Iv therapy jan

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Iv therapy jan

  1. 1. INTRAVENOUS THERAPY REVISED 6 JAN 05
  2. 2. Terminal Learning Objective <ul><li>Given a casualty in a combat environment and the standard field medical equipment and supplies, perform procedures for intravenous (IV) therapy to prevent further injury or death. (FMST.04.18) </li></ul>
  3. 3. Enabling Learning Objective <ul><li>Without the aid of references, given a description or list, identify medical terminology associated with IV therapy, per the student handout. (FMST. 04.18a) </li></ul>
  4. 4. Enabling Learning Objective <ul><li>Without the aid of references, given a description or list, identify the characteristics of different types of IV fluids, per the student handout. (FMST.0418h) </li></ul>
  5. 5. Enabling Learning Objective <ul><li>Without the aid of references, given a description or list, identify the use for specific IV fluids, per the student handout. (FMST. 04.18c) </li></ul>
  6. 6. Enabling Learning Objective <ul><li>Without the aid of reference, given a description or list, identify the indications for initiating IV therapy, per student handout. (FMST.04.18b) </li></ul>
  7. 7. Enabling Learning Objective <ul><li>Without the aid of reference, given a description or list, identify the contraindications for initiating IV therapy, per student handout. (FMST.04.18i) </li></ul>
  8. 8. Enabling Learning Objective <ul><li>Without the aid of references, given a description or list, identify the equipment required for IV therapy, per the student handout. (FMST.04.18d) </li></ul>
  9. 9. Enabling Learning Objective <ul><li>Without the aid of reference materials, given a description or list, identify the procedural sequence for IV therapy, per the student handout. (FMST. 04.18e) </li></ul>
  10. 10. Enabling Learning Objective <ul><li>Without the aid of reference, given a description or list, identify potential complications of IV therapy, per the student handout (FMST. 04.18f) </li></ul>
  11. 11. Enabling Learning Objective <ul><li>Without the aid of references, given a simulated casualty and standard field medical equipment and supplies, perform procedures for IV therapy, per the student handout. (FMST. 04.18g) </li></ul>
  12. 12. Terms / Definitions <ul><li>Homeostasis </li></ul><ul><ul><li>Physiological equilibrium, a balance of functions and chemical composition within the body </li></ul></ul>
  13. 13. Terms / Definitions <ul><li>Electrolyte </li></ul><ul><ul><li>Ions that carry electric current </li></ul></ul><ul><ul><li>Vital to maintain homeostasis </li></ul></ul><ul><ul><li>Fluids containing electrolytes are called “Crystalloids” </li></ul></ul>
  14. 14. Terms / Definitions <ul><li>Colloids </li></ul><ul><ul><li>Large molecules such as proteins </li></ul></ul><ul><ul><li>Hypertonic Volume Expanders </li></ul></ul><ul><ul><li>Blood plasma, serum albumin, etc. </li></ul></ul><ul><li>Total Body Water </li></ul><ul><ul><li>% of persons weight consisting of H2O </li></ul></ul>
  15. 15. Terms / Definitions <ul><li>Body Fluid Compartments </li></ul><ul><ul><li>Intra-cellular fluid (ICF) </li></ul></ul><ul><ul><ul><li>Fluid w/in the cell </li></ul></ul></ul><ul><ul><ul><li>Essential to electrolyte balance </li></ul></ul></ul>
  16. 16. Terms / Definitions <ul><li>Body Fluid Compartments </li></ul><ul><ul><li>Extra-cellular fluid (ECF): Fluid in the; </li></ul></ul><ul><ul><ul><li>Intravascular (IVF) spaces - (Vessels) </li></ul></ul></ul><ul><ul><ul><li>Interstitial spaces </li></ul></ul></ul>
  17. 17. Characteristics of IV Fluids <ul><li>Isotonic Solution: </li></ul><ul><ul><li>Triggers least amount of water movement from IVF in/out of ICF and Interstitial compartments </li></ul></ul><ul><ul><ul><li>NS (0.9%) </li></ul></ul></ul><ul><ul><ul><li>Lactated Ringers </li></ul></ul></ul>
