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Iv therapy jan Iv therapy jan Presentation Transcript

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