IV Therapy Ru

8/8/2019 IV Therapy Ru

1/22

Silliman University

College of Nursing

Dumaguete City

Level III NCM 102

Submitted by:

Elissa Maryle P. Hucal

Kevin T. Katada

Submitted to:

Ms. Mary Nathalie Cata-al


2/22

VISION

A leading Christian Institution committed to total human development for the wellbeing of society and environm

MISSION

Infuse into the academic learning the Christian faith anchored on the gospel of Jesus Christ; provide an environmeChristian fellowship and relationship can be nurtured and promoted.

Provide opportunities for growth and excellence in every dimension of the University life in order to strengthened ccompetence and faith.

Instill in all members in the University, community an enlightened social consciousness and a deep sense of just

compassion.

Promote unity among people and contribute to national development.


3/22

Topic Description: This topic deals on the review of IV therapy and its purposes in the care of hospitalized patients. It emphasizes on the nurses respreventing complications and providing patient safety before, during and after the procedure.

Time Allotment: 1.5 to 2 Hours

Placement: Level III NCM 102 2nd

Semester

Central Objective: At the end of two hours socialized discussion, the students shall acquire comprehensive knowledge, strengthen skills and man

attitude in maintaining safety and preventing complications during IV therapy.

Specific Objectives Content T.A. T-LActiviti

Within the 1.5-2 Hours

discussion, the student

nurse shall:

y Appreciate theimportance of the IVtherapy in the care of

patients.

y Enumerate at leastthree principles in IV

therapy.

y Correctly classify IVF.

I. Introduction of IV therapya. DefinitionIntravenous (IV) therapy is the administration of fluids or medication via a needle or a catheter

(sometimes called a cannula) directly into the bloodstream. The practice of IV therapy is governed by state nurse

practice acts as statutory laws. Some states now include IV therapy within the licensed practical nurse (LPN) and

licensed vocational nurse (LVN) roles. The practice acts define the parameters within which individuals arequalified and licensed to practice nursing in a particular state and serve to codify the nursing obligation to act in

the best interest in the society.

b. Goalsi. Maintain or replace body stores of water, electrolytes, vitamins, proteins, fats and

calories when a patient or client cannot maintain an adequate intake by mouth.ii. Restore acid-base balance

iii. Restore volume of blood componentsiv. Provide avenues for the administration of medicationv. Provide nutrition while resting the gastrointestinal tract

II. Physiologic Assimilation of Solutions1. Isotonic Solution

- has the same osmolarity as serum and other body fluids, hence, it stays where it is infused(intravascular space). It expands this compartment without pulling fluids from other compartments

(intracellular & interstitial) Ex.: LR, NSS (0.9 NS)

5mins

20mins

Interactdiscussi

and giviof

handou


4/22

y

Verbalizeunderstanding on thesignificance of the

proper sequence instarting a peripheralline.

Indications: Blood loss or hypovolemia2. Isotonic solution has a total electrolyte content approximately 310 mEq/L.

4. Used most commonly for extracellular fluid replacement.

2. Hypertonic Solution

- osmolarity is higher than serum. When infused, it initially increases the osmolarity causing thefluid to be pulled from the interstitial and intracellular compartments into the blood vessels

(intravascular space). Ex.: D5, 45 NS, D5N5, D5LR

Indications: Regulate urine output, stabilize blood pressure, reduce risk of edema, post-op patients5. Hypertonic solution has a total electrolyte content of 375 mEq/L or greater.

3. Hypotonic Solution- osmolarity is lower than serum. When infused, fluids shift out of the blood vessels (intravascular

space) and into the cells and interstitial spaces where osmolarity is higher. It hydrates the cells while

reducing the fluid in the circulatory system.

Ex.: 0.45 NS, 0.33 NS, Dextrose 2.5% in waterIndications: Dehydration, DKA, HHNK

6. Hypotonic solution has the total electrolyte content below 250 mEq/L

III. Phillips 15 step method for starting a peripheral line

PHASE STEP

Precatheterization(preparation)

1. Check physicians order

2. Wash your hands for 15 to 20 seconds.

3. Prepare the equipment.

4. Assess the patient.

5. Select the site and dilate the vein.Catheterization

(venipuncture)

6. Select the needle (catheter).

7. Put on gloves.

8. Prepare the site.9. Enter the vein using the direct or indirect

method.

