IV THERAPY

DEFINITION OF TERMS

 Hypotonic - solutions that have a lower osmolality than body fluids

 Hypertonic - solutions that have a higher osmolality than body fluids
 Isotonic - solutions that have the same osmolality as body fluids
 Phlebitis – an inflammation of the vein that can result mechanical or chemical
trauma or local infection
 Infiltration – seepage of IVF out of the vein and into the surrounding interstitial
space

DEFINITION OF TERMS

 Air embolism – obstruction caused by a bolus of air that enters the vein through
an inadequately primed IV line, from a loose connection, or during tubing change
or removal of IV line
 Catheter embolism – obstruction that results from breakage of the tip of the
catheter during IV line insertion

IV THERAPY

 lIntravenous (iv) therapy is the insertion of a needle or catheter/cannula into a

vein, based on the physician’s written prescription. The needle or catheter /
cannula is attached to a sterile tubing and a fluid container to provide medication
and fluids.

IV THERAPY

 Is used to sustain clients who are unable to take substance orally

 Replaces water, electrolytes and nutrients more rapidly then oral administration
 Provides immediate access to the vascular system for the rapid delivery of
specific solutions
 Provides a vascular route

TEN GOLDEN RULES FOR ADMINISTERING DRUG SAFELY

 Administer the right drug

 administer the right drug to the right patient.
 Administer the right dose
 Administer the right drug to the right route
 Administer the right drug to the right time
 Document each drug you administer
 Teach patient about the drugs he is receiving
DOCUMENTATION OF IV THERAPY

 Proper documentation provides:

 an accurate description of care that can serve as legal protection
 a mechanism for recording and retrieving information

INFORMATION WRITTEN ON IV TAPE

 size, type and length of cannula/ needle

 name of person who inserted the IV catheter
 date and time of insertion

Label the IV solution specifying

 type of IV fluid
 medication additives and flow rate
 use of any electronic infusion device
 duration of therapy and the nurse’s name and signature

TEN GOLDEN RULES FOR ADMINISTERING DRUG SAFELY

 Take a complete patient drug history. (There is a risk of adverse drug reactions
when a number of drugs are taken or when patient is taking alcohol drinks)
 Find out if the patient has any drug allergies
 Be aware of potential drug to drug or drug to food interactions. To protect your
patients or your license.

TONICITY OF IV FLUIDS

 0.45% SALINE (1/2 NS) Hypotonic

 0.9% NS Isotonic
 5% dextrose in water D5W Isotonic
 D5 ¼ NS Isotonic
 Lactated Ringer’s solution Isotonic
 D5LR Hypertonic
 D5 ½ NS Hypertonic
 D5 NSS Hypertonic
 D10W Hypertonic

TYPES OF SOLUTIONS

 Hypotonic - solutions that have a lower osmolality than body fluids

 Hypertonic - solutions that have a higher osmolality than body fluids
 Isotonic - solutions that have the same osmolality as body fluids
  Crystalloids – solutions that contain electrolytes (fluid volume replacement)
 Colloids/ plasma expanders – pull fluid from the interstitial compartment into the
vascular compartment (hge or hypervolemia)

IV Cannulas

 Steel needle of butterfly sets

o Wing tip needle with a metal cannula
o Needle is 0.5 – 1.5 inches in length (G16 -26)
o Use in small and fragile bones
o Infiltration is more common
 Plastic needle
o Use in short term therapy
o Use for rapid infusion and more comfortable for the client
o In-needle catheter can cause catheter embolism

IV GAUGES

 Gauge 14 – 25
 The smaller the gauge the larger the outside diameter
 G14 -19 – for rapid fluid administration (blood products or anesthetics)
 G20 - 21 – for peripheral fat infusion
 G22 - 24 – STD IV fluid and clear liquid medication
 G24 - 25 – for very small veins

