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IV THERAPY

By: Liezel A. Castillo


DEFINITION OF TERMS
 Hypotonic - solutions that have a lower osmolality
than body fluids
 Hypertonic - solutions that have a higher
osmolality than body fluids
 Isotonic - solutions that have the same osmolality
as body fluids
 Phlebitis – an inflammation of the vein that can
result mechanical or chemical trauma or local
infection
 Infiltration – seepage of IVF out of the vein and
into the surrounding interstitial space
DEFINITION OF TERMS
 Airembolism – obstruction caused by a
bolus of air that enters the vein through an
inadequately primed IV line, from a loose
connection, or during tubing change or
removal of IV line
 Catheter embolism – obstruction that results
from breakage of the tip of the catheter
during IV line insertion
IV THERAPY
 Intravenous (iv) therapy is the insertion of a
needle or catheter/cannula into a vein,
based on the physician’s written
prescription. The needle or catheter /
cannula is attached to a sterile tubing and a
fluid container to provide medication and
fluids.
IV THERAPY
 Isused to sustain clients who are unable to
take substance orally
 Replaces water, electrolytes and nutrients
more rapidly then oral administration
 Provides immediate access to the vascular
system for the rapid delivery of specific
solutions
 Provides a vascular route
TEN GOLDEN RULES FOR
ADMINISTERING DRUG SAFELY
 Administer the right drug
 administer the right drug to the right patient.
 Administer the right dose
 Administer the right drug to the right route
 Administer the right drug to the right time
 Document each drug you administer
 Teach patient about the drugs he is
receiving
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
INFORMATION WRITTEN ON IV
TAPE
 size,type and length of cannula/ needle
 name of person who inserted the IV
catheter
 date and time of insertion
Label the IV solution specifying
 type of IV fluid
 medication additives and flow rate
 use of any electronic infusion device
 duration of therapy and the nurse’s name
and signature
TEN GOLDEN RULES FOR
ADMINISTERING DRUG SAFELY
 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)
 Find out if the patient has any drug allergies
 Be aware of potential drug to drug or drug
to food interactions. To protect your
patients or your license.
TONICITY OF IV FLUIDS
 0.45% SALINE (1/2 NS) Hypotonic
 0.9% NS Isotonic
 5% dextrose in water D5W Isotonic
 D5 ¼ NS Isotonic
 Lactated Ringer’s solution Isotonic
 D5LR Hypertonic
 D5 ½ NS Hypertonic
 D5 NSS Hypertonic
 D10W Hypertonic
TYPES OF SOLUTIONS
 Hypotonic - solutions that have a lower osmolality
than body fluids
 Hypertonic - solutions that have a higher
osmolality than body fluids
 Isotonic - solutions that have the same osmolality
as body fluids
 Crystalloids – solutions that contain electrolytes
(fluid volume replacement)
 Colloids/ plasma expanders – pull fluid from the
interstitial compartment into the vascular
compartment (hge or hypervolemia)
IV Cannulas
 Steel needle of butterfly sets
 Wing tip needle with a metal cannula
 Needle is 0.5 – 1.5 inches in length (G16 -26)
 Use in small and fragile bones
 Infiltration is more common
 Plastic needle
 Use in short term therapy
 Use for rapid infusion and more comfortable for
the client
 In-needle catheter can cause catheter embolism
IV GAUGES
 Gauge 14 – 25
 The smaller the gauge the larger the outside
diameter
 G14 -19 – for rapid fluid administration
(blood products or anesthetics)
 G20 - 21 – for peripheral fat infusion
 G22 - 24 – STD IV fluid and clear liquid
medication
 G24 - 25 – for very small veins
IV CONTAINERS
 Glass or plastic
 Do not write the plastic IV bag with marker
pen
IV TUBING
 Contains the spike end, drop chamber,
roller clamp, Y – site and adapter end
 Use of vented or non – vented tubing
 Shorter secondary tubing – use for
piggyback solutions, connecting them to the
injection site
DRIP CHAMBER
 Microdrip
 Are used if fluid will be infused at 50cc/ hr
 Used if solution contains potent medication that
needs to be titrated
 Delivers 60drops/ ml

