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IV Tx

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by

Andrea Yates

on 11 January 2016

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Transcript of IV Tx

Uses of IV Therapy
Fluid & Electrolyte Balance
Continuous
an infusion of a carefully regulated amount of fluid
administered over a long period of time
via peripheral or central vein
Advantages
easy access to vein
rapid admin. of solutions, blood & drugs
sites are easy to see & monitor
can admin. drugs continuous or intermittent
IV Solutions
Isotonic
IV Devices
IV Therapy
IV fluids can be administered:
Intermittent
infusion over a shorter period or in varying intervals
via saline lock (peripheral vein), central line or IVAD
(implantable venous access device)
Adminstration depends on pt condition, age, history, condition of veins
help fluid distribution between compartments (ICF, ECF) stay constant.
Condition that alters normal I&O may require IV fluid replacement
(dehydration, FVD, NPO status)
Drug administration
may be given intermittently or IVP:
antibiotics
thrombolytics
histamine-receptor antagonists
antineoplastics
Transfusion
Parenteral Nutrition
administration of blood or blood components to:
maintain adequate blood volumes
prevent cardiogenic shock
maintain homeostasis
nutrients provided by IV route
low concentration may be given via peripheral vein
high concentration requires central vein
Disadvantages
infection
bleeding
complications of IVP drugs:
heart, kidney damage
hearing loss
hypotension
Or
IV orders must include:
date & time
type & amt of solution
additives & concentration
rate of infusion
duration of infusion
MD signature
Patient teaching:
explain why tx is needed & duration
describe procedure in detail
some discomfort @ insertion, should stop once device in place
call nurse for pain @ site or during infusion
do not adjust machine settings or silence alarms- call nurse
Vein selection
consider pt's age & skin condition, type of solution & duration of therapy
Vein should be soft, full & long, elastic,
round & firm
ensure vessel is not artery: assess for pulsations & valves
go proximal to sore, tender, bruised areas or phlebitis
use dorsal veins 1st unless ordered solution is irritating
cephalic & basilic veins of upper arms more suitable for irritating drugs & solutions
veins of hands & forearm suitable for most drugs and solutions
leg or foot veins require specific MD order
AVOID:
veins on inner arm (thin-walled &
prone to bleeding & phlebitis)
antecubital space
affected arm of post-mastectomy
affected arm of AV fistula
arm treated for thrombosis or cellulitis
same osmolarity as serum.
stays inside the vessel- expands intravascular space without pulling fluid or electrolytes from other compartments (this increases risk for fluid overload, especially in CHF or HTN pt.)
D5W
can increase ICP because quick metabolism of dextrose draws water (hypotonic fluid)
0.9% NaCL (normal saline, NS)
lactated ringers (LR, ringers lactate)
liver converts lactate to bicarbonate, so do NOT give blood if pH>7.5
do not give to pt w/ liver failure (won't be able to metabolize lactate
Hypotonic
lower osmolarity as serum
fluid & electrolytes shift out of vessel into cells & interstitial space (hydrates cells while depleting circulatory volume)
used when diuretic tx dehydrates cells or hyperglycemia (draws fluid out of cells to dilute blood)
can cause sudden shift from vessels to cells, leading to cardiovascular collapse
not given to pt @ risk for third spacing
burns, trauma, low serum protein levels
can increase ICP from fluid shift into brain cells
not given to CVA, head trauma, neurosurgery pts
Complications
0.45% NaCL (1/2 NS)
0.33% NaCL
D2.5%W
Hypertonic
higher osmolarity than serum
fluid & electrolytes pulled from intracellular & interstitital to intravascular
uses include:
post-op to reduce risk of edema
stabilize BP
maintain urine output
quickly leads to fluid overload
do NOT give to pt with cellular dehydration (diuretic tx, DKA)
do NOT give to pt with poor heart or kidney function (can't handle the extra fluid)
Complications
D5 1/2NS
D5NS
D5LR
3% NS
Winged infusion device (butterfly)
ONC (over-the-needle catheter
Central lines
PICC (peripherally-inserted central catheter)
Hickman
Groshong
Broviac
IVAD (implanted venous access device
