fluid balance: IV therapy Flashcards
- Maintain/correct fluid imbalance
- Maintain/correct electrolyte or acid-base imbalance
- Expand vascular space
- Provide nutrition
peripheral intravenous (PIV) lines
- Placement
- Catheter size
- Infection Risk
- Safety
PIV critical thinking
- Upper extremities best for adults
- Avoid area w/ joint flexion (wrist and bend or elbow) if possible
- Nondominant arm if possible
- Choose distal site for first attempt and work proximal
- Avoid affected areas
- Avoid palmar side of wrist if possible
sites of PIV treatment
Smaller size larger number
24 & 26 - 24 yellow, 26 purple
22 - blue
20 - pink/red
18 - green
14 & 16 - 14 orange, 16 black/gray
catheter size
yellow & purple
infants and children, NOT for viscous fluids
24 & 26
blue
small adults and dehydration
22
pink or red
good choice for most
BLOOD
20
green
preferred for surgery
18
orange and black/gray
best for trauma and rapid fluid infusions
14 & 16
- Aseptic technique
- Hand hygiene before palpation
- Clip hair – do not shave
- Clean skin
- Wear clean gloves for insertion
infection risk
Avoid:
- Mastectomy
- Axillary lymph node
- Lymphedema
- Paralysis
- Dialysis graft
Infection prevention
safety w/ PIV
- Phlebitis
- Infiltration
- Extravasation
- Venous spasm
- Nerve damage
- Embolus
- Infection
PIV complications
inflammation of vein
can occur as a result of vein trauma during insertion, use of an inappropriate I.V. catheter size for the vein, or prolonged use of the same I.V. site
Chemical, Mechanical, Infectious
usually associated with acidic or alkaline solutions or solutions that have a high osmolarity
S&S
- Swelling, Redness, Heat, Pain , Cordlike vein , Induration
Nursing Action:
- Remove PIV
- Elevate
- Warm compress
- MONITOR
Phlebitis
fluid leaks into tissues
most commonly occurs when the IV catheter is dislodged from its normal place, leading to the fluids infiltrating in the nearby tissues
S&S
- Pain – Tight
- Swelling
- Coolness
- Infusion may be slow or stop
Nursing Action
- Stop infusion
- Elevate extremity
- Warm Compress
Infiltration
tissue damage from infiltration
Causes
- Infiltration of vesicant fluids
S&S
- Blanching, burning, or discomfort
- Cool skin
- Swelling
- Blistering and/or skin sloughing
Nursing Action
- Elevate Extremity
- Follow protocol for administering - Antidote
- Follow protocol for heat/cold
- Frequent assessment of circulation, sensation, mobility
extravasation
-Gather your materials
- Hand Hygiene and gloves
- Assess veins and determine best site
- Apply a tourniquet
- Palpate the vein if necessary
- Disinfect the IV site
- Insert the needle (go in at 30-45 degree angle and then lower to 10-15 degree angle)
- Remove needle from catheter and discard safely
- Attach tubing to catheter port
- Secure the catheter with transparent dressing
- Label dressing with Initial, date, and time.
- Document site, size of catheter
PIV insertion
- Gathered the necessary equipment and supplies
- Explained the procedure
- Turned the IV tubing roller clamp to the “off” position or remove tubing from tube extender
- Performed hand hygiene, and applied clean gloves
- Carefully remove the IV site dressing
- Placed clean sterile gauze above the insertion site
- Keep the hub parallel to the skin and remove catheter using a slow, steady motion
- Applied pressure to the site
Inspected the catheter tip (catheter intact) - Apply a sterile, gauze dressing over the insertion site, and secured it with tape
- Document
removal of PIV
1500 IV inserted with 20-G catheter to posterior lower arm, 2.5 cm (1 inch) above wrist. Flushes easily with good blood return. Covered with transparent dressing. Stated insertion was not painful and “felt fine” afterward. T. Woolfley, NS, SAU
1300 Redness noted, and patient complains of tenderness and burning at IV site. Discontinued 20 g IV, catheter tip intact. Minimal bleeding from site that stopped after applying pressure for 30 seconds. Covered with sterile dressing. Patient tolerated procedure well. Warm cloth applied to IV site, and arm elevated on pillow. T. Woolfley, NS, SAU
Documentation examples
primary
secondary (piggy-back)
IV infusion set up
used to infuse continuous or intermittent fluids or medication
primary
small bag of solution attached to a primary infusion line or intermittent venous access device to deliver medication over a specified period of time
secondary (piggy-back)
primarily used for therapeutic purposes such as administration of medications, fluids and/or bloomost commonly used intravenous device in hd products as well as blood sampling.
peripheral intravenous catheters (PIVC)
