IV therapy Flashcards
1
Q
Purpose of IV therapy
A
- To maintain fluid, electrolyte & energy demands
- To prevent fluid and electrolyte imbalances
- To administer blood and blood products
- To administer TPN (total parental nutrition)
- To administer prescribed IV medications (ex: antibiotics)
- To have venous access in emergency situations: KVO (keep vein open)
2
Q
Nursing responsibilities of IV therapy
A
- Assess need for IV therapy
- Assess IV site
- Assess/maintain prescribed IV flow rate
- Assess patient response to IV therapy
- Prevent complications associated with IV therapy
3
Q
Fluid volume deficit (FVD) signs/symptoms
A
- Loss > 2.2lbs in body wt in 24hr
- Decreased B/P
- Tachycardia
- Slow cap refill
- Dry skin and mucous membranes
- Decreased skin turgor
- Thirst (later sign)
- Decreased urine output
- Confusion/restlessness (very late sign; only with severe deficit)
4
Q
Fluid volume excess (FVE) signs/symptoms
A
- Gain > 2.2lbs in body wt in 24hr
- Bounding pulse
- Distended neck veins
- Abnormal lung sounds (e.g., crackles)
- Edema (often present in extremities, in the ankles)
5
Q
Types of vascular access devices
A
1) Peripheral Vascular Access Devices (PVADs)
2) Central Vascular Access Devices (CVADs)
- Central Venous Catheters (CVC)
- Implanted infusion ports
- Peripherally inserted central catheters (PICC)
6
Q
Peripheral vascular access uses
A
- Short term use
7
Q
Central vascular access uses
A
- Long term use
- Medications and solutions irritating to veins
- Peripheral access is limited or contraindicated
- Large volumes of fluid
8
Q
Central venous catheter (CVC)
A
Reasons we use
- For longer term use as well as for administration of medications that are irritant to the veins
- Patient has poor peripheral veins; cant find anywhere to put
- Large volumes of fluid
- Emergency situation need to secure immediate access
- Inserted by MD or NP; usually RN doesn’t insert
- Be mindful of infection; at high risk, make sure to assess regularly for sign/symptoms
- Infection indications; redness, swelling, purulent discharge, pain, fever
Other complications
- Penumothorax
- Arterial puncture during insertion
- Hemmorrage
- Cardiac tampinade
- Risk of nerve injury during insertion
- Occlusion
- Most have a tip that lies in the lateral portion of the superior vena cava
- Inserted through different major vessels, but tip consistent
9
Q
Implanted infusion port (CVC)
A
- Implanted underneath the skin
- Accessed with specialized types of needles
- Found in special care; i.e. oncology
- Lower risk of infection; not exposed to air
10
Q
Peripherally inserted central catheters (PICC)
A
- Central lines inserted through a peripheral vein; usually somewhere in the arm
- Long catheter; tip goes into the superior vena cava
- Mindful of infection; good hand hygiene, good aseptic technique
- Potential for CLABSI (central-line associated blood stream infections)
11
Q
IV equipment
A
- IV cannulas (Sizes: 16G, 18G, 20G, 22G, 24G)
- Tourniquet
- Gloves
- Antiseptic swabs
- IV Dressing (transparent occlusive)
12
Q
Common peripheral IV sites
A
- Inner arm/hands/feet
- Choose patient non-dominant hard
- Choose most distal site possible; if accidentally punctured, “blowing the vein” and no longer good – have to use distal to it instead of proximal
- Peds often use feet; not for adults patients, increased risk of clot formation in feet, in infants/small children not the same risk; older adults tend to have less venous return in lower extremities as well
- Avoid anywhere that has signs of infection, thrombosis, blood clot, if patient has graft/fistula for dialysis we don’t want to go in there
13
Q
How to clean IV site before insertion
A
- Cleaning with cholorhexine solution or 70% alcohol
- Circulation motions for 30 seconds then let dry for 2 minutes
- Once site has been cleaned, we don’t want to touch it afterwards
- Use alcohol swab as a marker so you don’t touch it again
14
Q
IV catheter/cannula
A
- Angle in insertion is 10-30 degrees
- Variety of different gages; smaller the number the large the diameter
- Only plastic tube gets left behind, the needle get taken out
- Flashback chamber; right site if blood appears in it
How do you decide on size of cannula?
