IV Therapy - PowerPoint Presentation

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IV Therapy

Peggy D. Johndrow(edited by Dr. C. Scudmore)Slide2

IV Administration

Administer into circulatory systemLarge volume infusions: 250mL to 1000 mL

Bolus injection: IV pushVolume-controlled infusions: 50 mL to 250 mLPiggybackTandemVolume-control set

Mini-infuser pumpSlide3

IV Solutions

Isotonic: concentration most like bloodUsed to expand blood volume

Normal saline or 0.9% NaClLactated RingersHypotonic: concentration less than bloodUsed for dehydration

0.45% NaCl0.33% NaClHypertonic : concentration greater than bloodDraws fluid into vascular compartment; not for clients with kidney or heart problems

D5 NS

D5 1/2 NS

D5LRSlide4

Overview: IV Insertion

Use needle with catheter sheath20-22 gauge typical for adult

If blood transfusion anticipated , use 18 or 20 gaugeMost IV solution sets deliver 10 drops per mL, or 60 drops per mL (microdrop)IV solution should be clear; cloudy solutions may indicate contaminationSafety shield type of catheter required by OSHA; also called over the needle (ONC)Slide5

IV sites

PeripheralMetacarpal: top of the hand

Basilic & Cephalic typically used on forearmUse most distal part firstConsider type of solution to be infusedCentralIVs inserted into subclavian or jugular vein

GroshongTriple lumenImplanted portsPICC linesSlide6

Precautions for IV Sites

AvoidBony prominencesLegs & feet

Mastectomy armOperative armInjured armDialysis catheter or shuntSlide7

Documentation IV Start

Number of attemptsType of fluid/saline lock

Insertion siteType and size of catheter or needleFlow rateResponse to IVRecord response to IV fluid, amount infused integrity and patency of system every 1-2 hoursSlide8

Procedure for Hanging IV Fluid

Remove IV bag from protective coverCheck expiration date & assess for cloudiness or leaks

Hang the IV bag on a poleRemove IV tubing from its bag Close roller clampSpike the bagFill drip chamber 3/4

fullOpen the roller clamp & prime tubingClose roller clamp & replace protective capLabel the tubing with date to be changedAdjust roller clamp to appropriate drip rate or place into IV pump and set rateSlide9

Procedure Hanging IVPB

Open tubing same as IVClose roller clamp

Hang IVPB bag on poleSpike bag same as IVPrime tubingConnect IVPB tubing to IV tubingPlace wire hanger on pole

Lower IV bag on to hangerSet correct drip rateLabel the tubing with date to be changedSlide10

Preparation for IV

Check physician orderCheck fluid, electrolyte, and nutritional status for baseline information to make comparison of IV effectiveness

Know agency policiesAssess client understanding of reasons for procedure Assess veinsSlide11

IV Equipment

Obtain equipmentSafety catheter needleTourniquet

Chlorhexidine prepAlcohol swabsGlovesTowelTransparent dressingTape

IV tubing & solution bagIV pole and/or pumpSlide12

CHAIN OF INFECTION

Microorganism

Carrier

Person

Travel

Method

A way out

Skin puncture

Susceptible

PersonSlide13

Prevention of IV site infection

CDC guidelinesWash HandsUse sterile technique

Change IV solution q 24 hrsChange IV site every 48 to 72 hoursChange IV tubing every 48 hoursUse gloves & sharps containersCheck agency policySlide14

Client Education

Teach S&S of infection or problemsWhen to call for help

How to prevent IV from clotting or being pulled outArm positioningWalking with IV poleSlide15

Starting IV

Check client’s ID braceletWash hands

Organize equipment at bedside within reachSet bed height for ease of nursePut towel under armPlace tourniquet around upper arm

Palpate dilated veinsHang arm down to dilate veinSelect site low on arm firstRelease tourniquet (if anticipate a lot of time passing)Slide16

Prepare Site & Insert IV

Put on glovesClean the site Alcohol, then betadine (let dry)

Re-apply the tourniquet 1-2 inches above siteSecure vein by placing thumb 2-3 in below site and gently stretching skinStick vein (15 to 30 degree angle) with bevel of needle upWatch for flashback in chamberSlide17

Insert Catheter

Stabilize stylet and advance catheterLoosen stylet from catheterRelease tourniquet

Hold thumb over vein above catheter tipRemove stylet and attach IV tubing; put stylet in sharps containerConnect tubingSlide18

Start Fluid

Start IV fluid at slow rateSecure catheter

Transparent dressing over insertion siteTape over hub of catheterNo tape near site of insertionLabel site with date, time & initialsLabel tubing with date to be changed

ChartDate, time, type & gauge of catheter, dressing typeFluid attached as IVClients reaction to procedureSlide19

IV Flow Rate

Nurse responsible for flow rate maintenanceCan result in fluid overload leading to cardiovascular, renal or neurological impairment

Controlled by roller clamp, controller device or IV pump, & affected by client positionController device & roller clamp work with gravity (must be 36 inches above site)Slide20

