IV Therapy

IV THERAPYBy: Liezel A. Castillo

DEFINITION OF TERMS Hypotonic - solutions that have a lower osmolality

than body fluids Hypertonic - solutions that have a higher

osmolality than body fluids Isotonic - solutions that have the same osmolality

as body fluids Phlebitis – an inflammation of the vein that can

result mechanical or chemical trauma or local infection

Infiltration – seepage of IVF out of the vein and into the surrounding interstitial space

DEFINITION OF TERMS

Air embolism – obstruction caused by a bolus of air that enters the vein through an inadequately primed IV line, from a loose connection, or during tubing change or removal of IV line

Catheter embolism – obstruction that results from breakage of the tip of the catheter during IV line insertion

IV THERAPY

Intravenous (iv) therapy is the insertion of a needle or catheter/cannula into a vein, based on the physician’s written prescription. The needle or catheter / cannula is attached to a sterile tubing and a fluid container to provide medication and fluids.

IV THERAPY

Is used to sustain clients who are unable to take substance orally

Replaces water, electrolytes and nutrients more rapidly then oral administration

Provides immediate access to the vascular system for the rapid delivery of specific solutions

Provides a vascular route

TEN GOLDEN RULES FOR ADMINISTERING DRUG SAFELY

Administer the right drugadminister the right drug to the right patient.Administer the right doseAdminister the right drug to the right routeAdminister the right drug to the right timeDocument each drug you administerTeach patient about the drugs he is

receiving

DOCUMENTATION OF IV THERAPY

Proper documentation provides:an accurate description of care that can

serve as legal protectiona mechanism for recording and retrieving

information

INFORMATION WRITTEN ON IV TAPE

size, type and length of cannula/ needlename of person who inserted the IV catheterdate and time of insertion

Label the IV solution specifying

type of IV fluidmedication additives and flow rateuse of any electronic infusion deviceduration of therapy and the nurse’s name

and signature

TEN GOLDEN RULES FOR ADMINISTERING DRUG SAFELY

Take a complete patient drug history. (There is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks)

Find out if the patient has any drug allergiesBe aware of potential drug to drug or drug

to food interactions. To protect your patients or your license.

TONICITY OF IV FLUIDS0.45% SALINE (1/2 NS) Hypotonic0.9% NS Isotonic5% dextrose in water D5W IsotonicD5 ¼ NS IsotonicLactated Ringer’s solution IsotonicD5LR HypertonicD5 ½ NS HypertonicD5 NSS HypertonicD10W Hypertonic

TYPES OF SOLUTIONS Hypotonic - solutions that have a lower osmolality

than body fluids Hypertonic - solutions that have a higher

osmolality than body fluids Isotonic - solutions that have the same osmolality

as body fluids Crystalloids – solutions that contain electrolytes

(fluid volume replacement) Colloids/ plasma expanders – pull fluid from the

interstitial compartment into the vascular compartment (hge or hypervolemia)

IV CannulasSteel needle of butterfly sets

Wing tip needle with a metal cannula Needle is 0.5 – 1.5 inches in length (G16 -26)Use in small and fragile bonesInfiltration is more common

Plastic needleUse in short term therapyUse for rapid infusion and more comfortable for

the clientIn-needle catheter can cause catheter embolism

IV GAUGESGauge 14 – 25The smaller the gauge the larger the outside

diameterG14 -19 – for rapid fluid administration

(blood products or anesthetics)G20 - 21 – for peripheral fat infusionG22 - 24 – STD IV fluid and clear liquid

medicationG24 - 25 – for very small veins

IV CONTAINERS

Glass or plasticDo not write the plastic IV bag with marker

pen

IV TUBING

Contains the spike end, drop chamber, roller clamp, Y – site and adapter end

Use of vented or non – vented tubingShorter secondary tubing – use for

piggyback solutions, connecting them to the injection site

DRIP CHAMBER

Microdrip Are used if fluid will be infused at 50cc/ hrUsed if solution contains potent medication that

needs to be titratedDelivers 60drops/ ml

Macrodrip Use if solution is thick or need to infuse rapidlyDelivers 10 – 20drops/ ml

FILTERS Filters provide protection by preventing particles

from entering the client’s veins Filters are used in IV lines to trap small particles

such as undissolved antibiotics or salt or medications that have precipitated in solution

Assess the agency policy regarding the use of filters

A 0.22-um filter is used for most solutions, a 1.2-um for solutions containing lipids or albumin, and a special filter for blood components

NEEDLELESS SYSTEMS

Needleless systems include recessed needles, plastic cannulas, and one-way valves; these systems decrease the exposure to contaminated needles

Do not administer total parenteral nutrition or blood products through a one-way valve

INTERMITTENT INFUSION SETS Intermittent sets are used when intravascular accessibility

is desired for intermittent administration of medications by IV push or IV piggyback

An IV lock is attached for intermittent infusion devices Patency is maintained by periodic flushing with normal

saline solution (sodium chloride and normal saline are interchangeable names)

When administering medication, flush with 1 to2 mL (depending on agency policy) of normal saline to confirm placement of the IV cannula; administer the prescribed medication, and then flush the cannula again with 1 to2 mL (depending on agency policy) of normal saline to maintain patency

