Pharmacology Week 10: IV Therapy Flashcards
Intravenous Therapy Uses
- correct fluid and electrolyte disturbances
- administer medications
- TPN (total parenteral nutrition), PPN
- administer blood and blood products
Components of IV Solutions
- fluid (water, saline)
- electrolytes (KCL)
- nutrients (dextrose, glucose, lipids)
- medication
Intravenous Solutions
- Dextrose and Water (D5W)
- Normal Saline (0.9% NaCl)
- Lactated Ringers (LR)
- 0.45% NaCl (half normal saline)
IV Orders
-type of solution
-amount of solution
-rate of fluid delivery
ex:
>1000ml q 8 hrs/ 3000ml / 24 hrs
>125 ml/hr
Solution D5W solute/solvent
D5W = 5% Dextrose and Water
- Dextrose = solute
- Water = solvent
- 5% = 5 grams dextrose/ 100 ml water
D5W
5% dextrose and water
- Dextrose = solute
- Water = solvent
- 5% = 5 grams dextrose/ 100 ml water
Types of Solutions
- colloidal solutions
- crystalloid solutions
Colloidal Solutions
water and protein (plasma expanders)
Crystalloid Solutions
may diffuse out of the vascular compartment
- Isotonic
- Hypotonic
- Hypertonic
Osmolarity
fluid type describes the effect the fluid has on the way fluid shifts between the intracellular and extracellular compartments
- fluid concentration (tonicity)
- relationship of solutes + solvents
- measured in mOsm per liter
- blood 290 mOsm
Isotonic Solutions
similar concentration (osmotic pressure) as blood
- 250-350 moSm
- stay in the vascular space
- prevent fluid shifts
- extend vascular volume
- 0.9% NS (308 mOsm)
- Lactated Ringers (273 mOsm)
Examples of Isotonic Fluids
- 0.9% NaCl NS (308 mOsm)
- Lactated Ringers (273 mOsm)
Hypotonic Solutions
less osmotic pressure than blood
- less than 250 mOsm
- fluid shifts out of the vascular space to hydrate cells
- 0.45% NS (154 mOsm)
Example of Hypotonic Solution
-0.45% NaCl NS (154 mOsm)
half normal saline
Hypertonic Fluid
greater osmotic pressure than blood
- greater than 375 mOsm
- cause fluid shifts from the tissues (intracellular and interstitial compartments) into the vascular space
- D5NS (560 mOsm)
Example of Hypertonic Solution
D5NS (560 mOsm)
Vascular Access Devices
Peripheral Line Catheters
- butterfly
- angio cath
Saline Lock
- intermittent use
- SAS = saline/administration/saline
- once a shift/ day when not in use (check policy)
- 1-5 mL saline (most common 1-3 mL)
Angio Catheter Care
- change site and tubing every 72-96 hours
- change bag every 24 hours
- IVPB tubing change every 24 hours
- use occlusive transparent dressing
Central Line Catheters
- Percutaneous central venous catheter
- PICC
- Implanted Ports–> Port a cath/ Medi Port
Heparin Flush
- 10 units/ mL
- 100 units/ mL
- 3-5 mL flush (minimum check hospital)
- SASH = saline/administration/saline/heparin
Complications of IV Therapy (Local)
- Infiltration
- Phlebitis
- Site Infection
Local Complication IV Therapy: Infiltration
escape of fluid into the subcutaneous space
-extravasation
Signs + Symptoms of Infiltration of IV
cool, pale, edema, decreased heart rate, resistance to flush, pain or burning at site
Prevention for Infiltration of IV
- secure site
- limit mobility (arm board)
- occlusive dressing
- assess hourly
Interventions for Infiltration of IV
D/C and apply compresses according to agency policy
Local Complication of IV Therapy: Phlebitis
inflammation of the vein
Signs + Symptoms of Phlebitis of IV
warm, red, thick, cord-like vein, red streaking up the vein, pain and tender at site
Prevention of Phlebitis of IV
- change site per policy
- assess hourly (occlusive dressing)
- dilution of meds (KCL needs to be well diluted)
Interventions of Phlebitis of IV
D/C and apply compresses according to agency policy
Local Complications of IV Therapy: Infection
Bacterial contamination of the site
Signs + Symptoms of Infection of IV
- red
- swollen
- warm
- pain at site
- purulent drainage
Prevention of Infection of IV
- change site per policy
- hourly assessment
- occlusive dressing
- good aseptic technique
Interventions for Infection of IV
- D/C
- bleed site
- culture tip
Systemic Complications of IV Therapy
- Septicemia
- Air Embolism
- Catheter Embolism
- Speed Shock
- Circulatory Overload
Systemic Complications of IV Therapy: Septicemia
bloodstream infection
Systemic Complications of IV Therapy: Air Embolism
air injected into IV line
Systemic Complications of IV Therapy: Catheter Embolism
tip of catheter in patients vein
Systemic Complications of IV Therapy: Speed Shock
IVPB med infuses too quickly
Systemic Complications of IV Therapy: Circulatory Overload
IV fluid infuses too quickly
TPN (total parenteral nutrition)
-dextrose (carbohydrate)
-amino acids (protein)
-lipids (fats)
-electrolytes (KCL)
-trace elements (vitamins/minerals)
-medication (insulin, heparin)
TPN for clients in need of calories in excess of 2500 calories
Dextrose Calories
1000 mL/ D5W = 5 gm Dextrose/ 100 mL water
=50 gms. Dextrose (10x5= 50)
50gms. Dextrose= 170 calories
3 liters/day = 510 calories
Caloric Needs
1000 ml/ D10W= 10gms dextrose/ 100 mL water
=100 gms. dextrose (10x10= 100)
100gms. Dextrose= 340 calories
3 liters/ day = 1020 calories
(TPN for clients in need of calories in excess of 2500 calories)
Electronic Infusion Devices
-pumps: exert pressure
>volumetric (ml/hr)