10.Stabilize the catheter with tape and applya dressing.

10mins


5/22

Post Catheterization

(clean-up)

11.Label the site, tubing and bag.

12.Properly dispose of used equipment.13.Educate the patient.

14.Calculate the drip rate if applicable.

15.Document the procedure.

STARTING A PERIPHERAL LINE- the Phillips 15-step approach to starting a peripheral line offers anorganized and thorough method. Remember to always check your institutions policy before performing any

procedure.

CHECK PHYSICIANS ORDER- a physicians order is necessary to initiate IV therapy. According to theIWS, a prescribers verbal order written by a nurse in the medical record in a hospital setting should be

signed by the prescriber within an appropriate time (according to institutions policy). The order shouldinclude solution, volume, rate and route. If medication is ordered, the order should also include the

medication, dosage and frequency.

WASH HANDS- before beginning the procedure, wash your hand for 15 to 20 seconds. Wear gloves wheninserting the catheter and any time you have a risk of exposure to body fluid.

GATHER EQUIPMENT- obtain the following equipment:

y Clean gloves

y Prepping solution (70% isopropyl alcohol, povidone-iodine [Betadine] or chlorhexidine).

y Sterile 2-inch by 2-inch gauze pads.

y inch or 1 inch tape.

y Disposable latex (or non-latex, in the case of allergy) tourniquet.

y Catheters (over the needle sizes, 18, 20,22 and 24 are the most common).

y Appropriate administration set.y IV solution (inspected for puncture holes, visible contamination, and expiration date).

y Prn device (locking device) if the catheter is maintained as a saline lock.

y IV pole if needed.

ASSESS AND PREPARE PATIENT- several factors should be considered before venipuncture. The type

of solution, condition of vein, duration of therapy, catheter size needed, patient age, patient activity, presenceof disease or previous surgery, presence of a dialysis, shunt or graft, medications being taken by the patient

(such as anticoagulant) and allergies must be assessed before a venipuncture. Provide privacy for the


6/22


7/22


8/22

y Correctly identify allequipments needed for

IV therapy.

y State correctly at leasttwo to three

appropriate healthteachings for eachkind of IV infusion.

DOCUMENT- document your actions and the patients response in the medical record according toinstitution policy. All IV solutions are also documented on the medication administration record. Include the

following:y Date and time of insertion

y Manufacturers brand name and style of device

y Gauge and length of the device

y Location of the assessed vein.

y Solution infusing and rate of flow.

y Method of infusion (gravity or pump).

y Number of attempts needed for a successful IV start.

y

Patients response and specific comments related to the procedure.y Signature.

IV. Types of I.V. administration

a. BOLUSMEDICATION

Giving bolus through a peripheral lineYou may need to give a drug by I.V. bolus, such as Atropine, especially in emergency situations.

What You Need:

-prescribed drug

-syringe of appropriate size (either needleless system or one with a 20G or 22G 1 needle-alcohol or povidone-iodine pads

-gloves

Getting Readyo If the drug isnt compatible with the patients I.V. solution, also get two 3-mL syringes with 20G or 22G

1 needles & fill them with normal saline solution.

o Check your facilitys policy to see if you need another 3-mL syringe with heparin flush solution.o Verify the order on the patients chart.o Make sure drug is compatible with I.V. solution.o Check expiration date, & reconstitute or dilute the drug as needed.o Identify the patient by checking the armband or by letting him/her identify himself.

15mins


9/22

o Wash your hands & put on gloves.

HowY

ou Do It1. Close the flow-control clamp on the existing I.V. line.2. Clean the Y-port closest to the venipuncture site with an alcohol pad or a povidone-iodine pad.3. Insert the needle of the syringe on the needleless system into the Y-port, & inject the drug at the

prescribed rate.

4. Remove the syringe from the Y-port, open the flow-control clamp, and set the primary flow rate asprescribed.

Practice Pointersy Because a bolus drug takes effect rapidly, youll need to monitor the patient carefully for adverse

reactions, such as hypersensitivity, hypotension, or cardiac arrhythmias.

y Make sure I.V. line is still patent after youve given a bolus dose.