- Size of the patient; their veins; older adults/children use 24G
- Viscosity of fluid you’re infusing
- Volume of fluid you’re infusing
- Diagnostic testing; CAT scans with IV contrast; department will have specifications of diameter (usually 18G)
15
Q
IV dressing
A
- Dressing transparent to monitor and assess the site of insertion
- Also prevents organisms from entering the site
16
Q
Changing an IV dressing
A
- Dressings are changed as per organizational policy
- Perform hand hygiene
- Apply gloves
- Remove old dressing being careful not to dislodge IV catheter
- Assess IV site
- Remove any additional tape and adhesive
- Clean site in a circular motion, working outwards with antiseptic swab, allow to dry
- Apply new dressing and secure with tape.
- Document as per policy (e.g., in chart and on dressing if required)
17
Q
IV considerations: older persons
A
- Use a smaller gauge needle (22 – 24g)
- Choose site that does not interfere with ADLs
- Use minimal tourniquet pressure (over clothes)
- Lower angle of insertion
- Apply traction to the skin below insertion site
- Use a protective device
- Older adults have smaller veins and poor venous return
Want to minimize shearing forces on the skin itself; tourniquet on top of clothing - Traction on the skin; pulling downwards on the site while inserting
- Protective site; help protect it from getting knocked out while moving, etc.
- Arm board; limb placed on board and taped on to minimize movement
18
Q
Types of IV fluids
A
1) Crystalloids
2) Colloids
3) TPN
19
Q
IV fluids: crystalloids
A
- Contain solutes that mix, dissolve and cross semi-permeable membranes
- Smaller molecules
- Most common
- Examples;
NaCl
Dextrose
Lactated Ringer’s
20
Q
IV fluids: colloids
A
- Contain proteins or starch that do not cross semi-permeable membranes
- Large molecules
- Remain in extracellular space / intravascular fluid
- Used to increase vascular volume (expand the vessel)
- Examples;
Blood
Plasma proteins
Pentastarch
21
Q
IV fluids: total parenteral nutrition (TPN)
A
- Nutritionally adequate solution
- Typically 2 bags; yellow and lipid bag
- Exclusively infused via central line access, not peripherally
- Examples;
Glucose
Nutrients
Other electrolytes
22
Q
Types of crystalloid IV solutions
A
Isotonic:
- Same osmolarity as blood
- Expands fluid volume without causing fluid to shift between compartments
- Create constant pressure within and outside cells
- Cells won’t shrink or swell in response; stay the same size
Hypotonic:
- Lower osmotic pressure
- Moves fluid into cells, causing them to enlarge
- Cause fluid to shift into intracellular space
- They hydrate the cells
Hypertonic:
- Higher solute concentration
- Pulls fluid away from cells, causing them to shrink
- Draw water out of intracellular space into extracellular space
- They dehydrate the cells
23
Q
Body fluids: intracellular vs extracellular
A
Intracellular Fluid
- Fluid within the cells
- Accounts for 60% of body fluids
Extracellular Fluid
- Fluid outside of the cells
- Interstitial; between the cells and outside of the vessels
- Intravascular; blood plasma
- Transcellular; cerebrospinal fluid, peritoneal, synovial and GI tract
24
Q
Common IV isotonic solutions
A
Uses:
- Volume replacement
- Treat diarrhea, vomiting, shock, resisitation
- Possibility of fluid overload
Examples:
- Normal Saline (0.9%)
- Dextrose 5% in water (D5W)
- Lactated Ringer’s (LR)
25
Q
Common IV hypotonic solutions
A
Uses:
- Lower solute concentration, causing fluid to shift into cells
- Cellular dehydration (e.g., dialysis patients on diuretics)
- Monitor patient for hypovolemia and related hypotension
- Also want to use caution in patient who have any increase in intracranial pressure; don’t want shift fluid into cells of brain tissue
Examples:
- 0.45% NS
- 0.225% NS
26
Q
Common IV hypertonic solutions
A
Uses:
- Higher levels of solutes; draw fluid out of cells and into extracellular/intravascular cells
- Not used very much in practice
- Careful with hypertonic solution; can easily cause fluid overload
- Short term use
- Treats cerebral edema, severe hyponatremia (low sodium)
Examples:
- Dextrose 10% in water (D10W)