  18. 18. Characteristics of IV Fluids <ul><li>Hypotonic Solution: </li></ul><ul><ul><li>Causes water to leave IVF compartment and enter ICF & Interstitial space </li></ul></ul><ul><ul><ul><li>D5W </li></ul></ul></ul><ul><ul><ul><li>All solutions containing only water and dextrose </li></ul></ul></ul>
  19. 19. Characteristics of IV Fluids <ul><li>Hypertonic Solution: </li></ul><ul><ul><li>Draws water from the ICF and interstitial spaces into the IVF compartment </li></ul></ul>
  20. 20. USES OF I.V. SOLUTIONS
  21. 21. I.V. Solutions <ul><li>Water and Glucose </li></ul><ul><li>Crystalloid </li></ul><ul><li>Colloid </li></ul><ul><li>Whole Blood or Blood Products </li></ul>
  22. 22. Crystalloids (Isotonic) <ul><ul><li>Effective, short term, volume replacement </li></ul></ul><ul><ul><li>Do NOT have O2 carrying capacity </li></ul></ul><ul><ul><li>Do NOT contain protein </li></ul></ul>
  23. 23. Crystalloids (Isotonic) <ul><ul><li>After 1 hour, only 1/3 remains in cardiovascular system </li></ul></ul><ul><ul><li>Most common crystalloids </li></ul></ul><ul><ul><ul><li>Normal saline </li></ul></ul></ul><ul><ul><ul><ul><li>Fluid of choice in combat </li></ul></ul></ul></ul><ul><ul><ul><li>Ringers lactate </li></ul></ul></ul><ul><ul><ul><ul><li>Most physiologically adaptable solution available </li></ul></ul></ul></ul>
  24. 24. Crystalloids (Isotonic) <ul><li>Precautions </li></ul><ul><ul><li>Always consider fluid volume overload </li></ul></ul><ul><ul><li>Excessive infusion of electrolytes may cause electrolyte imbalances </li></ul></ul><ul><ul><li>DO NOT use in patient’s with </li></ul></ul><ul><ul><ul><li>Cardiac failure </li></ul></ul></ul><ul><ul><ul><li>Liver disease </li></ul></ul></ul>
  25. 25. Water and Glucose <ul><li>These solutions are Hypotonic </li></ul><ul><li>Most common concentrations: </li></ul><ul><ul><li>D5W – Fluid replacement and caloric supplementation </li></ul></ul><ul><ul><li>D50W – treats hypoglycemic (low blood sugar) in adults </li></ul></ul>
  26. 26. Water and Glucose <ul><li>Contraindications: </li></ul><ul><ul><li>DO NOT use in HEAD INJURIES </li></ul></ul><ul><ul><ul><li>Will cause cellular swelling </li></ul></ul></ul><ul><li>Precautions: </li></ul><ul><ul><li>Volume overload </li></ul></ul><ul><ul><li>Electrolyte imbalance </li></ul></ul>
  27. 27. Whole Blood <ul><li>Available in combat, (ONLY in higher echelons of emergency care) </li></ul><ul><li>Must be ordered by an M.O. </li></ul><ul><li>Type O-Negative is supplied in combat and can be given without cross-typing </li></ul>
  28. 28. Whole Blood <ul><li>Indications </li></ul><ul><ul><li>Acute massive blood loss </li></ul></ul><ul><ul><li>Will resolve symptoms of hypovolemic shock and anemia </li></ul></ul><ul><li>Note: Whole Blood is not suited for the following: </li></ul><ul><ul><li>Shock without hemorrhage (Burns) </li></ul></ul>
  29. 29. INDICATIONS for I.V. THERAPY
  30. 30. Indications <ul><li>Primarily for treatment of a source of hypovolemia </li></ul><ul><li>Hemorrhage or Trauma </li></ul><ul><li>Dehydration </li></ul><ul><li>Burns </li></ul>
  31. 31. Indications <ul><li>Diarrhea or Vomiting </li></ul><ul><li>Unable to tolerate fluids by mouth </li></ul><ul><li>Pass Medications </li></ul><ul><li>Maintain Nutrition </li></ul>
  32. 32. Contraindication <ul><li>Absence of Signs and symptoms of Indications </li></ul>
  33. 33. I.V. THERAPY EQUIPMENT
  34. 34. IV Equipment
  35. 35. EQUIPMENT <ul><li>Needle and catheter </li></ul><ul><ul><li>Large 16-18g for trauma patients </li></ul></ul><ul><ul><li>20g for non-traumatic fluid replacement </li></ul></ul><ul><li>IV solution </li></ul><ul><li>Administration set </li></ul>
