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Intravenous ther..

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  • 1. MS. NISHA T. MATHEW 2ND YEAR M. SC NURSING
  • 2. INTRAVENOUS THERAPY
  • 3. Historical background  In the 1830s, a lethal strain of cholera wracked much of Europe. This type of cholera was called “Russian cholera,” or “blue cholera,” for the dusky cyanotic complexion of its
  • 4.  Mr. Thomas Latta, implemente d this iv therapy.
  • 5. Intravenous therapy  Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein”.  Iv therapy constitutes the administration of liquid substances directly into a vein and general
  • 6. Infusion therapy  Infusion therapy is defined as the parenteral infusion of fluids, electrolytes, bl ood components, nutrient s, or medications to prevent or treat deficiencies or
  • 7.  Infusion therapy may be dispensed by I.V., subcutaneous, intraosseous or intrathecal routes of administration.
  • 8. Femur
  • 9. Fluid compartments  EXTRACELLULAR FLUID (ECF) Approximately 80% of extracellular fluid is interstitial, which occupies the microscopic spaces between the cells. 20% is plasma, which is the liquid portion of the blood.  Intracellular fluid ( ICF) This is known as cytosol and is fluid
  • 10.  Substances move around from areas of high concentration to low concentration and a concentration gradient will exist between the two. They move passively.  Movement is facilitated through process of osmosis or diffusion.
  • 11. Indications for I.V. Therapy  To provide Parenteral nutrition  To provide avenue for dialysis/apheresis  To transfuse blood products  Replace fluids and replace imbalances  To provide avenue for hemodynamic monitoring  To provide avenue for diagnostic testing  To administer fluids and medications
  • 12. FLUID AND ELECTROLYTE BALANCE  Dehydration is a common indication for I.V. therapy not only fluids be restored to the vasculature, but electrolyte levels also must be assessed and possibly treated as well.
  • 13. Intravenous fluids are divided into  Crystalloids  Colloids
  • 14. Classification of solutions Isotonic fluids Hypotonic fluids Hypertonic fluids
  • 15. 0.9% NaCl (normal saline) isotonic 0.25% NaCl hypotonic 0.45% NaCl hypotonic 2.5% dextrose hypotonic Lactated Ringer's solution isotonic D5W (acts as a hypotonic solution in body) isotonic D5 NaCl hypertonic D5 in Lactated Ringer's hypertonic D5 0.45% NaCl hypertonic
  • 16. BLOOD COMPONENT THERAPY  Common blood components that may be transfused include red blood cells, fresh-frozen plasma, platelets, and clotting factors .
  • 17. PARENTERAL NUTRITION  Parenteral nutrient solution composition is determined individually to meet each patient’s nutritional needs.  Parenteral solutions include electrolytes, dextrose, amino acids, vitamins, and various trace elements. These solutions are referred to as total parenteral nutrition (TPN).
  • 18.  There are also solutions referred to as total nutrient admixture (TNA) solutions that provide a nutrient mix that includes electrolytes, dextrose, amino acids, vitamins, trace elements, and fats.
  • 19.  The concentration of nutrients in TPN solutions, IVFEs, and TNA solutions, is determined by I.V. delivery route.  The solutions are less concentrated when they are delivered by a peripheral I.V. route and are more concentrated when delivered by a central I.V. route.
  • 20. MEDICATION THERAPY  Some patients require continuous I.V. infusions of medications.  Others may require intermittent infusions of medications in I.V. solutions that can be “piggybacked” into their main I.V. lines.
  • 21.  Some patients may need bolus doses of medications  In some instances, patients with unstable physiologic status may have an I.V. access site set up “just in case” so that medications may be administered rapidly if there is an emergent or urgent indication (e.g., amiodarone [Cordarone] and epinephrine).
  • 22.  In other instances, patients may have a chronic illness and require intermittent infusions of medications.
  • 23. Intravenous access devices  These can all be used to obtain blood also known as phlebotomy as well as for the administration of medication/fluids.  Hypodermic needle  Peripheral cannula  Central IV lines  Peripherally inserted central catheter  Central venous lines
  • 24.  Tunnelled Lines  Implantable ports Intravenous access devices
  • 25. Hypodermic needle  The simplest form of intravenous access is by passing hollow needle through the skin directly into the vein.
  • 26. Peripheral cannula  A peripheral IV line (PVC or PIV) consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein .  This is usually in the form of a cannula- over-needle device, in which a flexible plastic cannula comes mounted on a metal trocar.
