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IV Therapy

IV Therapy. NRS 108 Majuvy L. Sulse RN, MSN, CCRN. Objectives of IV therapy. Achieve & maintain normal fluid & electrolyte balance Achieve optimal nutritional status Maintain homeostasis through blood & blood products administration Medication administration.

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IV Therapy

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  1. IV Therapy NRS 108 Majuvy L. Sulse RN, MSN, CCRN

  2. Objectives of IV therapy • Achieve & maintain normal fluid & electrolyte balance • Achieve optimal nutritional status • Maintain homeostasis through blood & blood products administration • Medication administration

  3. Composition & Distribution of body fluids • Component • Water • electrolytes • Distribution • Intracellular- • Extracellular • Interstitial-Lymph • Intravascular-plasma • Transcellular-CSF, pleural, peritoneal & synovial

  4. Movement of body fluids • Osmosis • Diffusion • Filtration • Active transport

  5. Osmolarity Number of milliosmosles in a liter of solution Volume Normal osmolarity of plasma and ECF 270-300 MOS/L Osmolality Number of milliosmoles in a kilogram of solution Weight Osmolarity vs. Osmolality& Tonicity Tonicity- ability of solution to cause a change in water movement across a membrane due to osmotic pressures

  6. Examples of IVF Isotonic Hypertonic Hypotonic 0.9% NaCl LR D5W Albumin 5% (colloid) NaCl 3%-5% 0.45% NaCl 0.33% NaCl 2.5% Dextrose D5 NaCl D5LR D5.45 NaCl

  7. Colloids Proteins/large molecules Increased osmotic pressure-plasma volume expandersUses: burns, hemorrhage, surgeryTypes: dextran-40-70 (decreases blood viscosity &reduces platelet adhesiveness) albumin- MannitolNurse Alert: Monitor for blood pressure

  8. Crystalloids Substances easily dissolved, pass through semi permeable membraneUses: replace fluid loss & promote urine outputTypes: Dextrose solutions sodium chloride solutions multiple electrolyte solutions

  9. IV Sites & Cannulas • Site-start from periphery, use vein on non dominant side, avoid areas of previous venipunctures, avoid areas of flexion, veins on a surgically/neurologically compromised limb • Catheter gauge-amount of fluid and how long it will infuse, viscosity of fluid, size & condition of vein

  10. Common IV sites 1-cephalic 2-basilic 3-median cubital 4- medial cutaneous nerve of forearmmedial antebrachial cutaneous n. 5-lateral cutaneous nerve of forearmlateral antebrachial cutaneous n.

  11. Standard intravenous catheter • Used for continuous fluid administration • Not considered for long term therapy • Flow rate regulated manually by clamp or regulated by an automatic pump

  12. Heparin Lock • Intermittent infusion lock • Used when fluid therapy is no longer required • Used to administer intermittent medication • Used to maintain venous access • Needs flushing to maintain patency

  13. Medication Administration • Added to primary intravenous fluids-large volume infusions • 10 mEq KCL to D51/2 NS • 1amp MVI to D51/2 NS • Added via piggyback-small amount IV fluid in a secondary set connected to Y port • antibiotics • Given via IV -push-confirm placement of catheter- • Lasix

  14. Intravenous Therapy & Piggyback

  15. Medication Administration • Preparation- • Always practice strict hand washing • Preparation for additives • Vial or ampule- measure appropriate amount • Powder- mix with diluents

  16. Common complications-Local • Hematoma • Leakage of blood into surrounding insertion site • Causes: • Perforation of opposite vein wall • Needle slips out of vein • Insufficient pressure after venipuncture is terminated • Signs/symptoms • IMMEDIATE SWELLING, ECCHYMOSIS • Interventions • Immediate pressure, sterile dressing, cold compress over 24 hrs then warm compress

  17. Common complications-Local • Infiltration • Leakage of fluid into surrounding insertion site • Causes: • Needle dislodges and fluid infuses into the tissues • S/S • Edema, area cool to touch, no blood return • Interventions • D/c Iv, sterile dressing, warm compress, elevate

  18. Common complications-Local • Tissue injury- may include necrosis and sloughing, deprive patient of fluid, infection, permanent damage • Causes • Infiltration of hypertonic, toxic, acidic or alkaline solutions • S/S • Pain, swelling, color changes, sloughing • Interventions • Notify MD, follow treatment

  19. Common complications-Local • Phlebitis-inflammation of vein • Causes: • Prolonged infusion, traumatic entry, fluid tonicity, cannula size, improper securing at site, poor sterile technique • S/S • Redness, warmth, swelling, burning pain, low flow rate • Interventions • D/c IVF, warm compress

