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1 • Purpose: The IV procedure involves inserting a needle into a vein for the purpose of administering fluids and medications • A physician’s order is always necessary for this procedure • IV solutions are always sterile 2 1. State 2 purposes for administrating IV fluids 2. List 4 classes of IV solutions and their major components 3. Identify information needed as a part of preparing for IV fluid administration 4. Discuss the delivery devices for IV fluid administration 5. Identify equipment necessary to set up intravenous fluids Photo: https://www.google.com/search?q=setting+up+iv+fluids&biw=1280&bih=689&source=lnms&tbm=isch&sa=X&ei=12EVbmFE4uhNs3clfAO&sqi=2&ved=0CAgQ_AUoAw#imgrc=kHejrtVAxxAgiM%253A%3BZ6d4_Iq3YWb1iM%3Bhttp%253A%252F%252Fi.ytimg.c om%252Fvi%252FaGbYoao7Ogw%252Fmaxresdefault.jpg%3Bhttp%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253DaGbYoao7O gw%3B1280%3B720 Special Directions • The NAII may assemble and flush tubing only as a non-direct patient care activity which is done in preparation for the licensed nurse. in The NAII does not connect any tubing of IV fluids directly to the patient. If the IV needs to be disconnected for patient activity, then the licensed Nurse would do this and then reconnect the IV to the patient. Information Needed as a Part Of Preparing for IV Fluid Administration • • • • • • Identification of patient Nurse’s instructions Body weight Vital signs Intake and Output Record Verification of correct solution https://commons.wikimedia.org/wiki/File:Nurse_poses_with_cancer_patient.jpg 5 • Intravenous Solution (determined by MD order) • Basic Administration Setincludes the flexible, plastic tubing through which the solution flows • Labels for bag and tubing • IV pole or electronic pump to measure drops Photo: "Infuuszakjes" by Harmid http://commons.wikimedia.org/wiki/File:Infuuszakjes.jpg#/media/Fi le:Infuuszakjes.jpg 6 Nutrient Solutions Purpose is for energy and fluid replacement Examples include: • D5W-dextrose 5% in water • Dextrose 5% in 0.45 % Sodium Chloride (5% dextrose in halfstrength saline) These are carbohydrates in the form of sugar http://www.acmhhosp.org/images/chem300.jpg 7 Electrolyte Solutions: • Maintain the body’s fluid balance and body functions • Correct electrolyte imbalances Examples include: • 0.9% Sodium Chloride-normal saline • 0.45 % Sodium Chloride with 20 meq Potassium Chloride (KCL) • Lactated Ringer’s • Ringer’s Solution (contains minerals, i.e. Sodium, Chloride, Potassium) 8 Blood/Blood Volume Expanders: -Increase blood volume -Treat hemorrhage (severe blood loss) -Plasma loss (severe burns) Examples include: Whole Blood, Packed Red Blood Cells, Dextran, Hespan, Albumin, and Plasma 9 Total Parenteral Nutrition (TPN): For patients who cannot digest for two weeks of more and have large caloric and nutrient needs Disease Processes: Small Bowel Syndrome, Inflammatory Disease, GI Fistulas, Severe Burns, and Cancer Examples: Dextrose 10/50% with electrolytes, minerals, and lipids per physician’s order 10 • Never write directly on the IV bag as the ink may bleed into the container • Use a label http://s3.amazonaws.com/ultracart/im/BPMED/3D6E48AD543741014 4D6DB8F07051600?AWSAccessKeyId=0P4TXH5AKGYC8WHDZFG2&Ex pires=1430411678&Signature=vkY6OAbxrnOh8D7fOa6CKU00Jc0%3D 11 The Leur slip at the bottom connects the tubing to the IV catheter The piercing pin pierces the plastic bag It is sterile and covered with a plastic cap The slide clamp is a plastic clamp used to stop or regulate the flow of fluid http://www.emswebstore.com/iv/administr ation-sets/83-i-v-administration-set-10-dropsper-ml.html In textbook, See Figure 7-2, page 129 Example of a Smart Pump http://www.hpnonline.com/i nside/2013-04/1304/ORBaxter-BAX_10_Eugene.jpg 13 NCBON Learning Objectives Part B: IV Fluid Monitoring Flow Rate • • • • State 2 observations necessary to insure appropriate IV flow Identify one cause of an obstructed IV Discuss the significance of a slowing in the IV rate Describe additional important observations in the patient receiving IV fluids • Identify special considerations related to patient age Photo: http://www.stkatherinessurgery.co.uk/clinics-and-services.aspx Special Directions: Part B http://commons.wikimedia.org/wiki/File:Intravenous_therapy_2007-SEP-13-Singapore.JPG • Flow rate per nurse’s instruction • Periodically check the IV flow rate and the infusion site • Check the IV each time you are in