Controller Device & Roller Clamp

Determine hourly rateDetermine drops/minute rate

Set rate by counting drips per 15 seconds & multiply by 4 to get drops per minuteMark time in hours on IV bag tape help keep the rate accurateReadjust rate as neededSlide21

IV Pump/Controller

IV pumps deliver IV fluids by exerting positive pressure on fluid tubingMost pumps alarm with an occlusion, but many times they continue to infuse even when infiltrated

Insert tubing into pump’s flow control chamber or pathSet rate in mLs per hour on the pumpSet the volume to be infused (VTBI)Press the start buttonMonitor a few minutes to be sure the pump is functioningSlide22

Intermittent Therapy or Saline LockMust be flushed at regular intervals with saline or heparin to maintain patency (usually q shift)

Flushes prevent clotting of catheter & maintain patency of IV siteFor intermittent access (meds)For potential access (telemetry)For tests (stress test, etc)Use push-pause technique

When client takes shower, cover IV site with plasticSlide23

Converting IV to Intermittent Therapy

Check the orderObtain equipment & take to bedside

Syringe with saline/heparinINT device & extension tubingCheck ID braceletInstruct clientWash handsDon glovesPrime INT device

Remove IV tubing & replace with INT device Tape securelyFlush with saline (3 mls)/heparin (as ordered)Slide24

IV Site Complications

Assess IV site for: Infection: redness, warmth, swelling & pain; possible fever, & site discharge

Infiltration: redness, edema at the site, burning pain, coldness, fluid will not flow by gravityBlood backflow does not always mean IV not infiltratedSlide25

Other IV Complications

Allergic reaction : rash, redness, itching, anaphylaxisCirculatory overload: dyspnea, cyanosis, JVD, edema, wt gain, ascites

Air embolism: decreased blood pressure, cyanosis, tachycardia, JVD, dyspneaSlide26

Macrodrops and MicrodropsSlide27

IV Tubing LabelSlide28

IV Tubing LabelSlide29

Math problemsSlide30

Calculating Rate in Drops per Minute

Formula

Volume x drop factor = gtts/minTime in minutes =60 x hoursSlide31

Calculating Rate in mL

per HourFormula:

Volume = mL/hrHours Slide32

Infusion Time

Formula:

Volume x drop factor (gtts/mL) = hours to infuseFlow rate (gtts/min) x 60Slide33

Calculation of Medication

Use ratio and proportionMedication amount available =

Amount to give Amount of mL X mLSlide34

Intermittent Therapy

Special adapter: flush with NS every shift; use push-pause technique to flush (push fluid in, pause, push fluid in, pause…),

if needle-less system clamp tubing while still pushing fluid; usually use 2-3 cc of NS to flushSAS : saline, additive (medication), salinePediatric clients: often use heparin solution to lock; SASH Slide35

IV Intake

Example: John's primary IV is running at 34 mL/hr while NPO. When the nurse runs the Vancomycin (250 mg IV q 8 hr) in over 90 minutes [volume is 100 ml], the primary IV is stopped. The ampicillin (395 mg IV q 6 hr) is given concurrently in 10 ml of fluid over 30 minutes. He received 2 boluses of aminophylline (20 ml each over 20 minutes). The IV fluids were stopped while the aminophylline infused. Since microtubing was used for the medications, total flush is negligible (approximately 3 ml). What is John’s total IV intake for 24 hours?Slide36

Calculate using the critical information

: Vancomycin runs 1.5 hrs x 3 doses = 4.5 hrs IV is stoppedPrimary IV flds 24 (hr) minus 4.5 = 19.5 hrs.

Primary fld stopped as aminophylline is infusing: 20 min x 2 = 40 minutesPrimary fld 19 hr 30 min. - 40 minutes = 18 hr 50min (18.83 hrs) x 34 mL = 640.22 mLSlide37

Calculation

Vancomycin: 100 cc x 3 = 300 mL Ampicillin 20 cc x 2 = 40 mL

Aminophylline 20 cc x 2 = 40 mL Normal saline flush (approx.) = 3 mL 640.22 + 300 + 40 + 40 + 3 =1023.22 mL/24hrsJohn's daily IV intake, based on all therapeutic modalities, is 1023.5 mLSlide38

Calculate Total Intake and Output

Example: Crystal has an IV infusing at KVO (10 mL/hr). She receives an antibiotic in 22.5 mL q 8° concurrently. One mL flush is given after each antibiotic. She is given 30 mL of formula q 3°. She had diaper weights of 17 mL, 33 mL, 55 mL, 45 mL, 52 mL, 50 mL, 15 mL, and 36 mL.

Calculate her I & O for the past 24 hours. Slide39

Intake:

IV @ 10 mL/hr x 24 hr = 240 mLMed of 22.5 mL x 3 (q8°) = 67.5 mLFlush of 1 mL x 3 = 3 mL

Formula of 30 mL x 8 (q 3°) = 240 mL240 mL + 67.5 mL + 3 mL + 240 mL = 550.5 mLCrystal's intake is 550.5 mL for the past 24 hours