IV CONTAINERS

 Glass or plastic
 Do not write the plastic IV bag with marker pen

IV TUBING

 Contains the spike end, drop chamber, roller clamp, Y – site and adapter end
 Use of vented or non – vented tubing
 Shorter secondary tubing – use for piggyback solutions, connecting them to the
injection site

DRIP CHAMBER

 Microdrip
o Are used if fluid will be infused at 50cc/ hr
o Used if solution contains potent medication that needs to be titrated
o Delivers 60drops/ ml
  Macrodrip
o Use if solution is thick or need to infuse rapidly
o Delivers 10 – 20drops/ ml

FILTERS

 Filters provide protection by preventing particles from entering the client’s veins
 Filters are used in IV lines to trap small particles such as undissolved antibiotics
or salt or medications that have precipitated in solution
 Assess the agency policy regarding the use of filters
 A 0.22-um filter is used for most solutions, a 1.2-um for solutions containing
lipids or albumin, and a special filter for blood components

NEEDLELESS SYSTEMS

 Needleless systems include recessed needles, plastic cannulas, and one-way

valves; these systems decrease the exposure to contaminated needles
 Do not administer total parenteral nutrition or blood products through a one-way
valve

INTERMITTENT INFUSION SETS

 Intermittent sets are used when intravascular accessibility is desired for

intermittent administration of medications by IV push or IV piggyback
 An IV lock is attached for intermittent infusion devices
 Patency is maintained by periodic flushing with normal saline solution (sodium
chloride and normal saline are interchangeable names)
 When administering medication, flush with 1 to2 mL (depending on agency
policy) of normal saline to confirm placement of the IV cannula; administer the
prescribed medication, and then flush the cannula again with 1 to2 mL (depending
on agency policy) of normal saline to maintain patency

SLECTION OF PERIPHERAL IV SITE

 Veins in the hand, forearm, antecubital fossa, scalp and feet

 Assess the veins of both arms closely before selecting a site
 Start IV infusion distally
 Determine the clients dominant side
 Bending the elbow on the arm with IV may obstruct the flow causing
thrombophlebitis and infiltration
 Use an armboard as needed in the area of flexion
ADMINISTRATION OF IV SOLN

 Check the IV solution for the type amount, percent of solution and rate of flow
 Assess the health status and medical disorders
 Wash hands thoroughly and use sterile technique
 Prime the tubing to remove air from the system

ADMINISTRATION OF IV SOLN

 Change the IV site every 48 – 72 hrs

 Change the IV dressing every 72 hrs especially when wet and contaminated
 Change the IV tubing every 24 to 72 hrs
 Label the tubing, dressing and solution bags indicating the date and time when
changed
 Before adding med or solutions, swab access ports with 70% alcohol

COMPLICATIONS

 Infection – redness, swelling and drainage at site; chills, fever, malaise, headache
 Tissue damage – skin color change, sloughing of skin, discomfort at site
 Phlebitis – heat, redness, tenderness, not hard and swollen
 Thrombophlebitis – heat, redness, tenderness, hard and cordlike vein
 Infiltration – Edema, pain, and coolness at the site

COMPLICATIONS

 Catheter embolism – decrease BP, pain along vein, weak, rapid pulse, cyanosis of
nail beds, loss of consciousness
 Circulatory overload – increased BP, distended jugular veins, rapid breathing,
dyspnea, moist cough and crackles
 Electrolyte overload – signs depend on the specific electrolyte imbalance
COMPLICATIONS

 Hematoma – ecchymosis, immediate swelling and leakage of blood at the site,

and hard painful lumps at the site
 Air embolism – tachycardia, dyspnea, hypotension, cyanosis, decreased level of
consciousness

COMPUTATIONS

 gtts/min = volume in cc x DF

nos. of hrs x 60 min

 nos. of hrs = volume in cc x DF

gtts/ min x 60 min

 cc/ hr = volume in cc

number of hours

 Infusion time = total volume to infuse

ml/ hr being infused

CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR

 Two Steps

1. determine the amount of medication/ ml

2. determine the infusion rate or ml/ hr

 Amount of medication/ ml
o med/ ml = known amount of medication
o total volume of diluent
 Infusion rate
o ml/ hr = dose per hour desired
o concentration per ml

