Na Ii Ppt Module 7


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Na Ii Ppt Module 7

  1. 2. <ul><li>Module Title: Peripheral IV Fluids </li></ul><ul><li>Part A: Preparing for Administration of IV Fluids </li></ul>
  2. 3. Peripheral IV Fluids <ul><li>Preparing for Administration of IV Fluids: </li></ul><ul><li>**IV- Intravenous- refers to instilling into the vein </li></ul><ul><li>**Peripheral—located at or occurring away from the center; usually refers to the arms and legs </li></ul><ul><li>The NA II is NOT permitted to connect any tubing or IV Fluids directly to the patient. </li></ul><ul><li>If the IV needs to be disconnected for patient activity, then the licensed nurse would do this and then reconnect the IV to the patient </li></ul><ul><li>This will be a non-direct patient care activity which is done in preparation for the licensed nurse to initiate or continue the administration of IV fluids. </li></ul>
  3. 4. Peripheral IV Fluids <ul><li>Two Main Purposes for an IV: </li></ul><ul><li>administer fluids or to administer medications </li></ul><ul><li>A physician’s order is required </li></ul><ul><li>In North Carolina, only RN’s and LPN’s are permitted to perform these procedures in MOST cases </li></ul>
  4. 5. Peripheral IV Fluids <ul><li>Classes of IV Fluids: </li></ul><ul><li>Nutrient Solutions-- provide energy and fluid replacement </li></ul><ul><li>D5W-Dextrose 5% in water </li></ul><ul><li>Dextrose 5% in .45% sodium </li></ul><ul><li>Chloride-dextrose in half-strength saline </li></ul><ul><li>(Carbohydrates in the form of sugar) </li></ul>
  5. 6. Peripheral IV Fluids <ul><li>Classes of IV Fluids: </li></ul><ul><li>Electrolyte Solutions---Maintain the body’s fluid balance and body functions and Correct electrolyte imbalances </li></ul><ul><li>.99% sodium chloride-Normal Saline </li></ul><ul><li>.45% sodium chloride with 20meq KCL (potassium chloride) </li></ul><ul><li>Lactated Ringers </li></ul><ul><li>Ringer’s Solution (contains mineral, i.e. sodium, chloride, potassium) </li></ul><ul><li>**electrolytes are a solution that conducts electricity such as sodium, potassium and chloride. These elements must be in balance for the body to function properly. </li></ul>
  6. 7. Peripheral Fluids <ul><li>Classes of IV Solution: </li></ul><ul><li>Blood/Blood Volume Expanders—increase blood volume, treat hemorrhage (severs blood loss), plasma loss (severe burns) </li></ul><ul><li>Whole blood </li></ul><ul><li>Packed red blood cells </li></ul><ul><li>Dextran </li></ul><ul><li>Hespan </li></ul><ul><li>Albumin </li></ul><ul><li>Plasma </li></ul>
  7. 8. Peripheral IV Fluids <ul><li>Classes of IV solutions: </li></ul><ul><li>Total Parenteral Nutrition (TPN)—For two weeks or more in patients with large caloric and nutrient needs, short bowel syndrome, GI fistulas, severe burns, and/or inflammatory disease </li></ul><ul><li>Dextrose 10/50% with electrolytes, minerals, and </li></ul><ul><li>lipids(fats) per MD order </li></ul><ul><li>**parenteral—denoting any medication route other than the alimentary canal, such as IV, SubQ, IM or mucosal </li></ul>
  8. 9. Peripheral IV Fluids <ul><li>Information needed as part of preparing the IVF (The Six Rights): </li></ul><ul><li>Right Patient </li></ul><ul><li>-ID the patient by checking the arm band and if applicable, asking the patient to state their name </li></ul><ul><li>If no ID band is noted, report this to the nurse for immediate replacement </li></ul>
  9. 10. Peripheral IV Fluids <ul><li>Right Solution: </li></ul><ul><li>Compare the label to the MAR or order </li></ul><ul><li>Check the IV three times </li></ul><ul><li>Make sure you have the correct preparation </li></ul><ul><li>Always check the expiration date </li></ul><ul><li>Always check for allergies, especially for the prep solution, dressing and tape. </li></ul><ul><li>Make sure the patient is not allergic to alcohol, iodine, tape or transparent dressings </li></ul>