What to Teach Tell the patient the name of the bolus drug, why youre giving it, and any adverse effects he/she may

experience or should report.

Advise him/her to report pain, redness, swelling, or other problems with the insertion site.

Giving bolus through a saline lockA saline lock converts an I.V. line into an intermittent infusion device. It connects to the venous access device byluer-lock, and it has a latex cap through which you can give repeated bolus doses using either a needle or aneedleless system.

What You Need

-prescribed drug-syringe of appropriate size 20G or 22G 1 needle

-alcohol or povidone-iodine pads-gloves

-two 3-mL syringes with 20G or 22G 1 needles filled with normal saline solution

Getting Ready

o Check your facilitys policy to see if you need another 3-mL syringe with heparin flush solution.


10/22

o Verify the order on the patients chart.o Make sure drug is compatible with I.V. solution.o

Check expiration date, & reconstitute or dilute the drug as needed.o Identify the patient by checking the armband or by letting him/her identify himself.o Wash your hands & put on gloves.

How You Do It

1. Clean the Y-port closest to the venipuncture site with an alcohol pad or a povidone-iodine pad.2. If saline lock is patent, you should be able to aspirate blood through it. To do so, insert the needle of a

saline-filled syringe and aspirate.

3. If no blood appears, apply a tourniquet above the site for about 1 minute. Aspirate again.

4. If no blood still doesnt appear, remove tourniquet & slowly inject normal saline solution & watch forsigns of infiltration, such as puffiness or pain at the site.

If you see swelling stop!

5. If infiltration occurs, remove the saline lock & insert a new one.6. After youve flushed the saline lock, maintain positive pressure and withdraw syringe & the needle.7. Insert the drug-filled syringe into the infusion port, & inject the drug at the prescribed rate & volume.

8. Flush the lock with the second saline syringe & then heparin if needed.9. Discard used items according to standard precautions.

Practice Points

y Because a bolus drug takes effect rapidly, youll need to monitor the patient carefully for adversereactions, such as hypersensitivity, hypotension, or cardiac arrhythmias.

y To keep the device patent, flush it twice according to your facilitys policy with enough solution tofill the saline lock & to clear residual blood.

y Saline can be used for up to 72 hours if it functions properly and if your facilitys policy allows.

What to Teach Tell the patient the name of the bolus drug, why youre giving it, and any adverse effects he/she may

experience or should report. Advise him/her to report pain, redness, swelling, or other problems with the insertion site.

Giving bolus directly into a veinIf your patient needs rapid drug action for example, in emergencies you may need to inject the drug directly


11/22

into a vein.

What You Need

-winged venipuncture device

-tourniquet-alcohol pads or povidone-iodine pads-two syringes filled with the prescribed drug

-appropriate bandage-sterile 2x2 gauze pads

-gloves

Getting Readyo Verify the order on the patients chart.o Identify the patient by checking the armband or by letting him/her identify himself.o Explain procedure to the patient.o Wash your hands and put on gloves.

How You Do It

1.

Select the largest suitable vein, keeping in mind the number of injections the patient may be receiving &the need to preserve proximal veins for future use. The smaller the vein you use for injection, the morethe drug must be diluted to minimize irritation.

2. Apply tourniquet above the injection site to distend it.3. Clean the injection site according your facilitys policy period. If you use both alcohol and povidone-

iodine, apply the alcohol first. Start at the site, then spiral outward about 2 (5 cm).

4. Insert the venipuncture needle, bevel up into the vein. You should see blood flashback.5. Tape the wings of the device to the patients skin.6. Insert a syringe of normal saline solution into the device. Withdraw the plunger to check again for blood

flashback.7. After you see blood backflow, remove the tourniquet and slowly inject normal saline solution into the

vein. Watch for signs of infiltration such as puffiness or pain.

8. Remove the saline-filled syringe, and insert the drug-filled syringe into the venipuncture device.9. Inject the drug as prescribed.10. If the drug is vesicant, double-check the patency of the device after injecting every 2-3 mL of the drug.11.Withdraw the empty syringe, and insert the second syringe filled with normal saline solution. Flush the

venipuncture device to ensure delivery of the full drug dose.