 Macrodrip
 Use if solution is thick or need to infuse rapidly
 Delivers 10 – 20drops/ ml
FILTERS
 Filters provide protection by preventing particles
from entering the client’s veins
 Filters are used in IV lines to trap small particles
such as undissolved antibiotics or salt or
medications that have precipitated in solution
 Assess the agency policy regarding the use of
filters
 A 0.22-um filter is used for most solutions, a 1.2-
um for solutions containing lipids or albumin, and a
special filter for blood components
NEEDLELESS SYSTEMS
 Needleless systems include recessed
needles, plastic cannulas, and one-way
valves; these systems decrease the
exposure to contaminated needles
 Do not administer total parenteral nutrition
or blood products through a one-way valve
INTERMITTENT INFUSION SETS
 Intermittent sets are used when intravascular accessibility
is desired for intermittent administration of medications by
IV push or IV piggyback
 An IV lock is attached for intermittent infusion devices
 Patency is maintained by periodic flushing with normal
saline solution (sodium chloride and normal saline are
interchangeable names)
 When administering medication, flush with 1 to2 mL
(depending on agency policy) of normal saline to confirm
placement of the IV cannula; administer the prescribed
medication, and then flush the cannula again with 1 to2 mL
(depending on agency policy) of normal saline to maintain
patency
SLECTION OF PERIPHERAL IV
SITE
 Veins in the hand, forearm, antecubital fossa,
scalp and feet
 Assess the veins of both arms closely before
selecting a site
 Start IV infusion distally
 Determine the clients dominant side
 Bending the elbow on the arm with IV may
obstruct the flow causing thrombophlebitis and
infiltration
 Use an armboard as needed in the area of flexion
ADMINISTRATION OF IV SOLN
 Check the IV solution for the type amount,
percent of solution and rate of flow
 Assess the health status and medical
disorders
 Wash hands thoroughly and use sterile
technique
 Prime the tubing to remove air from the
system
ADMINISTRATION OF IV SOLN
 Change the IV site every 48 – 72 hrs
 Change the IV dressing every 72 hrs
especially when wet and contaminated
 Change the IV tubing every 24 to 72 hrs
 Label the tubing, dressing and solution bags
indicating the date and time when changed
 Before adding med or solutions, swab
access ports with 70% alcohol
COMPLICATIONS
 Infection – redness, swelling and drainage
at site; chills, fever, malaise, headache
 Tissue damage – skin color change,
sloughing of skin, discomfort at site
 Phlebitis – heat, redness, tenderness, not
hard and swollen
 Thrombophlebitis – heat, redness,
tenderness, hard and cordlike vein
 Infiltration – Edema, pain, and coolness at
the site
COMPLICATIONS
 Catheter embolism – decrease BP, pain
along vein, weak, rapid pulse, cyanosis of
nail beds, loss of consciousness
 Circulatory overload – increased BP,
distended jugular veins, rapid breathing,
dyspnea, moist cough and crackles
 Electrolyte overload – signs depend on the
specific electrolyte imbalance
COMPLICATIONS
 Hematoma – ecchymosis, immediate
swelling and leakage of blood at the site,
and hard painful lumps at the site
 Air embolism – tachycardia, dyspnea,
hypotension, cyanosis, decreased level of
consciousness
COMPUTATIONS
 gtts/min = volume in cc x DF
nos. of hrs x 60 min
 nos. of hrs = volume in cc x DF