  10. 11. Peripheral IV Fluids <ul><li>Right Strength: </li></ul><ul><li>Always ask an RN to check your calculations of drip rates </li></ul><ul><li>Some solutions are available in different concentrations </li></ul><ul><li>If you have any doubts about whether the solution you are using is correct, check with the RN </li></ul>
  11. 12. Peripheral IV Fluids <ul><li>Right Route: </li></ul><ul><li>Make sure the preparation you are using is labeled for IV use </li></ul><ul><li>Make sure all equipment is sterile and that flawless sterile technique is maintained </li></ul>
  12. 13. Peripheral IV Fluids <ul><li>Right Time: </li></ul><ul><li>Check the order for correct time </li></ul>
  13. 14. Peripheral IV Fluids <ul><li>Right Documentation: </li></ul><ul><li>Never chart IV’s in advance </li></ul><ul><li>Initial the IV record immediately after starting the IV </li></ul><ul><li>Document other care (changing dressings or tubing) on the correct form </li></ul><ul><li>If the patient is not on intake and output (I&O), place an I&O worksheet at the beside and inform the RN so he or she can initiate I&O monitoring </li></ul><ul><li>Document vital signs, such as pulse or blood pressure and body weight, and other monitoring as warranted by patient condition, physician’s orders, and facility policy </li></ul>
  14. 15. Peripheral IV Fluids <ul><li>Deliver y Types: </li></ul><ul><li>#1 The Basic Administration Set: </li></ul><ul><li>Flexible, plastic tubing through which the solution flows is attached to the IV solution on one end and the patient on the other </li></ul><ul><li>Designs will vary slightly with the manufacturer </li></ul><ul><li>A manual (clamp) or electronic device (IV pump) is used to control the flow of solution </li></ul>
  15. 16. Peripheral IV Fluids <ul><li>Parts of the Basic Administration Set: </li></ul><ul><li>Piercing pin- pierces the solution bag or bottle. This pin is sterile and is covered with a cap </li></ul><ul><li>Drop Orifice- entrance to the drip chamber and controls the size of the drops of fluid </li></ul><ul><li>Drip Chamber-semi-rigid container that is filled halfway with fluid. Allows easy visualization of the flow rate. </li></ul><ul><li>Y-sites-connection for administering medication into the IV tubing </li></ul>
  16. 17. Peripheral IV Fluids <ul><li>Basic Administration Set Parts: </li></ul><ul><li>Flow Control Clamp-is a roller clamp used to regulate the speed or rate of the fluid flow </li></ul><ul><li>Slide Clamp- plastic clamp used to stop or regulate the flow of fluid and may be used to stop the fluid quickly if needed. </li></ul><ul><li>Luer slips- connect the tubing to the needle or IV catheter. Provides a means of locking the tubing and needle or catheter together, making them more difficult to separate </li></ul>
  17. 18. Peripheral IV Fluid <ul><li>#2 Secondary Set or Piggyback Set </li></ul><ul><li>Used to run medication into an existing IV site </li></ul><ul><li>Can run congruently with the IV fluid or the initial IV Fluid may be stopped while the medication is run in </li></ul><ul><li>The Secondary Set will be connected to the Basic Administration set at a Y-site or the IV pump will have a special connection for this set </li></ul>
  18. 19. Peripheral IV Fluid <ul><li>#3 Heparin Locks/Hep Locks/Saline Locks: </li></ul><ul><li>May be used for patients who are receiving intermittent IV medication but not IV Fluids </li></ul><ul><li>Once the IV catheter is inserted, the hep lock is attached to the catheter by the Luer lock. </li></ul><ul><li>The Hep lock is a short piece of tubing with a luer slip at one end and an injectable cap at the other </li></ul><ul><li>When using a Hep lock, a liquid solution such as heparin, an anticoagulant or normal saline is injected into the lock to maintain patency when not being used. </li></ul>
  19. 20. Peripheral IV Fluid <ul><li>Macrodrip and Microdrip Versions of IV sets: </li></ul><ul><li>Macrodrip most common for adults </li></ul><ul><li>Delivers fluid in a larger volume typically 10-20 drops per milliliter of fluid </li></ul><ul><li>Microdrip most common for pediatrics and may be used for certain adults </li></ul><ul><li>Delivers fluid in a smaller drop, usually 60 drops per milliliter of fluid </li></ul>