  20. Common complications-Local • Thrombosis-formation of thrombose without inflammation • Causes: • Damage to intima of vein, deposition of fibrin, clot occlusion • S/S • Little to no pain, low/no flow rate • Interventions • D/c IV • DO NOT IRRIGATE

  21. Common complications-Local • Thrombophlebitis-clot formation with inflammation of vein • Causes: • Damage to intima of vein, fibrin deposit, clot, occlusion • S/S • Pain, redness, warmth, swelling • Interventions • D/C IV, do not irrigate, notify MD, warm compress, elevate

  22. Common complications-Local • Clotting of cannula • Causes: • Empty IV or interrupted flow, kinked tubing, failure to flush heparin lock • S/S • IV flow stops, backflow of blood in IV tubing • Interventions • Aspirate clot (do not use force) restore flow

  23. Complications-Systemic • Infection • Causes: introduction of microorganism at catheter insertion or during therapy, contaminated equipments or solutions • S/S • Dependent upon the degree and the individual • Interventions • Notify the MD, supportive care

  24. Complications-Systemic • Air embolism • Causes: • Introduction of air during insertion of central line, administration tubing, solution run dry • S/S • Pallor, cyanosis, dyspnea, cough, tachycardia, syncope, shock • Interventions • Place client on Left side, emergency supportive care, notify MD

  25. Complications-Systemic • Thrombolism- obstruction of blood vessel by carried via the circulatory system • Causes: • Release of clot from the catheter tip via manipulation or tubing • S/S • Depending upon size & location of clot • Interventions • Notify MD, monitor VS, supportive nursing care, treat as per MD

  26. Complications-Systemic • Allergic reaction- hypersensitivity to solution or medication • Causes: • Antigen-Antibody reaction • S/S • Skin: rash, urticaria • Respiratory: dyspnea, stridor, wheezing • Non specific: nausea, vomiting, chest tightness • Interventions • Stop IV, change tubing, run KVO, notify MD

  27. Complications-Systemic • Circulatory overload-infusion of excessive fluids • Causes: • Failure to monitor rate • S/S • Edema, puffy eyelids, SOB, rales, hypertension • Interventions • Decrease Iv rate, raise of head of bed up, monitor VS, notify MD, O2

  28. Complications-Systemic • Speed shock-related to toxic concentration of drug • Causes: • Rapid administration of IV drug • S/S • Tachycardia, hypotension, syncope, shock, cardiac arrest • Interventions • Stop drug infusion, KVO fluids, Monitor VS, notify MD

  29. Vascular Access Devices • Short Peripheral catheters • Midline Catheters • PICC-peripherally inserted central catheters • Nontunneled Percutaneous Central Catheters • Implanted ports • Dialysis catheters

  30. Catheter care & Maintenance • Educate client • Assessment • Securing& dressing the catheter • Changing administration sets • Controlling infusion pressure • Obtaining blood samples from catheter • Keeping catheter patent • Discontinuing catheter

  31. IV Flow Rate Calculations • Know tubing • Macro drip • 10gtts • 15 gtts • 20 gtts • All equals 1 cc • Micro drip • 60 gtts= 1cc

  32. IV Flow Rate Calculations • Must know • Total volume to be infused • Calibration of tubing • Time ordered for infusion • Formula flow rate= volume x calibration time in minutes

  33. IV Flow Rate Calculations • Order: 1000 ml D5w TO INFUSE OVER 8 HOURS. Drip factor: 20 gtts/ml. Calculate the correct gtt/min. • 1000ml x 20gtt=20,000=41.6gtts/min 8x60 480

  34. IV Flow Rate Calculations • Ordered D5W to infuse at 83 ml/hr. The drop factor is 10. 10 x 83= 1 x 83= 13.8 or 14gtts/min 1 hr x 60 min 6

  35. Calculating drug doses • Formula: Dose= Rate x concentration • Dose= expressed in different units: mg/hr, mg/min, units/hr, etc • Rate=always in ml/hr as IV pumps are used to administer these drugs • Concentration=found on the label of the drug which maybe in mg/ml, units/ml or mcg/ml

  36. Calculating drug doses • 1) You need to administer 800 units of heparin. The label states there are 25,000 Units/500 ml of fluid. calculate the rate you will set on the pump • 500ml x 800 U= 40000 ml =16ml/hr • 25,000 U 1 hr 25000

  37. Calculating drug doses • At the beginning of your shift, you note that Theophylline 1 gm/500ml is infusing at 20 ml/hr. You have an order to administer Theophylline at 40 mg/hr. Is the rate correct? 500ml x 40 mg =20000 ml =20ml/hr 1000mg 1 hr 1000hr

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