IVs

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IVs

  1. 1. IV’s OVERVIEW <ul><li>IV solutions are instilled through a vein. </li></ul><ul><li>Includes water, chemicals, blood, blood products, and meds. </li></ul><ul><li>LPN’s are certified through their facility, each facility’s policies/procedures vary. </li></ul>
  2. 2. ADVANTAGES/DISADVANTAGES <ul><li>ADVANTAGES </li></ul><ul><li>Drug or solutions enter bloodstream instantly and circulate into the tissue. This can be considered a disadvantage also. </li></ul><ul><li>DISADVANTAGE </li></ul><ul><li>Fluids cannot be retrieved in the event of an error. </li></ul><ul><li>Extreme caution must be used. </li></ul><ul><li>Needle or catheter must be used to provide entry. </li></ul><ul><li>Materials must be sterile to prevent infection. </li></ul>
  3. 3. IV DRUGS ARE ADMINISTERED FOR : <ul><li>Restoring fluid balance secondary to trauma, illness, or dehydration. </li></ul><ul><li>Maintain fluid balance when pt is NPO. </li></ul><ul><li>Administer medication/electrolytes/vitamins. </li></ul><ul><li>Administer anesthesia. </li></ul><ul><li>Administer blood/blood products. </li></ul><ul><li>Long-term pain management. (avoids multiple injections) </li></ul><ul><li>Trauma. </li></ul><ul><li>Maintain blood levels of drugs. </li></ul><ul><li>Establish access to vascular system for Dialysis, etc. </li></ul>
  4. 4. IV ADMINISTRATION <ul><li>IV MEDICATIONS ARE ADMINISTERED THROUGH 2 TYPES OF VEINS: </li></ul><ul><li>PERIPHERAL </li></ul><ul><li>CENTRAL (requires sterile dressing changes.) </li></ul>
  5. 5. TYPES OF IV CATHETERS <ul><li>CENTRAL VENOUS: </li></ul><ul><li>Extends to vena cava or right atrium. Administers meds in a large volume of blood. Used for long-term IV therapy or when meds are irritating to peripheral veins. If catheter is multiple lumen, meds incompatible w/each other can be administered simultaneously. </li></ul><ul><li>TUNNELED: </li></ul><ul><li>Inserted into central vein. Part of the catheter is secured in subcutaneous tissue. </li></ul>
  6. 6. TYPES OF IV CATHETERS (CONT) <ul><li>PERCUTANEOUS: </li></ul><ul><li>Inserted into a peripheral vein. For short-term therapy. Sutured to the skin. </li></ul><ul><li>IMPLANTED: </li></ul><ul><li>(Porta-Cath). Sealed beneath the skin. Greatest protection against infection. Self-sealing port which is pierced through the skin with a special needle. Local anesthetic can be applied prior. Can remain for several years. Flushed periodically with Heparin. </li></ul><ul><li>PICC LINE: </li></ul><ul><li>Peripherally inserted central catheter. </li></ul>
  7. 7. TYPES OF IV SOLUTION <ul><li>ISOTONIC: </li></ul><ul><ul><li>Maintains balance-resembles body fluids. </li></ul></ul><ul><ul><li>0.9% NS (Sodium Chloride). Fluid loss/rehydration. </li></ul></ul><ul><ul><li>D5W (Dextrose 5% in water). Hydration. </li></ul></ul><ul><ul><li>Lactated Ringers. Hydration, burns, acute blood loss, replace electrolytes. </li></ul></ul>
  8. 8. TYPES OF IV SOLUTIONS (CONT) <ul><li>HYPOTONIC: </li></ul><ul><li>Causes cellular hydration. Used for fluid loss secondary to diarrhea/vomiting. </li></ul><ul><li>Normal Saline 0.45%. Cellular hydration, electrolyte replacement. </li></ul><ul><li>Dextrose/Water (DW) 2.5%. Hydration. </li></ul><ul><li>Dextrose 5% in Normal Saline 0.45% (D51/2NS). Hydration. </li></ul><ul><li>Normosol M. Hydration, electrolyte replacement. </li></ul>