the room • Microdrip administration set delivers fluid at 60 drops per mL • Macrodrip administration set delivers fluid at 10-15 drops per mL 16 IV Drip Chamber The drop orifice is the entry to the drip chamber. This controls the size of drops of fluid One More Time: Microdrip administration set delivers fluid at 60 drops per mL Macrodrip administration set delivers fluid at 10-15 drops per mL http://commons.wikimedia.org/wiki/File:Druppelcilinder_%281%29.JPG 17 IV Roller Clamp The flow control clamp is a roller clamp used to regulate the speed or rate of fluid flow "Infuusdebietregelaar" by Harmid - http://commons.wikimedia.org/wiki/File:Infuusdebietregelaar.jpg#/media/File:Infuusdebietre 18 gelaar.jpg • Sometimes an IV is administered at a very slow rate, just enough to keep the vein open • This may be called KO (keep open), TKO (to keep open), KVO (keep vein open) • When this rate is ordered, the patient does not need fluid. The site is used for emergencies and/or for the administration of medicines Photo: http://slothed.com/2013/08/27/how-the-healthcare-industrymarks-up-saltwater-for-big-profits/iv-bag-pic/ 19 Used for patients who do not need continuous fluids via IV, but do need a line for intravenous medications • The heparin lock is a cap that covers the end or hub of the catheter • The lock must fit the catheter with either a male or female adapter http://www.givereport.com/medication-administration/intravenous-bolus-medicationadministration 20 Med Lock Continued • The RN will flush the lock • Injectable heparin (an anticoagulant) or normal saline is injected into the lock to keep it open (patent) • Heparin locks are changed every 96 hours or per facility policy http://i.ytimg.com/vi/P2212yBCU-w/hqdefault.jpg 21 Troubleshooting the IV • If the IV stops dripping, confirm that fluid is present in the container • Check the IV site for possible infiltration • Check the patient’s position • Check the height of IV solution, should be 3036 inches above the insertion site 22 Equipment Function Checks • Check tubing for kinks, position, and bubbles • Check the clamps for patency • Check the pump/controller for designated flow rate • If you cannot find the problem, notify the RN 23 1. 2. 3. 4. 5. Identify the most common site for venipuncture Describe the appearance of a normal venipuncture site Define phlebitis and infiltration Recognize and report 2 signs each of phlebitis and infiltration Discuss the care activities for the patient with an IV https://ocg.cancer.gov/e-newsletter-section/target-program-highlight • No redness, swelling, heat, pain, or foulsmelling drainage at insertion site • Patient does not complain of pain or any problems Photo: http://www.hpnonline.com/inside/2013-01/1301-IP-IVsitecare.html 25 Butterfly Used for short-term IV therapy https://commons.wikimedia.org/wiki/File:Butterfly_needle.png 26 Over-the-Needle Catheters flexible, plastic, Teflon. Used for short or long-term IV Therapy https://commons.wikimedia.org/wiki/File:Intravenous_cannula_05.JPG 27 Use: • standard precautions • strict aseptic technique • good handwashing Some facilities attach in-line filters to the administration set; they allow the fluid to pass, but trap particles 28 Hematoma A collection of blood outside of the blood vessel In the photo, the vein was injured during venipuncture Stop the procedure, apply firm pressure, and elevate the extremity Photo: https://quizlet.com/37975611/phlebotmy-vocab-with-pictures-flash-cards/ 29 Infiltration occurs when the catheter comes out of the vein and fluid flows into the surrounding tissue • Monitor the insertion site for swelling, cool skin temperature, and white or pale skin color • Report to nurse right away. Probable next steps: Stop the IV solution, remove the catheter, and apply warm, moist compresses Photo courtesy of Catherine Noonan, RN, PNP, Children's Hospital Boston. Photo: http://news.nurse.com/apps/pbcs.dll/article?AID=2004407010305#.VT-NTJMYEsI Phlebitis irritation of the vein. May be caused from the irritation of the IV or medication • More common in lower extremity insertions • Risk is reduced by using aseptic technique, taping the IV catheter securely • Rotating of the IV site every 48-72 hours helps to reduce irritation (per CDC) • Avoid insertion in the distal vein of the phlebitis. • Elevate the extremity and apply warm, moist compresses as directed Illustration: http://www.nlm.nih.gov/medlineplus/ency/imagepages/18086.htm Air Embolus— occurs when air