short-term therapy w/ cooperative pt.
easy to insert
good for IVP drugs
prone to infiltration
long-term therapy
more comfortable for pt
harder to insert
radiopaque
long-term therapy
inserted only by MD
good for antibiotic therapy or irritating solutions
good for repeat IV meds (i.e. chemo)
inserted by specially-trained staff
x-ray guided placement
threaded to superior vena cava
long-term indwelling catheter
placed surgically via incision in deltopectoral groove
tunneled into place near right atrium
long-term indwellling catheter
small diameter, silicone catheter
used for pediatric pts
long-term indwelling catheter
two-way valve @ the end to prevent
blood return
placed surgically & tunneled
closed, self-sealing system
composed of implantable device with reservoir & port
accessed with non-coring needle
for intermittent infusions
Central Venous Catheters
barrel capacity of syringe
no < 10mL
for irrigation
Needle Gauges
16ga
18ga
20ga
22ga
24ga or 26ga
for adolescents or adults when large amounts of fluid are required (trauma, burns, major surgery)
painful insertion
requires large vein
older children, adolescents & adults
min required for administration of blood & blood products
good for viscous solutions
painful insertion
requires large vein
children, adolescents, & adults
suitable for most IV infusions
most commonly used
can be used for all infants & older (adults-good for elderly)
easy to insert in small, thin, fragile veins
requires slower infusion rates
difficult to insert through tough skin
neonates
other ages for extremely small veins
very hard to insert through tough skin
Infiltration
Swelling at & above IV site
Burning, discomfort, pain
blanched, tight skin w/
coolness at site
slowed or stopped infusion
S&S
causes
displaced cannula
enlarged puncture wound
treatment
DC infusion
elevate affected limb
apply heat (w/ MD order)
restart IV
prevention
frequently assess site
teach pt to report discomfort
Complications
Extravasation
swelling at & above IV site
burning, discomfort, pain
blanching or redness, warm or cool skin
fluids may continue to infuse
S&S
causes
leakage of irritating infusate into
surrounding tissue
dislodged catheter
perforated vein
enlarged puncture wound
treatment
stop infusion, notify MD
use antidote if ordered
DC IV, apply heat (MD order)
prevention
Frequently assess site
If giving known vesicant, freq. check blood return
don’t obscure site w/ tape
Teach pt to report pain
Local infection
Tenderness, redness, swelling @ site
Possible drainage or pus
S&S
causes
Faulty aseptic technique
Contaminated equipment
Pt’s skin flora
treatment
stop infusion, notify MD
culture if drainage present
cleanse site & apply bacteriostatic oint
Restart infusion, document
prevention
aseptic technique on insertion & maintenance of IV site
secure site well to prevent motion
change tubing & fluids per policy
good assessment of site
Phlebitis
Tenderness or discomfort @ tip of venipuncture device & above
Redness @ tip of catheter & along vein
Vein puffy @ hard on palpation
Possible fever
S&S
treatment
DC IV, notify MD if fever present
Warm pack (MD order)
Thrombophlebitis
Severe discomfort
Vein red, swollen, hardened
S&S
causes
thrombosis & inflammation @ catheter tip
treatment & prevention
same as phlebitis
Catheter dislodgement
Loose tape
catheter backed partly out of vein
S&S
causes
Poor taping
Tubing snagged
Confused pt
treatment
If no infiltration present, redress & secure well
If catheter partly exposed, attempt to resecure but do NOT advance catheter back in
prevention
Secure IV well on insertion
Pt education
Close monitoring, possibly wrap site for confused pt
Occlusion
Slowed or stopped infusion
No change in rate when container raised
Blood backup in vein
Discomfort @ site
S&S
causes
IV flow interrupted
Intermittent device not flushed
Blood back up in line when pt up amb (arm dependent)
Hypercoagualable pt
line clamped too long
treatment
Gently aspirate tubing
use mild flush solution
DO NOT force injection. If unsuccessful, DC IV
prevention
Maintain IV flow rate, use infusion pump
Flush line after intermittent infusions
Have pt keep arm elevated (arm across chest) when amb to avoid blood backup in tubing
Severed catheter
Leakage from catheter shaft
S&S
causes
inadvertently cut by scissors
Reinsertion of needle into catheter
treatment
If broken part visible, attempt to retrieve
