INTRAVENOUS (INFUSION) THERAPY is

the insertion of a needle or catheter/ cannula onto a vein, based on the physicians written prescription. The needle or catheter / cannula is attached to a sterile tubing and fluid container to provide medication and fluid.

INDICATIONS OF IV THERAPHY
To maintain hydration and /or correct dehydration in patients unable to tolerate sufficient volumes of oral fluid / medications. Parenteral Nutrition. Administration of Cdrugs, i.e. chemotherapy, other drugs Transfusion of blood or blood components.

CONTAINDICATION OF PERIPHERAL I.V. FLUIDS

Administration of irritant fluids or drugs through peripheral access {i.e. highly concentrated, high osmolarity solution like Na Chloride, Hypertonic K Chloride, etc.}

PROCESS:
A. STANDARD POLICIES AND PROCEDURES
Standard operating procedure are established to secure safe I.V. therapy , to protect the patient by maximizing benefits and minimizing risk associated with this I.V. therapy and to protect the practice of registered professional I.V. therapy nurses. The I.V. therapy policies and procedures are written and continuously updated and reviewed as necessary.

Key Points Prior To Initiation of I.V. Therapy

1. Physicians prescribed treatment.
The initiation of I.V. therapy is upon the written prescription of a licensed physician which is checked for the following : Type and amount of solution The flow rate The type, dose, and frequency of medications to be incorporated/ pushed Others affecting the procedures {X-ray, treatment to the extremities,}

Key Points Prior To Initiation of I.V. Therapy

2. Patient Assessments
Factors To Consider For I.V. Therapy Duration of therapy Cannula Size Condition of the vein / skin. Type of solution Patients level of consciousness Patients activity Dominant arm Clinical status of patient

Key Points Prior To Initiation of I.V. Therapy

3. I.V. Set and equipment preparation
Check for expiration date Check for clarity, any presence3 of holes on plastic cover {packaging} plastic container (bag) or presence of sediments or insects. Check label against the physicians order Label for any medication that are added; date, time, medication and amount. Compatibility of drug with the solution. Functionality of Infusion Pump, Patients Controlled Analgesia {Pt CA}

Key Points Prior To Initiation of I.V. Therapy

4. Medications
Nurses administering I.V. therapy should have a knowledge on all medications administered including dosages, drug interactions and possible clinical effects on the vascular system.

10 Golden Rules For Administering Drugs Safely

[from Nursing 88 Vol. 18. August 1988]
1. 2. 3. 4. 5. 6. 7. 8. Administer the right drug. Administer the right drug to the right patient. Administer the right dose. Administer the right drug by right route. Administer the right drug at the right time. Document each drug you administer. Teach your patient about the drug he is receiving. Take a complete patient drug history. { There is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks.} 9. Find out if the patient has any drug allergies. 10.Be aware of potential drug drug or drug food interactions To protect your patient and your license, follow these guidelines for avoiding medication error.

PROCESS:
B. INITIATION OF I.V. THERAPY
The initiation of IV therapy shall be to provide peripheral intravascular access for therapeutic indications. This requires a physicians written prescriptions.

PROCESS:
C. CHOICE OF CANNULA FOR PERIPHERAL INFUSION.
The factors to consider for the choice of cannula are; Purpose of the infusion. Type of infusion. Size and condition of the patients vein. Duration of treatment. Condition of the patient.

Nursing Alert: Choose the shortest catheter with the smallest gauge. Appropriate for the type and duration of the infusion. The higher the gauge number, the smaller the bore of the catheter.

PROCESS:
D. SELECTION OF VENIPUNCTURE SITE
The patients condition and age, the size and vein condition, type and duration of therapy and functional utilization of the hand shall be assessed to ensure ideal and safe IV access.

E. ANCHORING OF CANNULA AND TUBING

Good anchoring allows normal blood flow, prevents movement of cannula and irritation of vein thus protecting the puncture site.

PROCESS:
F. IV CANULLA REMOVAL
Peripheral IV cannulas and yhe site are routinely changed aseptically or re-sited every 48 72 hours or when necessary.

G. EXPLAINING THE PROCEDURES TO THE PATIENT AND SIGNIFICANT OTHERS. H. QUALITY CONTROL OF IV SOLUTION
All IV fluids shall be inspected prior to use and check for visible sediments, turbidity, discoloration, leaks, cracks, damaged caps and expiration date.

PROCESS:
I. DOCUMENTATION OF IV THERAPY
Proper documentation provides: an accurate description of care that can serve as legal protection. a mechanism for recording and retrieving information. a record for health insurers and retrieving information documenting the insertion of a venipuncture device or the beginning of therapy.

a. The following is written on the IV tape:

size, type and length of cannula/ needle name of person who inserted the IV catheter date and time of insertion

b. Label the IV solution specifying:

type of IV fluid medication additives and flow rate use of any electronic infusion device duration of therapy nurses signature

c. In addition to the above documentation the following information is documented in the patients chart.
location of and condition of insertion site complications, patients response and nursing interventions. patient teaching and evidence of patient understanding{ for example ability to explain instructions or perform a return demonstration Signature of nurse other observations

TYPES OF IV FLUID
1. ISOTONIC SOLUTION Has the same concentration
as body fluids. It is often used to restore vascular volume.
0.9% Na Cl (Normal Saline) - Isotonic solution NS and LR initially remain in the vascular compartment, expanding the vascular volume. Watch out for: S/S of hypovolemia such as bounding pulse and shortness of breath. - isotonic on initial administration but provide free H2o when dextrose is metabolized.