SLECTION OF PERIPHERAL IV SITE

Veins in the hand, forearm, antecubital fossa, scalp and feet

Assess the veins of both arms closely before selecting a site

Start IV infusion distally Determine the clients dominant side Bending the elbow on the arm with IV may

obstruct the flow causing thrombophlebitis and infiltration

Use an armboard as needed in the area of flexion

ADMINISTRATION OF IV SOLN

Check the IV solution for the type amount, percent of solution and rate of flow

Assess the health status and medical disorders

Wash hands thoroughly and use sterile technique

Prime the tubing to remove air from the system

ADMINISTRATION OF IV SOLN

Change the IV site every 48 – 72 hrsChange the IV dressing every 72 hrs

especially when wet and contaminatedChange the IV tubing every 24 to 72 hrsLabel the tubing, dressing and solution bags

indicating the date and time when changedBefore adding med or solutions, swab

access ports with 70% alcohol

COMPLICATIONS Infection – redness, swelling and drainage at

site; chills, fever, malaise, headacheTissue damage – skin color change,

sloughing of skin, discomfort at sitePhlebitis – heat, redness, tenderness, not

hard and swollenThrombophlebitis – heat, redness,

tenderness, hard and cordlike vein Infiltration – Edema, pain, and coolness at

the site

COMPLICATIONS

Catheter embolism – decrease BP, pain along vein, weak, rapid pulse, cyanosis of nail beds, loss of consciousness

Circulatory overload – increased BP, distended jugular veins, rapid breathing, dyspnea, moist cough and crackles

Electrolyte overload – signs depend on the specific electrolyte imbalance

COMPLICATIONS

Hematoma – ecchymosis, immediate swelling and leakage of blood at the site, and hard painful lumps at the site

Air embolism – tachycardia, dyspnea, hypotension, cyanosis, decreased level of consciousness

COMPUTATIONS

gtts/min = volume in cc x DF nos. of hrs x 60 minnos. of hrs = volume in cc x DF gtts/ min x 60 mincc/ hr = volume in cc

number of hours Infusion time = total volume to infuse

ml/ hr being infused

CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR

Two Steps1. determine the amount of medication/ ml

2. determine the infusion rate or ml/ hrAmount of medication/ ml

med/ ml = known amount of medication total volume of diluent

Infusion rateml/ hr = dose per hour desired concentration per ml

CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR

PROBLEMOrder: continuous heparin Na by IV at 1000

units per hourAvailable: IV bag 500 ml D5W with 20,000

unit of heparin NaHow Many ml/hr are required to administer

the correct dose

ANSWER

Conc/ ml = 20, 000 units 500 ml =40 units/ ml

ml/ hr = 1000 unit 40 units =25 ml/ hr

Types of BLOOOD COMPONENTS

RBCWhole bloodPlateletsFFPAlbumincryoprecipitate

RBC

Used to replace erythrocytespRBC (250ml) Increases the hemoglobin by 1g/dl and

hematocrit by 2 - 3 %Acute and chronic anemia

WHOLE BLOOD

Use to resolve hypovolemic shock resulting from excessive bleeding

500mlRarely use

Platelets

Use to treat thrombocytopenia and platelet dysfxn

X – matching is not required 50 – 70ml /unit or 200 – 400ml/ unitAdminister immediately and given for 5 –

30minEvaluated after 1 hr and 24 hrs after

transfusion

FFP

Use to provide clotting factors or volume expansion

Infused within 6 hours of thawing Infused as rapidly as possibleX- matching is neededPT and aPTT

ALBUMIN

Use to treat hypovolemic shock or hypoalbuminemia

Prepared from plasma and can be stored for 5 years

25g/100ml of albumin = 500ml of plasma

CRYOPRECIPITATES

Use to replace factor VIII and fibrinogenPrepared from FFPCan be stored for 1 year but once thawed,

the product must be used

TYPES OF BLOOD DONATION

AutologousBlood salvageDesignated donor

AUTOLOGOUS

Donation of the clients own blood before the scheduled procedure

Reduces the risk of disease transmission and potential transmission complications

Can be made every 3 days as long as hemoglobin remains with in a safe range

Donation should be made within 5 weeks of the transfusion date and end at least 3 days before the date of transfusion

BLOOD SALVAGE

An autologous donation Involves suctioning of blood from body

cavities, joint spacesBlood may need to be washed by a special

process that removes tissue debris before reinfusion

DESIGNATED DONOR

When recipients select their own compatible donors

Does not reduce the risk of contracting infection but they feel comfortable

COMPATIBILITY

Rh type and ABO type are identifiedUse to prevent transfusion rxnCrossmatching – the testing of donors blood

and the recipients for compatibility

COMPLICATIONS

Transfusion rxnCirculatory overloadSepticemia Iron overloadDisease transmission Hypocalcemia and citrate intoxicationHyperkalemia

NURSING INTERVENTIONA large volume of blood transfused rapidly

through a central catheter into the ventricle of the heart will cause cardiac dysrhythmias

No solutions other than NS should be added on blood components

Infusion should not exceed more than 4 hrs Medication are never added to blood

components Blood administration set should be changed

every 4 - 6 hrs

NURSING INTERVENTION

Check the date of expiration Inspect he blood for abnormal color, leaks,

clots, bubblesBlood must be administered 20-30 minutes

from its being received from the blood bankNever refrigerate blood in refrigerator other

than blood bankMonitor vs and assess lung sounds

NURSING INTERVENTION

2 RN need to check the physicians order, clients identity, clients identification band

Check the blood bag tag, label and blood requisition form

CLIENT ASSESSMENT

Assess for any cultural or religious beliefs Informed consent has been obtainedCheck the clients vital sign and medical

status

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