Download NUR 121 L - wcunurs120and121

•Common Venipuncture Sites
•Dose Calculators
•Insertion of Peripheral IV Catheter
•Insertion of a Central Line Catheter
•Methods of IV Medication Administrations
•Six “Rights” for the administration of IV medications
•Classification of Fluid Replacement
•Common IV Solutions: Indications, Precautions, and
Incompatibilities
IV Delivery Methods – Advantages and Disadvantages
Solution Compatibility Chart
Common Venipuncture Sites
 Cephalic Vein – thumb side
 Basilic Vein 
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little finger side
Median Cubital vein – connects cephalic and basilic
Medial vein of forearm – center of the forearm
Radial vein – wrist area , thumb side
Superficial dorsal veins
Dorsal venous arch
Sites of IV Insertions
Dosage Calculators
1. Dose ordered/Dose on hand = Amount to administer
2. IV Dose Rate Calculation
Dose Ordered/Solution Concentration = Volume/hour
e.g. 50 mg/hr/2 mg/ml = 25 ml/hr
3. Calculation for gtts/minute
# ml ordered/# hr x 60 min X # gtts/ml = # gtts/min
e.g. D5W 1000 ml in 8 hours, drip factor of tubing is 15
gtts/ml.
1000 ml/8 hr x 60 minutes/hr x 15 gtts/ml = 31 gtts/min
Generalizations you can Make
 For 10 gtts /ml tubin g Rate = 1/6 (# ml/hr)
e.g. For 125 ml/hr , 1/6 (125 ml/hr) = 21 gtts/min
 For 15 gtts/ml tubing
Rate = ¼ (#ml/hr)
e.g. For 125 ml/hr , ¼ (125 ml/hr) = 31 gtts/min
 For 20 gtts/ml tubing
Rate = 1/3 ( #ml/hr)
e.g. For 125 ml/hr, 1/3 (125 ml/hr) = 42 gtts/min
 For 60 gtts/ml tubing , Rate = (#ml/hr)
e.g. For 125 ml/hr,
(125 ml/hr) = 125 gtts/min
Tubing/Pumps
 Usage
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- Primary
- Secondary
Drip Factor
- Macro
10, 15, 20
- Micro
60
Infusion Ports
- w/ backcheck valve
- w/o backcheck valve
Extension Tubings
Filters
Flow Regulator(ml/hr)
Infusion pumps ( ml/hr)
Types of Catheters
 Peripheral
- Winged ( butterfly), Heparin Lock, Over-the Needle
angiocath
 Central Catheters
 Short term:
- single lumen ( only one sol’n)
- Multi lumen ( allows for more than one sol’n at a
time without regard for compatibility.
- CVP (Central Venous Pressure Cath) used only to measure C/V
fluid status.
 Long term;
 Hickman (single lumen), Broviac (similar to Hickman) and
Groshong (single or double lumen) catheters
 Hickman/broviac (combined cath)
 Long Line cath ( PICC)
Things to Know ( Central Catheters)
 Important to verify placement by X-rays.
 Apply and maintain occlusive dressing (follow
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protocol)
Change dressing, sol’n, tubings per protocol.
Instructing pt. to do valsalva maneuver when changing
tubings, lessens a chance for air embolism.
Flush catheter(s): all ports need to be flushed, unless
being used continuously.
Flushing solution: heparin solution (10 u – 1000u/ml)
Saline Solution
6 Rights of IV Medication Administration
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Right Patient
Right Dose
Right Route
Right Time
Right Attitude/Documentation.
Advantages:
1.
No absorption problems, drug go directly into pt. circulation, reaching
therapeutic levels rapidly.
2.
Accurate titration can be achieved by adjusting the concentration and
administration rate.
3.
Generally less discomfort.
Disadvantages:
1.
Incompatibility
2.
IV soln containing divalent cations has a > incidence of incompatibility.
3.
Loss of potency of drug can occur.- Binding, Alteration, Chemical change
Common IV Problems
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Infiltration
Phlebitis
Clot Formation
Infections
 Prevention of Complications
1. Change Parenteral fluids, tubes per policy (48-72 hours)
2. Change peripheral and central sets q 48 hours ( hospitals
now change central sets 72 hours). Check protocols.
3. Change dressing q 48 hours ( central lines are change
dressing q weekly).
4. Label dressings
5. Rotate sites q 72 hours.
Reconstituting Powder
 IVs are generally prepared by the pharmacy
- diluent
- Asepsis
- Mix thoroughly
- label – date time, concentration, and the person who
prepared the sol’n.
 Adding drug to IV bottles/bags;
- Consider the amount of the solution in the bag before
adding the med.
- Check the label of the container/solution ( mix-o-vial).
 Hanging IV solution
- Take out the sol’n out of refrigerator 1 hour before
administration.
- Check meds for meds expiration date/time.
- Check for cloudiness, sediments, color change