CALCULATION OF INFUSION OF UNIT DOSAGE PER HOUR

 PROBLEM
 Order: continuous heparin Na by IV at 1000 units per hour
  Available: IV bag 500 ml D5W with 20,000 unit of heparin Na
 How Many ml/hr are required to administer the correct dose

ANSWER

 Conc/ ml = 20, 000 units

500 ml

=40 units/ ml

 ml/ hr = 1000 unit

40 units

=25 ml/ hr

Types of BLOOOD COMPONENTS

 RBC
 Whole blood
 Platelets
 FFP
 Albumin
 cryoprecipitate

RBC

 Used to replace erythrocytes

 pRBC (250ml)
 Increases the hemoglobin by 1g/dl and hematocrit by 2 - 3 %
 Acute and chronic anemia

WHOLE BLOOD

 Use to resolve hypovolemic shock resulting from excessive bleeding

 500ml
 Rarely use

Platelets

 Use to treat thrombocytopenia and platelet dysfxn

 X – matching is not required
 50 – 70ml /unit or 200 – 400ml/ unit
  Administer immediately and given for 5 – 30min
 Evaluated after 1 hr and 24 hrs after transfusion

FFP

 Use to provide clotting factors or volume expansion

 Infused within 6 hours of thawing
 Infused as rapidly as possible
 X- matching is needed
 PT and aPTT

ALBUMIN

 Use to treat hypovolemic shock or hypoalbuminemia

 Prepared from plasma and can be stored for 5 years
 25g/100ml of albumin = 500ml of plasma

CRYOPRECIPITATES

 Use to replace factor VIII and fibrinogen

 Prepared from FFP
 Can be stored for 1 year but once thawed, the product must be used

TYPES OF BLOOD DONATION

 Autologous
 Blood salvage
 Designated donor

AUTOLOGOUS

 Donation of the clients own blood before the scheduled procedure

 Reduces the risk of disease transmission and potential transmission complications
 Can be made every 3 days as long as hemoglobin remains with in a safe range
 Donation should be made within 5 weeks of the transfusion date and end at least 3
days before the date of transfusion

BLOOD SALVAGE

 An autologous donation
 Involves suctioning of blood from body cavities, joint spaces
 Blood may need to be washed by a special process that removes tissue debris
before reinfusion
DESIGNATED DONOR

 When recipients select their own compatible donors

 Does not reduce the risk of contracting infection but they feel comfortable

COMPATIBILITY

 Rh type and ABO type are identified

 Use to prevent transfusion rxn
 Crossmatching – the testing of donors blood and the recipients for compatibility

COMPLICATIONS

 Transfusion rxn
 Circulatory overload
 Septicemia
 Iron overload
 Disease transmission
 Hypocalcemia and citrate intoxication
 Hyperkalemia

NURSING INTERVENTION

 A large volume of blood transfused rapidly through a central catheter into the
ventricle of the heart will cause cardiac dysrhythmias
 No solutions other than NS should be added on blood components
 Infusion should not exceed more than 4 hrs
 Medication are never added to blood components
 Blood administration set should be changed every 4 - 6 hrs

NURSING INTERVENTION

 Check the date of expiration

 Inspect he blood for abnormal color, leaks, clots, bubbles
 Blood must be administered 20-30 minutes from its being received from the blood
bank
 Never refrigerate blood in refrigerator other than blood bank
 Monitor vs and assess lung sounds

NURSING INTERVENTION

 2 RN need to check the physicians order, clients identity, clients identification

band
 Check the blood bag tag, label and blood requisition form
CLIENT ASSESSMENT

 Assess for any cultural or religious beliefs

 Informed consent has been obtained
 Check the clients vital sign and medical status