  20. 21. Peripheral IV Fluids <ul><li>Administering Fluids: </li></ul><ul><li>By Controller or Pump </li></ul><ul><li>Attached to the IV Pole or Standard and run on electricity </li></ul><ul><li>There are many manufacturers of IV Pumps and operating instructions will vary </li></ul>
  21. 22. Peripheral IV Fluids <ul><li>Volumetric Intravenous Pumps- regulate the flow of fluids electronically </li></ul><ul><li>Ensure accurate flow of IV Fluids and drugs </li></ul><ul><li>Can measure flow of fluids in milliliters per hour of solution infused </li></ul><ul><li>IV Controllers – regulate gravity flow of IV fluids by counting drops of solution </li></ul><ul><li>Controllers count drops and because the drops are not always exactly identical, they are not as accurate as using a pump </li></ul>
  22. 23. Peripheral IV Fluid <ul><li>When preparing IV Fluid for the Nurse: </li></ul><ul><li>Always observe Strict Aseptic Technique and Standard Precautions to include good hand washing </li></ul><ul><li>To infuse properly, the solution must hang at least 30-36 inches above the level of the heart and is hung on an IV Pole or IV Standard </li></ul><ul><li>All IV Tubing should be primed or flushed to fill the tubing with solution and remove any air bubbles to reduce the risk of air entering the vein which could lead to death </li></ul><ul><li>Never write directly onto the solution bag as the ink may bleed through and contaminate the solution </li></ul><ul><li>Labels are provided for documentation of: patient’s name, room number, date and time, flow rate, duration of IV and your name or initials (per facility policy) </li></ul><ul><li>Never place the label over any IV solution information on the bag </li></ul>
  23. 25. <ul><li>Part B: </li></ul><ul><li>IV Fluid Monitoring Flow Rate </li></ul>
  24. 26. Peripheral Fluids <ul><li>Monitoring IV’s : </li></ul><ul><li>You will be responsible for periodically monitoring the IV flow rate and checking the infusion site </li></ul><ul><li>This may mean looking at a digital display or counting the drip rate </li></ul><ul><li>The nurse will inform you of the correct flow rate and/or the designated drip rate. </li></ul><ul><li>You will also be responsible for monitoring the amount of fluid remaining in the solution bag/bottle </li></ul><ul><li>You may be required to monitor the infusion site for signs of infection, infiltration or other complication </li></ul>
  25. 28. Peripheral IV Fluid <ul><li>Causes of an Obstructed IV: </li></ul><ul><li>Kinks or bends (occlusions) in the tubing that prevent the flow of solution </li></ul><ul><li>Position of the infusion site causing the IV catheter to be kinked or bent inside the vein. Some sites such as the wrist or elbow are said to be “positional” sites and usually require that body part to be immobilized with an arm board to prevent further movement </li></ul><ul><li>Position of the body part or patient. If the patient is laying on the arm which has the IV, that could cause the tubing to kink or the catheter to be kinked </li></ul>
  26. 29. Peripheral IV Fluid <ul><li>Obstructed IV’s continued: </li></ul><ul><li>Bubbles are air in the tubing (air embolus) which if allowed to enter the patient’s vein could lead to death </li></ul><ul><li>Most IV Pumps will alarm if a large bubble of air is detected in the tubing and will stop the flow of IV solution until corrected </li></ul><ul><li>Correction of this error will usually require a nurse </li></ul>
  27. 30. Peripheral Fluids <ul><li>Equipment Function Checks: </li></ul><ul><li>To ensure correct flow rate or to ensure the ability to change a flow rate if necessary </li></ul><ul><li>Drip Chamber —semi-rigid container that is filled halfway with fluid. This chamber is initially squeezed to fill with fluid </li></ul><ul><li>Problems will occur with the flow rate if : </li></ul><ul><li>The chamber becomes too full of fluid </li></ul><ul><li>The chamber is not filled at least half full </li></ul>
