INTRAVENOUS THERAPY

Presented by: Bracket A

INTRAVENOUS THERAPY
It is an effective and efficient method of supplying fluid directly into intravenous fluid compartment producing rapid effect with availability of injecting large volume of fluid more than other method of administration.
Kozier and Erbs Fundamental of Nursing Vol.2 Page 1455

History

1831-Europe

History

Russian Cholera or Blue Cholera -dusky cyanotic complexion of its victims

History
William Brooke OShaughnessy, hypothesized that the primary cause of death in persons who has blue cholera was a deciency of uids and electrolytes

History

Dr. Thomas Latta

LEGAL BASIS
IV Therapy and Legal Implications

R.A. 7164 The Philippine Nursing Act of 1991 Section 28 states that in administration of IV injections, special training shall be required.

LEGAL BASIS
IV Therapy and Legal Implications

Board of Nursing Resolution No.8 Sc. 30 Art. VII or administratively under Sc. 21 Art. III states that any registered nurse without training and who administers IV injections to patients shall be held liable, either criminally, administratively or both.

LEGAL BASIS
IV Therapy and Legal Implications
R.A. 9173 The Philippine Nursing Act of 2002, Article VI Nursing (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to . . . Administration of written presentation for treatment, therapies, oral, topical and parenteral medications . . .

that in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice.

PURPOSE OF IV THERAPY
Restore or maintain F & E Administer meds Provide nutrition Transfusion

TYPE OF IV SOLUTIONS
Type of IV solution

Isotonic

Hypotonic

Hypertonic

GREEN

0.9% SODIUM CHLORIDE/ PNSS

ISOTONIC SOLUTION

D5 Lactated Ringers (D5LR)

PINK
HYPERTONIC SOLUTION

BLUE

PLAIN LACTATED RINGERS (PLR)

ISOTONIC SOLUTION

LIGHT BLUE

D5 0.3 Sodium Chloride (D5 0.3 NaCl)

HYPOTONIC SOLUTION

YELLOW

D5 Normal Saline Solution (D5NSS)

HYPERTONIC SOLUTION

PURPLE

Balanced Multiple Maintenace Solution with 5% dextrose (D5IMB)

5% Dextrose, water and isotonic solution

D5 WATER (D5W)
RED
ISOTONIC SOLUTION

ISOTONIC O.9% NaCl PLR

HYPERTONIC HYPOTONIC D5NSS D5LR 0.33% Saline 0.45% Saline

D5W

D5 in 0.45 Saline 3% NaCl

D10W

D5 0.3 NaCl

Categories of intravenous solutions according to their purpose:

Nutrient solutions. Electrolyte solutions. Volume expanders.

Nutrient solutions.
It contain some form of carbohydrate and water. Water is supplied for fluid requirements and carbohydrate for calories and energy.

They are useful in preventing dehydration and ketosis but do not provide sufficient calories to promote wound healing, weight gain, or normal growth of children.
Common nutrient solutions are D5W and dextrose in half-strength saline.

Electrolyte solutions (Crystalloid)

fluids that consist of water and dissolved crystals, such as salts and sugar. Used as maintenance fluids to correct body fluids and electrolyte deficit . Commonly used solutions are: -Normal saline (0.9% sodium chloride solution). -Ringers solutions (which contain sodium, chloride, potassium, and calcium. -Lactated Ringers solutions (which contain sodium, chloride, potassium ,calcium and lactate) .

Volume expanders (Colloid)

Are used to increase the blood volume following severe loss of blood (haemorrhage) or loss of plasma ( severe burns). Expanders present in dextran, plasma, and albumin.

VENIPUNCTURE SITES
VARIES WITH CLIENTS: AGE LENGTH OF TIME OF INFUSION TYPE OF SOLUTION CONDITIONS OF VEINS

VENIPUNCTURE SITES

VENIPUNCTURE SITES

VENIPUNCTURE SITES

CENTRAL VENOUS CATHETERS

VENIPUNCTURE SITES

CENTRAL VENOUS CATHETERS

IV Infusion Method
I.V. Bolus (I.V. push)

IV Infusion Method
Intermittent infusion Continuousdrip infusion

DUTIES AND RESPONSIBILITIES

1. Interpret and carry out the physicians prescriptions for IV therapy. EG. D5LR to run for 8 hours

DUTIES AND RESPONSIBILITIES

2. Preparing necessary materials and observing inaccuracy
Materials

Infusion Set IV Solution IV pole Adhesive tape Clean Gloves Tourniquet Antiseptic swabs IV catheter Arm splint If required Electronic infusion device

Infusion Set

IV SOLUTION

IV POLE

ADHESIVE TAPE

ANTISEPTIC SWABS

TOURNIQUET

IV CANNULA

INFUSION PUMP
SPLINT

Nursing assessment
1- assess the solution:
Sterile

Clear and not expired

No small particles

No leakage

2- Reading the label on the solution. 3- Determine the compatibility of all fluid and additives. 4- observe I.V sets
Cracks Holes Missing clamps

Expired date

 Also, the nurse should assess the patient for : 1- Any allergies and arm placement preference. 2- Any planned surgeries. 3- Patients activities of daily living.
4- Type and duration of I.V therapy, amount, and rate.

