IV Therapy (Class 11)

Question 0

Total body fluid

Answer 0

• Varies according to age, lean body mass and sex.
• Contained in 2 main compartments: Intracellular (IC) and Extracellular (EC)
• Total body fluid is 65% of body weight
• IC fluid is 40% of body weight
• EC fluid 20% of body weight and can be broken down into (1) interstitial fluid (around cells) that is 15% and (2) plasma (Intravascular) that is 5%.

Question 1

Why do you administer IV fluids?

Answer 1

• To replace fluid and electrolytes (dehydration)
• Administer medications (IV push and IVPB’s - antibiotics, other medications)
• Administer blood and blood products
• Adequate nutrition (TPN)

Question 2

Water in the body functions primarily as a(an) what?

Answer 2

• Medium to transport nutrients to cells and wastes from cells.
• Transport for hormones, enzymes, platelets, RBC’s, WBC’s
• Facilitator for cellular metabolism
• Solvent for electrolytes and nonelectrolyte solutes
• Aid to maintain normal body temperature
• Facilitator for digestion and promote elimination.

Question 3

Solvent, Solute, and Solution

Answer 3

Solvent (a liquid, solid, or gas) dissolves the Solute (another solid or gas) —> results in a Solution

Question 4

Intravenous Therapy

Answer 4

• IV solutions consist of water (the solvent) containing one or more types of dissolved particles (or solutes)
• Solvents most commonly dissolved in IV solutions are sodium chloride and dextrose.
• Solutes that dissolve in water and disassociate into charged particles (Na+, Cl-, K+) are electrolytes.

-IV solutions also contain particles and have an osmolarity which is measure against normal blood serum.

Question 5

Electrolytes

Answer 5

• Substances capable of breaking into electrically charged ions when dissolved in solution (K+, Na+, Cl-, Ca+)
• Milliequivalent (mEq) is one unit of measure for electrolytes
• Necessary for metabolism, cell functioning, acid base balance, and water distribution.

Question 6

Osmosis

Answer 6

• Is the movement of water across the intravascular capillary membranes to the interstitial spaces and across the cell membranes and back to the intravascular capillary space.
• Through osmosis, water moves from area of high concentration of water (low electrolyte concentration) to an area of low concentration (high electrolyte concentration).
• Osmosis is the movement of water through a semipermeable membrane to a higher concentration of solutes.
• Water easily moves through cell membranes by osmosis

Question 7

Osmolality

Answer 7

The measure of solute (dissolved particles such as sodium, chloride, potassium, and glucose) concentration in the solvent (blood).
-It is calc as the osmosis of these solutes per kilogram of solvent (the solution they are dissolved in)

Question 8

Tonicity

Answer 8

-The measure of the osmotic pressure gradient between 2 solutions. Tonicity implies 2 fluids separated by a membrane and is the ability of a solution to exert osmotic pressure across a membrane.

• Concentration of ions in a solution
• Tonicity range for IV fluids is 103->560 mOsm/L

Question 9

Isotonic Solution

Answer 9

• If IV solution has approximately same osmolarity as blood then it is isotonic.
• Tonicity: 280-300 mOsm
• Causes fluid to remain in the intravascular (IV) compartment.
• Used to increase intravascular volume during acute blood loss, GI bleeding, to support BP when patient is hypotensive, hypovolemic
• NS or 0.9% sodium chloride (310 mOsm)
• Lactated Ringers (LR) solution (275 mOsm)
• D5W (250 mOsm) –> D5W isotonic in IV bag but quickly becomes hypotonic in body because body uses the glucose, which leaves free water.

Question 10

Hypotonic Solution

Answer 10

• IV solutions with fewer dissolved particles than blood is hypotonic.
• Tonicity:Less than 280 mOsm
• Causes fluid to move out of the intravascular space and into cells: cells swell and burst
• Used for cellular dehydration. Fluid goes into cells.
• None of the hypotonic solutions have dextrose (D): 0.25% NS, 0.33% NS (112 mOsm), 0.45% NS (154 mOsm)

Question 11

Hypertonic Solution

Answer 11

• IV solutions with more dissolved particles than blood is hypertonic.
• Tonicity:Above 300 mOsm
• Causes fluid to move out of cells into IV space: cells shrivel and shrink
• Used to shift fluid from intercellular and interstitial spaces into intravascular space in order to reduce cellular edema, and vascular volume overload.
• Solutions all have dextrose (D, sugar) sugar makes you hyper —> D5/0.45NS (405 mOsm), D10W, D5/NS (560 mOsm), D5/LR, D5/0.2NS, D5/0.33NS

Question 12

What are the classifications of IV solutions?

Answer 12

(1) Crystalloids: dextrose, saline, LR
(2) Colloids: volume expanders - dextran, plasmanate, Hespan, Voluven, blood.
(3) Blood and blood products: whole, packed, plasma, albumin
(4) Lipids: balance nutritional needs - total parenteral nutrition or TPN

Question 13

Explain the basic concept of total parenteral nutrition.