- 3-5% NaCl/NS
- D50.45%NaCl
- D5LR
27
Q
Common additives to IV solutions
A
Potassium Chloride (KCl)
- KCl used fairly commonly; be careful when using because it can result in death (failed arythermias)
- Compound used in USA for lethal injections
- Typically administer from pharmacy or comes in pre-mixed bag
- Red writing; K involved, careful with administration
- Never administer KCl as push; always run through infusion, want to use pump when using KCL to ensure correct amount
Multivitamins
- Yellow solution
- Mix on unit; according to instruction
- “banana bag”
Physician’s Order:
ex: 0.9NS with 20meq KCl/1000cc at 125ml/hr
28
Q
Structure of an IV pole
A
Primary bag
- Two ports; one that gets spikes and in injection port
- Drip chamber; 1/3-2/3 full of fluid; leave enough space to count drips as coming down
- Back flow valve; stops fluid from going back up into bag
- Port to attach another IV bag to or to get air out of line
- 2 types of clamps; slider clamp and roller clamp (used to regulate flow)
- Port closest to patient; used to flush IV line with saline to ensure it’s working
29
Q
IV tubing
A
Macrodrip
- (10 or 15 gtts/mL)
- Find information to which type of tubing you have on the IV packaging
- Typically found in adult settings
Microdrip
- (60 gtts.mL)
- More precise than macro drip
- Make sure we’re not touching the spike before it goes into the bag and the cap
- When priming IV; keep both clamps closed to prevent accidently letting it go
30
Q
Buretrols
A
- Buretrol or volume control device.
- This chamber can be filled with a smaller volume than the IV bag.
- Reduces risk of an increased volume being infused.
- Attached to the IV tubing
- Sits right underneath the IV bag
- Purpose is to manage the amount of fluid we are giving to the patient
- Commonly in past in peds
- Don’t over fluid the patient
- Now with more advanced syringe and pumps we are seeing these less
31
Q
Regulating the IV flow rate
A
Two ways to do this
- Manual regulation using roller clamp
- Electronic infusion devices (EIDs)
i. e. Infusion pumps
Why properly regulate IV flow rate?
- If too slow we might be depriving patient of fluid they need, or IV the is administered really slowly can clot more easily
- Too fast can result in fluid overload
32
Q
How to regulate the IV flow rate (formula)
A
(Infusion volume x drop factor)/ time in minutes = gtt/min
33
Q
Regulating the flow rate: electronic infusion devices
A
- If not using manual regulation use IV pump to regulation the flow
- ID or electronic diffusion devices
- Used positive pressure to manage the flow
- Seen commonly now
- Alarms for air in line; fluid running out of bag; line occlued
- Tons of different models
- Want to make sure pump used for peds/neonatal patients or older patients at risk of volume overload
34
Q
Factors influencing flow rates
A
- Patency of IV catheter; open and flowing, no clots in the way, not against a wall, not occluded in anyway
- Patency of IV tubing; no kinks of knots in tubing
- Height of solution; if free flowing, the higher the flow the faster the fluid goes
- Restrictive IV dressing
- Position of extremity; if arm bent can bed the tip of the catheter and occlude the line
- Infiltration; IV solution is infusing into the surrounding tissue instead into the vein
35
Q
What to do if IV is not working
A
- Check site for infiltration
- Check for kinks
- Reposition arm
- Lower bag below arm to check for blood return
- Raise IV pole
- Check that slide clamp & roller clamp are open
36
Q
Removing air from IV
A
- Strumb tubing like a guitar string and air should come to top
How much air is a problem
- As little as 10mL can cause issues
- Can flip upside down as priming to help get air out
37
Q
IV maintenance
A
- Keep the system sterile
- Use alcohol or chlorhexidine gluconate when accessing a port
- Only access if necessary
- Be aware of policies regarding hanging solutions, tubing, and site dressings
- Assist the patient with self-care activities so as not to disrupt the system
- Assess the IV infusion and site regularly
38
Q
Changing an IV bag
A
- Verify orders and determine compatibility if different solution.
