not exceed 40 degrees. 5- Shave adequate area of head to permit stabilizationof IV.

  6. Precautions:6- Apply tourniquet correctly.7- Be alert for signs of phlebitis or infiltration.8- Write the date, time, signature on piece of tape secured to size.

  7. Complications: 1-Infection. 2-Tissue damage. 3-Phlebitis. 4- Infiltration. 5-Catheter embolism. 6- Air embolism.

  8. UMBILICAL CATHETERIZATION

  9. Umbilical Arterial Catheterization Indications: a)Monitoring blood pressure. b)Monitoring arterial blood gases when infant is on supplemental oxygen. c)May be considered as access and infusion site in all neonates. d)May be used as an alternative site of fluid administration when attempt at venous access are unsuccessful.

  10. Umbilical Venous Catheterization Indications: a) Emergency vascular access for fluids and medication infusion and for blood drawing. b) Central venous pressure monitoring. c) Exchange transfusion. d) Long term central venous access in low birth weight infants.

  11. Equipments: 1-Cut-down set. 2-IV fluids. 3-Tape measure. 4-Alcohol. 5-Povidine solution. 6-Suture. 7- Umbilical catheter.

  12. Equipments8- Normal saline.9-  Syringes.10- Three-way stopcock.11-  Umbilical tie tape.12-  Sterile gown, caps, gloves and mask.13- Graphs to determine appropriate depth of Insertion.

  13. Length of UAC InsertionShoulder-umbilicus UAC UVC 9cm 10cm 5.2cm 10cm 10.5cm 6cm 11cm 12cm 6.5cm 12cm 13cm 7cm 13cm 15cm 8cm 14cm 16cm 8.5cm 15cm 17cm 9cm 16cm 18.5cm 9.8cm 17cm 19cm 10.5cm 18cm 20cm 11cm

  14. Procedure: 1- Set up the cut-down set on a sterile mayo table using aseptic technique and add to the sterile field- syringes, sutures, blade, stopcock, umbilical catheter, then assist the physician in drawing normal saline.

  15. Procedure: 2-Prepare IV fluids- heparinized D.W5% (1IU/1cc) for the arterial line and plain D.W10% for the venous line. 3- IV rate is regulated according to the doctor’s order.

  16. Procedure: 3- Obtain x-ray film to check catheter position (by the physician). 4- If desired secure catheter with tape bridge. 5- Continue routine cord care using sterile gauze and povidine.

  17. Nursing Care:-Keep catheter free of blood to prevent clot formation.- Flush catheter with normal saline solution slowly each time blood sample is drown.- Infuse IV solution continuously to catheter between sample to prevent retrograde flow.- Note amount of blood removed and IV/ flush solution infused and add to fluid-balance record.

  18. Nursing Care: 2-Watch for indication of clot formation difficulty withdrawing blood sample. 3-   Take appropriate action if clot formation do not attempt to flush clots forcibly. 4- Note for any discoloration of lower extremities

  19. Complications: 1-Infection. 2-Thrombo embolic. 3- Catheter mal-positioned in heart and great vessels. 4- Catheter mal-positioned in portal system. 5- Bleeding. 6-Ischaemia/ infarction of lower extremities. 7- Arrhythmia if the catheter is in the heart

  20. FLUID ADMINISTRATION Fluid requirements (per day) First day of life 60-70ml/kg Second day 75-85ml/kg Third day 85-100ml/kg Fourth day 100-125ml/kg Fifth – 30 days 125-150ml/kg

  21. FLUID ADMINISTRATIONFluid needs may be increased or decreased depending on the clinical situation of the patient, daily weight, urine and serum urea nitrogen with electrolytes should be monitored carefully to determine water balance and fluid needs.

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