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  • There are disadvantages:Time, skill to establish & maintainMobilityInfectionSevere reactionsAccidental removalHematoma, infiltration (medication or fluid enters the surrounding tissue), & phlebitis (inflammation of the vein).Opens a direct route to the cardiovascular system for microorgansisms. So very important to use aseptic techniques. Placing IV can be risky due to needle stick & exposure to blood borne pathogens (HIV, hepatitis B, Hepatitis C).
  • Steel needles not seen as much any more—butterfliesOver-the –needle what we useThrough-the-needle is were you have a inducer as in a PICC line
  • Most common IV sites in adults are the lower arm & hand (hand not ideal; movement, painful, & lots of valves)If possible use the non-dominant hand or armMedian cubital vein most commonly use for blood draws but not good for IV site due to this is a joint of flexion.Hand is easy quick access. Try to avoid the wrist in laboring mothers due to bending of the wrist to push. Sites must be rotated q48-72hrs depending on the facility.When placing a IV or changing sites the new site needs to be proximal, meaning above & closer to the point of attachment.
  • Subclavian vein—few structures near it, but can cause a pneumothorax (air in the pleural cavity cause clasping of the lung).Always get a chest x-ray to confirm placement.Jugular veins—are easily visualized but lie near major arteries. Pt drool & increase infection risk. Still chest x-ray after placement.Femoral vein—used in emergencies, or unable to place SC due to anatomy/dehydration. Increased risk of infection. No x-ray needed.Intraosseous IV—when unable to get access in emergency placed in the tibia long bone. Faster when pt is in a low flow perfusion state. Risks are fracture, pain, compartment syndrome, & infection. PICC—placed by a specially trained nurse. High risk for blood clots.
  • Veins are easy to see and palpate but tend to roll.With age arteries lumen size decreases & harden due to arteriosclerosis (thickening of vessel walls & accumulation of calcium causing vessels to become stiff) & atherosclerosis (accumulation of plaque inside the walls).Veins more fragile.Age also affects the ability to metabolize drugs.
  • Most accurate but still room for error. Roller clamps must count gtts per min to calculate gtts per hr. Volume-control device pg 72 in atlas.
  • Whole blood—is separated into red blood cells, plasma, & platelets. People rarely need whole blood transfusions.RBC’s—gives blood its color, transports O2, & carries CO2 to the lungs to be exhaled. Made in the bone marrow which is stimulated by the hormone erythropoietin from the kidneys. Transfusion of RBC’s is in the form of packed RBC’s, where most of the plasma & other cells have been removed. Plasma—infused in the form of FFP. Plasma can be frozen for up to a yr. Straw color contains clotting factors & proteins for clotting & antibodies. Platelets—also come from the bone marrow. There is only a small amount in whole blood, so it takes several donors to replace someone who needs platelets. Usually 6-10 pack.Volume expanders (common OR): NS, lactated Ringer’s (NS with some other chemicals), albumin, & hydroxyethyl starch (HES span). Used to prevent pt’s from going into shock from volume loss. Working on developing blood substitutes, still experimental. 18 gauge needle prefered. Can make due with a 20 & even 22 but your pushing it!
  • Typed—is A, B, AB, or O. Rh + or -. NS to flush, in case of a reaction. Clamp blood & open NS 3-4 hrs because of the risk for bacterial growth. No faster than 150ml/hr due to risk of circulatory overload resulting in HTN.
  • Most common. Piggybacks. Use port closest to the cannula.Solution, TPN, any gtt should be replaced q24hr. Make sure to do your I & O’s at least once per shift.
  • ClotAccumulation of air in the pleural space that can result in the collapsing of the lung. Inflammation of the veinAbnormal particle (air, clot, fat, tissue, foreign body) circulating in the blood that can travel & lodge itself in a vessel, thus occluding the vessel.Fluid escaping from the veins into the surrounding tissue. UnobstructedPuncture of a vein for medical purposesSame as extravasation except it is an accumulation, pulling of fluid in the tissue

Transcript

  • 1. Chapter 23
    Intravenous Medication Administration
    Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 2. Percutaneous Administration
    Intravenous Therapy
    Provide fluid and electrolyte maintenance, restoration, and replacement
    Administer medication and nutritional feedings
    Administer blood and blood products
    Administer chemotherapy to cancer patients
    Administer patient-controlled analgesics
    Keep a vein open for quick access
  • 3. Intravenous Therapy
    • Introduced directly into the blood stream
    • 4. Most rapid of all routes
    • 5. Large volumes
    • 6. Less irritation
    • 7. Intermittent or continuous
    • 8. Comfortable
    • 9. Bypasses all barriers
  • Percutaneous Administration
    Methods of Intravenous Administration
    IV push
    Intermittent venous access device
    Intermittent infusion (or piggyback)
    Continuous infusion
    Electronic pumps and controllers
    Patient-controlled analgesia
    Volumetric chambers
  • 10. Disadvantages of IV Therapy
    Local complications
    Accidental needle stick
    Rapid administration
  • 11. Catheters
    Peripheral catheters
    Steel Needles
    Over-the-Needle Catheter
    Central Venous Catheters
    Central Line
    Implanted
    Tunneled
    PICC
    Hemodialysis
  • 12. Site Selection for Venipuncture
    Age & status of the patient
    Purpose of the infusion
    Duration of the therapy
    Condition of the patient’s veins
    • Accessory cephalic vein
    • 13. Median basilic vein
    • 14. Dorsal metacarpal veins
    • 15. Digital veins
  • Site Selection for Central Line
    Subclavian vein
    Internal & external jugular veins
    Femoral vein
    PICC
  • Special Issues for Older Patients
    Thinner skin
    Decreased subcutaneous tissue
    Age
  • 18. Infusion Devices
    Electronic infusion pumps
    Syringe pumps
    Roller clamps
    Volume-control device
  • 19. Blood Products
    Whole Blood
    Red Blood Cells
    Plasma
    Platelets
  • 20. Blood Transfusion Reaction
    Typed & crossed
    S/S: Fever, increase or decrease HR, &/or rash
    Always hang with NS
    Infuse within 4 hours
    Monitor VS every 15 min.
  • 21. IV Medication Administration
    Fluid replacement
    Intermittent medication
    Replace q24hr
    Intake & output
  • 22. Percutaneous Administration
    Nursing Responsibility
    The nurse must ensure that fluid of the ordered type and amount is started and that the fluid is regulated to infuse over the period ordered.
  • 23. Percutaneous Administration
    Nursing Responsibility
    Monitor intravenous therapy
    Check the infusion and the IV needle site at least every hour.
    Flow of fluid
    IV site: erythema, wetness, and edema
    Phlebitis
    Infiltration
    Assess for chills, fever, headache, nausea, vomiting, anxiousness, and dyspnea.
  • 24. Percutaneous Administration
    Nursing Responsibility
    Assess for anaphylactic shock
    Respiratory distress
    Skin reactions
    Signs of circulatory collapse
    GI signs and symptoms
    Change in mental status
    Requires immediate intervention.
  • 25. Key Terms
    Thrombosis
    Pneumothorax
    Phlebitis
    Embolus
    Extravasation
    Patency
    Venipuncture
    Infiltration