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DESCRIPTION
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INTRAVENOUS THERAPY
Presented by:Bracket A
INTRAVENOUS THERAPYIt is an effective and
efficient method of supplying fluid directly into intravenous fluid compartment producing rapid effect with availability of injecting large volume of fluid more than other method of administration.
Kozier and Erb’s Fundamental of Nursing Vol.2 Page 1455
History
• 1831-Europe
History
• Russian Cholera or Blue Cholera-dusky cyanotic complexion of its victims
History
• William Brooke O’Shaughnessy, hypothesized that the primary cause of death in persons who has blue cholera was a deficiency of fluids and electrolytes
History
• Dr. Thomas Latta
LEGAL BASIS
• R.A. 7164 – The Philippine Nursing Act of 1991 Section 28 states that in administration of IV injections, special training shall be required.
IV Therapy and Legal Implications
• Board of Nursing Resolution No.8 Sc. 30 © Art. VII or administratively under Sc. 21 Art. III – states that any registered nurse without training and who administers IV injections to patients shall be held liable, either criminally, administratively or both.
LEGAL BASISIV Therapy and Legal Implications
• R.A. 9173 – The Philippine Nursing Act of 2002, Article VI Nursing (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to . . .
Administration of written presentation for treatment, therapies, oral, topical and parenteral medications . . .
that in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice.
LEGAL BASISIV Therapy and Legal Implications
PURPOSE OF IV THERAPY
–Restore or maintain F & E–Administer meds–Provide nutrition–Transfusion
TYPE OF IV SOLUTIONSType of IV solution
Isotonic Hypotonic Hypertonic
GREEN
0.9% SODIUM CHLORIDE/
PNSS
ISOTONIC SOLUTION
PINK
D5 Lactated Ringers (D5LR)
HYPERTONIC SOLUTION
BLUE
PLAIN LACTATED
RINGERS (PLR)
ISOTONIC SOLUTION
LIGHT BLUE
D5 0.3 Sodium Chloride (D5
0.3 NaCl)
HYPOTONIC SOLUTION
YELLOW
D5 Normal Saline Solution
(D5NSS)
HYPERTONIC SOLUTION
PURPLE
Balanced Multiple Maintenace
Solution with 5% dextrose (D5IMB)
5% Dextrose, water and isotonic
solution
RED
D5 WATER(D5W)
ISOTONIC SOLUTION
ISOTONIC HYPERTONIC HYPOTONIC
O.9% NaCl D5NSS 0.33% Saline
PLR D5LR 0.45% Saline
D5W D5 in 0.45 Saline
D5 0.3 NaCl
3% NaCl
D10W
Categories of intravenous solutions according to their
purpose: Nutrient solutions. Electrolyte solutions. Volume expanders.
Nutrient solutions. It contain some form of carbohydrate and
water.
Water is supplied for fluid requirements and carbohydrate for calories and energy.
They are useful in preventing dehydration and ketosis but do not provide sufficient calories to promote wound healing, weight gain, or normal growth of children.
Common nutrient solutions are D5W and dextrose in half-strength saline.
Electrolyte solutions (Crystalloid)
fluids that consist of water and dissolved crystals, such as salts and sugar.
Used as maintenance fluids to correct body fluids and electrolyte deficit .
Commonly used solutions are: -Normal saline (0.9% sodium chloride solution).-Ringer’s solutions (which contain sodium, chloride, potassium, and
calcium. -Lactated Ringer’s solutions (which contain sodium, chloride, potassium ,calcium
and lactate) .
Volume expanders (Colloid)
• Are used to increase the blood volume following severe loss of blood (haemorrhage) or loss of plasma ( severe burns).
• Expanders present in dextran, plasma, and albumin.
VENIPUNCTURE SITES
VARIES WITH CLIENT’S:• AGE• LENGTH OF TIME OF INFUSION• TYPE OF SOLUTION• CONDITIONS OF VEINS
VENIPUNCTURE SITES
VENIPUNCTURE SITES
VENIPUNCTURE SITES
CENTRAL VENOUS CATHETERS
VENIPUNCTURE SITES
CENTRAL VENOUS CATHETERS
IV Infusion Method
IV Infusion Method
I.V. Bolus (I.V. push)
Continuous-drip
infusion
Intermittent infusion
DUTIES AND RESPONSIBILITIES
1. Interpret and carry out the physician’s prescriptions for IV therapy.
EG.D5LR to run for 8 hours
DUTIES AND RESPONSIBILITIES
2. Preparing necessary materials and observing inaccuracy
Materials• Infusion Set• IV Solution• IV pole• Adhesive tape• Clean Gloves• Tourniquet• Antiseptic swabs• IV catheter• Arm splint If required• Electronic infusion device
Infusion Set
IV SOLUTIONIV POLE
ADHESIVE TAPE
TOURNIQUET
ANTISEPTIC SWABS
IV CANNULA
SPLINT
INFUSION PUMP
ADPIE
Nursing assessment1- assess the solution:
2- Reading the label on the solution.3- Determine the compatibility of all fluid and
additives.4- observe I.V sets
No leakage
Sterile
No small particles
Clear
and
not
expired
Cracks
Holes
Missing
clamps
Expired
date
• Also, the nurse should assess the patient for :1- Any allergies and arm placement preference.2- Any planned surgeries.3- Patient’s activities of daily living.4- Type and duration of I.V therapy, amount, and rate.
