Intravenous Infusion Flashcards
Efficient and effective way of administering medications and supplying fluids
Intravenous Therapy
Reasons for IV therapy (4)
- Replaces and maintains balance of fluids and electrolytes
- Administration of medications
- Administration of blood and blood products
- Delivers nutrients and nutritional supplements
Guidelines for IV therapy (8)
- Ordered by a physician or a nurse practitioner
- It is an invasive procedure
- Maintain aseptic technique
- Understand indications and duration of IV therapy
- TKVO
- There are complications with IV therapy
- Assess site of insertion for 2 hours prn
- Assess saline lock site for 12 hours prn
Types of Venous Access
Peripheral IV and Central Venous Catheter
It is a short term method for IV therapy and done through a subcutaneous venipuncture through the peripheral vein
Peripheral IV
Guidelines in removing PIV (6)
- Every 72 to 96 hrs prn
- If client is stable and no longer requires IV therapy
- If client is stable and needs an insertion of a cannula in an area of flexion
- If there is inflammation, redness or purulent drainage from insertion site
- If new administrations set is needed
- If there are several potential complications
Potential complications: Inflammation of inner lining of nerve (tunica intima)
Phlebitis
Mechanical & Chemical causes of Phlebitis
- Rubbing of cannula (irritation) on inner lining
- Use of medications that are high in alkaline, acidic or hypertonic
Treatment for Phlebitis
- Remove cannula
- Elevate arm and apply warm compress to IV site
- Document and insert new IV set if necessary
Potential complications: Inadvertently administering non-vesicant solution on surrounding tissues
Infiltration
Treatment for Infiltration (4)
- Remove cannula
- Follow agency policy
- Secure with gauze or any IV stabilization device
- Avoid areas of flexion and assess IV site before administration
Potential complications : Inadvertently administering vesicant solutions (medication) to surrounding tissues
Extravasation
Treatments for Extravasation
Stop and remove infusion, follow agency policy
Potential complications : Bleeding at IV insertion site
Hemorrhage
Treatment for Hemorrhage
- Apply gauze at site to stop bleeding
- Apply transparent sterile dressing
Systemic complications: Purulent drainage from IV site 2-3 days after insertion
Local Infection
Treatment for Local infections
- Remove IV infusion while practicing sterile technique
- Monitor for signs and symptoms for systemic infections
Systemic complication: Fluid overload or circulatory overload.
- Fluid accumulation in lungs due to accumulation of fluid in circulatory system.
Pulmonary edema
Systemic complication: Presence of air in vascular system
Air embolism - caused by air introduced in the venous system which travels into the right ventricle and enters the pulmonary circulation
Treatment for Air embolism (4)
- Occlude source of air entry
- Position client in Trendelenburg on their left side
- Apply oxygen at 100%
- Obtain Vital signs & Notify physician
Systemic complication: Tip of cannula has broken off and is in the vascular system
Catheter Embolism - check tip of cannula when removing it
Systemic complication : Microorganisms introduced in bloodstream through IV site, hub or IV tubing and solution
Catheter-related bloodstream Infection ( CR-BSI ) - Leads to bacteremia or sepsis
Treatment for CR - BSI
Antibiotic therapy and for prevention, proper hand hygiene…
It is known as a central venous line or access and its administered by inserting the IV catheter into a large vein in the central nervous system to the superior vena cava and an area right above the right atrium
Central Venous Catheter
Guidelines or Contraindications for CVC insertion (10)
- Require antineoplastic medications
- For those who are chronically ill
- Require vesicants or irritant medications
- Require central venous pressure monitoring
- Rqr. long term venous access or dialysis
- Rqr. toral parenteral nutrition
- Rqr. meds greater than ph 9 or less than 5; and osmolality greater than 600 mOsm/L
- Rqr. toxic or multiple meds
- Have poor vasculature
- Had multiple PIV insertions/attempts
Potential complications with CVC ( 9 )
- Pulmonary edema
- Mechanical complications
- CR-BSI
- Infection at insertion site
- CR- thrombosis
- Air embolism
- Occlusion of CVC
- Damage to CVC line
- Catheter migration
Inserted directly through the skin and internal or external jugular vein or subclavian or femoral vein is used.
Percutaneous CVC(PCVC)
Can be inserted at home, bedside or radiology setting.
Peripherally inserted central catheter (PICC)
- Hickman,Boviac,or groshong
- Long term CVC which passes through subcutaneously and exits out of the skin
Subcutaneous or tunnelled central venous catheter (SCVC)
Inserted into the body and is attached to a reservoir or port located under the skin
Implanted Central venous catheter (ICVC)
IV FLUIDS
Crystalloid
Colloid
Contains large molecules that cannot pass through the semi-permeable membrane ; used to expand intravascular volume
Colloid solutions
Contains solutes such as electrolytes which can be easily mixed and dissolved in solutions
Crystalloid solutions
Type of crystalloid solutions
Isotonic
Hypotonic
Hypertonic
- osmolality is between 250-275 mOsm/L
- increases intravascular volume
- used for nausea,vomiting, diarrhea,shock,metabolic acidosis and resuscitations
Isotonic solutions
- less than or equal to 250 mOsm/L
- low conc. of solutes
- cells will swell and may deplete fluid from vascular spaces
Hypotonic solutions
- greater than or equal to 375 mOsm/l
- higher conc. of solutes
- can cause intravascular fluid overload and pulmonary edema
Hypertonic solutions
-can be macro drip (10,15,20 gtts/ml) or micro drip (60 gtts/ml)
Primary IV tubing
- used for secondary IV meds
Secondary IV tubing
IV solution bags should have the following:
- date, time and initials of healthcare provider
- Add-on devices should be changed every 96 hrs.
IV should be changed if:
- it is disconnected or contaminated
- if its less than 100 ml
- if there is cloudiness or precipitates
- if its outdated ( equipment, IV set and solutions )
Primary tubing with crystalloid solutions
every 72-96 hours
Secondary or intermittents solutions
every 24 hrs
infusions containing fat emulsions
every 24 hrs
Blood and blood products
every 4 hours
Ways in regulating IV fluid rates
- Gravity
- Electronic Infusion device
Factors influencing flow rate
- Tube occlusion
- Vein spasms
- Height of fluid container
- Location / position of iv cannula
- Infiltration or extravasation
- Accidental bumping or touching of control clamp
- Raising arm above heart level
- Needle or cannula gauge diameter
