Download IV Therapy

Intravenous Fluid
Administration
B260 Fundamentals of
Nursing
IV Fluid Administration:
Objectives
• Discuss purposes and procedures for
initiation, maintenance and
discontinuing an infusion.
• Explain the importance of infection
control in the management of
intravenous solutions, tubing, and
dressings.
• Discuss the complications of
intravenous therapy.
• Discuss the procedure for initiating a
blood transfusion and interventions to
manage a transfusion reaction.
Intravenous Therapy
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Goal: Correct or prevent fluids
and electrolyte disturbances
Allow direct access to the
vascular system
Requires close monitoring
Knowledge required: solutions,
equipment, procedures,
regulating flow, maintenance,
identifying and correcting
problems, and how to
discontinue
Intravenous Therapy: Types of Solutions
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Isotonic: same concentration as body fluids
including Blood, most common
use for volume replacement (eg. after
prolonged vomiting);
NaCl 0.9% normal saline,
D5W 5% Dextrose in water
Hypotonic: concentration lower than body
fluids
 Use to rehydrate the cells;
 0.45% NaCl or ½ normal saline
Hypertonic: concentration higher than body
fluids
 Used to increase vascular volume, use with
caution due to risk for fluid overload
 D5 0.45% NS
 D10W
 D5LR
http://www.youtube.com/watch?feature=player_de
tailpage&v=_slUL3kMZlU
Intravenous Therapy:
Additives
IV Fluids may contain additives:
• Hyperalimentation or Total Parenteral
Nutrition
• Lactated Ringers, D5LR
• Dextrose and saline combinations,
with added KCL
• KCL is commonly added to IV
solutions when patients are NPO;
body cannot conserve K
• Never give KCL IV push directly as
it may be fatal!
• KCL: administer slowly over several
hours and diluted
Intravenous Therapy:
Orders
Should contain:
• specific solution
• additives
• time schedule
• Example: D5½ NS with 20 meq
KCL
Follow 7 rights of medication
administration, same as with all
medications
Review: Seven Rights
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Right Person
Right Drug
Right Dose
Right Route
Right Time
Right Documentation
Right to refuse
IV Therapy: Equipment
Intravenous Therapy: Equipment
• Butterfly
Angiocath
• Saline lock
IV Therapy: Peripheral
IV Therapy: Peripheral Sites
Feet not recommended for
adults
IV Therapy: Starting an IV
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Review order
Get supplies
Explain to patient
Find best vein
Start distally
Perform venipuncture, secure, start
fluids
• Document
• Dressing should be transparent
IV Therapy: Angle of Entry
IV Therapy: Insertion with Flashback
http://www.youtube.com/watch?feature=pla
yer_detailpage&v=DHuOIcxJTIY
IV Therapy: Dressing
Intravenous Therapy: Equipment
Bottles,
Bags
IVPB
Tubing
IV Therapy: Administration
Sets
IV Therapy: Administration Sets
Intravenous Therapy: Equipment
Central lines
PICC lines
Implanted ports
IV Therapy: Central
Line
IV Therapy: Central
Line
IV Therapy: Central Line
Dressing
IV Therapy: PICC
Line
IV Therapy: PICC
Line
IV Therapy: Implanted Ports
IV Therapy: Implanted
Ports
IV Therapy: Implanted
Ports
IV Therapy: Hyperalimentation
IV Therapy: Lipids
IV Therapy: Assessment
Important areas to assess:
• Daily wt
• I&0
• Labs=Na+, K+, Cl, glucose, BUN
• Skin turgor
• Breath sounds
IV Therapy: Assessment
• Psychological responses
• Independence
• Condition of vein and surrounding
tissues
• Infiltration
• Phlebitis
• Infection
• Bleeding
• Circulatory overload
• Severe untoward reactions
IV Therapy: Complications
Extravasation
IV Therapy: Complications
Swelling-Edema from Infiltration
IV Therapy: Complications
Phlebitis
This child's IV site was completely wrapped, preventing proper assessment.
IV Therapy: Complications
Redness and Swelling
IV Therapy: Complications
Phlebitis
IV Therapy: Complications
This child’s antibiotic infiltrate went
untreated for a few days.
IV Therapy: Complications
Bruising
Intravenous Therapy:
Discontinue IV
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Review order
Explain to patient
Stop IV fluids, remove
dressing
Stabilize the cannula and
clean site
Cover with sterile gauze,
gentle pressure and remove
cannula
Apply pressure 2-3 minutes
and secure dressing
IV Therapy
Blood Administration
IV Therapy: Blood
Administration
Blood transfusion includes
any of the following :
• Whole blood
• Packed RBC’s
• Plasma
• Platelets
IV Therapy: Blood Products
IV Therapy: Whole Blood
IV Therapy: Blood
Administration
Purpose:
1. Increase blood volume
2. Treat anemia
3. Replace blood components
(clotting factors, platelets,
albumin)
IV Therapy: Blood
Administration
Blood Grouping
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“O” is universal donor
AB is universal recipient
A blood
B blood
Rh factor
If mismatched, transfusion reaction
may occur (mild  severe)
IV Therapy: Blood Transfusion
Guidelines for Safe Blood
Administration
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Blood tubing has an in-line filter
Prime with 0.9% normal saline
Educate patient
Assess patient for history of reaction
Consent signed
Checked by 2 RN’s
Vital signs: baseline, 15 minutes after
starting the infusion, when complete,
and prn.
IV Therapy: Blood
Transfusion
Guidelines for Safe Blood
Administration
• Stay with patient during first 15
minutes
• IV gauge: 18-19 preferred, 20g or less.
• Start blood within 30 minutes from
blood bank
• Administer slowly in first 15 min, then
increase rate as ordered or within 2 - 4
hours.
• Not longer than 4 hours - risk bacterial
contamination
• Use gloves to prepare and administer
IV Therapy: Transfusion
Reactions
Acute Hemolytic: Incompatibility to
antibodies causing RBC breakdown
• Signs & Sx: chills, fever, pain, flushing,
tachycardia, tachypnea, etc.
Febrile nonhemolytic:
• Sensitization to specific blood
components
• Signs & Sx: chills, fever, headache,
flushing, etc.
Mild allergic: sensitivity to plasma proteins
• Signs and Sx: flushing, itching, hives
IV Therapy: Transfusion
Reactions
Anaphylactic: reaction to blood proteins
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Signs & Sx: anxiety, itching, wheezing,
cyanosis, shock, etc.
Circulatory Overload: fluid administered
faster than the circulation can accommodate
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Signs & Sx: cough, dyspnea, pulmonary
congestion, headache, hypertension,
tachycardia, distended neck veins
Sepsis: contaminated blood
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Signs & Sx: chills, high fever, vomiting,
diarrhea, hypotension, shock
IV Therapy: Transfusion
Reactions
Management:
stop transfusion!
keep IV line open with 0.9%
normal saline
notify provider
stay with patient and monitor
(vitals, observe and treat)