professor hill, rn,mn,msg. maintain daily fluid balance resore & maintain acid-base balance ...

IV THERAPYPROFESSOR HILL, RN,MN,MSG

ANATOMY

MAINTAIN DAILY FLUID BALANCE RESORE & MAINTAIN ACID-BASE BALANCE

ROUTE FOR MED ADMINISTRATION ROUTE FOR BLOOD/BLOOD PRODUCT ADM

NUTRITIONAL SUPPORT

PURPOSE

Tunica Intima - inner layer

Tunica Media - middle layer

Tunica Adventia - outer layer

LAYERS OF THE VEIN

VALVES

INJECTIONS OF A SOLUTION/MEDICATION/ BLOOD OR BLOOD PRODUCT IN THE VENOUS SYSTEM

MOST RAPID & EFFECTIVE ROUTE OF MEDICATION ADMINISTRATION

BENEFITS: IMMEDIATE RESULTS

WHAT IS IV THERAPY?

ELDERLY POPULATION

Tunica Intima becomes thickens & less smooth

↑ed risk of platelet aggregation & thrombus formation

Lumen is smaller due to thickening

Slower perfusion Small spidery veins

ELDERLY POPULATION

YOU MUST KNOW:

FLOW RATE DROP FACTOR PRIMARY BAG PRIMARY LINE SECONDARY BAG SECONDARY LINE

TERMINOLOGY

IV FLOW

IV FACTORS (MUST KNOW)

FLOW RATE DROP FACTOR

THE NUMBER OF DROPS PER MINUTE (GTTS/MIN) DELIVERED.

# OF DROPS PER mL DETERMINED BY SIZE

OF LUMEN IN DRIP CHAMBER OF IV TUBING

MICRODRIP = 60 gtts/mL

BLOOD = 10 gtts/mL PRIMARY= 15 gtts/mL

SPIKE & DRIP FACTOR

IV BAGS

IV BAG

IV TUBING

IV CATHETERS

PROVIDES IV ACCESS INTERMITTENT INJECTION CAP

INFUSION OF SOLUTIONS/MEDICATIONS FLUSH WITH NORMAL SALINE

INFUSE MEDICATION FLUSH WITH NORMAL SALINE

SALINE/HEPARIN LOCK

A SET AMOUNT OF SOLUTION THROUGH AN INTERMITTENT INJECTION CAP

ENSURE PATENCY OF A DEVICE NOT IN CONTINUOUS USE

SOLUTIONS ARE TYPICALLY NORMAL SALINE (0.9%) OR HEPARIN SOLUTION

THAT IS 100 U/mL

FLUSH

IV PUMP

IV THERAPY THAT IS ADMINISTERED THROUGH A VEIN IN THE HAND, ARM, OR LESS FREQUENTLY THE LEG OR FOOT.

IDEAL FOR SHORT TERM USE.

PERPHERAL VENOUS CATHETER

- IV THERAPY ADM THROUGH A LARGE CENTRAL VEIN, R/L SUBCLAVIAN OR

JUGULAR USE FOR LARGE VOLUMES OF FLUID,

HYPERTONIC SOLUTION, MEDICATIONS, TPN

IDEAL FOR LONG TERM USE

CENTRAL VENOUS CATHETERS

INTERESTING???

INTRACELLULAR

INTERSTITIAL

INTRAVASCULAR

FLUID COMPARTMENTS

ISOTONIC SOLUTIONSEQUAL CONCENTRATION AS SERUM & OTHER BODY FLUIDS

SALINE/HEPARIN LOCK

HYPERTONIC SOLUTION

HYPOTONIC SOLUTIONS

IV SOLUTIONS

CRYSTALLOIDS COLLOIDS

ISOTONIC – NS, LR, D5W

HYPOTONIC – 0.45%NS, D51/2NS

HYPERTONIC -3%NS, D10W, D20W, TPN

BLOOD

BLOOD PRODUCTS

PLASMA EXPANDERS

IV SOLUTIONS

SOLUTIONS % IN SOLUTIONS

Body fluid compartments are affected depending upon the osmolarity of the IV solution in comparison to the patient’s serum osmolarity.

IV solution can actually expand one compartment while depleting another.

GRAMS OF DRUG PER 100 mL OF FLUID

E.G: D5w IS 5% DEXTROSE IN WATER

HYPERTONIC CONSIST OF NUTRIENTS GIVEN TO MALNOURISHED PTS UNABLE TO

EAT OR DRINK FOR LONG PERIODS OF TIME SHOULD BE INFUSED IN CENTRAL

CIRCULATION

OBSERVE FOR HYPERGLYCEMIA

TOTAL PARENTERAL NUTRITION(TPN)

COMPLICATIONS

INFILTRATION THROMBUS

LEAKAGE OF IV FLUID OR MEDICATION INTO THE EXTRACELLULAR TISSUE

COMMONLY CAUSED WHEN IV CATH SLIPS OUT OF THE VEIN

IV COMPLICATIONS

PHLEBITISTENDERNESS & PUFFINESS @ SITE

VEIN HARD WITH PALPATION

WARM @ SITE

INCREASED TEMP

REDNESS AT TIP & ALONG VEIN

SYSTEMIC COMPLICATIONS

PROBLEMS S/S

INFECTIONS - BACTREMIA, SEPTICEMIA

CIRCULATORY OVERLOAD

AIR EMBOLISM

FEVER, CHILLS MALAISE, CONTAMINATED IV SITE

SOB, RESP DISTRESS CRACKLES, ORTHOPNEA, INCREASED BP

SUDDEN CP, UNEQUAL BREATH SOUNDS, WEAK PULSE, TACHY,↓ BP,↓ LOC,↓

INTERVENTIONS

LOCAL SYSTEMIC

STOP INFUSION MAY APPLY HEAT IF

NOT CONTRAINDICATED

ELEVATE MONITOR RESITE & DOCUMENT

AIR –TRENDELENBURG POSITION & PLACE ON LEFT SIDE , ADM O2, CALL HELP

NOTIFY MD DOCUMENT OVERLOAD-PULSE OX,

↑HOB, O2, NOTIFLY MD, ADM MEDS AS ORDERED (LASIX)

PROFESSIONAL ORGANIZATION - SETS STANDARDS OF CARE FOR CLINICIANS PRACTICING IN THE FIELD OF INFUSION THERAPY

STANDARDS SET BY INS ARE RELECTED IN POLICIES & PORCEDURES RELATED TO INFUSION THERAPY

IN COURT OF LAW, THE STANDARDS SET BY INS ARE USED TO ASSESS CLINICIAN’S PERFORMANCE

INFUSION NURSES SOCIETYWWW.INS1.ORG

RESOURCES

QUESTIONS