12/22

12.Another method is to attach a 3-mL syringe filled with normal saline solution to one side of a three dashway stopcock and the drug-fille syringe to the other side. Then attach the stopcock to the venipuncturedevice. You can check for blood backflow, inject the drug, and flush the device by turning the stopcock

to appropriate positions.

13.Remove the venipuncture device from the vein and cover the site with a sterile 2x2 gauze pad.14.Apply pressure to the site for at least 3 minutes to prevent formation of a hematoma.15.After the bleeding stops, apply a dressing.16.Discard used items according to standard precautions.

Practice Points

y Certain drugs are packaged by the manufacturer with specific administration guidelines, such as the

appropriate injection rate. Make sure you follow these directions.y Because a bolus drug takes effect rapidly, youll need to monitor the patient carefully for adverse

reactions, such as hypersensitivity, hypotension, or cardiac arrhythmias.

y Make sure your facility has a written policy concerning direct I.V. bolus injection, & follow it carefully.

What To Teach

Tell the patient the name of the bolus drug, why youre giving it, and any adverse effects he/she mayexperience or should report. Advise him/her to report pain, redness, swelling, or other problems with the insertion site.

b. INTERMITTENT INFUSIONUsually intermittent drug infusion is given through a secondary administration set or a volume-control set.

Giving intermittent infusion through a secondary lineMost primary administration sets have one or twoY-sites that allow secondary administration commonly

known as a piggyback infusion. When a piggyback infusion runs for several hours, its known as a continuoussecondary infusion.

What You Need

-prescribed drug-continuous secondary tubing or piggyback extension tubing

-extension hook


13/22

-20G or smaller 1 needle or needleless system-medication label-alcohol pads

-1 adhesive tape

-gloves

Getting Ready

o If the drug is incompatible with the primary I.V. solution, also get two 3-mL syringes with 22G 1needles; fill them with normal saline solution.

o Check your facilitys policy to see if you need another 3-mL syringe with heparin flush solution.o You may also need an infusion pump or a time tape.

o Verify the order on the patients chart.o Identify the patient by checking the armband or by letting him/her identify himself.o Wash your hands and put on gloves.

How You Do It1. If you need to add a drug to a secondary I.V. solution, remove any seals from the secondary container.

Most solution bags have sealed outlet and unsealed injection ports, whereas most bottled solutions have a

seal covering their dual-outlet port.2. Clean the injection port with an alcohol pad.3. Inject the prescribed drug into the solution, and gently agitate the container to thoroughly mix the

solution.

4. Label the container with the patients name, the date and time, the drug and amount mixed, and yourinitials.

5. Remove the secondary administration set from its packaging.6. Straighten the tubing, and close the roller clamp.7. Remove the protective cap from the distal end of the tubing, and attach the 20G (or smaller) needle or

needleless adapter.

8. Remove the protective cap from the infusion (outlet) port of the drug container; then remove the capfrom the I.V. piercing spike.

9. Insert the spike into the port of the container.10. If the drip chamber has a vent on the side, close it if youre using a bag and open it if youre using a

bottle.11. If you havent already done so, take the equipment and the prepared I.V. solution to the bedside.12.Examine the primary I.V. container for cracks or leaks.13.Locate the Y-port on the primary line.


14/22

14.For an intermittent piggyback infusion, the port should be positioned above the roller clamp. For acontinuous secondary infusion, it should be near the lower end of the primary line.

15.Hang the secondary setup on the I.V. pole.16.Using an alcohol pad, clean the selected Y-port on the primary I.V. tubing.17. Insert the needle or needleless adapter from the secondary line into the Y-port of the primary line.18.Securely tape the connection, unless youre using a click-clock device with a recessive needle. This

device doesnt require taping because a plastic covering locks the needle in place.

Giving a piggyback infusion

1. To infuse a piggyback drug without also infusing the primary solution, hang the piggyback containerabove the level of the primary I.V. solution, using the extension hook thats supplied with the piggybackinfusion set.

2. Open the roller clamp on the piggyback tubing; then adjust the roller clamp of the primary set to regulatethe infusion rate of the piggyback infusion. The primary I.V. solution wont run while the piggybackdrug infuses. (To infuse the primary and secondary solutions simultaneously, hang them at the same

height.)

