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Transcript
Intravenous therapy
Introduction
Administering medications and fluids via intravenous route has become common
In the pediatric setting. Intravenous injections are the most effective way for quick
response and are the only acceptable route for some drugs. They also provide less
traumatic administration.
Purpose of IV therapy
To maintain fluid and electrolyte balance
To administer antibiotic therapy
To provide nutritional support
To administer anticancer drugs
To administer pain medications
Candidates for IV medication administration
Children with poor absorption due to vomiting or diarrhea
Children who require higher serum concentration in a short period of
Time eg; sepsis, meningitis etc)
Children with resistant infections who require IV medications over a long period
Children with acute problems
Children who require continuous pain relief
Intravenous access
Intravenous therapy can be administered via peripheral catheter, peripherally
Inserted central catheter or central catheter. Common and easy access is via
peripheral catheter.
Guidelines for selection of IV site and catheter
1. The rate and type of fluid to be infused, the projected length of time and
availability of veins determine the site selection in children.
2. Consider the developmental level. The placement of an IV line in the
toddler’s foot will inhibit the child’s walking which is a newly acquired
skill
3. Avoid inserting IV line into a dominant hand if possible, because it
interferes with activities of daily living.Also; avoid insertion into
antecubital fossa as it restricts movement.
4. Scalp veins are sometimes used in children. Scalp veins have no valves and
can be used in either direction.iv catheters can be secured to allow infant to
move without dislodging the catheter.
5. Vein size and type of fluid to be infused or the nature of medication to be
injected often guides the selection of catheter.
1
6. Generally the smallest catheter through which fluids and medications can
be safely infused should be used. A 20 to 24 gauge provides adequate
access.
7. IV fluids are infused through over the needle catheter or butterfly cannula,
preferably over the needle catheter.
Guidelines for IV medications
1. Properly dilute the medication using the package directions
2. Check the length of time over which h it is safely administered
3. Check compatibility of different medication and fluids
4. Assess cumulative effect of drugs
5. Consider the rate of infusion the child may tolerate
6. Assess IV site prior to infusion
7. Medication labels to be placed on the IV bag, tubing.buretrol and infusion
pump to indicate that medicine is added
8. Follow IV medication with appropriate flush solutions to ensure that all
medication has been infused
9. Use an IV pump whenever possible to ensure a constant rate of drug
infusion
Calculating the daily maintenance fluid requirement
The daily fluid requirement is calculated on the basis of body weight
Up to 10 kg
10-20 kg
More than 20 kg
100ml/kg body weight
1000ml+50ml/kg for each additional kg
1500ml+20ml/kg for each additional kg over 20 kg
To determine the hourly rate divide the daily requirement by 24
Example: the daily maintenance fluid requirement for a child weighing 15 kg is
1000ml for the first 10kg +50ml/kg for each kg between 10-20 kg
=1000+ (50 X 5) =1000+250=1250ml/day
Hourly rate =Daily amount = 1250 = 52mls/hr
---------------- -----24 hrs
24
Commonly used administration sets
1. Burette set-macro drip---15drops/ml
2. Solusetmicro drip---60 drops/ml
3. Hemoset
10drops/ml
2
4. Syringepump /infusion pump
Calculating the infusion flow rate
Using the drop factor method
Flow rate =total volume of infusion X drop factor
--------------------------------------------Time of infusion in minutes
Example: a 2 year old infant is ordered 200 ml of DNS to be infused over 8 hours
using soluset. Calculate the rate of infusion/hr
Flow rate=total volume of fluid X drop factor
-------------------------------------------Time in minutes
Flow rate = 200 X 60
-------------= 25 drops/minute
8 X 60
Equipments for IV therapy
1. Local anaesthetic: Topical agent like EMLA cream, Numby Stuff, or
injectable buffered lidocaine unless in emergency
2. IV catheter of appropriate size and length
3. Tourniquet or rubber band
4. Nonsterile gloves
5. Alcohol swab
6. Sterile saline filled 3 ml syringe
7. Short T infusion primer set
8. Dressing material: cotton or gauze and tape, semipermeable transparent
dressing
9. Heparinised saline if heplock to be used
10. Prescribed IV fluid
11. IV tubing
12. Infusion pump
13. Material to secure line: tape, secure lock device, surgical net, padded arm
board
Procedure
Steps
rationale
Check the physicians order for IV fluids/
Prevent medication errors
3
Medication, verify the accuracy
Identify the patient by ID band
Identify the vein and insertion site. Apply
EMLA cream 1 hour before venipuncture
Wash hands
Assemble equipments
Prime T infusion set with sterile saline and
Keep syringe attached to primer set
Prepare infusion pump if needed and prime
with IV fluid
Prepare the IV medication if any according
to instruction
Prepare for the IV therapy in the medication
room
Take the equipments to the bedside
Put on non sterile gloves
Apply tourniquet above the proposed site
For scalp veins in infants a large rubber band
around the head with a gauze pad under the
band
Cleanse the area around insertion site with
antiseptic swab in circular motion
If local anesthetic is used clean with soft cloth
before cleaning with alcohol swab
Hold extremity of insertion with
Non dominant hand.