  36. 36. EQUIPMENT <ul><li>Tape </li></ul><ul><li>Constriction band </li></ul><ul><li>Alcohol/Betadine prep </li></ul><ul><li>2x2 </li></ul><ul><li>IV pole </li></ul>
  37. 37. Procedural Steps
  38. 38. Procedure <ul><li>Make your decision </li></ul><ul><li>Assemble and check gear </li></ul><ul><ul><li>Ensure sterility of your equipment </li></ul></ul><ul><ul><li>Check all packaging for damage </li></ul></ul><ul><li>Prepare the administration set </li></ul><ul><ul><li>See following slides </li></ul></ul>
  39. 39. Equipment Preparation <ul><li>Remove tubing and IV fluid from their protective coverings </li></ul>
  40. 40. Equipment Preparation <ul><li>Remove the protective tab from the spike port </li></ul>
  41. 41. Equipment Preparation <ul><li>Remove the protective cover from the spike (over the inspection bulb) of the IV tubing </li></ul>
  42. 42. Equipment Preparation <ul><li>Close the tubing by rotating the thumb lock to the closed position </li></ul>
  43. 43. Equipment Preparation <ul><li>Assemble the IV tubing to the IV fluid </li></ul><ul><ul><li>Insert spike into spike port </li></ul></ul><ul><ul><li>Puncture seal with the spike by using a twisting, pushing motion until spike is fully inserted </li></ul></ul>
  44. 44. Equipment Preparation <ul><li>Fill drip chamber </li></ul><ul><li>Remove air from tubing </li></ul>
  45. 45. VEIN SELECTION
  46. 46. VEIN SELECTION <ul><li>Vein should be stable and accessible </li></ul><ul><li>Select a large springy vein </li></ul><ul><li>Work distal to proximal </li></ul>
  47. 47. Use constricting band for vein dilation
  48. 48. Prepare site <ul><li>Alcohol swab </li></ul><ul><ul><li>Cleanse the area with an alcohol swab three times if able </li></ul></ul><ul><ul><li>Dry area </li></ul></ul><ul><li>Don gloves </li></ul>
  49. 49. Prepare catheter
  50. 50. Insert Needle <ul><li>Apply traction to the skin and vein to make those areas taught </li></ul><ul><li>BEVEL UP </li></ul><ul><li>Needle at 30 degree angle </li></ul>
  51. 51. Procedure <ul><li>Check flashback after the “pop” </li></ul><ul><li>Lower needle to 10-15 degrees and thread catheter into vein </li></ul>
  52. 52. Advance catheter <ul><li>While maintaining the grasp to the catheter with one hand, hold the colored portion of the catheter with the index finger and thumb </li></ul>
  53. 53. Attaching IV tubing <ul><li>Place thumb over the end of the catheter in the vein and apply pressure to stop blood flow out of the catheter </li></ul><ul><li>Dispose of Needle </li></ul>
  54. 54. Connect IV tubing <ul><li>Remove the protective cap from the end of the IV tubing and insert the tubing end into the hub of the catheter </li></ul>
  55. 55. Remove Constriction Band
  56. 56. Adjust Drip Rate
  57. 57. Secure the IV <ul><li>Tape catheter in place </li></ul><ul><li>Cover site with 2x2 and tegaderm </li></ul><ul><li>Loop tubing around hand </li></ul><ul><li>Consider splinting </li></ul>
  58. 58. Apply Tape Securely Around Hub
  59. 59. Discontinue the IV <ul><li>Peel back taping </li></ul><ul><li>Place 2x2 over site </li></ul><ul><li>Remove catheter with one quick motion </li></ul><ul><li>Apply pressure with 2x2 to stop bleeding </li></ul><ul><li>Apply bandaid </li></ul>
  60. 60. COMPLICATIONS OF IV THERAPY
  61. 61. Infiltration (local) <ul><li>Escape of fluid from vein into tissue after catheter dislodges from the vein </li></ul>
  62. 62. Infiltration (local) <ul><li>Symptoms </li></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Localized pain </li></ul></ul><ul><ul><li>Coolness to site </li></ul></ul><ul><ul><li>Blanching at the site </li></ul></ul><ul><ul><li>Flow stops or slows </li></ul></ul>
  63. 63. Infiltration (local) <ul><li>Treatment </li></ul><ul><ul><li>Discontinue IV </li></ul></ul><ul><ul><li>Select alternate site </li></ul></ul><ul><ul><li>Apply heat to site </li></ul></ul><ul><ul><li>Elevate limb </li></ul></ul>
