objective 5 (1) Flashcards
delivers fluids directly into a vein
commonly used to treat many different fluid and
electrolyte imbalances
intarvenous therapy
what are the clinical indications of IV therapy?
- Maintain or prevent fluid & electrolyte
imbalances
oral intake restricted
client can’t swallow/absorb med by
any other route
GI absorption impaired - Administer medications
- rapid drug effect needed
- Replenish blood volume
- Continuous therapeutic blood level
desired - Assist in pain management
what are the risks of IV therapy?
- phlebitis, ecchymosis, extravascular fluid infiltration, infection,
thrombosis, and venous spasm. - Systemic complications may also occur, such as bacteremia and
sepsis, air embolism, and pulmonary edema.
what are the benefits of IV therapy?
Giving drugs IV is rapid and effective
Drugs can also be delivered long term by continuous infusion, or
over short period, directly as single dose.
what are the commonly infused drugs?
- antibiotics
- thrombolytics
- histamine-receptor antagonists
- antineoplastics
- anticonvulsants
- cardiovascular drugs
what are the types of IV solutions?
isotonic
hypotonic
hypertonic
H2O & molecules suspended
(undissolved) substances i.e. blood cells
& blood products (albumin)
colloid
H2O & dissolved crystals i.e. salt
(sodium chloride) or sugar (glucose,
dextrose)
crystalloid
- same concentration of dissolved
substances as plasma (ECF) - RBCs does not shrink or swell
- Use- clients who can’t eat/drink for short
time
isotonic solutions
what are the types of isotonic solutions>
- 0.9% NaCl (NS -normal saline)
- 5% dextrose & H2O (D5W - glucose &
H2O) - Lactated Ringer’s (RL: E- solution)
provides more water than electrolytes, diluting the
ECF
* Use
* rehydrating clients (cause body to
retain fluid, draws fluid into cells
causing blood cells to swell)
hypotonic solutions
what are the types of hypotonic solutions?
- 0.45% NaCl (half strength saline)
- 0.33% sodium chloride
- more concentrated than plasma
- Draws water from the ICF into the ECF
- Use:
- Total Parenteral Nutrition – TPN
- D10W (Dextrose) or 3% Saline
- useful in treatment of hypovolemia
and hyponatremia
hypertonic solutions
how do we maintain therapy?
- Nursing responsibility to check continuous IV every
hour - Knowledge of the solutions being administered and
principles of flow - Assess for local and systemic complications
- Excessive IV fluids causes increased blood pressure and
central venous pressure
pulmonary edema
what are the S&S of pulmonary edema
↓SpO2, ↑respiratory rate, dyspnea, coughing up
pink frothy sputum, auscultation of dependent fine
crackles
what is the nsg care for pulmonary edema?
- Prevention: Use IV controller / pump to prevent accidental bolus.
- Treatment: Must be immediate. ↑HOB, vitals, administer
oxygen, notify prescriber. Anticipate - diuretics and slowed IV rates
at insertion site or systemically
infection
what are the S&S of infection?
Insertion site may become red, tender, swollen, or have
purulent drainage. Systemic signs and symptoms may
include malaise, fever, hypotension, or tachycardia
what is the nsg care for infection?
PVAD-short and midline catheters showing S&S of local
infection should be removed immediately. Monitor for signs
and symptoms of systemic infection
air enters circulatory system via
bubbles in tubing/solution running out
air travels to lungs
air embolism
what are the S&S of air embolism?
Palpitations, dyspnea, cyanosis,
hypotension, weak rapid pulse, loss of
consciousness, chest pain
what is the nsg care for air embolism?
- Stop infusion, administer oxygen
- position client on Lt side,
Trendelenburg position, call doctor
movement of previously stationary blood clot to lungs
pulmonary embolus
what are the S&S of pulmonary embolus?
Sudden chest pain, Cyanosis, SOB,
decreased B/P, Tachycardia, anxiety
IV needle/catheter slips out of vein or not inserted
into vein
results in fluid build-up in extravascular tissue
infiltration
what are the S&S of infiltration?
swelling, pain, redness, decreased
infusion rate, coolness at site
- Similar to infiltration
- Administration of irritant solutions into surrounding
tissue
extravasation
what are the S&S of extravasation?
Pain, burning, redness, blistering, inflammation,
necrosis
inflammation of vein from:
prolonged use of vein
irritating solution
phlebitis
what are the S&S of phlebitis?
Redness, heat, swelling & pain along
vein
inflammation of vein /c blood clot formation
results from blood stasis inside vein at
catheter/needle tip
thrombophlebitis
what are the S&S of thrombophlebitis?