Answer 13

• This is a last resort feed them this way only if you have tried everything else first.
• High glucose (sugar) content cause complications, prone to infections.
• Get nutrition totally through veins.
• When pt cannot be fed by the other preferred routes, TPN bypass the process of eating and digestion.
• Receives nutritional formulas containing salts, 25%-70% dextrose, amino acids, lipids, added vitamins, minerals, and electrolytes.

Question 14

Peripheral IV Site

Answer 14

• Over-the-Needle catheter for brief use with 1-2 ports.
• Change dressing every 72 hours
• New site Q72H (or 96 hours when stabilization device used) sooner if complications.
• Hand or arm sites

Question 15

Central IV Site

Answer 15

• For longer use (2-6 weeks) with 2-4 access ports.
• When TPN is needed
• When pt has hard to find arm veins or frequent blood draws.
• Change dressing Q7Days unless soiled
• Makes a bigger hole so there is more risk for infection.

Question 16

List the types of equipment needed for basic peripheral IV therapy.

Answer 16

• IV solution and tubing
• IV pump
• STAT-Lock (stabilization device)
• Non-sterile gloves
• Sterile antimicrobial wipe
• Transparent dressing
• Tape
• Skin prep (makes tape stick)
• Pen: to date and initial site

Question 17

Basic IV Therapy Equipment: IV Tubing

Answer 17

• Basic and secondary administration set (2 ports coming off)
• Blood tubing (always have normal saline with blood)
• Vented set

Question 18

Basic IV Therapy Equipment: IV Fluid Containers

Answer 18

• Plastic or glass

- Variety of sizes (50ml-1000ml)

Question 19

What are the components of a complete order for IV fluids?

Answer 19

• Specific type of solution
• Rate: ml/hr, my/hr, units/hr, etc.
• Total volume to be administered
• Hours over which the IV bag should be run (example: infuse 1000ml 0.45 NS at 125 ml/hr for 24 hours)

Question 20

Spike

Answer 20

You spike a bag of IV fluids when you pierce the port at the bottom of the bag and insert the IV tubing tip.

Question 21

Hang

Answer 21

When you “hang” an IV bag, you are discarding the old and empty IV bag for a new bag which you “hang” in its place.

Question 22

Infuse

Answer 22

• An IV infusion is the act of administering a solution intravenously. When you infuse IV fluids you drip the fluids into the vein.
• An IV bag that is infused is a bag that has completely dripped into the patient and the IV bag is now empty.

Question 23

What is the nurses role in initiating/administering IV therapy?

Answer 23

• Understand patients need for IV therapy
• Type of solution used
• Desired effect
• Untoward reactions that may occur
• Fluid treated like medication, checked for clarity, particles or precipitates.
• Peripheral or central line vs. PICC
• Assist with central line insert, specially trained RNs insert PICC.

Question 24

What is the nurses role in maintenance/monitoring the IV?

Answer 24

• Monitoring/Maintenance: IV rate; phlebitis; irritation; pain; tubing; dressing and site changes.
• IV site check every hour includes: patient condition, IV site, correct solution, proper flow rate, fluid level as expected, when will IV run dry or expire.
• Solution, Tubing and Dressing changes: IV bag labeled and changed every 24 hours, IV tubing labeled and changed on average every 72 hours, IV site rotated Q72 hours, IV dressing changed every 72 hours and always check agency policy.
• Monitoring IV fluids: volume control device monitors drip rate, time tape on IV bag gives hourly indication of where fluid level should be, check infusion rate every hour.

Question 25

Discontinuing IV Therapy Steps

Answer 25

• Gather equipment: gauze, band aid or tape, clean gloves.
• Perform hand hygiene and put on PPE if indicated.
• Explain procedure to the patient
• Turn IV fluids off and put on gloves
• Stabilize IV catheter with non dominant hand, carefully remove tape and/or stabilization/securing device and discard.
• Remove dressing (but don’t allow IV catheter to come out yet)
• Remove IV catheter with dominant hand and quickly apply pressure to site with 2x2 gauze and elevate limb.
• Palm the plastic IV catheter and the old dressing in non dominant hand glove.
• Hold pressure for at least 1 min while arm held in air. If the patient been getting anticoagulant hold for at least 5 min.
• Inspect IV site. If bleeding stopped, apply band aid or tape gauze to site. If bleeding not stopped, continue applying pressure.
• While removing glove (with plastic IV catheter and the old dressing in it), check integrity of IV catheter (ensure part of the catheter did not break off in patient).
• Dispose IV bag/bottle and tubing according to agency policy. Always drain excess IV fluid into IV liquid waste container before discarding empty IV bag in trash.
• Remove additional PPE, if used. Perform hand hygiene.
• Document procedure, noting how patient tolerated procedure, integrity of catheter, and assessment of IV site.