- Change solution when there is ~50mls remaining
- Assess IV site
- Ensure that the drip chamber is 1/2 – 1/3 full
- Perform hand hygiene
- Prepare new bag by removing protective cover
- Clamp IV to stop flow
- Remove old bag
- Carefully spike new bag & hang
- Check for air in tubing – remove as required
- Ensure that the drip chamber is 1/2 – 1/3 full
Regulate flow
39
Q
Complications of IV therapy
A
- Infiltration
- Extravasation
- Phlebitis
- Infection
- Bleeding/Bruising
- Fluid Overload
- Air Embolism
40
Q
Infiltration
A
IV fluids (non-vesicant) enter the subcutaneous space
Characterized by:
- Swelling
- Pallor
- Coolness
- Pain (in some cases)
- Change in IV flow rate
- Leaking from IV site
41
Q
Infiltration prevention
A
- Avoid areas of flexion when selecting site
- Use proper venipuncture technique
- Observe the IV site frequently
- Advise the patient to report any swelling or tenderness
42
Q
Infiltration interventions
A
- Discontinue IV
- Raise the affected extremity
- Apply warm, moist compress for 20 minutes
43
Q
Extravasation
A
Vesicant medications/fluids enter the subcutaneous space
Characterized by:
- Burning or pain at IV site
- Swelling
- Coolness
- Blistering or skin sloughing
- Change in IV flow rate
- Leaking from IV site
44
Q
Extravasation prevention
A
- Avoid veins that are small and/or fragile as well as areas of flexion
- Follow agency policy when administering vesicant medications.
- Give vesicants last when multiple drugs are ordered
Strictly adhere to proper administration techniques - vesicant medications are meds that have the potential to cause extravasation (i.e. blistering) examples include chemotherapy, epinephrine*
45
Q
Extravasation intervention
A
- Discontinue IV (unless administering antidote)
- Notify physician
- Elevate extremity
- Apply compress (warm or cool) as per manufacturer indications.
46
Q
Phelbitis
A
Inflammation of the vein
Characterized by:
- Pain
- Edema
- Redness (may travel along the vein)
- Warmth
- Can result in blood clots and emboli
Risk factors:
- Certain types of catheter material
- Certain meds with chemical additives
- Certain drugs like antibiotics
47
Q
Phlebitis prevention
A
- Avoid areas of flexion when selecting site
- Use proper venipuncture technique
- Dilute medications as per instructions (if we don’t dilute them they can irritate the vein)
- Monitor administration rates and inspect the IV site frequently.
48
Q
Phlebitis interventions
A
- Stop the infusion at the first sign of redness or pain
- Apply warm, moist compress
49
Q
Infection
A
Characterized by:
- Redness and possible discharge at IV site
- Elevated temperature
50
Q
Infection prevention
A
- Use aseptic technique during IV insertion
- Perform hand hygiene before any contact with the infusion system or the patient
- Clean injection ports before each use
- Follow your institution’s policy for dressing changes and changing of the solution and administration set.