Nursing diagnosis:
• Anxiety (mild, moderate, severe) related to threat regarding therapy.
• Fluid volume excess. • Fluid volume deficit. • Risk for infection. • Risk for slKnowledge deficit eep pattern
disturbance. • related to I.V therapy.
Planning
• Identify expected outcomes which focus on:• preventing complications from I.V therapy.• minimal discomfort to the patient.• restoration of normal fluid and electrolyte
balance .• patient’s ability to verbalize complications.
Implementation I. Implementation during initiation phase A) Solution preparation: the nurse should: Label the I.V container. Avoid the use of felt-tip pens or permanent
markers on plastic bag. Hang I.V bag or bottle .
University of La SaletteCollege of Nursing
Date:______________
Patients’s Name
______________________________
IVF:_________________________
Additives: ___________________
______________gtts/min
Time Started:________________
Hours to run:__________________
Prepared by:
______________________/BSN student
DUTIES AND RESPONSIBILITIES
3. Performing Peripheral vein puncture
Implementation
B) Site preparation:1- Cleanse infusion site.2- Excessive hair at selected site should be
clipped with scissor .3- Cleanse I.V site with effective topical antiseptic.4- Made Venipuncture at a 10 to 30 degree angle.
DUTIES AND RESPONSIBILITIES
4. Determine solution and medication incompatibilities.
Table 1Examples of drug compatibilitiesDrug Compatible in syringe Incompatible in syringe Comments
Benzylpenicillin 600 mg powder for reconstitution
No common drugs listed in published data Prochlorperazine, promethazine, chlorpromazine, sodium bicarbonate
Dexamethasone sodium phosphate 4 mg/1 mL Metoclopramide, ondansetron, ranitidine Glycopyrrolate, midazolam, prochlorperazine, promethazine
Diazepam 10 mg/2 mL Nil Widely incompatible - do not mix with other drug solutions
Poorly water soluble drug marketed in a complex solvent system
Frusemide 20 mg/2 mL No common drugs listed in published data Buprenorphine, chlorpromazine, droperidol, metoclopramide, midazolam, morphine sulfate, prochlorperazine, promethazine
pH of solution is 8.0-9.3. Frusemide is unstable in acidic media which may include glucose 5% solution.
Haloperidol 10 mg/2 mL Hydromorphone Benztropine, ketorolacHydrocortisone sodium succinate 100 mg powder for reconstitution
Metoclopramide Prochlorperazine, promethazine, midazolam
Lignocaine hydrochloride 2% in 5 mL Glycopyrrolate, metoclopramide Ampicillin, sodium bicarbonate solution
Metoclopramide hydrochloride 10 mg/2 mL Chlorpromazine, dexamethasone, droperidol, fentanyl, hydrocortisone sodium succinate, lignocaine, midazolam, morphine, pethidine, promethazine
Ampicillin, frusemide, sodium bicarbonate
Morphine sulfate, morphine tartrate (various strengths)
Stability of at least 15 minutes published for atropine, bupivacaine, droperidol, fentanyl, glycopyrrolate, hyoscine butylbromide, ketamine, prochlorperazine, and up to 24 hours for metoclopramide
Aminophylline, flucloxacillin, frusemide, phenytoin, promethazine, sodium bicarbonate
Is less soluble in alkaline conditions
Prochlorperazine edisylate Atropine, hydromorphone, hyoscine hydrobromide, morphine sulfate (may vary with brand), pethidine
Aminophylline, amphotericin, ampicillin, benzylpenicillin, calcium gluconate, cephalothin, dexamethasone sodium phosphate, frusemide, heparin, hydrocortisone sodium succinate, midazolam
The bulk of the published data refer to the edisylate salt which is marketed overseas. The salt marketed in Australia is mesylate which is similar, and for which extrapolation of data is considered reasonable.
Promethazine hydrochloride 50 mg/2 mL Atropine, droperidol, fentanyl, glycopyrrolate, metoclopramide, midazolam, pethidine
Aminophylline, benzylpenicillin, dexamethasone sodium phosphate, frusemide, hydrocortisone sodium succinate, morphine, phenytoin, sodium bicarbonate
Locally irritant and unsuitable for subcutaneous injection. Avoid extravasation in intravascular injection.
