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IV Therapy and Blood Administration

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on 22 January 2014

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Transcript of IV Therapy and Blood Administration

IV Therapy and Blood Administration
IV Therapy Review
Nursing Responsibilities
Blood Administration
IV Complications
IV Solutions
Similar osmolality to blood
Used for fluid replacement
0.9% sodium chloride (NS)
Lower osmolality than blood
Used for cellular dehydration
0.2% sodium chloride
0.45% sodium chloride (1/2 NS)
Higher osmolality than blood
Rarely used
Pulls fluid from extracellular into intravascular space
3% NS

IV Therapy
Types of Blood Components
Red Blood Cells
Used to replace erythrocytes
1 unit usually infused between 2-4 hours
treats thrombocytopenia and platelet dysfunctions.
infused rapidly, usually over 15 to 30 minutes
Fresh-Frozen Plasma
used to provide clotting factors or volume expansion
infused after thawing, usually over 15-30 minutes.
Donors blood and recipients blood must be compatible or a life-threatening transfusion reaction can occur.
Blood samples are drawn, and labeled at the bedside.
Recipients ABO and Rh factor are identified
An antibody screen is done to determine the presence of antibodies.
Cross-matching is done, in which the donors RBCs are combined with recipient's. They are a match if no agglutination occurs.
The universal RBC donor is O negative
Universal recipients is AB positive.
Precautions and Nurses Responsibilities
pg 137 box 13-2 NCLEX-PN
Client Identity and Compatibility
The most critical phase of transfusion is confirming product compatibility and verifying client identity.
2 licensed nurses need to check the;
Physician's Prescription
Client's Identity (identify band or bracelet number are identical to those on the blood tag.)
Have client state his/her name and make sure it matches name on ID band, and blood tag.
Nurse checks the blood tag, label and blood requisition form to ensure that ABO and Rh types are compatible.
If any inconsistencies are found, notify blood bank immediately!
Administration of the Transfusion
Maintain Standard precautions
Assist RN in administrating blood
Blood products should be infused through administrations sets designed for blood products. (a set that contains a filter)
Pre-medicate client with Tylenol, or Benadryl as prescribed. (oral meds should be given 30 mins prior to administration, IV immediately before administration)
Instruct Client to report anything unusual
Begin transfusion slowly, after 15 mins, if no reaction is noted, speed up rate to ordered rate.
If there is a major ABO incompatibility or a severe allergic reactions occurs, the reaction is most evident within the first 50 mL of blood or within the first 15 min.
Stay with the client for the first 15min of the infusion and monitor for signs of transfusion reaction. The first 15 minutes are te most critical!
Document client's tolerance to administration.
Monitor lab values for effectiveness of transfusion.
Transfusion Reactions
Signs and Symptoms
Immediate transfusion Reaction:
Chills and Diaphoresis
Muscle aches, back/chest pain
Rapid, thready pulse
Rashes, hives, itching, swelling
Dyspnea, cough, wheezing
Pallor or cyanosis
Tingling and numbness
Nausea, vomiting, and abdominal cramping
Delayed transfusion reaction:
Reactions can occur days to years after
Signs include, fever, mild jaundice, decreased hematocrit
Priority Nursing Actions
Change IV tubing down to the IV site and keep the IV open with normal saline
notify physician and blood bank
stay with the client, observing signs and symptoms and monitoring vital signs
Assist to administer emergency meds as prescribed
obtain urine specimen for lab studies
Return blood bag, tubing, and attached labels to blood bank
Document occurrence, actions taken, and client's response.
IV therapy
Injection of solution into the vein

Requires physician order
Order must include
Solution/medication type

IV Therapy Equipment
10 gtt/mL
20 gtt/mL

Microdrip Chamber:
60 gtt/mL
IV Access Devices
Peripheral Devices
Short term devices
Hand and forearm veins most typically used for these devices.
Mid-line Catheters
2-4 weeks use ( cheaper and less risk than central lines)
Cephalic or Basilic veins, advanced to distal subclavian
Not for blood draws
Central Devices
Long term use
PICC and tunneled to superior vena cava
Implantable venous infusion ports
infus-a-port or port-a=-cath
IV drip chambers
60 gtt/mL
usually seen in pediatrics

Micro drip Chambers
IV cannulation
Care of sites and implanted ports
Dressing changes
Flushing catheters
IV med administration
Know medications that can be infused
Check drug order
Recommended infusion rate
Discontinuing IV infusion
Patient teaching

Other Complications
Air embolus
Chest pain
Shortness of breath
Weak, thready pulse
Circulatory overload
Pulmonary edema
Pulmonary embolism
“Speed shock”
Shock, syncope, & cardiac arrest

Macro drip Chambers
10 gtt/mL
15 gtt/mL
30 gtt/mL
Full transcript