Intravenous Therapy Overview

Intravenous Therapy

• Intravenous therapy (IV) is a method of administering fluids, medications, nutrition, or blood components directly into the bloodstream via a vein.
• Cannulas (peripheral venous catheters) and central venous catheters are used for IV therapy.
• Cannula sizes are categorized by gauge (e.g., 14G, 16G, 18G).
• IV solutions are classified based on their tonicity:
  • Crystalloids (small molecules that contain electrolytes)
    • Isotonic: same osmotic pressure as body fluids
    • Hypertonic: higher osmotic pressure than body fluids
    • Hypotonic: lower osmotic pressure than body fluids
  • Colloids (large proteins that cannot pass through capillary walls)
  • Blood products (whole blood, packed red blood cells, etc.)
• IV therapy goals include maintaining fluid, nutrient, and electrolyte balance in conditions where oral intake is insufficient.
• IV therapy is used to replace fluid loss, administer medications, and provide pain relief.

Parenteral Nutrition (Hyperalimentation)

• Parenteral nutrition provides essential nutrients intravenously when enteral nutrition is not possible.
• Indicated when the patient has issues with the digestive system or has increased metabolic needs (e.g., burns, cancer).

IV Infusion Methods

• Bolus (IV push): administering a substance directly into a vein all at once, typically for emergencies.
• Continuous drip infusion: slowly infusing fluids or drugs over several hours in a large volume (e.g., 500-1000 mL).
• Intermittent infusion: administering medications within a specific time period (e.g., every 4 hours) or over a short period (e.g., up to 1 hour).

Complications of IV Therapy

• Local complications: infiltration, extravasation, phlebitis, thrombophlebitis, hematoma, clotting, and obstruction.
• Systemic complications: fluid overload, air embolism, septicemia, and allergic reactions.

Nurse's Role in Managing an IV Patient

• Solution preparation: assess solutions for clarity, expiration, and label appropriately.
• Site preparation: cleanse the infusion site using a surgical soap, clipping (not shaving) excessive hair and using an antiseptic.
• Regulating flow rate: calculate the infusion rate.
• Monitoring IV infusion therapy: inspect tubing, assess for leakage, daily inspection of the IV set and for adverse systemic reaction.

Blood Transfusion Considerations

• Use the correct access device (18-gauge or larger).
• Avoid shaking or squeezing the blood container.
• Check the blood's expiration date.
• Reject the blood if inappropriate.
• Infuse packed RBCs and whole blood within 4 hours for bacterial contamination prevention.

Parenteral Nutrition Administration Considerations

• Remove nutrient solutions one hour before administration from the refrigerator.
• Avoid solutions that are cracked or have creamed, indicating fluid separation.
• Administer fluids through an in-line filter.
• Use an electronic device for accurate administration timing.
• Change the solution container and tubing every 24 hours.

Fluid, Electrolyte, and Acid-Base Balance

• Introduction: Water is the primary component of the human body, distributed among three compartments. A balance of fluids, electrolytes, and acids/bases is vital for health.
• Body Fluid Compartments: There are intra- and extracellular fluids, further divided into interstitial and intravascular fluids and transcellular fluids (e.g., cerebrospinal fluid).
• Functions of Body Fluids: The primary function of body fluids is to transport nutrients, wastes, hormones and enzymes, facilitate metabolism, and maintain temperature.
• Regulation of Body Fluids: This is regulated through osmosis, diffusion, filtration and active transport.
• Electrolytes: Elements and compounds that dissolve in water and dissociate into charged ions (cations and anions); crucial for various bodily functions.
• Functions of Electrolytes: Critical in maintaining fluid balance, contributing to acid-base regulation, facilitating enzymatic reactions, and transmitting nerve impulses.
• Fluid Balance: Fluid intake should equal output, with a typical adult intake of approximately 2500mL/day and output of about 1500mL/day, mostly excreted as urine, perspiration and through lungs/feces.
• Electrolyte Imbalances: Sodium (hyponatremia, hypernatremia), Potassium (hypokalemia, hyperkalemia), Calcium, Magnesium, Phosphorus, Chloride imbalances are common and require assessment and management.
• Acid-base Balance: Maintaining the pH of body fluids (7.35-7.45) is crucial; influenced by respiratory and renal mechanisms for acid-base balance.
• Interpretation of ABGs (Arterial Blood Gases): Analyze the pH, PaO2, PaCO2 and HCO3 to diagnose acid-base disorders.
• Normal Values of ABGs: provide the normal values for pH, PaO2, PaCO2, HCO3, and O2 saturation.
• ABG Interpretation: Describe the different types of acid-base disorders.
• Respiratory Acidosis & Alkalosis: Identify risk factors, clinical manifestations, and nursing interventions.
• Metabolic Acidosis & Alkalosis: Determine risk factors, explain clinical manifestations and nursing interventions.

Nursing Diagnoses

• Identify the nursing diagnoses relevant to a patient with IV, nutrition, blood, or fluid imbalances.

Nursing Management

• Provide detailed information about the nursing management/implementations based on those diagnoses.