Nursing diagnosis:
Anxiety (mild, moderate, severe) related to threat regarding therapy. Fluid volume excess. Fluid volume deficit. Risk for infection. Risk for slKnowledge deficit eep pattern disturbance. related to I.V therapy.

Planning
Identify expected outcomes which focus on: preventing complications from I.V therapy. minimal discomfort to the patient. restoration of normal fluid and electrolyte balance . patients ability to verbalize complications.

Implementation
I. Implementation during initiation phase A) Solution preparation: the nurse should: Label the I.V container. Avoid the use of felt-tip pens or permanent markers on plastic bag. Hang I.V bag or bottle .

University of La Salette
College of Nursing Date:______________ Patientss Name ______________________________

IVF:_________________________ Additives: ___________________

______________gtts/min

Time Started:________________ Hours to run:__________________

Prepared by:

______________________/BSN student

DUTIES AND RESPONSIBILITIES

3. Performing Peripheral vein puncture

Implementation
B) Site preparation: 1- Cleanse infusion site. 2- Excessive hair at selected site should be clipped with scissor . 3- Cleanse I.V site with effective topical antiseptic. 4- Made Venipuncture at a 10 to 30 degree angle.

DUTIES AND RESPONSIBILITIES

4. Determine solution and medication incompatibilities.

Table 1 Examples of drug compatibilities Drug

Compatible in syringe

Incompatible in syringe

Comments

Benzylpenicillin 600 mg powder for reconstitution Dexamethasone sodium phosphate 4 mg/1 mL

Diazepam 10 mg/2 mL

No common drugs listed in published data Metoclopramide, ondansetron, ranitidine

Nil

Prochlorperazine, promethazine, chlorpromazine, sodium bicarbonate Glycopyrrolate, midazolam, prochlorperazine, promethazine Widely incompatible - do not mix with other drug solutions Buprenorphine, chlorpromazine, droperidol, metoclopramide, midazolam, morphine sulfate, prochlorperazine, promethazine
Benztropine, ketorolac Prochlorperazine, promethazine, midazolam Ampicillin, sodium bicarbonate solution Ampicillin, frusemide, sodium bicarbonate

Frusemide 20 mg/2 mL

No common drugs listed in published data

Poorly water soluble drug marketed in a complex solvent system pH of solution is 8.0-9.3. Frusemide is unstable in acidic media which may include glucose 5% solution.

Haloperidol 10 mg/2 mL Hydrocortisone sodium succinate 100 mg powder for reconstitution Lignocaine hydrochloride 2% in 5 mL Metoclopramide hydrochloride 10 mg/2 mL

Hydromorphone Metoclopramide Glycopyrrolate, metoclopramide Chlorpromazine, dexamethasone, droperidol, fentanyl, hydrocortisone sodium succinate, lignocaine, midazolam, morphine, pethidine, promethazine

Morphine sulfate, morphine tartrate (various strengths)

Stability of at least 15 minutes published for Aminophylline, flucloxacillin, frusemide, atropine, bupivacaine, droperidol, fentanyl, phenytoin, promethazine, sodium bicarbonate glycopyrrolate, hyoscine butylbromide, ketamine, prochlorperazine, and up to 24 hours for metoclopramide

Is less soluble in alkaline conditions

Prochlorperazine edisylate

Atropine, hydromorphone, hyoscine Aminophylline, amphotericin, ampicillin, hydrobromide, morphine sulfate (may vary with benzylpenicillin, calcium gluconate, cephalothin, brand), pethidine dexamethasone sodium phosphate, frusemide, heparin, hydrocortisone sodium succinate, midazolam Atropine, droperidol, fentanyl, glycopyrrolate, metoclopramide, midazolam, pethidine

The bulk of the published data refer to the edisylate salt which is marketed overseas. The salt marketed in Australia is mesylate which is similar, and for which extrapolation of data is considered reasonable.