Tramadol hydrochloride 100 mg/2 mL No common drugs listed in published data Diazepam, midazolam This is a relatively recently marketed drug on which there is a paucity of published compatibility data
DUTIES AND RESPONSIBILITIES
5. Administer computed medications, chemotherapeutic drugs, flow rates of solutions, compatible blood/blood components and parenteral nutrition as prescribed by the physician.
Regulating flow rate:
The nurse calculate the infusion rate by using the following formula :
Fluid delivered
IV pump Gravity
Volume (ml) X Drop factor (hospital protocol) (gtts/min) = Drop RateHours to run (hr) 60 min/hr
DUTIES AND RESPONSIBILITIES
6. Assess all adverse reactions related to IV therapy and initiate appropriate nursing interventions.
7. Establish nursing care plan related to IV Therapy.
8. Adhere to established infection control practices.
9. Maintain proper care of IV equipments.
II. Implementation during maintenance phase
A) Monitoring I.V infusion therapy: the nurse should :
inspect the tubing. inspect the I.V set at routine intervals at least daily. Monitor vital signs . recount the flow rate after 5 and 15 minutes after initiation
B) Intermittent flushing of I.V lines Peripheral intermittent are usually flushed with saline (2-3
ml 0.9% NS.)
C) Replacing equipments (I.V container, I.V set, I.V dressing):
I.V container should be changed when it is empty. I.V set should be changed every 24 hours. The site should be inspected and palpated for tenderness
every shift or daily/cannula should be changed every 72hours and if needs.
I.V dressing should be changed daily and when needed
III. Implementation during phase of discontinuing an I.V infusion
The nurse never use scissors to remove the tape or dressing. Apply pressure to the site for 2 to 3 minutes using a dry,
sterile gauze pad. Inspect the catheter for intactness. The arm or hand may be flexed or extended several times.
DUTIES AND RESPONSIBILITIES
10. Document relevant data in the preparation, administration and termination of all forms of IV therapy
Recording and reporting:
• Type of fluid, amount, flow rate, and any drug added.
• Insertion site. • Size and type of I.V catheter or needle. • The use of pump. • When infusion was begun and discontinuing. • Expected time to change I.V bag or bottle,
tubing, cannula, and dressing.
• Any side effect. • Type and amount of flush solution. • Intake and output every shift, daily weight. • Temperature every 4 hours. • Blood glucose monitoring every 6 hours, and
rate of infusion.
Evaluation
• Produce therapeutic response to medication, fluid and electrolyte balance.
• Observe functioning and patency of I.V system.
• Absence of complications.
Parenteral Nutrition (PN)
• Parenteral nutrition is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes , vitamins, minerals, and fluids via the IV route to meet the metabolic functioning of the body.
Clinical indications of parenteral nutrition
• Client cannot tolerate internal nutrition as in case of paralytic ileus, intestinal obstruction, persistent vomiting.
• Client with hyper metabolic status as in case of burns and cancer.
• Client at risk of malnutrition because of recent weight loss of > 10%, NPO for > 5 days, and preoperative for severely depleted clients.
Local Complication- Hematoma
• Hematoma– S & S– Interventions– Prevention
Local Complication-Infiltration
• Infiltration– S & S– Interventions– Prevention
Local Complication-Phlebitis
Local Complication-Site Infection
Local complication-Tissue Sloughing
• Fluid overload• This occurs when fluids are given at a higher rate or in a
larger volume than the system can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema.
• Hypothermia• The human body is at risk of accidentally induced
hypothermia when large amounts of cold fluids are infused. Rapid temperature changes in the heart may precipitate ventricular fibrillation.
• Electrolyte imbalance• Administering a too-dilute or too-concentrated solution
can disrupt the patient's balance of (sodium) (potassium) (magnesium), and other electrolytes. Hospital patients usually receive blood tests to monitor these levels.
Systemic Complications• Embolism• A blood clot or other solid mass, as well as an air bubble, can be delivered into
the circulation through an IV and end up blocking a vessel; this is called embolism. Peripheral IVs have a low risk of embolism, since large solid masses cannot travel through a narrow catheter, and it is nearly impossible to inject air through a peripheral IV at a dangerous rate. The risk is greater with a central IV.
• Air bubbles of less than 30 microliters are thought to dissolve into the circulation harmlessly. Small volumes do not result in readily detectable symptoms, but ongoing studies hypothesize that these "micro-bubbles" may have some adverse effects. A larger amount of air, if delivered all at once, can cause life-threatening damage to pulmonary circulation, or, if extremely large (3-8 milliliters per kilogram of body weight), can stop the heart.
• One reason veins are preferred over arteries for intravascular administration is because the flow will pass through the lungs before passing through the body. Air bubbles can leave the blood through the lungs. A patient with a heart defect causing a right-to-left shunt is vulnerable to embolism from smaller amounts of air. Fatality by air embolism is vanishingly rare, although this is in part because it is so difficult to diagnose.