iv therapy indications.pp
TRANSCRIPT
IV Therapy Indications
fluid volume maintenance, fluid volume replacement, med
administration, blood administration, TPN, emergency
line,
faster absorption, rapid distribution, emergency access, unconscious patient
Advantages of IV Therapy
70% isopropyl alcohol inhibits bacterial growth, apply with friction; Iodine, inhibits
bacterial growth, penetrates cell wall
Infection Control in IV
PICC-every 6 weeks, IV inserted by paramedic w/in 24 hours, Peripheral site every 72 hours, Blood and TPN every 24 hours, CVC every 48-72 hours or 3xper week.
IV and Dressing Changes
assess site whenever in room, document at least every 8 hours, site CDI (clean, dry, intact), sterile technique, changine tubing and solution, awareness of complications, awareness of fluid types, 5 rights
Nursing Responsibilities for IV Sites
Pain and irritation, infiltration and exravasion, occlusion, loss of patency, phlebitis, fluid overload
Complications of IV Therapy
increase amt of dilutent, arm board
Pain and Irritation of IV-intervention
seepage of IV fluids into tissue when IV cath penetrates vein
Infiltration
escape of irritating agent into tissue
Extravasion
swelling, pain, cool to touch, decreased flow, wet dressing, no back flow.
Extravasion and Infiltration Assessment
catheter permeates vein, poor taping of site, over manipulation
Causes of Infiltration and Extravasion
Intervention for Infiltration and Extravasion
Remove IV, cold compress
kinked tubing, patient lying on tubing, infusion too slow
Occlusion Causes
Occlusion Assessment IV stops dripping
milk IV, aspirate, irrigate (if no resistance OK, if resistance may be clot>
Occlusion Intervention
don't let IV run dry, flush periodically with 1-5 cc of NSS and before and after any
intermittent IV therapy.
Occlusion Prevention
bacterial, chemical, mechanical
Phlebitis Causes
Phelebitis Intervention
remove IV, cold compress
erythemia, pain or burning, warmth, edema, cordlike vein.
Phlebitis Assessment
IV left in too long
Bacterial Phlebitis possible cause
Chemical Phlebitis Cause irritating fluids
clot at tip of cannula, cath too large for vein.
Mechanical Phlebitis
clear fluids, dextrose of saline, can be Iso, Hypo or Hyper tonic
Crystalloids
cloudy, yellowish, used to raise osmotic pressure, Dextran is clearish
Colloids
Hypotension (increases BP), Hypovolemia
Indications for Isotonic IV
fluid overload
Complications of Isotonic IV
0,9% NSS, D5W(isotonic in bottle, hypotonic in body), Lactated Ringers
Examples of Isotonic Solutions
Will cause fluid to shift from intravascular to intracellular space.
Indications for Hypotonic IV
dehydration
Indications for Hypotonic IV
.45% sodium chloride, 5%dextrose water (becomes hypotonic in body)
Hypotonic Solutions
May cause edema
Complications of hypotonic solution
low bp, slight edema but not w/CHF, pulls fluid from intracellular space to intravascular space
Indications for hypertonic IV
Not as strong as Albumin, 10% Dextrose in Water D10W, 5% normal saline, D5 Ringers Lactate
Hypertonic IV Solution
more fluid in bloodstream can cause circulatory overload.
Complications of Hypertonic IV
Patient Controlled Analgesia
PCA
drug dosage, lockout period, basal rate
3 settings of PCA
inadequate vascular access, complex treatment regimes, hyperosmolar infustions ie parenteral nutrition, irritating or vesicant druges, (ie. dopamine cancause necrosis) rapid absorption, long term therapy.
Central Venous Therapy Indications
altered skin integrity, anomalies of central vasculature, cancer in area, coagulopathies, fractured clavicle, septicemia, radiation to insertion site
Contraindications for Central venous therapy
subclavian, jugular, femoral vein, cephalic vein(is peripheral but the line runs to central area)
Common insertion pathways for Central Venous Therapy
Air embolism, pneumothorax, sepsis,chest pain, confusion, hypotension, dyspnea, pallor, tachycardia, tachypnea, unresponsiveness
Risks and Complications of Central Venous Therapy
amino acids, carbohydrates, electrolytes, minerals, vitamins, lipids, other (ie insulin
Components of Intravenous Nutritional Support
lipids are administered via Piggy back. (white, thin liquid)
Lipids in Intravenous Nutritional Support
not refrigerated, observe for spoilage (fat on top, discoloration), expiration dateNo filter. , must be infused on IV pump, glucose monitored, gradual weaning. Daily weights,
Cautions for IV nutritional support
hypoglycemia, hyperglycemia, dehydration, infection
Complications for IV nutritional support
bowel surgery, chronic weight loss, bowel rest, coma, excess nitrogen loss, hepatic or renal failure, malnutrition, low serum albumin, hypermetabolic states
Indications for IV Nutritional Support