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Intravenous therapy

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Intravenous therapy

  1. 1. Intravenous therapy By- Dr. ASHOK DHAKA BISHNOI Director, JINC
  2. 2.  It is the administration of fluid in to blood stream by I/V catheter or butterfly needle inserted in to a peripheral vein replace water, Electrolyte & Nutrients Introduction:-
  3. 3. 1. Used to clients who are unable to take orally. 2. Replaces water, electrolytes, & nutrients more rapidly than oral administration 3.Unconcious patient 4.Hypovolumic shock 5.During surgery uses:-
  4. 4.  I/V:- 30-60 second (Give quick effect in all parental route)  IV injection (IV push) = 1-60 ml
  5. 5. Types of solutions: 1. Hypertonic solutions 2. Hpotonic solution 3. Isotonic solution Osmolality:- Concentration of a solution expressed as the total number of solute particles per kilogram. 270-300 Mosm/kg water Osmolarity :-the concentration of a solution expressed as the total number of solute particles per litre.  Measured by Osmometer. Osmoler Gap :-Deference B/W Osmolality & Osmolarity normal osmol gap is < 10 mOsm/kg .
  6. 6. 1.Hypertonic solutions:-more concentrated than body fluids.  Causes movement of H2O from cells into the extracellular fluid. Eg.  3% NS  5% NS  10% dextrose in water (D10W)  5% dextrose in 0.45% sodium chloride (NS) (D5W/½ NS)
  7. 7. 2.Hypotonic solution:-Solutions that are more dilute or have a lower osmolality than body fluids.  Causes movement of water into cells by osmosis.  Administer slowly to prevent edema. Eg.  0.45% sodium chloride (NS ); (½ NS) Osmolarity of 154 mOsmol/L  0.225% sodium chloride (NS); (¼ NS)  0.33% sodium chloride (NS); (⅓ NS) 
  8. 8. 3.Isotonic solution:-Solution that have the same osmolality as body fluids.  It increases extracellular fluid volume.  These solutions do not enter the cells because no osmotic force exists to shift the fluids.  Eg.  0.9% sodium chloride (NS); (0.9% NS)  5% dextrose in water (D5W)  5% dextrose in 0.225% saline (D5W/¼ NS)  Lactated Ringer’s (LR)/Sodium lactate solution / Hartmann's solution .
  9. 9. Lactated Ringer’s (LR)/Sodium lactate solution / Hartmann's solution Composed of  sodium chloride 6 g/L,,,,,,sodium lactate 3.1 g/L  potassium chloride 0.3 g/L……..calcium chloride 0.2 g/L. Lactated Ringer's contains ions of  Sodium 130 mEq/L……..Potassium 4 mEq/L  Calcium 2.7 mEq/L …….Chloride 109 mEq/L  Lactate 28 mEq/L. Uses:-  Low blood volume,Low BP,Burn Contraindication:-  RF
  10. 10. 0.9% sodium chloride (NS); (0.9% NS)  Half-NS (0.45% NaCl)  Quarter-NS (0.22% NaCl) used alone in Neonatal Intensive Care Units.  pH of NS is 5.5 (4.5 to 7.0) Composition:-  9 g/L Sodium Chloride  Osmolarity of 308 mOsmol/L. It contains 154 mEq/L Sodium &Chloride (GMCH). Uses:-  Clean wounds, help remove contact lenses  Dehydration  Dilute BCG (AIIMS Bhubaneswar 2018)  Nebulization .Hemodialysis, Hyponatremia Contraindication:-  HT, PE, CHF,Pre-eclampsia
  11. 11. Types of volume expanders 1.Crystalloids:-contain electrolyte.  Used for fluid volume replacement.  Eg. Ringer's solution & 5% dextrose in water. 2.Colloids/Plasma expanders.  It pull fluid from the Interstitial compartment into the vascular compartment  Used to increase the vascular volume rapidly. Eg.Hemorrhage or severe hypovolemic.  Eg. Albumin, Hetastarches (starches), Dextran
  12. 12. Size of cannula according to color:-
  13. 13.  16 G needle used if Major Surgery/RTA accident require massive fluid  18 G needle Used in Blood and lots of fluid  20 G needle is a Universal  22 G needle used in Small and elderly (Appropriate for fluid maintenance)
  14. 14. Containers:-  1. Container may be glass or plastic.  2. Squeeze the plastic bag to ensure intactness & assess the glass bottle for any cracks before hanging.  Range in size from 50 mL to 1000 mL  Note:-Do not write on a plastic IV bag with a marking pen because the ink may be absorbed through the plastic into the solution.  Use a label & a ballpoint pen for marking the bag, placing the label onto the bag.
  15. 15.  Note:- During I/V therapy , hang the bottle on the I/V pole about 18-24 inch height.
  16. 16.  The needle is 0.5 to 1.5 inches in length with 16 to 26 G.  The smaller the gauge number, the larger the outside diameter of the cannula.  For peripheral fat infusion (lipids), a 20 or 21 gauge is used. Instruction which follow during administration of I/V fluid:-
  17. 17. The micro drip chamber delivers about 60 drops or gtt/ml.  Micro drip chamber are used if the fluid will be infused at a slow rate (<50ml/Hr)  Macro drip chamber deliver 15 (10-20) drops or gtt/ml.
  18. 18. Formula:-
  19. 19. 1.The physician orders dextrose 5 % in water, 1,000 ml to be infused over 8 hours. The I.V. tubing delivers 15 drops/ml. Nurse John should run the I.V. infusion at a rate of:  a. 30 drops/minute b. 32 drops/minute c. 20 drops/minute d. 18 drops/minute  b. 32 drops/minute
  20. 20.  Change the filter/Drip set every 24 to 72 hours to prevent bacterial growth.  Veins in the hand, forearm & antecubital fossa are suitable sites.
  21. 21.  The most frequently used sites are the veins of the forearm because the bones of the forearm act as a natural support & splint.  Veins in the hand (Cephalic vein) , forearm (Basilic vein) & antecubital fossa are suitable sites in adult.  Veins in the scalp & feet (Sephanous vein)may be suitable sites for Infants
  22. 22. Site Selection:-  Short term:- (Peripheral vein (7days)  Mid term:- (anterior Jugular vein, Subclavian vein (4Week)  Long term:-( PICC Line)-Peripheral insert Central catheter) (6Month)  Incase of 3-5 year (Port Implant –Cancer patient-Superior vena- cava & Rt Atrium
  23. 23.  Before inserting the IV line. Clean the IV site, skin & an antimicrobial solution, using an Inner to outer circular motion.
  24. 24.  If client with CHF usually not giving a solution containing saline because it increase water retention of water.  If client with DM usually does not receive dexrose (Glucose) solution.  RL Solution contain Potasium & should not be administered to client with renal failure
  25. 25. IV Complications:-  Phalibitis:-An inflammation of the vein.  Thrombophalibitis:- Development of a clot & infection of vein  (Thrombophob Ointment used to minimize clot)  Infiltration:-Seepage of Intravenous fluid out of the vain& in to the surrounding in to the interstitial space.  Air embolism ◦ Air enters blood stream  Infection ◦ Localized or systemic  Tissue damage  Hematoma
  26. 26.  A client is nauseated, has been vomiting for several hours, and needs to receive an antiemetic (anti- nausea) medication. Which of the following is accurate? A. An enteric-coated medication should be given. B. Any medication will not be absorbed as easily because of the nausea problem. C. A parenteral route is the route of choice. D. A rectal suppository must be administered.  C. A parenteral route is the route of choice. MCQ

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