  64. 64. Infiltration (local) <ul><li>Prevention </li></ul><ul><ul><li>Secure catheter properly </li></ul></ul><ul><ul><li>Limit limb movement </li></ul></ul>
  65. 65. Phlebitis <ul><li>Inflammation of a vein due to bacterial, chemical or mechanical irritation </li></ul>
  66. 66. Phlebitis <ul><li>Symptoms </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Redness </li></ul></ul><ul><ul><li>Warmth along the area </li></ul></ul><ul><ul><li>Vein feels hard </li></ul></ul>
  67. 67. Phlebitis <ul><li>Treatment </li></ul><ul><ul><li>Discontinue IV </li></ul></ul><ul><ul><li>Apply heat to site </li></ul></ul><ul><ul><li>Antibiotics </li></ul></ul>
  68. 68. Phlebitis <ul><li>Prevention </li></ul><ul><ul><li>Ensure aseptic technique </li></ul></ul><ul><ul><li>Place date and time on tape </li></ul></ul><ul><ul><li>Rotate sites based on local policy </li></ul></ul>
  69. 69. Nerve Damage (local) <ul><li>Results from arm secured tightly, compressing nerves </li></ul>
  70. 70. Nerve Damage (local) <ul><li>Symptoms </li></ul><ul><ul><li>Numbness to fingers </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Reposition or loosen arm board </li></ul></ul><ul><li>Prevention </li></ul><ul><ul><li>Ensure tape is not applied too tight </li></ul></ul>
  71. 71. Circulatory Overload (systemic) <ul><li>Increased fluid volume leading to heart failure and pulmonary edema. </li></ul><ul><li>Results from infusing IV fluid too rapidly </li></ul>
  72. 72. Circulatory Overload (systemic) <ul><li>SYMPTOMS </li></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Venous distention </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Increased B/P </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Pulmonary edema </li></ul></ul>
  73. 73. Circulatory Overload (systemic) <ul><li>Treatment </li></ul><ul><ul><li>Slow down flow rate </li></ul></ul><ul><ul><li>Place PT in high Fowlers position </li></ul></ul><ul><li>Prevention </li></ul><ul><ul><li>Monitor and control flow rate </li></ul></ul>
  74. 74. Air Embolism <ul><li>Air introduced into the blood through the IV tubing </li></ul>
  75. 75. Air Embolism (systemic) <ul><li>Symptoms </li></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Weak and rapid pulse </li></ul></ul><ul><ul><li>Shortness of breath </li></ul></ul><ul><ul><li>Tachypnea </li></ul></ul>
  76. 76. Air Embolism (systemic) <ul><li>Treatment </li></ul><ul><ul><li>Place PT in left side reverse Trendelenberg </li></ul></ul><ul><ul><li>Administer oxygen </li></ul></ul><ul><ul><li>Notify MO </li></ul></ul><ul><ul><li>Monitor V/S </li></ul></ul>
  77. 77. Air Embolism (systemic) <ul><li>Prevention </li></ul><ul><ul><li>Flush line prior to insertion </li></ul></ul><ul><ul><li>Monitor tubing during therapy </li></ul></ul><ul><ul><li>Avoid introducing air into tubing </li></ul></ul>
  78. 78. Systemic infection <ul><li>Bacterial contamination of IV tubing and/or fluid due to poor insertion technique or contaminated equipment </li></ul>
  79. 79. Systemic Infection <ul><li>Symptoms </li></ul><ul><ul><li>Sudden rise in temp and pulse </li></ul></ul><ul><ul><li>Chills and shaking </li></ul></ul><ul><ul><li>Blood pressure changes </li></ul></ul>
  80. 80. Systemic Infection <ul><li>Treatment </li></ul><ul><ul><li>Look for Sources of Infection </li></ul></ul><ul><ul><li>DC IV </li></ul></ul><ul><ul><li>Restart in other site </li></ul></ul><ul><ul><li>Notify M.O. </li></ul></ul>
  81. 81. Systemic Infection <ul><li>Prevention </li></ul><ul><ul><li>Use aseptic technique </li></ul></ul><ul><ul><li>Date/Time on Catheter </li></ul></ul><ul><ul><li>Rotate sites Q72° (or as local policy) </li></ul></ul>
  82. 82. Questions? Review

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