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IV .ppt
- 1.
- 2. I. Introduction toIV Therapy • Indications for IV therapy • To provide water, electrolytes, and nutrients to meet daily requirements • To replace water and correct electrolyte deficits • To administer medications and blood products
- 3. What Do IVsolutions consist of? • IV solutions contain • dextrose or electrolytes mixed in various proportions with water • Can electrolyte-free water can be administered by IV? • NO! it rapidly enters red blood cells and causes them to rupture
- 4. IV Solutions • Thereare several types of IV fluids • type of fluid used selected according to the client and the reason for its use • IV solutions are clearly labeled with the exact components and amount of solution • IV solutions orders – often written with abbreviations
- 5. Remember the Abbreviations! •“D” is for dextrose • “W” is for water • “S” is for saline • “NS” is for normal saline • Ringer lactate (lactated Ringer)- commonly used electrolyte solution • abbreviated “RL” or “LR”
- 6. Solution Strength • IV’soften identified with abbreviation letters • These indicate the components in the IV solution • the numbers indicate the solution strength or concentration of components in the IV fluid • numbers written as subscripts • for example, D5W (dextrose 5% in water).
- 7. Let’s Practice: • Whatis the full name of the IV’S from these abbreviations? • NS = • D5W = • RL = • D5 and ½ NS (0.45%) =
- 8. • What isthe full name of the IV’S from these abbreviations? • NS = Sodium Chloride 0.9% • D5W = Dextrose 5% in water • RL = Lactated Ringer solution (electrolytes) • D5 and ½ NS (0.45%) = Dextrose 5% in 0.45% sodium chloride
- 9. Components of IVSolutions D5W- each 100 mL of solution contains 5 g dextrose D5W/0.9NS - solution contains 5 g of dextrose & 0.9 g (or 900 mg) of NaCl per 100 mL solution D5W/0.45NS - solution contains 5 g of dextrose & 0.45 g (or 450 mg) of NaCl per 100 mL solution
- 10. • Potassium chloride(KCl) – • common additive to IV fluids • Potassium chloride- measured in milliequivalents (mEq) • order usually written to indicate the amount of milliequivalents per liter • IV solutions are often available with Potassium premixed in them IV Solution Additives- Potassium
- 11. IV Fluid • 3main types: • Isotonic • Hypotonic • provides more water than electrolytes- diluting the ECF • Hypertonic
- 12. Types of IVSolutions Isotonic Hypotonic Hypertonic 0.9% Sodium Chloride = Normal Saline 0.45% NaCl D5/LR Lactated Ringer’s (LR) 0.33% NaCl D5/0.9%NS (D5/NS) D5W D5W- Glucose rapidly metabolized = hypotonic TPN D5/0.45 %NS Solutions containing meds
- 13. Isotonic fluids • Closeto the same osmolarity as serum • Isotonic fluids expand the ECF volume • expand the intravascular space What implications does this have for a patient with Hypertension or Heart failure if they receive isotonic IV’s? • Risk of fluid overload
- 14. Isotonic Solutions • ProvidesBenefits OF: • Hydration • maintain electrolytes • Used during and after surgery
- 15. D5/W -Helpful for: •Provides free water necessary for renal excretion of solutes • Used to replace water losses and treat hypernatremia • Provides 170 calories/L
- 16. Hypotonic Fluids –Purpose • Replace cellular fluid • Provides free water for excretion of wastes • Often use 0.45% NS – Rx hypernatremia or other hyperosmolar conditions • Less osmolarity than serum • Dilutes the serum
- 17. Excessive Use ofhypotonic Solutions • Leads to intravascular fluid depletion • Decreased blood pressure • Cellular edema
- 18. 0.45% NS -Hypotonic • Provides free water in addition to Na+ and Cl– • Used to replace hypotonic fluid losses • Used as maintenance solution • does not replace daily losses of other electrolytes • Provides no calories • A hypotonic solution that provides Na+, Cl−, & free water • Used as a basic fluid for maintenance needs