3. If the secondary solution isnt compatible with the primary solution, flush the primary line before andafter the piggyback solution is infused.

Giving a continuous secondary infusion

1. For a continuous secondary infusion, adjust the roller clamp on the secondary line to the desired driprate. Then adjust the roller clamp on the primary line to achieve the desired total infusion rate.

2. If your facility policy allows, use a pump on the secondary line to maintain steady flow rate (or a timetape to verify a steady rate).

3. If youre using a continuous secondary setup and the primary and secondary solutions are incompatible,

stop the primary infusion. Flush the line with two or 3 mL of normal saline solution. Then start thesecondary infusion. At the end of the secondary infusion, flush the line again before restarting the

primary infusion.If you cant interrupt the primary infusion to run an incompatible secondary infusion, consider a double-lumen

catheter or starting another I.V. line.

c. CONTINUOUS INFUSION


15/22


16/22

y Recognize correctlythe causes of different

complications of IVtherapy

y Recognize the specificsigns and symptoms ofeach IV complication.

y Identify 2-3immediate nursinginterventions for each

complication.

What To Teach Tell the patient the name of the bolus drug, why youre giving it, and any adverse effects he/she may

experience or should report.

Advise him/her to report pain, redness, swelling, or other problems with the insertion site. If the patient will receive infusions at home, make sure he or a caregiver can administer them safely and

correctly. Also make sure you teach how to take care of the I.V. site and identify complications.

V. ComplicationsA. Infiltration

- Infiltration is the unintentional administration of a nonvesicant solution or medication into

surrounding tissue.1. Causes

y Can occur when the IV cannula dislodges or perforates the wall of the vein.2. Clinical manifestations

y Edema around the insertion site

y Leakage of IV fluid from the insertion site

y Discomfort and coolness in the area of infiltration

y A significant decrease in the flow rate

3. Preventiony Closely monitor the insertion site

y Use appropriate size and type of cannula for the vein

y Make certain IV site is secure

y Use of armboard on flexor areas is useful

y Lift the arm and evaluate for dependent swelling

y Be sure that tape is not too tight it can obstruct circulation

y Use catheters that are flat will decrease skin and vein tearing

y Minimize movement of the catheter in the skiny Proper venipuncture technique

4. Nursing interventions

y Infusion should be stopped, the IV discontinued, and a sterile dressing applied to the site aftercareful inspection to determine the extent of infiltration.

y IV infusion should be started in a new site or proximal to the infiltration if the extremity is used.

y Apply warm compress to the site to increase circulation and to ease the pain

y Affected extremity should be elevated to promote the absorption of fluid

25mins


17/22

y A cold compress may be applied to the area if the infiltration is recent

B. Thrombophlebitis- Refers to the presence of clot and plus inflammation in the vein.1. Causes

y Length of time IV line is in place

y The composition of the fluid or medication infused (especially its pH and tonicity)

y The size and site of the cannula inserted

y Ineffective filtration

y Improper anchoring of the line

y Introduction of microorganisms at the time of insertion2. Clinical manifestations

y Localized pain, redness, warmth, and swelling around the insertion site or along the path of thevein

y Immobility of the extremity because of discomfort and swelling

y Sluggish flow rate, fever, malaise, and leukocytosis3. Prevention

y Using aseptic technique during insertion

y Using the appropriate size cannula or needle for the vein, considering the composition of fluids

and medications when selecting a sitey Observing the site hourly for any complications

y Anchoring the cannula or needle well

y Changing the IV site according to agency policy and procedures4. Nursing interventions

y Discontinuing the IV infusion

y Applying a cold compress first to decrease the flow of blood and increase platelet aggregationfollowed by a warm compress

y Elevating the extremityy Restarting the line in the opposite extremity.

