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Comprehensive Guide to Intravenous Therapy: Techniques and Complications

This guide covers IV therapy objectives, fluid composition, movement, osmolarity, types of IV fluids, nurse alerts, IV sites, catheters, medication administration, heparin locks, piggyback administration, and common complications with interventions.

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Comprehensive Guide to Intravenous Therapy: Techniques and Complications

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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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