  9. 9. TYPES OF IV SOLUTIONS (CONT) <ul><li>HYPERTONIC: </li></ul><ul><li>Causes cell shrinkage. Used with extreme caution when reducing cerebral edema or to expand circulatory volume rapidly. Can cause circulatory overload by increasing the circulatory volume too rapidly. </li></ul><ul><li>5% Dextrose in Normal Saline. Hydration and shock. </li></ul><ul><li>5% Dextrose in 0.45% Normal Saline. Diabetic Ketoacidosis. </li></ul><ul><li>5% Dextrose in Lactated Ringer’s. Hydration. </li></ul><ul><li>5% Dextrose in 0.33% Normal Saline. Hydration. </li></ul><ul><li>10% Dextrose in Water. Provides a small amount of nutritional glucose. </li></ul>
  10. 10. TYPES OF IV SOLUTIONS (CONT) <ul><li>TPN: </li></ul><ul><li>Usually in Central Line. For nutrition if unable to eat or consume fluids over a long period. Example: Cancer, trauma, inflammatory bowel disease. </li></ul><ul><li>BLOOD AND BLOOD PRODUCTS: </li></ul><ul><li>Whole Blood-Massive blood loss, restores blood volume. Raises HMG and HMCT count. </li></ul><ul><li>Packed Cells-Cellular replacement. Extra volume not needed. </li></ul><ul><li>Plasma-Replaces clotting factors. </li></ul>
  11. 11. ASSESSMENT OF SITE <ul><li>What is the IV used for? Irritating substances, larger volumes, thicker fluids require larger veins. </li></ul><ul><li>Use F/A and hand in adults. Legs used only with a Dr order. Scalps used for infants. </li></ul><ul><li>Use non-dominant hand. </li></ul><ul><li>Where is the surgery? </li></ul><ul><li>Patient preference. </li></ul><ul><li>Do not use a compromised site. (bruising, swelling, previous IV, impaired circulation, rash, infection, amputation, etc.) </li></ul><ul><li>Choose a site good for 72 hours. </li></ul><ul><li>Use alternate sites. </li></ul><ul><li>Try a warm compress for 10 minutes, BP cuff, have pt make a fist, tap skin, lower arm (promotes distal pooling). </li></ul>
  12. 12. INFUSION TECHNIQUES <ul><li>CONTINUOUS; </li></ul><ul><li>Administration of a drug over a period of several hours. </li></ul><ul><li>INTERMITTENT: </li></ul><ul><li>Administration of medication in a relatively short span. </li></ul><ul><li>BOLUS: </li></ul><ul><li>Medication given all at one time. Through an existing port or lock. </li></ul>
  13. 13. INFUSION TECHNIQUES (CONT) <ul><li>SECONDARY INFUSION: </li></ul><ul><li>Administration of a drug that has been diluted in a small volume of IV solution, usually over 30-60minutes. (Piggyback) Hang higher than Primary. </li></ul><ul><li>VOLUME CONTROL SET: </li></ul><ul><li>Chamber in IV tubing that holds a portion of the solution from a larger container. Avoids overloading Circulatory System. (Volutrol, Buretrol, Soluset.) </li></ul>
  14. 14. <ul><li>PRIMARY: </li></ul><ul><li>Approx 110in. Spans the distance between solution and infusion site. </li></ul><ul><li>SECONDARY: </li></ul><ul><li>Approx 37in. Used to administer small volumes of solution into a port within the Primary Tubing. </li></ul><ul><li>VENTED: </li></ul><ul><li>Draws air into the container. Used with glass container. Allows fluids to flow. </li></ul><ul><li>NON-VENTED: </li></ul><ul><li>Prevents air from entering container. Does not need air because plastic bag collapses as fluid infuses. </li></ul>IV TUBING
