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    This document provides information on intravenous (IV) therapy including definitions of terms related to tonicity and complications, descriptions of IV equipment and procedures, calculations for IV drug administration, and types of blood components. Key points covered include definitions of hypotonic, isotonic and hypertonic solutions; components of IV equipment like tubing, containers and cannulas; procedures for administering IV fluids and changing dressings/tubing; potential complications and their signs; and examples of blood products like packed red blood cells, platelets, and fresh frozen plasma.

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    C CCC !"#" $ !"#" C !"#" !%# # # C#%$#C #""$

    Uploaded by

    acque
    127 views10 pages
    This document provides information on intravenous (IV) therapy including definitions of terms related to tonicity and complications, descriptions of IV equipment and procedures, calculations for IV drug administration, and types of blood components. Key points covered include definitions of hypotonic, isotonic and hypertonic solutions; components of IV equipment like tubing, containers and cannulas; procedures for administering IV fluids and changing dressings/tubing; potential complications and their signs; and examples of blood products like packed red blood cells, platelets, and fresh frozen plasma.

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    IV Therapy

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    This document provides information on intravenous (IV) therapy including definitions of terms related to tonicity and complications, descriptions of IV equipment and procedures, calculations for IV drug administration, and types of blood components. Key points covered include definitions of hypotonic, isotonic and hypertonic solutions; components of IV equipment like tubing, containers and cannulas; procedures for administering IV fluids and changing dressings/tubing; potential complications and their signs; and examples of blood products like packed red blood cells, platelets, and fresh frozen plasma.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    127 views10 pages

    C CCC !"#" $ !"#" C !"#" !%# # # C#%$#C #""$

    Uploaded by

    acque
    This document provides information on intravenous (IV) therapy including definitions of terms related to tonicity and complications, descriptions of IV equipment and procedures, calculations for IV drug administration, and types of blood components. Key points covered include definitions of hypotonic, isotonic and hypertonic solutions; components of IV equipment like tubing, containers and cannulas; procedures for administering IV fluids and changing dressings/tubing; potential complications and their signs; and examples of blood products like packed red blood cells, platelets, and fresh frozen plasma.

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    of 10

    IV THERAPY

    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

     lIntravenous (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 drug


     administer the right drug to the right patient.
     Administer the right dose
     Administer the right drug to the right route
     Administer the right drug to the right time
     Document each drug you administer
     Teach patient about the drugs he is receiving
    DOCUMENTATION OF IV THERAPY

     Proper documentation provides:


     an accurate description of care that can serve as legal protection
     a mechanism for recording and retrieving information

    INFORMATION WRITTEN ON IV TAPE

     size, type and length of cannula/ needle


     name of person who inserted the IV catheter
     date and time of insertion

    Label the IV solution specifying

     type of IV fluid
     medication additives and flow rate
     use of any electronic infusion device
     duration 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 allergies
     Be aware of potential drug to drug or drug to food interactions. To protect your
    patients or your license.

    TONICITY OF IV FLUIDS

     0.45% SALINE (1/2 NS) Hypotonic


     0.9% NS Isotonic
     5% dextrose in water D5W Isotonic
     D5 ¼ NS Isotonic
     Lactated Ringer’s solution Isotonic
     D5LR Hypertonic
     D5 ½ NS Hypertonic
     D5 NSS Hypertonic
     D10W 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 Cannulas

     Steel needle of butterfly sets


    o Wing tip needle with a metal cannula
    o Needle is 0.5 – 1.5 inches in length (G16 -26)
    o Use in small and fragile bones
    o Infiltration is more common
     Plastic needle
    o Use in short term therapy
    o Use for rapid infusion and more comfortable for the client
    o In-needle catheter can cause catheter embolism

    IV GAUGES

     Gauge 14 – 25
     The smaller the gauge the larger the outside diameter
     G14 -19 – for rapid fluid administration (blood products or anesthetics)
     G20 - 21 – for peripheral fat infusion
     G22 - 24 – STD IV fluid and clear liquid medication
     G24 - 25 – for very small veins

    IV CONTAINERS

     Glass or plastic
     Do 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 tubing
     Shorter secondary tubing – use for piggyback solutions, connecting them to the
    injection site

    DRIP CHAMBER

     Microdrip
    o Are used if fluid will be infused at 50cc/ hr
    o Used if solution contains potent medication that needs to be titrated
    o Delivers 60drops/ ml
     Macrodrip
    o Use if solution is thick or need to infuse rapidly
    o Delivers 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 hrs


     Change the IV dressing every 72 hrs especially when wet and contaminated
     Change the IV tubing every 24 to 72 hrs
     Label the tubing, dressing and solution bags indicating the date and time when
    changed
     Before adding med or solutions, swab access ports with 70% alcohol

    COMPLICATIONS

     Infection – redness, swelling and drainage at site; chills, fever, malaise, headache
     Tissue damage – skin color change, sloughing of skin, discomfort at site
     Phlebitis – heat, redness, tenderness, not hard and swollen
     Thrombophlebitis – 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 min

     nos. of hrs = volume in cc x DF

    gtts/ min x 60 min

     cc/ 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 Steps

    1. determine the amount of medication/ ml

    2. determine the infusion rate or ml/ hr

     Amount of medication/ ml
    o med/ ml = known amount of medication
    o total volume of diluent
     Infusion rate
    o ml/ hr = dose per hour desired
    o concentration per ml

    CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR

     PROBLEM
     Order: continuous heparin Na by IV at 1000 units per hour
     Available: IV bag 500 ml D5W with 20,000 unit of heparin Na
     How 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

     RBC
     Whole blood
     Platelets
     FFP
     Albumin
     cryoprecipitate

    RBC

     Used to replace erythrocytes


     pRBC (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


     500ml
     Rarely use

    Platelets

     Use to treat thrombocytopenia and platelet dysfxn


     X – matching is not required
     50 – 70ml /unit or 200 – 400ml/ unit
     Administer immediately and given for 5 – 30min
     Evaluated 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 possible
     X- matching is needed
     PT 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 fibrinogen


     Prepared from FFP
     Can be stored for 1 year but once thawed, the product must be used

    TYPES OF BLOOD DONATION

     Autologous
     Blood salvage
     Designated 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 spaces
     Blood 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 identified


     Use to prevent transfusion rxn
     Crossmatching – the testing of donors blood and the recipients for compatibility

    COMPLICATIONS

     Transfusion rxn
     Circulatory overload
     Septicemia
     Iron overload
     Disease transmission
     Hypocalcemia and citrate intoxication
     Hyperkalemia

    NURSING INTERVENTION

     A 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, bubbles
     Blood must be administered 20-30 minutes from its being received from the blood
    bank
     Never refrigerate blood in refrigerator other than blood bank
     Monitor 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 obtained
     Check the clients vital sign and medical status

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