  • 27. 3 way stopcock
  • 28. SCALP VEIN SET  to provide rapid venous access  Short beveled siliconised needle facilitates atraumatic cannulation.  Thin wall needle provides better flow rate per gauge
  • 29. SCALP VEIN SET SIZE Sizes in NG Color Code 18 Pink 19 Brown 20 Yellow 21 Green 22 Black 23 Sea Green 24 Red 25 Blue
  • 30. Central IV lines  Central IV lines flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart.
  • 31. Advantages  It can deliver fluids and medications that would be overly irritating to peripheral veins because of their concentration or chemical composition.  These include some chemotherapy drugs and total parenteral nutrition.
  • 32.  Medications reach the heart immediately, and are quickly distributed to the rest of the body.  There is multiple parallel compartments (lumen) within the catheter, so that multiple medications can be delivered at once.
  • 33.  Caregivers can measure central venous pressure and other physiological variables through the line  Central IV lines carry risks of bleeding, infection, gangrene, thromb oembolism and gas embolism.
  • 34. Peripherally inserted central catheter  Required over a prolonged period of time.  When the material to be infused would cause quick damage and early failure of a peripheral IV and  When a conventional central line may be too dangerous to attempt.
  • 35. Uses  Typical uses for a PICC include: long chemotherapy regimens, ext ended antibiotic therapy, or total parenteral nutrition.
  • 36. Central venous lines  There are several types of catheters that take a more direct route into central veins. These are collectively called central venous lines.  In the simplest type of central venous access, a catheter is inserted into a subclavian, internal jugular, ) or a femoral vein.
  • 37. SWAN GANZ CATHETER
  • 38. SWAN
  • 39. Tunnelled Lines  Another type of central line, called a Hickman line or Broviac catheter, is inserted into the target vein and then "tunneled" under the skin to emerge a short distance away.  This reduces the risk of infection  These catheters are also made of materials that resist infection and clotting.
  • 40. Implantable ports  A port (Port-a-Cath or MediPort) is a central venous line that does not have an external connector; instead, it has a small reservoir that is covered with silicone rubber and is implanted under the skin.
  • 41. Varicose Veins – Injection Treatment or Sclerotherapy  Sclerotherapy is a procedure used to treat blood vessels vascular malformations and also those of the lymphatic system.  A medicine is injected into the vessels, which makes them shrink.  In adults, sclerotherapy is often used to treat spider veins, smaller varicose veins and hemorrhoids.
  • 42. INFUSION EQUIPMENT  Consists of a pre-filled, sterile container of fluids with an attachment that allows the fluid to flow one drop at a time, making it easy to see the flow rate and also reducing air bubbles.  A long sterile tube with a clamp  A connector
  • 43. Syringe pump
  • 44. An infusion pump  An infusion pump allows precise control over the flow rate and total amount delivered.
  • 45. Rapid infuser  A rapid infuser can be used if the patient requires a high flow rate and the IV access device is of a large enough diameter to accommodate it.  This is either an inflatable cuff placed around the fluid bag to force the fluid into the patient or a similar electrical device that may also heat the fluid being infuse.
  • 46. Adverse effects  Infection  Phlebitis  Infiltration / Extravasations  Fluid overload  Hypothermia  Electrolyte imbalance  Embolism
  • 47. Cannulation  IV-Site Infection: Does not produce much (if any) pus or inflammation at the IV site. This is the most common cannula-related infection, may be the most difficult to identify 53
  • 48. Cannulation  Cellulites: Warm, red and often tender skin surrounding the site of cannula insertion; pus is rarely detectable. 54
  • 49. Cannulation  Infiltration or tissuing occurs when the infusion (fluid) leaks into the surrounding tissue. It is important to detect early as tissue necrosis could occur. 55
  • 50. Cannulation  Thrombolism / thrombophlebitis occur when a small clot becomes detached from the sheath of the cannula or the vessel wall – prevention is the greatest form of defence. Flush cannula regularly and consider re-siting the cannula if in prolonged use. 56
  • 51. Cannulation  Extravasation is the accidental administration of IV drugs into the surrounding tissue, because the needle has punctured the vein and the infusion goes directly into the arm tissue. The leakage of high osmolarity solutions or chemotherapy agents can result in significant tissue destruction, and significant complications 58
  • 52. Cannulation  Bruising commonly results from failed IV placement - particularly in the elderly and those on anticoagulant therapy. 59
  • 53. Cannulation  Air embolism occurs when air enters the infusion line, although this is very rare it is best if we consider the preventive measures – Make sure all lines are well primed prior to use and connections are secure 60
  • 54. Cannulation  Air embolism occurs when air enters the infusion line, although this is very rare it is best if we consider the preventive measures – Make sure all lines are well primed prior to use and connections are secure 61
  • 55. SUMMARY
  • 56. Questions?
  • 57. THANK YOU