51
Q
Infection interventions
A
- Stop the infusion and notify the physician
- Remove the device, and culture the site and catheter as ordered
- Monitor the patient’s vital signs
52
Q
Bleeding/bruising
A
Risk Factors:
- Patients receiving heparin
- Patients with bleeding disorders
- Common in patient on anticoagulants or who have fragile skin
Nursing interventions:
- Apply a pressure dressing at the site
53
Q
Fluid overload
A
- Occurs when fluids are given at a higher rate or in a larger volume than the body can absorb or excrete.
- Possible complications: hypertension (HTN), heart failure, and pulmonary edema
- Treatment will depend on severity (ex: fluid management and/or medication administration)
- Mindful when administering fluid to patient; people with cardiac or renal disorders are at a higher risk of overload
54
Q
Air embolism
A
Presence of air in the vascular system that travels into the right ventricle and/or pulmonary circulation.
Characterized by:
- SOB
- Cough
- Neck/shoulder pain
- Anxiety/feelings of doom
- Light headedness
- Hypotension
- Increased HR
55
Q
Air embolism prevention
A
- Ensure drip chamber is 1/3 -1/2 full
- Ensure IV connections are secure
- Remove air by priming tubing
56
Q
Air embolism intervention
A
- Occlude source of air entry (if known)
- Trendelenburg position (if not contraindicated)
- Oxygen (nurses can apply about 2L/min)
- Vital signs
- Notify physician
57
Q
Advantages of intravenous route
A
1) Rapid Response
- Directly into the bloodstream
2) Effective Absorption:
- Other routes can be problematic: IM & subcut, oral
- IV route quick, doesn’t have to be absorbed by an organ
3) Accurate titration
4) IV drug delivery can be stopped immediately if adverse reaction
- As opposed to pill form that has already been swallowed then there’s a reaction
58
Q
Disadvantages of intravenous route
A
1) Solution and drug incompatibilities:
- Physical or pharmaceutical incompatibility
- Chemical incompatibility; reaction can cause foaming, crystals, etc.
- Therapeutic incompatibility; can make it more or less potent
- May not be able to give 2 meds too close together
2) Immediate adverse reactions
- Can happen instantly due to directness of route
3) Long-term use damages intima
- Can be damaging long term to the insides of the vessels
- Important to ensure we give the right meds via the right route and dosage
- Mindful of pH of meds and it’s relation to blood
59
Q
Preparing intravenous medications
A
- Maintain aseptic technique
- Independent double check of calculated, high or unusual doses, and high-alert drugs
- Reconstitute powdered drugs
- Dilute medication in suitable amount of compatible solution
- Label IV bag (if not labelled by pharmacy)
- Check compatibility
Know key information about the drug:
- CPS
- Hospital drug formulary online
- Drug handbook
- Intranet: e-CPS, Lexi-Comp online, Micromedex
- Ask pharmacist if any doubt
60
Q
Administering intravenous medications
A
- Check intravenous site first
- Look for patency, infection, document properly
- Follow 10 rights and 3 checks using MAR
- Observe closely for signs & symptoms of adverse reactions
- Not just the first time but ongoing (can crop up later)
61
Q
Infusion methods for intravenous medications
A
1) Continuous infusions
- Bag dripping in
2) Direct injection (IV push or bolus)
- Usually directly into the vein and not being diluted
- High acuity area
3) Piggy-back or mini bag infusions via:
- Primary IV line
- Intermittent infusions (aka saline or heparin locks)
4) Other methods:
- Volume-control sets such as buretrols
- PCA (Patient-Controlled Analgesia)
- Syringe pumps (found rural)
62
Q
“above drip chamber”
A
- All RNs can give IV drugs “above the drip chamber”
- This about continuous infusion
- As well as piggy back
63
Q
Continuous infusion IV
A
- Mixture within large volume of IV fluid
- Pre-mixed: heparin drip, morphine drip, KCl added, etc
- Added by RN: morphine drip, multivitamins, etc.