  28. 31. Peripheral IV Fluid <ul><li>Equipment Check: </li></ul><ul><li>Clamps – Both the Flow Control Clamp and the Slide Clamp can be used to change or stop the rate of flow </li></ul><ul><li>Problems —if the solution is not flowing, check both clamps to ensure that they are both open </li></ul><ul><li>The IV Pump usually will alarm if the solution is not flowing </li></ul>
  29. 32. Peripheral IV Fluid <ul><li>Equipment Check: </li></ul><ul><li>IV Pump must be attached to an IV Pole or Standard </li></ul><ul><li>Must be plugged in </li></ul><ul><li>Place the pole on the same side of the bed as the IV </li></ul><ul><li>Tubing should never be draped across the patient or the bed </li></ul><ul><li>Follow manufacturer’s instructions for tubing placement or threading the tubing through the cassette </li></ul>
  30. 34. Peripheral IV Fluid <ul><li>Observing the patient receiving IV Fluid: </li></ul><ul><li>Position of Extremity: </li></ul><ul><li>Hands, wrists, and arms should be maintained at an elevated position while IV is infusing to prevent occlusions </li></ul><ul><li>Extremities should be free and clear of the body in all positions (lateral, fowlers, and supine) to prevent kinking of tubing </li></ul>
  31. 35. Peripheral IV Fluid <ul><li>Volume in Container: </li></ul><ul><li>To infuse properly, the solution must hang at least 30 to 36 inches over the level of the heart </li></ul><ul><li>The height of the IV pole will affect the rate of flow </li></ul><ul><li>Never allow the solution to run empty as this could cause an air embolus </li></ul>
  32. 37. Peripheral IV Fluid <ul><li>Patient Complaints: </li></ul><ul><li>Infiltration -occurs when the catheter or needle comes out of the vein and fluid flows into the surrounding tissue; </li></ul><ul><li>can also cause the flow rate to slow or stop; </li></ul><ul><li>S/S are swelling, cool skin at the site, a white or pale skin color; wet or damp site dressing; rigid, taut skin at the site </li></ul><ul><li>Lowering the IV bag below the heart should produce a blood return if it does not, then it is infiltrated </li></ul><ul><li>TX is to stop the IV and apply a warm moist compress to the area to relieve pain and promote absorption </li></ul>
  33. 38. Peripheral IV Fluid <ul><li>Hematoma -can occur during venipuncture; it looks like a bruise that fills rapidly with blood; </li></ul><ul><li>TX is to elevate the extremity and apply firm pressure to the area. </li></ul><ul><li>Phlebitis -irritation of the vein </li></ul><ul><li>Caused by IV device or from medication or due to infection </li></ul><ul><li>S/S are redness, warmth, swelling and pain; possibly a red streak extending from the site up the arm </li></ul><ul><li>TX is stop the IV, elevate the extremity, apply warm moist compresses to the area </li></ul>
  34. 39. Peripheral IV Fluid <ul><li>Air Embolus- -air enters the vein and moves freely throughout the body </li></ul><ul><li>S/S are shortness of breath, cyanosis, weak, rapid pulse, decreased blood pressure, loss of consciousness and cardiac arrest </li></ul><ul><li>TX--Stay in the room, call the nurse, turn the patient onto their left side </li></ul><ul><li>The nurse will administer O2 and contact the MD </li></ul>
  35. 40. Peripheral IV Fluid <ul><li>Catheter Breakage or Embolus -loss of part or all of the catheter into the circulatory system causes a catheter embolus </li></ul><ul><li>S/S are respiratory distress, chest pain, cyanosis, rapid pulse, and decreased blood pressure </li></ul><ul><li>May be difficult to differentiate between air embolus </li></ul><ul><li>TX Stay with the patient, call for the nurse; they may instruct you to apply a tourniquet above the insertion site; MD will be notified </li></ul><ul><li>X-ray will be used to determine placement and surgery will be used to remove the catheter </li></ul>