C. Bacteremia- Contamination of IV site and solution which results to fever, chills and general malaise1. Causes

y Incorrect insertion of catheter

y Inadequate preparation of IV site


18/22

y Inadequate care of IV site2. Clinical manifestations

y Vein is sore and red

y cord-like vein

y Fever3. Prevention

y Practice good handwashing

y Maintain aseptic technique in the care of IV site

y Observe IV site routinely

y Provide routine care along with proper dressing4. Nursing interventions

y Discontinue IV line and restart it in another vein as ordered

y Monitor V/S

y Notify physician

D. Circulatory overload- Overloading the circulatory system with excessive IV fluids causes increased blood pressure and

central nervous pressure.

1. Causesy Rapid infusion of an IV solution or hepatic, cardiac, or renal disease

2. Clinical manifestations

y Moist crackles on auscultation of the lungs

y Edema

y Weight gain

y Dyspnea

y Rapid shallow breathing

3. Preventiony Using an infusion pump for infusions and by carefully monitoring all infusions

y Know patients cardiovascular history4. Nursing interventions

y Decrease the IV rate

y Frequently monitor vital signs

y Asses breath sounds

y Place the patient in high Fowlers position


19/22

y Notify the physician

E. Air embolism- An abnormal circulatory condition in which air/gas travels through the bloodstream and becomes

lodged in a blood vessel.

1. Causes

y Air enters catheter during tubing changes

y Air enters tubing during IV push2. Clinical manifestations

y Dyspnea and cyanosis

y Hypotension

y Weak, rapid pulsey Loss of consciousness

y Chest, shoulder, and lower back pain3. Prevention

y Using a Luer-Lok adapter on all lines

y Filling all tubing completely with solution

y Using an air detection alarm on an IV pump4. Nursing interventions

y Immediately clamp the cannulay Place the patient on the left side in the Trendelenburg position

y Assessing vital signs and breath sounds administer oxygen

y Stay with the patent


F. Hemorrhage1. Causes

y Loose connection of tubing or injection porty Inadvertent or accidental removal of peripheral or central catheter

y Anticoagulant therapy2. Clinical manifestations

y Oozing or trickling of blood from IV site or catheter

y Notify physician3. Prevention

y Tape all catheters securely use transparent dressing for peripheral or central catheters


20/22

y Tape the remaining catheter lumens in a loop so tension is not directly on the catheter

y Keep pressure on site at least 10 mins. after removal of catheter for anti-coagulated clients4. Nursing interventions

y Pressure dressing may be applied over the site to control the bleeding


G. Venous thrombosis1. Causes

y Stasis of blood (venous stasis)

y Vessel wall injury

y Altered blood coagulation

2. Clinical manifestationsy Deep veins

- Edema and swelling of the extremities- Tenderness- Signs of pulmonary embolus are the first indication of deep vein thrombosis

y Superficial veins- Pain or tenderness, redness, and warmth in the involved area.

3. Prevention

y Apply elastic compression stockingsy Use of intermittent pneumatic compression devices

y Special body positioning and exercise4. Nursing interventions

y If patient is receiving anticoagulant therapy, frequently monitor the partial thromboplastin time,prothrombin time, hemoglobin and hematocrit values, platelet count, and fibrinogen level

y Observe closely to detect bleeding

y If bleeding occurs, report immediately and discontinue anti coagulant therapy.


21/22

MICROSET60gtts/minute

HV= Rate of infusion x 60 min/hr.

60 gtts/min

=

y Accurately solve forthe hourly volume andthe rate of infusion in

a given hypothetical

problem.

y Verbalize appreciationon the importance of

maintaining and preventing safetyduring IV therapy.

VI. IV Computation

VII. Evaluation

40mins

5mins

MACROSET15gtts/minuteor 20gtts/minute


15 gtts/min

R= HV x 15 gtts/min

60min/hr

BLOODSET10gtts/minute


10 gtts/min

R= HV x 10 gtts/min

60min/hr


22/22

References: Potter, P. & Perry, A. (2001) Fundamentals of Nursing. (5th Ed.) Missouri: Mosby Inc. Kozier, B. (2004) Fundamentals of Nursing. New Jersey: Pearson Education Inc. Lippincott Williams & Wilkins. Medical Administration Made Incredibly Easy: Springhouse 2003. Lippincott The Manual of Nursing Practice 7th Ed. Lippincott 2001. Williams and Hopper Understanding Medical Surgical Nursing 3rd Ed. FA Davis 2003.

Documents

IV Therapy Ru