  15. 15. TYPES OF TUBING (CONT) <ul><li>MICRODRIP: </li></ul><ul><li>Used for slow infusing solutions. </li></ul><ul><li>MACRODRIP: </li></ul><ul><li>Easier to count if infusing fast-flowing solutions. </li></ul><ul><li>FILTERED: </li></ul><ul><li>Removes air bubbles as well as undissolved drugs, bacteria, and larger substances. Used for: Parenteral nutrition, Pediatrics, High Infection Risk, Administering blood. </li></ul><ul><li>NEEDLELESS SYSTEM: </li></ul><ul><li>Eliminates need for needle access. </li></ul>
  16. 16. IV COMPLICATIONS <ul><li>CIRCULATORY OVERLOAD </li></ul><ul><li>INFILTRATION </li></ul><ul><li>THROMBUS </li></ul><ul><li>THROMBOPHLEBITIS </li></ul><ul><li>INFECTION </li></ul><ul><li>PULMONARY EMBOLUS </li></ul><ul><li>AIR EMBOLISM </li></ul>
  17. 17. COMPLICATIONS <ul><li>CIRCULATORY OVERLOAD: </li></ul><ul><li>Symptoms: Increased BP, SOB, Anxiety. </li></ul><ul><li>Cause: Rapid infusion, reduced kidney function, impaired heart contractions. </li></ul><ul><li>Action: First action of nurse is to assess for Respiratory Distress (VS), then Decrease Flow-Rate, Fowler’s position, call Physician. </li></ul><ul><li>INFILTRATION: </li></ul><ul><li>Symptoms: Swelling at site, burning, color-pallor, coldness, slow or no rate. </li></ul><ul><li>Cause: Solution escaping into subcutaneous tissue. </li></ul><ul><li>Action: Restart IV, elevate, warm compress X20 minutes. </li></ul>
  18. 18. COMPLICATIONS (CONT) <ul><li>THROMBUS: </li></ul><ul><li>Symptoms: Pain, swelling. </li></ul><ul><li>Cause: Cannula point traumatizes wall of vein. Thrombi form on the vein and tip of cannula. Traps bacteria. </li></ul><ul><li>Action: D/C site. Call physician. </li></ul><ul><li>THROMBOPHLEBITIS: </li></ul><ul><li>Symptoms: Pain along length of vein. Vein becomes increasingly painful and hard. </li></ul><ul><li>Cause: Thrombus with inflammation, chemicals or irritation. </li></ul><ul><li>Action: Watch for Septicemia and Acute bacterial endocarditis. D/C IV, notify Physician. </li></ul>
  19. 19. COMPLICATIONS (CONT) <ul><li>INFECTION: </li></ul><ul><li>Symptoms: Redness, puffiness. Purulent drainage. Temperature and chills. </li></ul><ul><li>Cause: Spread of bacteria. </li></ul><ul><li>Action: D/C site. Notify physician. Culture if necessary. </li></ul><ul><li>PULMONARY EMBOLUS: </li></ul><ul><li>Symptoms: SOB, Anxiety, Sudden Chest Pain, Rapid heart rate with a drop in BP. </li></ul><ul><li>Cause: Movement of previously stationary blood clot. </li></ul><ul><li>Action: Stay with patient and call for assistance. </li></ul>
  20. 20. COMPLICATIONS (CONT) <ul><li>AIR EMBOLUS: </li></ul><ul><li>Symptoms: Drop in BP, Tachycardia, Decreased LOC, Cyanosis. </li></ul><ul><li>Cause: Air enters vein, disconnected tubing, running solutions simultaneously, lethal amount unknown. Associated with Central Lines. </li></ul><ul><li>Action: Trendelenberg position on L side. (air rises to R atrium, preventing it from entering the Pulmonary Artery. </li></ul><ul><ul><ul><ul><ul><li>CALL FOR ASSISTANCE </li></ul></ul></ul></ul></ul>
  21. 21. BLOOD TRANSFUSION <ul><li>Blood is dispensed in 500ml containers. It is very thick and viscous. A pressure bag may be used to permit continuous drip. VS are closely monitored. Usually Q5minX3 then Q15min. Check with your facility policy. First sign of a reaction is usually within 5-15min. Patients will c/o a burning sensation, after this they will develop: </li></ul><ul><li>Tachycardia Hypotension Flushing </li></ul><ul><li>Dyspnea Restlessness Back Pain </li></ul><ul><li>Mild Allergic Reaction: </li></ul><ul><li>Hives Itching </li></ul><ul><li>If the infusion continues: </li></ul><ul><li>Fever Chills Change in body temp. </li></ul><ul><li>Intervention: </li></ul><ul><li>Stop the transfusion Do not remove needle Report observations </li></ul><ul><li>Monitor VS Save tubing for analysis by Lab </li></ul>