Using dominant hand remove the
protective sheath over the catheter and
puncture skin at a 45 degree angle with
the bevel up, parallel to vein
Reduce the angle of the catheter needle
Insert 1/8 to ¼ inch into vein until blood
appears in the catheter
Release tourniquet
Advance catheter into vein while gently
Removing inner needle from catheter,
Leaving only catheter in place
Stabilize the catheter with non dominant
Hand and connect primed extension tube to
Hub of the catheter
Initiate flow and assess for signs of
Prevent administration to
wrong patient
Reduce pain during insertion
Reduces transmission of infection
Efficient and quick insertion
Prevent air embolism
Prevents anxiety due to the sight
of needle
Standard precaution
Increase venous pressure and
Better visualization of the vessel
Decrease number of organisms
Keeps the extremity steady
Allows insertion into lumen
without puncturing the posterior
wall of the vein
Prevents rupture of vein
Establish catheter in place
Provides direct entry for IV fluids
and assesses patency of catheter
4
Infiltration
Secure catheter with gauze and tape or
Semipermeable transparent dressing
Connect the extension to the IV tubing
Begin IV fluids/ IV medication. Heparin lock
or saline lock for intermittent delivery
Secure line with additional tape and arm board
Label the site with date time and
initials of person
Discard used supplies
Remove gloves and wash hands
Comfort the child
Record the procedure according to hospital
Policy
Prevents accidental dislodgement
Transparent dressing provide
better visualization
Prevent accidental dislodgement
Identifies proper change timings
Standard precaution
Prevents transmission of infection
Reduce the effect of painful
procedures
Prevents duplication and is
legal document
Maintenance of infusion
Assess the IV site every hour for complication
Discontinue if indicated
Hang no more than 4 hours of fluids at any
one time during infusion.Use volume control
chamber
Change IV tubing using aseptic technique
every 72 hrs or when
contamination is suspected
Label tubing with date time and initials of
person who hung the tubing
Change IV site dressing when the site is soiled
damp or loose using aseptic technique
Label the dressing with date time and
initials of person who did the dressing
Removal of peripheral IV catheter
Wash hands
Collect all equipments
Explain the procedure
Put on non sterile gloves
Close clamp on IV set and extension
Remove tape and dressing from site
Ensures early detection of
complication
Prevents accidental overload
Limits bacterial contamination
Identifies proper change timings
Limits bacterial contamination
Identifies proper change timings
Reduce transfer of organisms
Reduces anxiety
Standard precaution
Stops flow and prevents potential
infiltration while removing
Allow access to site
5
Using gauze pad, apply slight pressure
over insertion site while withdrawing
catheter
Apply pressure over the site after catheter
is removed for 1-2 minutes
Remove gauze, assess for bleeding, infection
infiltration or phlebitis
Apply bandage over insertion site
Discard used supplies
Remove gloves and wash hands
Comfort the child
Prevents bleeding
Ensures detection of complication
Standard precaution
Prevents transmission of infection
Reduce the effect of painful
procedures
Record the procedure according to hospital
Policy
6