Download IV Therapy and Blood Administration

IV Therapy
Vema Sweitzer, MN,RN
1
Vascular Access Devices (VADs)
• Peripheral catheters: short term use (after surgery or a
procedure)
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Vascular Access Devices (VADs)
• Central Catheters: long-term use (chemo
therapy, PN)
• More effective than peripheral catheters for
administering large volumes of fluid, PN and
medications
3
IV Therapy: Implanted Ports
Vascular Access Devices (VADs)
• Central Catheters: long-term use (chemo
therapy, PN)
• PICC: Peripherally inserted central catheters
5
IV Therapy: Peripheral Sites
Feet not recommended for adults
IV Therapy: Starting an IV
• Review order
• Get supplies
• Explain to patient
• Find best vein
• Start distally
• Perform venipuncture, secure, start fluids
• Document
• Dressing should be transparent
Complications of Intravenous
Therapy
Circulatory overload
• Caused by infusing excessive
amounts of isotonic or
hypertonic crystalloid solutions
to rapidly, failure to monitor
the IV infusion or too rapid
infusion of any fluid in a
patient compromised by
cardiopulmonary or renal
disease
Circulatory Overload
Circulatory Overload
• NI/Treatment
• Plan ahead if patient is to receive a lot
of fluid
• Stop the fluids and contact the HCP
immediately for new orders.
• Continue to monitor the patient and
anticipate doctor’s orders:
• Oxygen
• Diuretics
Infiltration
• Occurs with IV becomes dislodged or a vein ruptures and IV
fluids enter subcutaneous tissue
• Nursing Assessment:
Infiltration
NI/Treatment
Prevention
• Remove the IV catheter
• Apply warm soaks to
aid in absorption (check
hospital’s policy)
• Elevate the limb
• Notify the HCP if severe
• Assess circulation
• Restart the infusion in
the other arm
• Document the patient’s
condition and your
interventions
• Check the IV site
frequently
• Don’t obscure area
above site with tape
• Teach the patient to
report discomfort, pain
swelling
Documentation
Infiltration Scale
Extravasation
• The inadvertent administration of a vesicant solution into
surrounding tissue
• Signs/symptoms
Extravasation
NI/Treatment
• Immediately stop the
infusion and remove the
device
• Elevate the affected limb
• Apply cold compress to
decrease edema and pain
• Apply moist heat to
facilitate the absorption
of fluid at grossly
infiltrated site
Prevention
• Check the IV site frequently
• Don’t obscure area above site with
tape
• Teach the patient to report
discomfort, pain swelling
• Drugs that can cause Necrosis
• Calcium chloride
• Calcium gluconate
• Vancomycin
• Cancer Chemotherapy drugs
Phlebitis
• An inflammation of the vein in which the
endothelia cells of the venous wall become
irritated and cells roughen, allowing platelets to
adhere and predispose the vein to inflammationinduced phlebitis
• Causes
• Injury during venipuncture
• Prolonged use of the same IV site
• Irritation/incompatible IV additives
• Use of vein that is too small for the flow rate
• Use of needle size too large for the vein size
Phlebitis
Signs/symptoms:
NI/Treatment
• Upon assessment of
phlebitis, remove the
needle
• Avoid multiple insertion
attempts
• Application of warm
compress
• Continuously monitor
the patient’s vital signs
Documentation
Phlebitis Scale
Local Infection
• Caused by poor aseptic technique during
catheter insertion
• Signs/symptoms
Hematoma at the IV Site
• Hematoma: formations resulting from
the infiltration of blood into the tissues
at the venipuncture site
• Causes: nicking the vein during an
unsuccessful venipuncture attempt,
discontinuing the I.V. cannula or needle
without pressure, applying a tourniquet
too tightly above a previously attempted
venipuncture site
Hematoma at the IV Site
• Signs/symptoms:
• Discoloration
• Site swelling and discomfort
• Prevention and treatment
Blood Seepage into the Extravascular Tissue
• Causes
• Coagulation
defects
• Inappropriate use
of tourniquet
• Unsuccessful
insertion attempts
• Little pressure
upon removal of IV
catheter