- Getting their IV fluids and the meds are in the primary IV site
64
Q
Direct injection (IV push or IV bolus)
A
- Directly into vein (no IV line)
- Or through an existing infusion line (an extension set but no IV)
- Only certain RNs are able to give IV push drugs (e.g. ICU, Emerg, PACU) – see hospital policy
- Not needle to vein, catheter used
- IV line clamped off (by hand) so that meds don’t go back up the bag and instead into the the person
- Mostly luer lock technology
- Similar to how we flush an IV
65
Q
Admixture: adding medication to the IV bag
A
- Scrub port for 15 seconds; wait for it to dry
- Inject medication into bag
- Tilt bag and squish a big to mix it around
66
Q
Admixture: adding a drug to an intravenous bag
A
- Use aseptic technique
- Inject into injection port using syringe
- Mix well
- Often pre-prepared (e.g. heparin drip from manufacturer or done ahead by pharmacist e.g. TPN, antibiotic)
- Label
- Be careful if using a needle that you don’t inject into the port and then inject out of the bag
- Use a blunt fill needle to puncture the bag
- Often come pre-prepared from the manufactures
- “red, stop, look at me” meaning it comes mixed
67
Q
Piggy-back of mini-bag infusion
A
Piggy-back (Add-a-Line or secondary medication set) through:
- Primary IV
- Device such as saline or heparin lock
- Use a mini bag; 25mL, 50mL, 100mL, sometimes a 250mL syringe
- They come in different sizes; go back to formulary to see what size you mix it in
- Put into the primary IV
- Or if they don’t have an IV attached they can have an access which the piggy back can be hooked up to for the med administration
68
Q
Piggy-back or mini-bag set up
A
- Back-check or one-way valve - to prevent retrograde flow
- Delivered by gravity (manual) or by infusion pump
- Have to use the same company
- Adult care often is prn morphine will be used through gravity
- Peds should use a pump because dosing is particular, and they’re little
- Secondary bag is higher than the primary bag; the effect of gravity is more and creates a greater pressure
- When secondary is running the primary stops
- Once secondary ends; primary takes over and restarts - once they are equal
- Important to reset primary line if once secondary line stops; especially if they need to be set at different rates
- Using the primary “gucci” clamp to control the rate
69
Q
How to prime the piggyback or secondary medication line
A
- Don’t prime it the same way you would a primary line
- Difficult to regulate the secondary line with the shitty clamp it comes with
- Instead; holding the secondary bag lower; using gravity to prime the line the put it up once full
70
Q
Intermittent infusion devices (saline or heparin locks)
A
- Pt can walk around, no tubes attached; can shower, people can have then in the community
Advantages:
- Freedom for client
- Cost savings
- Convenience for nurse
- Minimal amount of fluid for patient
Disadvantages:
- Must be flushed after each use
- Can clot easily if blood backs up (small catheter)
71
Q
Types of saline locks
A
- All needle-less access
1) Prepierced septum/blunt cannula
2) Luer-activated device (LAD)
3) Valve technology – positive pressure caps
72
Q
Valve technology: positive pressure caps
A
- Used for CVAD
- Caps redirects a small amount of fluid into the internal catheter tip when the tubing or syringe is disconnected from the device hub preventing blood reflux into the lumen
- Create positive pressure when removing so you don’t have back fill or blood; can be done with any type of saline lock
73
Q
Syringe technology and PSI
A
- Use 10 mL diameter syringes pre-filled with normal saline
- PVAD (saline lock) flushed with at least 3 mL of normal saline before and after administration of medications and prior to locking
Flushing saline locks
- Flushing solution – 0.9% NS
- Amount; double the volume of the device and attached tubing; sufficient volume to clean the internal lumen of the device
- 3-5mL for PVAD
- 10-20mL for CVAD
- Size of syringe; must be 10mL dimeter syringe (can be 3, 5, or 10mL in syringe)
- Using special syringes; usually see the 10mL ones
- For PVAD just use half of it; for - CVAD may need to use 2
74
Q
Flushing method: SAS
A
S: saline
A: administration of med
S: saline
- Check patency; you might draw back some blood to see
- if you don’t it’s not the end of the world
- Can flush very carefully and slowly; watching the site and asking if they have any pain; doesn’t take a lot to blow the vein or any the right vein
- Flush every time you give a med
- Community often a little less
- Flush on your shift (even if med given Q24H)
- Point is to keep it patent, in care we need the site we have it available
75
Q
Turbulent flush technique
A
- Allows the flushing solution to “scrub or clean” the inside of the device wall
- Promotes removal of blood/fibrin and prevents buildup of medication precipitate on the internal lumen of the device.