  22. 22. SIGNS/SXS’S OF INFECTION (LOCAL AND SYSTEMIC) <ul><li>ABDOMINAL PAIN </li></ul><ul><li>DIAPHORESIS </li></ul><ul><li>GLUCOSE INTOLERANCE </li></ul><ul><li>NV/DIARRHEA </li></ul><ul><li>ALTERED MENTAL STATUS </li></ul><ul><li>FATIGUE, MUSCLE ACHES, WEAKNESS </li></ul>
  23. 23. KEY POINTS <ul><li>HL need to be flushed QS and after admin of med. </li></ul><ul><li>Make sure flush is compatible with medication being given and IV fluid. </li></ul><ul><li>Use filter needle when using ampules. </li></ul><ul><li>Cleanse site first. </li></ul><ul><li>When giving antineoplastic drugs, wear long-sleeved, cuffed, low-permeable gown with closed front and non-powdered gloves. Cover drug preparation area with disposable pad to absorb spills. Avoid inhalation of drug. </li></ul><ul><li>If IV is running too slowly, do not play catch-up. Assess patient for respiratory distress secondary to fluid overload. </li></ul><ul><li>IV fluids are considered medications and are ordered by the Physician. The Five Rights are strictly adhered to and are critical, as well as assessment of the patient and site. </li></ul><ul><li>The drug, rate, and volume must be included in the order. </li></ul>
  24. 24. ASSESSMENT/CARE OF THE IV <ul><li>ASSESSMENT: </li></ul><ul><li>Q1HOUR </li></ul><ul><li>SITE </li></ul><ul><li>RATE </li></ul><ul><li>TIME STRIP </li></ul><ul><li>NOTIFY MED NURSE IF BAG RUNNING DRY. </li></ul><ul><li>CARE: </li></ul><ul><li>MAY USE ARMBOARD FOR POSITIONING </li></ul><ul><li>PROTECT NEEDLE SITE/STERILITY OF FLUID </li></ul><ul><li>CHANGE DRESSING Q24-72HR ACCORDING TO POLICY </li></ul><ul><li>KEEP SITE CLEAN/DRY </li></ul><ul><li>CHECK FOR BUBBLES </li></ul><ul><li>(wind tubing around pencil, milk tubing) </li></ul>
  25. 25. GENERAL INFORMATION <ul><li>The longer the duration of infusion, the more likely complication are to occur. </li></ul><ul><li>Solutions/meds are irritating to the vein. </li></ul><ul><li>Cannula’s can irritate and pierce venous walls causing complications. </li></ul><ul><li>Small veins are more likely to be irritated. </li></ul><ul><li>Cannula can occlude vein and prevent blood flow. </li></ul><ul><li>Veins in lower extremities are a factor when there is pooling or stagnant blood. </li></ul><ul><li>Poor technique can cause inflammation and infection. </li></ul><ul><li>Phlebitis with sepsis is associated with technique. (like disconnecting a gown) </li></ul><ul><li>Infection is a risk. Skin must be thoroughly and properly cleansed to maintain asepsis. Such as thorough handwashing. </li></ul>
  26. 26. <ul><li>TOTAL VOLUME IN MILLILITERS </li></ul><ul><li>TOTAL HOURS </li></ul><ul><li>EXAMPLE: 1000ML GIVEN OVER 8HRS </li></ul><ul><li>1000ML = 125ML/HR </li></ul><ul><li>8HOURS </li></ul>IV CALCULATION USING PUMP
  27. 27. CALCULATIONS DROP RATE: REGULAR : 15GTTS/ML MACRO: 10GTTS/ML (BLOOD) MICRO: 60GTTS/ML (INFANTS/PEDS) EXAMPLE: 1000ML OVER 12 HRS (ADULT) VOLUME X SIZE OF DROP TIME (IN MINUTES) 1000x15 = 21GTTS/MIN 60MINx12HRS

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