  36. 41. Peripheral IV Fluid <ul><li>Infection -caused by contamination somewhere in the IV system or by improper insertion technique </li></ul><ul><li>S/S of a local infection are redness, swelling, heat and pain at the insertion site. Also, foul smelling drainage may be noted. </li></ul><ul><li>S/S of a systemic infection are fever, chills, headache, and rapid respirations. The blood pressure may drop </li></ul><ul><li>TX Stay with the patient, call the nurse. </li></ul><ul><li>You may be instructed to remove the catheter in which case save it to be sent to the lab for testing </li></ul>
  37. 42. Peripheral IV Fluids <ul><li>Fluid Overload- occurs when fluids infuse too rapidly </li></ul><ul><li>Monitor the flow rate frequently and ensure that fluid is flowing at the proper rate </li></ul><ul><li>S/S are rapid respirations, shortness of breath, rapid pulse, increased blood pressure, distended neck veins, then turning towards respiratory distress, and cardiac arrest </li></ul><ul><li>TX Stay with the patient, call the nurse, position the bed in the Fowler’s position </li></ul>
  38. 43. Peripheral IV Fluid <ul><li>Special Considerations for children and the elderly </li></ul><ul><li>Patients of any age may fear being stuck with a needle </li></ul><ul><li>Be sure to explain the procedure before beginning </li></ul><ul><li>Both geriatrics and pediatrics have small fragile veins that require a smaller gauged catheter </li></ul><ul><li>Geriatrics also have limited veins and paper thin skin always tape with hypoallergenic tape </li></ul><ul><li>Pediatrics require the site to be taped very securely so as not to get dislodged when playing </li></ul><ul><li>Assistance may be required to hold a confused patient or a frightened child </li></ul>
  39. 44. <ul><li>Part C: </li></ul><ul><li>IV Fluids Site Care and Patient Activities </li></ul>
  40. 45. Peripheral IV Fluid <ul><li>Common IV Sites: </li></ul><ul><li>Hands and forearms are the most commonly used sites in adults </li></ul><ul><li>Dorsal hand, dorsal foot and scalp veins are the most common sites for pediatrics </li></ul><ul><li>Avoid the antecubital (inner elbow) space whenever possible </li></ul><ul><li>Use of lower extremities increases the risk of thrombophlebitis </li></ul><ul><li>Avoid areas of swelling, redness, sores, rash, shunts, grafts, the arm on the side of a mastectomy or burn, cast or a severely scarred area </li></ul>
  41. 46. Peripheral IV Fluid <ul><li>Normal IV Site: </li></ul><ul><li>Dry, warm= clean, no swelling, no redness, no odor, no drainage </li></ul><ul><li>Catheter is lying flat, properly secured and infusing </li></ul><ul><li>Visualization of the site is to your advantage and covering the site with dressings or roller gauze should be avoided if possible </li></ul>
  42. 47. Peripheral IV Fluids <ul><li>Abnormal Site Appearance: </li></ul><ul><li>Dressing is wet or damp </li></ul><ul><li>Moist blood is noted under the dressing </li></ul><ul><li>The catheter is out of the skin </li></ul><ul><li>Site is red, warm or exceptionally cool to touch, swollen, or draining </li></ul><ul><li>Be sure to check the underside of the arm for edema, since infiltration allows the IV fluid to infuse into the soft tissue which could pool on the underside of the arm and not show at the site </li></ul><ul><li>Complaints of pain or detection of fever </li></ul>
  43. 48. Peripheral IV Fluids <ul><li>Most health care facilities have policies and procedures for dressing the IV site </li></ul><ul><li>Techniques vary but will always be done with Sterile Technique </li></ul><ul><li>Some facilities cover the insertion site with a transparent film dressing </li></ul><ul><li>Some facilities tape the hub and tubing to the skin </li></ul><ul><li>Roller gauze should be avoided but if used should allow vision of the insertion site at all times. </li></ul><ul><li>Frequency of the dressing change varies with facility policy </li></ul>
  44. 51. <ul><li>Part D: </li></ul><ul><li>Discontinuing Peripheral Intravenous Infusions </li></ul>
  45. 52. Peripheral IV Fluids <ul><li>Discontinuing an IV: </li></ul><ul><li>An IV is usually D/C’ d if complications develop such as infiltration, phlebitis, or infection </li></ul><ul><li>If the MD orders to stop the fluids and D/C the IV </li></ul><ul><li>If the site is due to be changed </li></ul>