- Pain & tenderness
- Redness & swelling
- heat along vein path
- Slowed infusion
Blood leakage into tissue around insertion
site
hematoma
what are the S&S of hematoma?
Ecchymosis, swelling, leakage of blood
caused by a clot due to inadequate flushing protocol on locked sites or
infusion rates too slow to keep vein open
occlusions
what are the S&S of occlusions?
Sluggish flow rate. Inability to flush or infuse IV solution
or meds. Frequent downstream occlusion alarms on the
IV controller / pump
Result of kinked tubing, slow infusion rate empty IV
bag or failure to flush line after intermittent
medication or solution
clotting and obstruction
what are the S&S of clotting and obstruction?
Slow infusion and blood back flow into line
Caused by microorganisms that are introduced into
the blood through the puncture site, the hub, or
contaminated IV tubing or IV solution, leading to
bacteremia or sepsis
catheter-related bloodstream infection (CRBSI)
what are the S&S of catheter-related bloodstream infection?
elevated temperature, flushed, headache, malaise, tachycardia, decreased BP,
and additional signs and symptoms of sepsis
- Regulate amount fluid over long period
- Primary & secondary lines
continuous
- Solution (drug) given in shorter period
- Piggy back, saline lock, & volume-control
set
intermittent
allows IV solutions to infuse into
client’s subcutaneous fat
* For first hour, rate should be set at
30 mls per hour
hypodermoclysis
- IV push
- Delivers single dose (bolus) of a drug
- Into a vein or existing line
direct injection
what are the types of IV tubing?
primary
secondary
Y-admin tubing
vented
unvented
used to admin lg volumes of IV
solution over long period of time
primary
shorter tube, used to admin sm
volumes of solution through port in
1° tubing
secondary
- for admin whole blood/packed
cells - 2 branches (1 for blood, 1 for
N/S) - filter below branches to remove
bld clots/cellular debris - N/S infuses before & after blood
or during if transfusion reaction
occurs
Y-admin tubing
- draws air into solution container
- used for solutions packaged in glass
bottles (lipids, in past) to facilitate flow
vented
- used for solutions packaged in plastic
- does not draw in air (regular tubing
set)
unvented
what does tubing consist of?
1)Spike (insertion spike for accessing
solution)
2)Drip chamber (holds sm amt fluid)
3)Length of plastic tubing ( connects
solution to catheter)
4)One or more ports ( to instill IV meds,
additional solutions)
5)Roller clamp (regulates rate of infusion)
- Most common sites arm/hand (back of
hand, arm, forearm or inner elbow - Avoid veins in foot/lower extremities -
IV here restricts mobility & risk for
blood clots - Infants - scalp veins
superficial veins
what are the common causes of IV flow interruption?
tubing block
faulty pump
air vent patency
how often is a continuous IV changed?
96 hrs
how often is an intermittent IV changed?
24 hrs
- Parenteral Nutrition, extended IV
therapy, solutions with PH > 9 or < 5;
removal blood specimens; For clients
with limited peripheral veins - Inserted antecubital area through
basilic, cephalic, or median cubital - Tip in axilla region
- Replace Q 2-4 wks
midline catheter
- Providing TPN, Monitor central venous
pressure - Administering concentrated or irritating IV
solution - Collapsed peripheral veins
- Long term IV therapy
- Peripherally Inserted Central Catheter
- Upper arm (basilic or cephalic vein)
- Inserted into jugular or subclavian vein to
just above heart (superior vena cava) - Done at bedside; placement verified by
- x-ray
peripherally inserted central catheters (PICC’s)
External Tunneled catheters
Surgically implanted
Held in place by Dacron cuff
hickman, broviac, groshong
- Surgically implanted
- Via subclavian or jugular vein
- Reservoir attached and placed in
subcutaneous pocket - Angle needle inserted through skin for
access
implanted venous ports
what can infusion rates be affected by?
- Changes in patient position,
- Flexion of the IV site extremity
- Occlusion of the IV device
- Venous trauma
- Manipulation of the VAD
- delivers a measured amount of fluid over a period of time (e.g., 100 mL/h)
- computer system with a drug library and are associated with reduced risk for
infusion-related medication errors
electronic infusion devices
- include flow regulators (i.e., dial or barrel-shaped)
- volume-control devices deliver small volumes with the aid of gravity
- height of the IV container, IV tubing size, or fluid viscosity) affect an IV gravity
controller.
manual flow-control devices
- delivers standard volume of 60gtts/ml
- delivers small-sized drops
microdrip
- drop size varies
- 10, 15 & 20 gtts / ml
- 10 is most common - delivers large-sized
drops
macrodrip
