intravenous infusion - east lancashire hospitals infusion.pdf · · 2015-07-27intravenous...

Intravenous Infusion

Eileen Whitehead 2010East Lancashire HC NHS Trust

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• Patients receive intravenous fluids when they are unable to maintain an adequate fluid balance and need fluid replacement

• This may be due to the inability to take oral hydration or as the result of excess losses, leading to dehydration if left untreated

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• Despite getting plenty of fluids intra-operatively, most patients are usually dehydrated after an operation. There are several reasons for this:

– Poor oral intake prior to fasting for theatre

– Fluid and blood loss intra-operatively

– Direct blood loss

– Exposure of large internal surfaces to the heat and light of the theatre lights

– Fluid loss from respiration while incubated

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Other possible causes of dehydration:

– Swallowing problems – CVA / Maxfax problems

– GI problems eg perforation / obstruction

– Excessive vomiting / diarrhoea

– Haemorrhage

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What are the physical signs of dehydration?

– Hypotension

– Tachycardia

– Reduced Urine Output

– Increased Respiration

– Headache

– If a patient is dehydrated the blood results show an increase in sodium and urea

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CrystalloidV

Colloid

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• Crystalloid solutions – are solutions of ions (usually sodium and chloride) and or sugars (glucose) contained in water. Solutions commonly used are isotonic with plasma; therefore they do not alter the osmotic movement of water across cell membrane:– Normal saline– Dextrose solutions– Ringer’s lactate– Hartmann’s solution

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• Colloid solutions – Gelatinous solutions containing large particles resulting in the fluid being hypertonic. They exert an osmotic pull on fluids from the interstitial spaces into the intravascular space increasing the circulatory volume:

– Albumin

– Dextrans

– Haemaccel

– Gelofusine

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Colloids can produce dramatic fluid shifts and place the patient in considerable danger if they are not administered in a controlled

settings

Not recommended for normal post op fluid replacement

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Intravenous Infusion• Potassium is a commonly infused electrolyte in

or added to crystalloid fluids. However excessive serum potassium (hyperkalaemia) can cause cardiac arrhythmias and is therefore potentially life threatening

• What are the normal levels?

3.5 – 5.0 mEq/L

(Should we be adding 20 mmol per litre post op) 10


Most common post op fluid replacement:

• 0.9% Normal Saline – Think of it as ‘Salt and Water’– Principal fluid used for intravascular resuscitation and

replacement of salt loss e.g diarrhoea and vomiting

• 5% Dextrose – Think of it as ‘Sugar and Water’– Primarily used to maintain water balance in patients who

are not able to take anything by mouth;

– Often prescribed as 2 L x 5% Dextrose and 1 L Normal Saline x 24 hours

? Recent research identifies Hartman's as the gold standard in place of Normal Saline

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Fluid Prescription Chart – You must fill in all the details requested – familiarise yourself with those of the Trust (Manchester Charts)

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• Useful to record the patient’s weight if known

• All fluid charts should be reviewed every 24 hours

• Different colours may identify allergy

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Infusion Calculations:

A standard IV giving set delivers 20 drops /mlBlood giving sets deliver 15 drops / ml

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To calculate the infusion rate in ml /hr

Volume of solution (ml) = ml/hr

Number of hours

e.g. A patient requires 1 litre of fluids administered over 8 hours

1000 = 125 ml / hr

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To calculate the drip rate in drops/min

Volume (ml) X drops per ml Time (in minutes)

e.g. A patient requires 1 litre of fluids administrating over 8 hrs. How many drops per minute is this?

1000 X 20 = 42 dpm8 x 60

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A patient requires 1 L of 5% Dextrose to be given

over 12 hours. If you were using an infusion

pump how many ml/hr would it be set on?

1000 = 83.3 ml/hr

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285 ml of blood needs to be given over 2 hours.

How many drops/min would this be?

285 X 15 = 36 drops/min

2 X 60

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1L of 5% Dextrose needs to be given via a pump

over 16 hours, what rate would it need to run at?

1000 = 62.5 ml/hr

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Procedure

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Before you start:

• Check patients details

• Check prescription - infusion & transfusion chart

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Prescription Chart• Black indelible ink - legible• Contain – patient’s name, DOB, clinical area, hospital &

hospital number, named consultant. If <16yrssex/weight (legal obligation)

• Only one prescription chart in use at any one time –unless items prescribed exceeds available spaces

• Prescription should state type and strength of IV fluid and duration of infusion

• Time of administration must be clearly identified using 24 hour clock

• Check that the patient has not already received the infusion.

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• Select correct fluid

• Inspect outer packaging, any breach of packaging – do not use

• Check clarity of contents cloudiness, discolouration or particles may indicate contamination

• Check expiry date on the bag

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Which IV Administration Set?

Standard Set Blood Set

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Administration (Giving Sets)• Check expiry date of administration

set

• Check packaging intact prior to use

• Clear fluid sets – change after 72 hours, providing set has not been disconnected during that time

• Blood transfusion set – during transfusion change admin set every 12 hours

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The Patient

• Identify correct patient

• Final wrist band check.

• Explain the procedure & answer any concerns or queries the patient may have.

• Visual Infusion Phlebitis Score (VIPS/VAD)-every day including before and after each medication / IV fluid administration

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Priming the Administration Set• Don apron & WASH YOUR

HANDS!!!!!• Clean work surface/trolley• Wear gloves• Remember to use ANTT- identify

and protect the key parts• Open fluid bag and lay on flat

surface (minimise risk of puncturing bag)

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Remove bung/cover from fluid bag with a twisting movement

Open administration set & check integrity

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Holding the administration set in both hands -close the roller clamp

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Carefully remove sheath from IV administration set –taking care not to touch the sterile spike – this is a key part!

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Gently but firmly insert the spike of administration set into the bag of fluid using a twisting movement . Ensuring the main bag is punctured

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• Hang bag onto drip stand

• Gently squeeze the drip chamber until it is half full

• DO NOT OVERFILL – difficult to see drops forming

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• Open roller clamp fast to prime the line – ensuring no air is trapped around roller clamp

• Close roller clamp when fluid reaches the end of the set

• Remove any air bubbles by flushing

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• Remove priming bung from end of administration set

• Remember the end is sterile so do not touch!-ANTT

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• Check cannula site as previous

• Apply pressure on vein - above cannula site –in order to prevent blood back flowing out of cannula when bung removed

Wrong Right

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• Whilst maintaining pressure over the vein – with other hand remove the bung on the end of the cannula

• Take care not to touch key parts

• If blood flows out from cannula your pressure application is inappropriate!!

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• Attach primed administration set to cannula

• Discontinue pressure on vein

• Make sure the connection is secure

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• Open roller clamp

• Check drip chamber to ensure fluid running

• Check cannula site for signs of leakage!

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• Secure trailing administration set

• Documentation

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Complete Infusion and Transfusion Chart

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References:

Powell-Tuck et al (2009) Guidelines on IV fluid therapy for surgical patients http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf

Clinical Education Group (2003) Delivering Intravenous Fluids

Undergraduate Dept Lancashire Teaching Hospitals

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http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf

intravenous infusion - east lancashire hospitals infusion.pdf · · 2015-07-27intravenous...

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