intravenous therapy
TRANSCRIPT
INTRAVENOUS THERAPY
By: Jahzeel B. AcabEnzo Miguel Bandoquillo
Definition:
- is the infusion of a fluid into a vein to treat and prevent electrolyte imbalance or to deliver medication through a needle or catheter (cannula) into the blood stream.
- The fastest way to deliver medications
Why infuse IV Solutions?
Correct volume deficiencies of blood components. Provide nutrition while resting the gastrointestinal
tract. Administer safe and effective infusions of
medications using the appropriate vascular access.
Restore acid-base balance. Monitor central venous pressure (CVP). Maintain or replace body stores of water,
electrolytes, vitamins, proteins, fats, and calories in the patient who cannot maintain an adequate intake by mouth
Physiologic Principles
Body fluids are distributed in two distinct compartments, the intracellular and extracellular compartment.
Tissue cells are surrounded by a semipermeable membrane.
Osmotic pressure
Types of Fluids
Isotonic – Same osmotic pressure of plasma
Ex. 0.9 NSS, D5W and Lr Hypotonic – Less osmotic pressure
than plasmaEx. ½ NS and 0.33 NaCl Hypertonic – Exerts higher osmotic
pressure than that of plasma.Ex. D5LR, 3% NaCl, D5NSS
Common Types of Infusions
D5W - Used to replace water (hypotonic
fluid) loss, supply some caloric intake, or administer as carrying solution for numerous medications
Normal Saline- Used to replace saline (isotonic fluid)
losses, administer with blood components or treat patients in hemodynamic shock
Lactated Ringers - Used to replace isotonic fluid losses,
replenish specific electrolyte losses, and moderate metabolic acidosis.
Phillip’s 15-step Method of Starting a Peripheral Line
Phase StepPrecannulation(Preparation)
1. Check physician’s order.2. Wash your hands for 15 to 20
seconds.3. Prepare the equipment4. Asses the patient5. Select the site and dilate the
vein
Cannulation(Venipuncture)
1. Select the needle (catheter)2. Put on gloves.3. Prepare the site.4. Enter the vein using the
direct or indirect method5. Stabilize the catheter with
tape and apply a dressing.
Postcannulation (clean-up) 1. Label the site, tubing and bag.
2. Properly dispose of used equipment
3. Educate the patient.4. Calculate the drip rate, if
applicable.5. Document the procedure
Types of IV Administration
IV Push
Equipment:
syringe of appropriate size (either a needleless system or one with a 20G or 22G 1” needle)
alcohol or povidone-iodine pads Gloves Prescribed Drug
Preparation: If drug isn’t compatible with the patient’s IV
solution, also get two 3-ml syringes with 20G or 22G 1” needles and fill them with normal saline solution
Check your facility’s policy to see if you need another 3-ml syringe with heparin flush solution
Verify the order on the patient’s chart Make sure the drug is compatible with the IV
solution Check the expiration date, and reconstitute or
dilute the drug as needed Identify the patient by checking his/her armband Wash your hands and put on gloves
Procedure: Close the flow-control clamp on the existing IV
line Clean the Y-Port closet to the venipuncture site
with an alcohol pad or a povidone-iodine pad Insert needle of the syringe or the needleless
system into the Y-Port, and inject the drug at the prescribed rate
Remove the syringe of the Y-Port, open the flow-control clamp, and set the primary flow rate as prescribed
Discard used items according to standard precautions
Patient Teaching: Tell the patient the name of the bolus
drug, why you’re giving it, and any adverse effects he may experience or should report
Advise him to report pain, redness, swelling, or other problems with the insertion site
Continuous Infusion
Equipment: pump drug administration set with the device 3 ml syringe with a needleless system
or a 25G 5/8” needle flushing solution alcohol pads patency solution (if indicated) gloves
Preparation: Verify the order on the patient’s
chart Identify the patient by checking
his/her armband
Procedure: Make sure the clamp on the
administration set is closed and the line has no air bubbles in it
Patient Teaching: Tell the patient the name of the drug, why
you’re giving it and about adverse effects he may experience or should report
Advise him to report pain, redness, swelling, or other problems with the insertion site
If the patient will receive infusions at home, make sure he or a caregiver can administer them safely and correctly. Also make sure you teach how to care for the IV site and identify certain complications
Intermittent Infusions
Equipment: volume control set prescribed fluid syringe (needleless or with an
appropriate needle) filled with the prescribed drug
alcohol pad or antiseptic specified by your facility
gloves
Preparation: Verify the order on the patient’s
chart Identify the patient by checking his
armband Wash your hands and put on gloves Remove the volume-control set from
its packaging
Procedure: Prime the set with IV fluid Clean the injection port on top of the chamber,
and inject the drug into the chamber Gently rotate the chamber to mix the drug Place the label on the chamber that identifies
the drug, dose, time, and date Fasten the tubing to the injection port of the
primary line Either stop the primary infusion or set a low drip
rate so the line will be open when the secondary infusion stops
Open the lower clamp of the volume-control set, and start the infusion at the desired rate
When the chamber is empty, allow about 10 ml of IV solution to flow into it and through the tubing to flush the system, unless contraindicated
Discard the used items according to standard precautions
Patient Teaching Tell the patient the name of the drug
why you’re giving it, and any adverse effects he may experience or should report
Advise him to report pain, redness, swelling, or other problems with the insertion site
Piggy BackEquipment: prescribed drug (usually premixed in a minibag) continuous secondary tubing or piggy back extension
tubing extension hook 20G or smaller 1” needle or needleless system medication label (if you aren’t using a premixed
solution) alcohol pads 1” adhesive tape gloves
Preparation: If the drug is incompatible with the