D5W

TYPES OF IV FLUID
2. HYPOTONIC has lower concentration than the body
fluids. Are used to provide free water and treat cellular dehydration. These solution promotes waste elimination by kidneys. Do not administer to clients at risk for IICP or third space fluid shift. Ex. 0.45 Na Cl ( half Normal Saline 0.33 Na Cl ( 1/3 Normal saline)

TYPES OF IV FLUID
3. HYPERTONIC draws fluid out of the intracellular and
interstitial compartment into vascular compartment, expanding of vascular volume. Do not administer to clients with kidney or heart disease or clients who dehydrated. Watch for the signs of hypervolemia. Ex.. 5% Dextrose in NS ( D5NS ) 5% dextrose 0.45 Nacl ( D51/2 NS ) D5LR

LARGE VOLUME INFUSION

Mixing a medication into a large volume IV container is the safest and easiest way to administer a drug intravenously. The drugs are diluted in volume of 1,000 ml or 500ml of compatible fluids. Fluids such as IV normal saline or Ringers lactate are frequently used. Commonly added drugs are potassium chloride and vitamin. The main danger of infusing a large volume of fluid is circulatory overload. The medication can be added to the fluid container running or before it is hung and infusing. Label with name and dose of medication, date, time, and nurses initials. Attach it upside down on the bag or bottle.

INTERMITTENT INTRAVENOUS INFUSION

It is a method of administering a medication mixed in a small amount of IV solution, such as 50 0r 100 ml. The drug is administered at regular intervals such as every 4 hours, with the drug being infused for a short period of time such as 30 to 60 minutes. Two commonly used additive or secondary IV set ups use the tandem and piggyback. In a tandem set up, a second container is attached to the line of the first container at the lover, secondary post. It permits medications set up to be administered intermittently or simultaneously with the primary solution. In the piggyback alignment, a second set connects the second container to the tubing of the primary container at the upper post. This set up is solely for intermittent drug administration.

INTRAVENOUS PUSH (IVP) (bolus) is the

intravenous administration of undiluted drugs directly into the systemic circulation. It is used when a medication cannot be diluted or in an emergency. An IV bolus can be introduced directly into a vein by venipuncture or into an existing IV line through an injection post or through an IV lock.

2 Major Disadvantages of Bolus:

a. Any error in administration cannot be corrected after the drug has entered the client. b. The drug maybe irritating to the lining of the blood vessels.

COMPLICATIONS OF IV INFUSION
1. Infiltration the needle is out of vein, and fluids
accumulated in subcutaneous tissues. Assessment pain, swelling, skin is cold at needle site, flow of IV rate decreases or stops, absence of back flow of blood into the tubing, as the IV fluid is put down on the IV tubing is kinked. Nursing Intervention Change the site of needle. Apply warm compress. This will reabsorb edema fluids and reduce swelling.

COMPLICATIONS OF IV INFUSION
2. Circulatory overload
Results from administration of excessive volume of IV fluids. Assessment Headache Syncope or faintness Pulmonary edema Coughing SOB (shortness of breath) Tachypnea Shock Flushed Skin Rapid pulse Increase BP Weight gain

Nursing Intervention Slow infusion to KVO (keep vein open - 10 drops per min.) Place patient in high fowlers position to ease breathing Administer diuretic, bronchodilator as ordered.

COMPLICATIONS OF IV INFUSION
3. Drug Overload The patient receives an
excessive amount of fluid containing drugs. Assessment Dizziness Shock Fainting Nursing Intervention Slow infusion to KVO and notify the physician.

COMPLICATIONS OF IV INFUSION
4. Superficial Thromboplebitis It is due to overuse of a
vein, irritating solution of drugs, clot formation, large base catheter.
Assessment Pain along the course vein Vein may feel hard and cordlike Edema and redness at needle insertion site Arm feels warmer than the other arm Nursing Intervention Change IV site every 72 hours Use large veins for irritating fluids Stabilize venipuncture at area of flexion Apply cold compress immediately to relieve pain and inflammation later follow warm compress to stimulate circulation and promote absorption. Do not irrigate the IV because this could push clot into the systemic circulation.

COMPLICATIONS OF IV INFUSION
5. Air Embolism
system.
Assessment Chest, shoulder or backpain Hypotension Dyspnea Cyanosis Tachycardia Increased venous pressure Loss of consciousness Nursing Intervention Do not allow bottle to run dry Prime IV tubing before starting infusion Turn patient to left side in the trendelenbeirg position to allow air to rise in the side of the heart. This prevents pulmonary embolism.