- 19. Helpful for: • Cellulardehydration: • Fluid shifts out of blood vessel (less concentrated) to the tissue cells (more concentrated) • Ex: dry mucous membranes • Hyperglycemic conditions: • Diabetic ketoacidosis
- 20. Can be harmful: •Sudden shift of fluid from blood vessel to the cells – cardiovascular collapse • Hypotonic solutions - potential to cause cellular swelling • Monitor for changes in mentation →indicate cerebral edema • Examples- Hypotonic IV solutions • D5NS.45 (5% dextrose in ½ normal saline) • 5% Dextrose and water (D5W)- Provides calories and water
- 21. Hypertonic (hyper-osmolar) • Higherosmolarity than serum • Pulls fluids and electrolytes from the intracellular & interstitial compartments into the intravascular compartment • Examples • D5/0.9NS and D5/0.45NS • Use Postop when some sodium is needed • D5LR
- 22. Helps to: • ↓edema • urine output • Stabilize BP • Used to maintain fluid intake • Can temporarily be used to treat hypovolemia if plasma expander is not available • Solutions with concentrations greater than 10% must be administered through a central line • Allows adequate dilution to prevent shrinkage of RBCs
- 23. IV sites •Peripheral • Superficial veins of forearm, hand, and scalp of children • arm veins - commonly used • relatively safe and easy to enter • Chose site - does not interfere with mobility • Use most distal site of the arm or hand first • This permits subsequent IV access sites to be moved progressively upward • IS the antecubital fossa a preferred IV site? • NO - Limits mobility
- 24. Other IV sitesto be Cautious OF: • Leg veins should rarely be used • high risk of thromboembolism • avoid vein access distal to a previous IV infiltration • Avoid sclerosed or thrombosed veins • Avoid an arm with an arteriovenous shunt or fistula • Avoid arm affected by edema, infection or blood clot • Avoid arm on the side of a mastectomy - impaired lymphatic flow.
- 25. • Can beinserted by nurses who have had special training • Long catheter inserted into antecubital vein with tip positioned in superior vena cava • Use for IV antibiotics for several weeks or TPN • Less risk of complications PICC line (peripherally inserted catheter)
- 26. • Centrally insertedcatheters - special catheter inserted into a large vein in the neck or chest (subclavian or jugular) • threaded through into the right atrium • tip rests in distal end of superior vena cava Central Line IV Therapy
- 27. Use of CVC’s(Central Venous Catheters) Medication administration •• Cancer •• Chemotherapy- infuse irritating or vesicant medications •• Infection •• Long-term administration of antibiotics Nutritional replacement •• Infusion of parenteral nutrition (PN) •• Able to infuse higher dextrose solutions through central line than peripheral line
- 28. • Use anIV infusion set • A drip chamber is connected to the IV bottle or bag • flow rate is adjusted to drops per minute (gtt/min) with roller clamp • Injection ports - located on the IV tubing & on most IV solution bags • allow for injection of medications directly into IV bag or IV line • injection ports also allow for attachment of secondary IV lines for IVPB medications Administration of IV Fluids
- 29. Common Complications ofPeripheral IV Therapy
- 30. • Signs &symptoms of phlebitis • redness, swelling, pain, and edema at the insertion site and/or along the vein • Treatment - removal of catheter & application of warm soaks Phlebitis : inflammation of a vein
- 31. • S &S: • local edema • skin blanching • skin coolness • leakage at the puncture site • Pain & feelings of Tightness • blanching at the site • absent backflow of blood • Treatment: • DISCONTINUE THE iv & MONITOR SITE Infiltration : venipuncture device is dislodged from the vein
- 32. • redness • Swelling •pain and edema at the insertion site and/or along the vein • Phlebitis edema skin blanching skin coolness leakage at the puncture site absent backflow of blood Infiltration Which is it?
- 33. Variety of waysfor Implementing IV Therapy