IV Lecture

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  • There are disadvantages:Time, skill to establish & maintainMobilityInfectionSevere reactionsAccidental removalHematoma, infiltration (medication or fluid enters the surrounding tissue), & phlebitis (inflammation of the vein).Opens a direct route to the cardiovascular system for microorgansisms. So very important to use aseptic techniques. Placing IV can be risky due to needle stick & exposure to blood borne pathogens (HIV, hepatitis B, Hepatitis C).
  • Steel needles not seen as much any more—butterfliesOver-the –needle what we useThrough-the-needle is were you have a inducer as in a PICC line
  • Most common IV sites in adults are the lower arm & hand (hand not ideal; movement, painful, & lots of valves)If possible use the non-dominant hand or armMedian cubital vein most commonly use for blood draws but not good for IV site due to this is a joint of flexion.Hand is easy quick access. Try to avoid the wrist in laboring mothers due to bending of the wrist to push. Sites must be rotated q48-72hrs depending on the facility.When placing a IV or changing sites the new site needs to be proximal, meaning above & closer to the point of attachment.
  • Subclavian vein—few structures near it, but can cause a pneumothorax (air in the pleural cavity cause clasping of the lung).Always get a chest x-ray to confirm placement.Jugular veins—are easily visualized but lie near major arteries. Pt drool & increase infection risk. Still chest x-ray after placement.Femoral vein—used in emergencies, or unable to place SC due to anatomy/dehydration. Increased risk of infection. No x-ray needed.Intraosseous IV—when unable to get access in emergency placed in the tibia long bone. Faster when pt is in a low flow perfusion state. Risks are fracture, pain, compartment syndrome, & infection. PICC—placed by a specially trained nurse. High risk for blood clots.
  • Veins are easy to see and palpate but tend to roll.With age arteries lumen size decreases & harden due to arteriosclerosis (thickening of vessel walls & accumulation of calcium causing vessels to become stiff) & atherosclerosis (accumulation of plaque inside the walls).Veins more fragile.Age also affects the ability to metabolize drugs.
  • Most accurate but still room for error. Roller clamps must count gtts per min to calculate gtts per hr. Volume-control device pg 72 in atlas.
  • Whole blood—is separated into red blood cells, plasma, & platelets. People rarely need whole blood transfusions.RBC’s—gives blood its color, transports O2, & carries CO2 to the lungs to be exhaled. Made in the bone marrow which is stimulated by the hormone erythropoietin from the kidneys. Transfusion of RBC’s is in the form of packed RBC’s, where most of the plasma & other cells have been removed. Plasma—infused in the form of FFP. Plasma can be frozen for up to a yr. Straw color contains clotting factors & proteins for clotting & antibodies. Platelets—also come from the bone marrow. There is only a small amount in whole blood, so it takes several donors to replace someone who needs platelets. Usually 6-10 pack.Volume expanders (common OR): NS, lactated Ringer’s (NS with some other chemicals), albumin, & hydroxyethyl starch (HES span). Used to prevent pt’s from going into shock from volume loss. Working on developing blood substitutes, still experimental. 18 gauge needle prefered. Can make due with a 20 & even 22 but your pushing it!
  • Typed—is A, B, AB, or O. Rh + or -. NS to flush, in case of a reaction. Clamp blood & open NS 3-4 hrs because of the risk for bacterial growth. No faster than 150ml/hr due to risk of circulatory overload resulting in HTN.
  • Most common. Piggybacks. Use port closest to the cannula.Solution, TPN, any gtt should be replaced q24hr. Make sure to do your I & O’s at least once per shift.
  • ClotAccumulation of air in the pleural space that can result in the collapsing of the lung. Inflammation of the veinAbnormal particle (air, clot, fat, tissue, foreign body) circulating in the blood that can travel & lodge itself in a vessel, thus occluding the vessel.Fluid escaping from the veins into the surrounding tissue. UnobstructedPuncture of a vein for medical purposesSame as extravasation except it is an accumulation, pulling of fluid in the tissue
  • IV Lecture