If unsuccessful, notify MD
If portion enters bloodstream, place tourniquet above IV site
Notify MD, radiology, document
prevention
Don’t use scissors around site
NEVER reinsert needle into catheter
After failed attempt at IV start, remove needle @ catheter together
Hematoma
Tenderness,
bruising
@ site
Inability to advance or flush line
S&S
causes
Vein punctured through other wall @ time of venipuncture
Leakage of blood if above occurred
treatment
DC IV, apply pressure
Warm pack (MD order)
prevention
Choose appropriate size catheter for vein
Release tourniquet after flashback on IV start
Venous spasm
S&S
Causes
treatment
prevention
Pain along vein, blanched skin over vein
Sluggish flow rate
Irritating solutions
Administration of cold fluids or blood
Very rapid flow rate
Apply warm pack over site &
surrounding area
Slow rate
Start infusion slow & increase rate slowly
Use warmer for blood & blood products
Vasovagal reaction
S&S
treatment
Sudden collapse of vein during venipuncture
Pt has
sudden pallor, sweating, faintness, dizziness, nausea
Drop in BP with syncope or unconsciousness
Lower HOB, have patient take deep breaths
Administer O2 if pt becomes cyanotic
Thrombosis
S&S
Causes
treatment
prevention
Painful, reddened, swollen vein
Sluggish or stopped flow rate
Injury to endothelial cells of vein wall
Allows platelets to adhere & thrombus to form
DC IV & restart in opposite extremity
Watch for infection
Proper technique in IV start
Avoid injury to wall (multiple or thru-and-thru punctures
Maintain patency of IV
Nerve, tendon, or ligament damage
S&S
Causes
treatment
prevention
Extreme pain (similar to electric shock) during insertion
If nerve is punctured, numbness & muscle contraction occur
Can lead to paralysis, numbness, deformity
Improper technique
Tight taping
Improper application of armboard
Stop insertion
Document
Avoid multiple punctures
Pad armboards
No excessive pressure when taping
Never encircle limb with tape
Allergic reaction to drug
S&S
treatment
prevention
Itching, rash, edema
Wheezing, bronchospasm
Anaphylaxis
FIRST, stop infusion immediately
Notify MD
Change solution & administration set
Maintain airway PRN
Obtain pt allergy hx
Be aware of cross-allergens
Observe pt closely for 1st 15min of new drug administration
Systemic infection (septicemia)
S&S
treatment
prevention
Unexplained fever, chills, malaise, hypotension
N&V, diarrhea, signs of local infection
Notify MD
DC IV & culture
Administer meds as ordered
Use aseptic technique in insertion & maintenance of site
Secure tubing connections
Change fluids/tubing per policy
Contaminated IV site
Failure to use aseptic technique
Severe phlebitis
Poor taping that allows device to move in & out
Device in place for prolonged time
Immunocompromised pt
causes
Air embolism
S&S
treatment
prevention
JVD,
respiratory distress, crackles,
increased BP,
I > O
DC infusion
Place pt on left side with head lower than heart
Allows air to enter Rt atrium & disperse via pulmonary artery
Notify MD
Administer O2 PRN
Prime tubing well before infusion
Use air-detection device on pump
Secure tubing connections
Rapid flow rate
Roller clamp loosened
Miscalculated fluid requirements
causes
causes
prevent
poor blood flow around IV device
friction from catheter movement in vein
device indwelling too long
irritating solution
use large vein for irritating solutions
dilute drugs when possible
secure device well to reduce friction
causes
prevention
pt education before procedure
prepare pt before stick
use local anesthetic cream if possible
vasospasm r/t anxiety or pain
Viscosity or type of IV fluid
Container height
Type of administration set
Type of venipuncture device (gauge, not length)
Factors affecting flow rate
Infection control
Change peripheral IV site every 48-72 hours
Restart “field” IVs (started by EMS before hospital arrival)
Good assessment of site
Change tubing & dressing every 48 hours for peripheral
Follow policy for central lines
S&S
respiratory distress, unequal breath sounds
weak pulse, decreased BP
decreased LOC
causes
air in line
solution container empties, new one hung without clearing air from line
improper priming before infusion
Circulatory overload
Treatment
Prevention
raise HOB
administer O2 PRN
notify MD
use infusion pump
monitor infusion
check solution fluid levels often
Full transcript