Brenda McLoud BSN, RN, CGRN
Mar 26, 2015
Brenda McLoud BSN, RN, CGRN
Learning ObjectivesDescribe the Nurse’s role in IV therapy
careExplain IV supplies, type of vascular
access devices, and administration of IV therapy
GI nurse’s role in IV therapyAssessmentPlanningImplementationEvaluation.
Competencies in IV Therapy for the GI NurseKnowledge of Vascular Access Devices (VAD)
usedSkill in performing procedure competently &
safelySkill in inspecting insertion siteAbility to problem solveKnowledge to monitor patient’s condition &
report changesProper 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 includeIsotonic SolutionsHypotonic SolutionsHypertonic Solutions
Body fluids are isotonic solutions
Basic Principles of Fluid & Electrolytes
Body water is contained in two major body compartmentsIntracellular 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 asNonelectrolytesElectrolytes
Cations Na, K, Ca, Mg, H
Anions Cl, P, HCO3
Electrolytes perform four essential functionsPromote neuromuscular irritabilityMaintain body fluid osmolalityRegulate acid-base balanceRegulate distribution of body fluids among body
fluid compartments
Fluid & Electrolyte imbalancesImbalances 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 medicationsRequires a Dr.’s orderTypes 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 NursePrimary risks due to needlesticks
InjuryDisease transmission
SpillsSplashes
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 allergiesIndividuals who develop burning or tingling
around mouth after blowing up latex balloonsKnown allergy to
BananasAvocadosPotatoesTomatoesPoinsettiasHistory of contact dermatitis History of asthma History of eczema
Vascular Access Devices (VAD)Steel winged infusion set (butterfly winged
device)Peripheral short IV cathetersPeripheral long or midline cathetersPeripherally inserted central catheters
(PICC)Nontunneled central venous catheters
(CVC’s)Tunneled central venous cathetersTotally implanted devices or ports
IV Insertion sitesPreferred sites
Dorsum of handUpper arm
Avoid Extremities withLymphedema, 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
ComplicationsInfiltration/extravasationHematomaPhlebitisPyrogenic reactionsAir embolismCatheter embolismPulmonary edemaSpeed shock/overloadNerve injury
IV Medication AdministrationTechniques & routes of administration
Appropriateness of the prescribed therapyPatient’s age and conditionAny medication allergiesDose, route and rate of the medication ordered
MedicationsIndicationsActionsSide effectsAppropriate nursing interventions with adverse
reactions
Indications for IV meds in GIModerate sedation/analgesiaControl of variceal hemorrhageTreatment of opioid-induced respiratory
depressionTreatment of benzodiazepine-induced
respiratory depressionTreatment of cardiac dysrhythmiasReducing peristalsis or intestinal spasmsTreatment for increased risk of infection
Blood & Blood ComponentsWhole bloodPacked red blood cellsLeukocyte-poor bloodPlateletsFresh frozen plasma (FFP)CryoprecipitatesFactor VIIIFactor IXHuman albuminAutologous transfusion
Adverse ReactionsCirculatory overloadAllergic reactionsHemolytic reactionsHepatitis B, hepatitis C and human immune
deficiency virusesOther transfusion-related infectious agentsCitrate toxicity
When Adverse Reaction OccursStop the transfusionKeep vein open with normal salineAsses vital signsNotify Dr.Notify blood bankSend all transfusion containers &
administration sets to blood bankTreat patient symptomatically & supportivelyPatient EducationDocumentation
ReviewSalts that dissociate in solution into positive
and negative ions are called:A. AnionsB. CationsC. ElectrolytesD. Colloids
ReviewDrugs 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.
ReviewThe following may indicate a higher risk for
latex allergy except,A. History of asthma.B. Use of powder-free gloves.C. Allergy to bananasD. History of multiple surgical procedures.
ReviewHemolytic reactions to blood transfusions
usually occur :A. ImmediatelyB. Within the first 5 to 15 minutes of the
transfusion.C. Within 24 hours.D. As long as 6 months after the transfusion.