    1. 1. Chapter 23<br />Intravenous Medication Administration<br />Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. <br />
    2. 2. Percutaneous Administration<br />Intravenous Therapy<br />Provide fluid and electrolyte maintenance, restoration, and replacement<br />Administer medication and nutritional feedings<br />Administer blood and blood products<br />Administer chemotherapy to cancer patients<br />Administer patient-controlled analgesics<br />Keep a vein open for quick access<br />
    3. 3. Intravenous Therapy<br /><ul><li>Introduced directly into the blood stream
    4. 4. Most rapid of all routes
    5. 5. Large volumes
    6. 6. Less irritation
    7. 7. Intermittent or continuous
    8. 8. Comfortable
    9. 9. Bypasses all barriers</li></li></ul><li>Percutaneous Administration<br />Methods of Intravenous Administration<br />IV push<br />Intermittent venous access device<br />Intermittent infusion (or piggyback)<br />Continuous infusion<br />Electronic pumps and controllers<br />Patient-controlled analgesia<br />Volumetric chambers<br />
    10. 10. Disadvantages of IV Therapy<br />Local complications<br />Accidental needle stick<br />Rapid administration<br />
    11. 11. Catheters<br />Peripheral catheters<br />Steel Needles<br />Over-the-Needle Catheter<br />Central Venous Catheters<br />Central Line<br />Implanted <br />Tunneled<br />PICC<br />Hemodialysis<br />
    12. 12. Site Selection for Venipuncture<br />Age & status of the patient<br />Purpose of the infusion<br />Duration of the therapy<br />Condition of the patient’s veins<br /><ul><li>Accessory cephalic vein
    13. 13. Median basilic vein
    14. 14. Dorsal metacarpal veins
    15. 15. Digital veins</li></li></ul><li>Site Selection for Central Line<br />Subclavian vein<br />Internal & external jugular veins<br />Femoral vein<br />PICC<br /><ul><li>Basilic
    16. 16. Median basilic
    17. 17. Cephalic veins</li></li></ul><li>Special Issues for Older Patients<br />Thinner skin<br />Decreased subcutaneous tissue<br />Age<br />
    18. 18. Infusion Devices<br />Electronic infusion pumps<br />Syringe pumps<br />Roller clamps<br />Volume-control device<br />
    19. 19. Blood Products <br />Whole Blood<br />Red Blood Cells<br />Plasma<br />Platelets<br />
    20. 20. Blood Transfusion Reaction<br />Typed & crossed<br />S/S: Fever, increase or decrease HR, &/or rash<br />Always hang with NS<br />Infuse within 4 hours<br /> Monitor VS every 15 min. <br />
    21. 21. IV Medication Administration<br />Fluid replacement<br />Intermittent medication<br />Replace q24hr<br />Intake & output<br />
    22. 22. Percutaneous Administration<br />Nursing Responsibility<br />The nurse must ensure that fluid of the ordered type and amount is started and that the fluid is regulated to infuse over the period ordered.<br />
    23. 23. Percutaneous Administration<br />Nursing Responsibility<br />Monitor intravenous therapy<br />Check the infusion and the IV needle site at least every hour.<br />Flow of fluid<br />IV site: erythema, wetness, and edema<br />Phlebitis<br />Infiltration<br />Assess for chills, fever, headache, nausea, vomiting, anxiousness, and dyspnea.<br />
    24. 24. Percutaneous Administration<br />Nursing Responsibility<br />Assess for anaphylactic shock<br />Respiratory distress<br />Skin reactions<br />Signs of circulatory collapse<br />GI signs and symptoms<br />Change in mental status<br />Requires immediate intervention.<br />
    25. 25. Key Terms<br />Thrombosis<br />Pneumothorax<br />Phlebitis<br />Embolus<br />Extravasation<br />Patency<br />Venipuncture<br />Infiltration<br />

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