- Air manages to get into the circulatory

COMPLICATIONS OF IV INFUSION
6. Nerve Damage
tightly to the splint.
Assessment Numbness of fingers and hand Nursing Intervention Massage area and move shoulder through its ROM Instruct the patient to open and close hand several times each hour. Physical therapy maybe required. NOTE: Apply splint with the finger free to move

May result from tying the arm too

COMPLICATIONS OF IV INFUSION
7. Speed Shock May result from administration of
IV push medication rapidly. To avoid speed shock and possible cardiac arrest, give most IV push medication over 3 to 5 minutes.

BLOOD TRANSFUSION THERAPY

is the introduction of whole blood or components of the blood ( ex. Plasma or erythrocytes ) into the venous circulation

Purposes:
To administer required blood components by the patient. To restore the blood volume. To improve oxygenation carrying capacity of the blood.

Nursing Intervention:
1. Verify doctors order. Inform the client and explain the purpose of the procedure. 2. Check the cross matching and blood typing. To ensure compatibility. 3. Obtain and record baseline vital sign. 4. Practice strict asepsis. 5. At least 2 nurses check the label of the blood transfusion.
Check the following: Serial number Blood component Blood Type RH factor Expiration Date Screening tests (VDRL for sexually transmitted disease, HBsAg for Hepatitis B, malarial smear for malaria

6. Warm blood at room temperature before transfusion, to prevent chills. 7. Identify client properly.

Nursing Intervention:
8. Use needle gauge 18 or 19. This allows easy flow of blood. 9. Use BT set with filter, to prevent administration of blood clots and other particulates. 10.Start infusion slowly at 10 gtts./min .Remain at bedside 15 to 30 min. Adverse reaction usually occurs during the first 15 to 20 minute. 11.Monitor VS. Altered V/S indicates adverse reaction. 12.Do not mix medications with blood transfusion. To prevent adverse effects.
Do not incorporate medication into blood transfusion Do not use the BT line for IV push of medications.

13.Administer 0.9% NaCl before during or after BT. Never administer IV fluid with dextrose. Dextrose causes hemolysis. 14.Administer BT for 4 hours (whole blood, packed RBC) for plasma platelets, cryo precipitate, transfuse quickly (20 min.) clotting factors can easily be destroyed. 15.Observe for potential complications. Notify the physician.

COMPLICATIONS OF BLOOD TRANSFUSION

1. Allergic Reaction It is caused by sensitivity to plasma protein
or donor antibody, which reacts with recipient antigen. Assessment Flushing Rash, hives Pruritus Laryngeal edema

2.

Febrile, Non hemolytic It is caused by hypersensitivity to

donor white cells, platelets or plasma protein. This is the most symptomatic complication of blood transfusion. Assessment Sudden chills with fever Flushing Headache Anxiety

COMPLICATIONS OF BLOOD TRANSFUSION

3. Septic Reaction It is caused by blood transfusion of blood
components contaminated by bacteria. Assessment Rapid onset of chills Vomiting Hypotension High fever

4.

Circulatory Overload It is caused by administration of blood

volume at a rate greater than the circulatory system can accommodate. Assessment Rise in venous pressure Dyspnea Crackle or rales Distended neck vein Elevated B/P

COMPLICATIONS OF BLOOD TRANSFUSION

5. Hemolytic Reaction It is caused by infusion of incompatible
blood products. Assessment Low back pain (first sign) this is due to inflammatory response of kidneys to incompatible blood. Chills Feeling of fullness Tachycardia Flushing Tachypnea Hypotension Bleeding Vascular collapse Acute renal failure

NURSING INTERVENTION WHEN COMPLICATIONS OCCURS IN BT

Stop the blood transfusion immediately. Start on IV line ( 0.9% NaCl ). Collect urine specimen. To detect presence of bacteria, which may be causing the adverse reaction to BT. Monitor V/S. Send unused blood and blood set to the blood bank for lab exam. Administer antihistamine, diuretics and bronchodilator as ordered. Make relevant documentation.

TOTAL PARENTERAL NUTRITION (TPN) also

referred to as intravenous hyperalimentation ( IVH ), is the parenteral administration of solution of dextrose, H20, fat, protein, electrolytes, vitamins and trace elements, it is the provision of all needed calories. Because TPN solutions are hypertonic (highly concentrated in comparison to the solute concentration of the blood) they are injected only into high flow central veins, where they are diluted by the clients blood. TPN are given to clients; with severe malnutrition, severe burns, bowel disease disorders, acute renal failure, hepatic failure, metastatic cancer, major surgeries when nothing may be taken by mouth for more than 5 days. Because TPN solutions are high in glucose infusions are gradually started to prevent hyperglycemia, and when TPN therapy is to be discontinued, the infusions rate s are decreased slowly to prevent hyperinsulinemia and hyperglycemia. Weaning clients from TPN may take 48 hours but can occur in 6 hours if patient receives adequate carbohydrates either orally or intravenously.