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Chapter 13 And 15 Iv Therapy
- 1. IV Therapy Peggy D. Johndrow
- 12. CHAIN OF INFECTION Microorganism Carrier Person Travel Method A way out Skin puncture Susceptible Person
- 27. IV Tubing Label
- 28. IV Tubing Label
- 29. Math problems
Editor's Notes
- Many Isotonic (most like blood ): used to expand blood volume; same concentration of solutes as blood. Assess for signs of hypervolemia such as bounding pulse, & SOB. Normal saline or 0.9% NaCl Lactated Ringers (sodium, chloride, potassium, calcium & lactate) Hypotonic : provide free water and treat cellular dehydration; promote elimination via kidneys; less concentration of solutes than blood 0.45% NaCl 0.33% NaCl Hypertonic: d raws fluid out of intracellular & interstitial compartment and into vascular compartment, due to higher concentration of solutes than blood; caution for clients with kidney or heart problems. D5 NS Osmosis = water moves from less to greater concentration to equalize D5 1/2 NS D5LR Acidifying solutions used to treat metabolic alkalosis; include D5W in ½ NS (½ NS is the same as 0.45% sodium chloride) Other fluids used to increase blood volume are Volume expanders; include: Dextran & Serum albumin
- Site varies depending on the client age, the type of solution, the length of time the infusion is to run, the type of solution used & the condition of the veins. Peripheral sites Metacarpal - in the top of the hand Basilic - In the forearm - arm is natural splint and armboards may not needed. Use cathelons/catheters that cover the needle; catheter left in, not needle Cephalic - Also in forearm
- Remove tubing from bag and straighten it Close roller clamp Hang IV bag on the IV pole Spike the bag by pulling off blue protective cover (keep sterile) and inserting tubing into bag Fill drip chamber ½ full by squeezing it gently Openroller clamp & prime tubing : fill entire tubing with IV solution avoiding any air bubbles; small air bubble less than 0.5 mL usually not harmful unless infusing into a central line Label the tubing with times for solution to be infused, especially if no pump and with tubing change date (usually q 72 hours) Adjust roller clamp to appropriate drip rate or place tubing into an IV pump; set the primary rate and volume in the pump
- Open tubing same as IV Close roller clamp Hang IVPB on pole Spike bag same as IV Prime tubing Connect IVPB tubing to IV tubing Place wire hanger on pole Lower IV bag on to hanger Adjust roller clamp to appropriate drip rate: check order, check bag correct rate. If using IV pump, set secondary volume & rate; primary IV will start to run when IVPB is infused Label the tubing with date to be changed
- Small amounts of air do not produce symptoms because air is removed from the circulation. Large boluses of air (3-8 mL/kg) can cause acute right ventricular outflow obstruction and result in cardiogenic shock and circulatory arrest. Subclinical air embolism in hospitalized clients may be common. Procedures that most commonly result in VAE are CV (internal jugular or subclavian) catheterization and pressure infusion of fluids and blood. Symptoms , which develop immediately following embolization, are similar to pulmonary thromboembolism. Severity of symptoms related to degree of air entry and include the following: Dyspnea, Chest pain, Tachycardia, Hypotension, Altered sensorium Circulatory shock or sudden death (clients with severe VAE) Physical: Acute respiratory distress, Tachypnea, Agitation, Disorientation Classic finding - Mill wheel murmur upon auscultation of the heart Cyanosis and hypotension - Accompany severe VAE Actions Once VAE suspected, immediately stop infusion and clamp line. Do not withdraw the catheter at this time unless it cannot be clamped. Promptly place client in Trendelenburg position and rotate toward the left lateral decubitus position. This maneuver helps trap air in the apex of the ventricle, prevents its ejection into the pulmonary arterial system, and maintains right ventricular output. Administer 100% oxygen and intubate for significant respiratory distress or refractory hypoxemia. If CV catheter is present, aspirate from the distal port and attempt to remove air. Catheter may have to be advanced for this to be successful. CPR helps expel air from the pulmonary outflow tract and disperse it into the peripheral pulmonary venous system. Admit client to ICU.