primary IV solution, also get two 3-ml syringes with 22G 1” needles; fill them with normal saline solution
Check your facility’s policy to see if you need another 3-ml syringe with heparin flush solution
You may also need infusion pump or a time tape
Verify the order on the patient’s chart Identify the patient by checking his
armband wash your hands
Procedure: If you need to add a drug to a secondary IV
solution, remove any seal from the secondary container. Most solution bags have a sealed outlet and unsealed injection ports, whereas most bottled solutions have a seal covering their dual-outlet port
Clean the injection port with an alcohol pad Inject the prescribed drug into the solution
and gently agitate the container to thoroughly mix the solution
Patient Teaching: Tell the patient the name of the drug,
why you’re giving it, and any adverse effects he may experience or should report
Tell him to report pain, redness, swelling, or other problems with the insertion site
COMPLICATIONS
Infiltration
occurs when IV fluids enters the subcutaneous space & around the venipuncture site
Cause: Dislodgement of the IV cannula from
the vein results in infusion of fluid into the surrounding tissues
Preventions: Ensure that IV and distal tubing are secured
sufficiently with tape to prevent movement Splint arm or hand as necessary Check IV site frequently for complications Proper venipuncture technique
Interventions: Stop infusion immediately and remove IV
needle or catheter Restart IV in the other arm If infiltration is moderate to severe, apply
warm, moist compresses and elevate limb Document interventions and assessment
Thrombophlebitis/Phlebitis inflammation of vein often
accompanied by clot formationCauses: Injury to vein during venipuncture,
large-bore needle/catheter use Irritation to vein due to rapid
infusions or irritating solutions Slow infusion rate due to clot
formation at the end of the needle/ catheter
Preventions: Anchor needle or catheter securely at
insertion site Change insertion site at least every 72
hours or according to hospital policy Use large vein for irritating fluid because
of higher blood flow, which rapidly dilutes irritant
Sufficient dilute irritating agents before infusion
Interventions: Apply cold compress immediately to
relieve pain and inflammation Discontinue IVF and remove
catheter/needle immediately Follow the moist, warm compresses
to stimulate circulation and promote absorption.
Document interventions and assessment
Bacteremia/Septicemia
contamination of IV site and solution which results to fever, chills and general malaise.
Causes: Incorrect insertion of catheter Contaminated equipment or infused
solution The critically ill or immunosupressed
patient is at greatest risk of bacteremia
Prevention: Practice good handwashing Use strict asepsis when inserting IV or
changing IV dressing Observe IV site routinely Provide routine care along with proper
dressing Maintain integrity of infusion systemIntervention: Discontinue IV line and restart it in
another vein as ordered Notify physician
Circulatory Overload
a condition which results when a client receives IV fluid faster than the body can distribute and excrete.
Causes Delivery of excessive amount of IV
fluids
Preventions: Always monitor intake and output
when patient has an IV line Know patient cardiovascular history Splint arm or hand if IV flow rate
fluctuates too widely with movementInterventions: Decrease IV to KVO rate- 10gtts/min Raise patient’s head to facilitate
breathing Keep patient warm to promote
peripheral circulation
Air Embolism an abnormal circulatory condition in
which air gas travels through the bloodstream and becomes lodged in a blood vessel.
Causes: Air enters the catheter during tubing
changes Air in tubing delivered by IV push or
infused by infusion pump
Prevention: Clear all air from tubing before infusion Change solution containers before they
run dry Ensure that all connections are securedIntervention: Immediately, turn patient on his/her left
side and lower head of the bed Notify the physician immediately Administer oxygen PRN Stay with the patient Document interventions and assessment
Hemorrhage/Bleeding
Causes: Loose connection of tubing or
connection port Inadvertent or accidental removal or
peripheral or central catheter Anticoagulant therapy
Preventions: Tape all catheters securely- use
transparent dressing when possible for peripheral or central catheters. Tape the remaining catheter lumens in a loop so tension is not directly on the catheter.
Keep pressure on site at least 10 minutes after removal of catheter for anticoagulated patients.
Interventions: Pressure dressing may be applied over
the site to control the bleeding Notify the physician.
Venous Thrombosis
Causes: Infusion of irritating solutions Infection along catheter may
preclude this syndrome Fibrin sheath formation with eventual
clot formation around catheter. This clot will eventually occlude vein.
Preventions: Ensure proper dilution of irritating
substances Ensure superior vena cava catheter tip
placement for irritating solutionsInterventions: Stop fluid immediately and notify health care
provider Reassure patient and institute appropriate
therapy: Anticoagulants Heat Elevation of affected extremity Antibiotics
IV Computations
Delivery System Microset – 60gtts/ml Macroset – 15gtts/ml Bloodset – 10gtts/ml
Formulas
Rate of Infusion/Flow Rate – drops of fluid to administer per minute (gtts/min)
FR= (ml of solution prescribed per hour) x (drops delivered per ml) 60min/hr
Example: An order has been written for a patient to receive 500ml
of 5% dextrose in water (D5W) over a period of 5 hours in a standard Microdrip system. Find the rate of infusion.
Hourly Volume
ml/hour = total volume total time ORHV = Flow Rate x (60min/hr) Drop FactorExamples:
A patient is to receive 1000ml of 5% dextrose in D5LR over a period of 5 hrs. How many ml will the patient receive in an hour?
Length of Time of InfusionL = total volume HVExamples:
A patient is to remove 720ml of 5% dextrose in LR at 15gtts/min. How long will the IVF be consumed?
At 7am, #2 D5LR is at 960ml running at 20gtts/min. How long will the IVF be consumed and at what time will it be consumed?