enters the vein, moving freely through the system Signs and Symptoms Include: • SOB • Cyanosis • Weak, rapid pulse • Decreased blood pressure • Loss of consciousness • Cardiac Arrest Treatment: • Stay in room with patient and call RN • Turn patient onto left side • RN will administer Oxygen and notify the physician Art credit: http://newsinhealth.nih.gov/2009/November/feature2.htm 32 Catheter Breakage or Embolus-loss of part or all of catheter into the system • Signs and symptoms similar to those of air embolus • The physician will order an X-ray and the circulating catheter will be removed surgically Cannula sheared into 2 pieces during IV insertion http://www.fda.gov/MedicalDevices/Safety /AlertsandNotices/TipsandArticlesonDevice Safety/ucm070030.htm 33 Infection caused by contamination somewhere in the IV system or improper insertion Signs and Symptoms • Redness, swelling, heat, and pain @ insertion site, foul smelling discharge • Systemic infection may include fever, chills, headache, and rapid respirations; followed by decreased blood pressure • Notify RN immediately; catheter will then be removed • Prevent by good handwashing, standard precautions, and aseptic technique!! https://www.healthtap.com/user_questions/259417 34 Fluid Overload occurs when fluids infuse too rapidly • This is a serious condition • Elderly and Pediatric patients are at high risk • Monitor IV rate frequently Early Signs and Symptoms • Rapid respirations • SOB • Rapid Pulse • Increased BP • Distended neck veins Treatment • Position patient in Fowler’s and stay with him/her • Call for RN 35 Patient Education Teach the patient to avoid: • Pulling on, kinking, or obstructing the IV tubing • Brushing teeth or combing hair with the affected arm NOTE: Bennett Gamel (the little boy above) has Cystic Fibrosis. http://bennettgamel.blogspot.com/2012/11/day-of-waiting.html 36 Removing/Replacing the Resident’s Clothing • When a resident is receiving IV fluids, he/she should wear a patient gown with snaps on the shoulders for ease of gown changes. • If he/she is wearing street clothing, a nurse must maneuver the IV during outfit changes. Photo: http://i.ytimg.com/vi/WSa1qk_Ypwk/maxresdefault.jpg IV Site Dressing Change • Most facilities use a transparent film dressing to cover the site • Works well because the site can be easily visualized • Do not use gauze dressings because you cannot see the site • The frequency of the dressing change may vary with facility • Supplies include transparent film, tape, gloves • See Procedure 132 on page 139 https://www.youtube.com/watch?v=wpS2mtvApDo 38 Ambulation of Patient with an IV • Explain to the patient what you will be doing • After easing the patient out of bed, move their IV pole along with them; support the patient as needed • Try to avoid sudden movements; do not allow tension on the tubing • Do not let the tubing drag on the floor • Do not tug on the tubing • Keep the IV bag 30-36 inches above the insertion site • If anything unusual occurs notify the nurse http://princetonhcs.kramesonline.com/HealthSheets/3,S,87065 39 NCBON Learning Objective: Describe the process for discontinuing an IV http://nursing-skills.blogspot.com/2013/12/discontinuingperipheral-iv.html#.VT-odpMYEsI • An IV is discontinued upon a physician’s order • Or if complications occur. Then it is restarted by a trained professional in another area • See Procedure 133 on page 140 Be sure to document that catheter and fluids were discontinued, appearance of site, dressing applied, whether or not the cannula was intact, and condition of patient 40 not in NA2 scope of practice inserted into a vein in the shoulder or neck area used for long-term IV Therapy changing the dressing is a sterile procedure Photo by John Campbell 41 https://www.flickr.com/photos/104346167@N06/15259958079/in/photolist-ovpDxw-4LvBWC-oektxT-3hPjHF-owuBDg-pftgTv-oumMwy-dkinZv4nhVV8-4nn14C-7Gcm3Z-ouQTwu-qe6oAE Image by Blausen Medical Communications http://upload.wikimedia.org/wikipedia/commons/f/f1/Blausen_0193_Catheter_PICC.png PICC Line: Peripherally Inserted Central Catheter Photo: http://www.cs.cmu.edu/~pausch/news/PICCline.jpg Hickman Catheter Look carefully to see catheter tunneled under the skin Insertion site is away from the central line to decrease the chances of a blood infection 2 separate lumens so that 2 treatments can occur at the same time http://en.wikipedia.org/wiki/Hickman_line Port-A-Cath http://commons.wikimedia.org/wiki/File:Port-catheter.jpg