Download IV lecture student

IV therapy
By: Susan Mberenga, RN, MSN
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
1
IV Therapy

Types of solutions





Isotonic
Hypotonic
Hypertonic
Caution: Too rapid or excessive infusion of
any IV fluid has the potential to cause serious
problems
Vascular access devices
2
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Vascular Access Devices

Major types:







Short peripheral catheters
Midline catheters
Peripherally inserted central catheters (PICC)
Nontunneled percutaneous central venous
catheters (CVC)
Tunneled catheters
Implanted ports
Hemodialysis catheters
3
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
3
Nontunneled Percutaneous Central
Venous Catheter





Inserted through subclavian vein in upper
chest or jugular veins in neck
May require insertion in femoral vein – Rate
of infection is high
7 to 10 inches (15 to 25 cm) long; up to 5
lumens
Tip resides in superior vena cava
Chest x-ray confirms placement
4
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
4
Central Venous Line
5
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Central IV Therapy

Vascular access device
(VAD) placed in central
circulation, specifically
within superior vena
cava (SVC) near junction
with right atrium

Chest x-ray to confirm
placement
6
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
6
Midline Catheter





3 to 8 inches long, 3 to 5
Fr, double or single lumen
Inserted through vein in
upper arm
Used for therapies lasting
1 to 4 wk
Can cause tissue damage
if extravasation occurs
Do not use to draw blood
7
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
7
Peripherally Inserted Central
Catheter (PICC)



Length of 18 to 29 inches
(45 to 72 cm)
Chest x-ray determines
placement
Power ICCs used for
contrast injection; can also
attach to transducers for
CVP monitoring
8
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
8
Tunneled Central Venous Catheter



Portion lies in
subcutaneous tunnel
Used for frequent and
long-term infusion
therapy (i.e. chemo)
Has cuff of antibioticcontaining material to
help reduce infection
9
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
9
Implanted Port






Consists of portal body, dense septum over a
reservoir, and catheter
Single or double
Surgically created subcutaneous pocket
houses the port body
Usually placed in upper chest/extremity
Not visible externally
Flushing after each use and at least once per
month between therapies prevents clot
formation in internal chamber
10
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
10
Dual-Lumen Implanted Port
and Noncoring Needle
11
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
11
Hemodialysis Catheter



Large lumens accommodate hemodialysis or
plasmapheresis procedure (harvests specific
blood cells)
Catheter-related bloodstream infections (CRBSI), vein thrombosis are common problems
Do not use for administering other
fluids/medications (except in emergency)
12
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
12
Dialysis catheters
13
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
13
Initiating IV Therapy

Equipment



Vascular access devices (VADs), tourniquets,
clean gloves, dressings, IV fluid containers,
various types of tubing, and electronic infusion
devices (EIDs), also called infusion pumps
Initiating the intravenous line
Regulating the infusion flow


Electronic infusion devices (EIDs or IV pumps)
Nonelectronic volume control devices
14
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Initiating IV Therapy

Maintaining the system




Changing intravenous fluid containers, tubing,
and dressings
Assisting patient with self-care activities
Complications


Keeping system sterile and intact
Fluid overload, infiltration, extravasation, phlebitis,
local infection, bleeding at the infusion site
Discontinuing peripheral IV access
15
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Over-the-Needle Catheter
16
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Peripheral IV Therapy

Short peripheral catheters:



Superficial veins of dorsal surface of hand and
forearm
Dwell for 72 to 96 hr, then require removal and
insertion into another site
Portable vein transilluminators available
https://www.youtube.com/watch?v=0csywpTvH
FM
Courtesy © Becton, Dickinson and Company.
17
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
17
Common IV Sites
18
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Potential Contamination Sites of
VADs
19
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Infusion System






Containers – Plastic (PVC-free or DEHPfree), glass
Administration sets – Secondary, intermittent
Add-on systems
Needleless connection devices
Rate-controlling infusion devices
Use of IV pumps does not decrease the
nurse’s responsibility to carefully monitor the
patient’s infusion rate and site!
20
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
20
Remember…

Veins cannot be used in patients with:





Mastectomy
Axillary lymph node dissection
Lymphedema
Paralysis of upper extremities
Dialysis graft or fistulas
21
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
21
Infusion Therapy




Delivery of medications in solutions and fluids
by parenteral route
Intravenous (IV) therapy most common route
IV therapy most common invasive therapy
administered to hospitalized patients
5 rights!
22
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
22
Types of Infusion Therapy Fluids



IV solutions (including parenteral nutrition)
Blood and blood components
Drug therapy
23
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
23
Infection Control

CDC recommends aseptic preparation and
technique including:





Hand hygiene
Clip hair; do not shave
Ensure skin is clean
Wear gloves
Prepare skin with 70% alcohol or chlorhexidine
24
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
24
Local Complications of
IV Therapy








Infiltration
Phlebitis and post-infusion phlebitis
Thrombosis
Thrombophlebitis
Ecchymosis and hematoma
Site infection
Venous spasm
Nerve damage
25
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
25
Systemic Complications of
IV Therapy




Circulatory overload
Speed shock
Allergic reaction
Catheter embolism
26
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
26
Alternative Sites for Infusion




Intra-arterial therapy
Intraperitoneal (IP) infusion
Intraspinal infusion
Intraosseous therapy
27
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
27
Blood Transfusion





Blood component therapy =
IV administration of whole
blood or blood component
Blood groups and types
Autologous transfusion
Transfusing blood
Transfusion reactions and
other adverse effects
28
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Blood types


The most important grouping for transfusion
purposes is the ABO system, which identifies A, B, O,
and AB blood types. Determination of blood type is
based on the presence or absence of A and B red
blood cell (RBC) antigens.
People with type O blood are considered universal
blood donors because they can donate packed RBCs
and platelets to people with any ABO blood type.
People with type AB blood are called universal blood
recipients because they can receive packed RBCs
and platelets of any ABO type.
29
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
29
30
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
30
Tubing for Transfusions
31
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Blood Transfusions and
Other Components





Packed red blood cells
Platelets
Fresh frozen plasma
Albumin
Several specific clotting factors
32
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
32
Different types of transfusion
reactions








Acute hemolytic
Febrile nonhemolytic
Mild allergic reaction
Anaphylactic reaction
Transfusion associated circulatory overload
Transfusion transmitted bacterial infection
Post transfusion purpura
Transfusion-related graft vs. host disease
33
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
33
Febrile nonhemolytic





most common
The patient’s antibodies react with donor
WBC antigens
Doesn’t cause hemolysis
Quick onset
Stop transfusion, administer antipyretic and
antihistamine as ordered, monitor vital signs
per hospital policy, and follow hospital policy
for blood post transfusion reaction protocol
34
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
34
Remember...




Change lipid tubing every 24 hr
Change blood tubing within 4 hr
Change propofol (Diprovan) tubing every 6 to
12 hr
Interventions to reduce infection risk:



Clean needleless system connections before use
with antimicrobial for 30 seconds
Do not tape connections between tubing sets
Use evidence-based hand hygiene guidelines
from CDC and OSHA
35
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
35