gtts/ min x 60 min


 cc/ hr = volume in cc

number of hours
 Infusion time = total volume to infuse
ml/ hr being infused
CALCULATION OF INFUSION OF
UNIT DOSAGE PER HOUR
 Two Steps
1. determine the amount of medication/ ml
2. determine the infusion rate or ml/ hr
 Amount of medication/ ml
 med/ ml = known amount of medication
 total volume of diluent
 Infusion rate
 ml/ hr = dose per hour desired
 concentration per ml
CALCULATION OF INFUSION OF
UNIT DOSAGE PER HOUR
 PROBLEM
 Order: continuous heparin Na by IV at 1000
units per hour
 Available: IV bag 500 ml D5W with 20,000
unit of heparin Na
 How Many ml/hr are required to administer
the correct dose
ANSWER
 Conc/ ml = 20, 000 units
500 ml
=40 units/ ml

 ml/ hr = 1000 unit


40 units
=25 ml/ hr
Types of BLOOOD COMPONENTS
 RBC
 Whole blood
 Platelets
 FFP
 Albumin
 cryoprecipitate
RBC
 Used to replace erythrocytes
 pRBC (250ml)
 Increases the hemoglobin by 1g/dl and
hematocrit by 2 - 3 %
 Acute and chronic anemia
WHOLE BLOOD
 Use to resolve hypovolemic shock resulting
from excessive bleeding
 500ml
 Rarely use
Platelets
 Use to treat thrombocytopenia and platelet
dysfxn
 X – matching is not required
 50 – 70ml /unit or 200 – 400ml/ unit
 Administer immediately and given for 5 –
30min
 Evaluated after 1 hr and 24 hrs after
transfusion
FFP
 Use to provide clotting factors or volume
expansion
 Infused within 6 hours of thawing
 Infused as rapidly as possible
 X- matching is needed
 PT and aPTT
ALBUMIN
 Use to treat hypovolemic shock or
hypoalbuminemia
 Prepared from plasma and can be stored for
5 years
 25g/100ml of albumin = 500ml of plasma
CRYOPRECIPITATES
 Use to replace factor VIII and fibrinogen
 Prepared from FFP
 Can be stored for 1 year but once thawed,
the product must be used
TYPES OF BLOOD DONATION
 Autologous
 Bloodsalvage
 Designated donor
AUTOLOGOUS
 Donation of the clients own blood before the
scheduled procedure
 Reduces the risk of disease transmission
and potential transmission complications
 Can be made every 3 days as long as
hemoglobin remains with in a safe range
 Donation should be made within 5 weeks of
the transfusion date and end at least 3 days
before the date of transfusion
BLOOD SALVAGE
 An autologous donation
 Involves suctioning of blood from body
cavities, joint spaces
 Blood may need to be washed by a special
process that removes tissue debris before
reinfusion
DESIGNATED DONOR
 When recipients select their own compatible
donors
 Does not reduce the risk of contracting
infection but they feel comfortable
COMPATIBILITY
 Rh type and ABO type are identified
 Use to prevent transfusion rxn
 Crossmatching – the testing of donors blood
and the recipients for compatibility
COMPLICATIONS
 Transfusion rxn
 Circulatory overload
 Septicemia
 Iron overload
 Disease transmission
 Hypocalcemia and citrate intoxication
 Hyperkalemia
NURSING INTERVENTION
A large volume of blood transfused rapidly
through a central catheter into the ventricle
of the heart will cause cardiac dysrhythmias
 No solutions other than NS should be added
on blood components
 Infusion should not exceed more than 4 hrs
 Medication are never added to blood
components
 Blood administration set should be changed
every 4 - 6 hrs
NURSING INTERVENTION
 Check the date of expiration
 Inspect he blood for abnormal color, leaks,
clots, bubbles
 Blood must be administered 20-30 minutes
from its being received from the blood bank
 Never refrigerate blood in refrigerator other
than blood bank
 Monitor vs and assess lung sounds
NURSING INTERVENTION
2 RN need to check the physicians order,
clients identity, clients identification band
 Check the blood bag tag, label and blood
requisition form
CLIENT ASSESSMENT
 Assess for any cultural or religious beliefs
 Informed consent has been obtained
 Check the clients vital sign and medical
status
THANK YOU