Promethazine hydrochloride 50 mg/2 mL

Aminophylline, benzylpenicillin, dexamethasone Locally irritant and unsuitable for subcutaneous sodium phosphate, frusemide, hydrocortisone injection. Avoid extravasation in intravascular sodium succinate, morphine, phenytoin, sodium injection. bicarbonate

Tramadol hydrochloride 100 mg/2 mL

No common drugs listed in published data

Diazepam, midazolam

This is a relatively recently marketed drug on

DUTIES AND RESPONSIBILITIES 5. Administer computed medications, chemotherapeutic drugs, flow rates of solutions, compatible blood/blood components and parenteral nutrition as prescribed by the physician.

 Regulating flow rate:

Fluid delivered IV pump Gravity

The nurse calculate the infusion rate by using the following formula :
Volume (ml) X Hours to run (hr) Drop factor (hospital protocol) (gtts/min) = Drop Rate 60 min/hr

DUTIES AND RESPONSIBILITIES

6. Assess all adverse reactions related to IV therapy and initiate appropriate nursing interventions. 7. Establish nursing care plan related to IV Therapy. 8. Adhere to established infection control practices. 9. Maintain proper care of IV equipments.

 II. Implementation during maintenance phase A) Monitoring I.V infusion therapy: the nurse should : inspect the tubing. inspect the I.V set at routine intervals at least daily. Monitor vital signs . recount the flow rate after 5 and 15 minutes after initiation

 B) Intermittent flushing of I.V lines

Peripheral intermittent are usually flushed with saline (2-3 ml 0.9% NS.)

C) Replacing equipments (I.V container, I.V set, I.V dressing):

I.V container should be changed when it is empty. I.V set should be changed every 24 hours. The site should be inspected and palpated for tenderness every shift or daily/cannula should be changed every 72hours and if needs. I.V dressing should be changed daily and when needed

 III. Implementation during phase of discontinuing an I.V infusion

The nurse never use scissors to remove the tape or dressing. Apply pressure to the site for 2 to 3 minutes using a dry, sterile gauze pad. Inspect the catheter for intactness. The arm or hand may be flexed or extended several times.

DUTIES AND RESPONSIBILITIES

10. Document relevant data in the preparation, administration and termination of all forms of IV therapy

Recording and reporting:

Type of fluid, amount, flow rate, and any drug added. Insertion site. Size and type of I.V catheter or needle. The use of pump. When infusion was begun and discontinuing. Expected time to change I.V bag or bottle, tubing, cannula, and dressing.

Any side effect. Type and amount of flush solution. Intake and output every shift, daily weight. Temperature every 4 hours. Blood glucose monitoring every 6 hours, and rate of infusion.

Evaluation
Produce therapeutic response to medication, fluid and electrolyte balance. Observe functioning and patency of I.V system. Absence of complications.

Parenteral Nutrition (PN)

Parenteral nutrition is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes , vitamins, minerals, and fluids via the IV route to meet the metabolic functioning of the body.

Clinical indications of parenteral nutrition

Client cannot tolerate internal nutrition as in case of paralytic ileus, intestinal obstruction, persistent vomiting. Client with hyper metabolic status as in case of burns and cancer. Client at risk of malnutrition because of recent weight loss of > 10%, NPO for > 5 days, and preoperative for severely depleted clients.

 Hematoma
S&S Interventions Prevention

Local ComplicationHematoma

 Infiltration
S&S Interventions Prevention

Local Complication -Infiltration

Local ComplicationPhlebitis

Local ComplicationSite Infection

Local complicationTissue Sloughing

 Fluid overload This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema. Hypothermia The human body is at risk of accidentally induced hypothermia when large amounts of cold fluids are infused. Rapid temperature changes in the heart may precipitate ventricular fibrillation. Electrolyte imbalance Administering a too-dilute or too-concentrated solution can disrupt the patient's balance of (sodium) (potassium) (magnesium), and other electrolytes. Hospital patients usually receive blood tests to monitor these levels.

Systemic Complications
Embolism A blood clot or other solid mass, as well as an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel; this is called embolism. Peripheral IVs have a low risk of embolism, since large solid masses cannot travel through a narrow catheter, and it is nearly impossible to inject air through a peripheral IV at a dangerous rate. The risk is greater with a central IV. Air bubbles of less than 30 microliters are thought to dissolve into the circulation harmlessly. Small volumes do not result in readily detectable symptoms, but ongoing studies hypothesize that these "micro-bubbles" may have some adverse effects. A larger amount of air, if delivered all at once, can cause life-threatening damage to pulmonary circulation, or, if extremely large (3-8 milliliters per kilogram of body weight), can stop the heart. One reason veins are preferred over arteries for intravascular administration is because the flow will pass through the lungs before passing through the body. Air bubbles can leave the blood through the lungs. A patient with a heart defect causing a right-to-left shunt is vulnerable to embolism from smaller amounts of air. Fatality by air embolism is vanishingly rare, although this is in part because it is so difficult to diagnose.