- Most important for CVAD
- Use a push-pause (stop-start) flushing method
- The turbulence helps keep the solution moving through
- Little bit at a time
76
Q
Positive pressure locking technique
A
- Why lock a VAD?
- Why use positive pressure? To prevent blood reflux from the vein into the lumen of the VAD; thus preventing fibrin build up, clots and device occlusions
- Syringe-induced blood reflux
- Maintain a forward motion on the syringe plunger as the syringe is removed from the access/injection site. If there is a slide clamp on extension tubing, close it while you are injecting the saline
- Don’t have to do this if you have the positive pressure caps
- But most likely won’t have access to these
- Can create out own positive pressure
- If blood comes out to the catheter the back in; high risk of clotting
- To prevent this; slide the clamp while we remove the syringe
- Then undo syringe and get rid of it
77
Q
Administering IV medications via Buretrol
A
- Used in peds; they can provide precise and smaller doses
- Not risking sending a hole bunch of fluid into them
- Similar to an IV bag
78
Q
Patient Controlled Analgesia (PCA)
A
- Good for pt who have pain for whatever reason
- They get a steady dose they’re prescribed
- Programmed on often they can give themselves an extra dose
- Can see how many times they’re trying to give themselves a dose; monitor to see if we need different doses
- Teaching the pt about it and opioid use and addiction; if you need meds you need meds
- Can be epidurally, subcut, IV – patient administers as needed
- Careful to put the right medications and dosing; not a fail safe thing
79
Q
Reducing adverse drug events (ADEs)
A
- IV med administrations have a higher risk and severity of error than other med administrations
- Nearly 70 % of IV med administration had at least one clinical error; ¼ of these were serious errors likely to cause permanent harm to patient
Suggestions:
- Standardized IV solutions
- Pre-mixed solutions
- IV solutions prepared in pharmacy
- Use IV pumps with safety features
- Use smart infusion pumps
- Label all distal ports and tubing on all lines
- Use tubing that is not interchangeable
- Use pre-made dose and flow rate charts
- Provide dose-calculation aids on IV solution bag labels
- Involve patients in checks of intravenous solutions
80
Q
Smart pumps
A
- Can be programmed with the formulary so the doses being used are within safe range
- But there are ways to override these pumps
81
Q
Troubleshooting IVs
A
If IV is not working:
- Check site for infiltration
- Check for kinks
- Reposition arm
- Increase flow rate
- Lower bag below arm to check for blood return
- Raise IV pole
- Check that slide clamp & roller clamp are open
82
Q
What to do if an adverse or allergic reaction occurs with IV meds
A
- Stop the medication immediately
- Follow institutional guidelines for the appropriate response, assessments, and reporting of adverse reactions
- Notify the patient’s health care provider
- Document the allergy in the health care record
83
Q
What to do if infiltration of phlebitis occurs with IV meds
A
- Stop infusion
- Discontinue or re-site IV
- Treat site as indicated by institutional policy
- For infiltration; some medications are harmful to subcutaneous tissue so treat extravasation as per institutional policy
84
Q
Discontinuations of peripheral IVs
A
- An order is required for discontinuation of fluids or medications
- Close all clamps prior to discontinuation
- Remove tape and site dressing; be sure to stabilize catheter while doing this
- Apply light pressure and withdraw catheter, keeping hub parallel to the skin
- Apply pressure to the site for 2-3 minutes
- Cover site with gauze or small bandage
- Inspect the catheter tip for intactness
- If catheter not all intact; it’s in the bloodstream, put a tuniquet and emergency
