IV Therapy Course Overview

Adult IV Therapy Course Overview

• This self-study module contains nine chapters and two appendices and requires approximately six to seven hours to complete.
• It is designed to teach Registered and Licensed Practical Nurses the basic principles and techniques of intravenous therapy in acute care settings and isn't intended to standardize guidelines for at home IV Therapy.
• Knowledge is assessed with study questions at the end of each unit, the final exam and a post-test.
• A passing grade on the final exam, which participants have a maximum of two attempts to pass, is 80% or higher.

Course Objectives

• State the importance of understanding the anatomy and physiology of the vascular system
• Discuss the role of intravenous therapy in maintaining fluid and electrolyte balance
• Discuss the role of the nurse in the safe administration of blood and blood products
• Identify the nursing responsibilities associated with the administration of intravenous medications and solutions
• Discuss the nursing interventions related to the complications of intravenous therapy
• Identify the nursing responsibilities associated with the care of central venous catheters
• State the legal implications associated with intravenous therapy
• Discuss the policies and procedures related to IV therapy within the specific hospital

Anatomy and Physiology of Vascular System

• Knowledge of the veins and arteries anatomy and physiology is essential to the patient's welfare
• The anatomical characteristics of the vascular system and consideration of several factors are essential for selecting a vein.
• The reaction of veins to vasoconstrictors and vasodilators influence their size and visibility before venipuncture.

Integumentary System Layers

• The first organ affected in IV access is the integumentary system.
• Epidermis is the uppermost layer, providing protective covering; its thickness depends on anatomic location and age.
• The dermis is the under layer. It contains many capillaries and thousands of nerve fibers.
• Superficial Fascia, or subcutaneous areolar connective tissue, is located below the epidermsi and the dermis layers of the skin containing veins to be used for venipuncture.
• Great care and meticulous aseptic technique must be observed because infection in this area can cause cellulitis very easily.

Vessel Layers

• There are three layers that makes up the vessels
• Tunica Intima is the inner layer composed of a smooth layer of flat cells (endothelial lining) that allows cells and platelets to flow freely.
• When inserting/removing IV catheters avoid roughening the Tunica Intima to prevent trauma and thrombus.
• Semilunar valve folds of endothelium are found in larger veins and are there to help keep blood flowing toward the heart, usually occurring at points of branching, causing a noticeable bulge in the vein
• Tunica Media, is the middle layer composed of muscular and elastic tissue, that contains nerve fibers, vasoconstrictors and vasodilators.
• The Tunica Media stimulation contracts (vasoconstrict) or relax (vasodilate) both arteries and veins, is not as strong or stiff in veins as in arteries, which result in veins tending to collapse or distend as pressure within falls or rises.
• Tunica Adventitia consists of areolar connective tissue that surrounds and supports vessels and is thicker in arteries so that they can be subjected to greater pressure from the force of blood within.
• Arteries pulsate, veins do not.

Preferred Sites for Peripheral IV Placement

• Superficial veins of the upper extremities consist of the digital, metacarpal, cephalic, basilica and median veins
• Digital veins travel along the fingers' lateral portions, joining each other through communicating branches, and are available only as a last resort using only isotonic.
• These veins make them suitable for IV use.
• Metacarpal veins are formed by the union of digital veins on the dorsum of the hand between the knuckles.
• Performing venipuncture at the distal end of the extremity early in therapy course with A 20 to 22G, 3¼-1 inch in length over-the-needle catheter or 21 to 25G steel needle.
• The dorsal venous arch is location where the metacarpal veins join the cephalic vein.
• The cephalic vein originates in the dorsal venous network's radial part formed by the metacarpal veins and flows along the radial border, where part of the radial artery runs under, making it an excellent route for medication and blood infusion.
• The Basilica vein is located on the ulnar aspect and Ulnar Artery run under this area
• The basilica vein is located with an area outside the antecubital fossa on the ulnar curve of the arm is not desirable due to increased risk of hematoma formation
• The median cubital vein is located just below the elbow bend connecting to the cephalic and basilica veins when using A 16 to 18G over-the-needle catheter.
• The Median Ante-brachial vein extends along the ulnar front of the forearm, often experiencing infiltration, can be used with an 18 to 22G.

Types of fluid

• Systemic veins are divided into superficial/cutaneous just beneath the skin in the superficial fascia and is used for venipuncture or deep.
• Deep veins are enclosed in the same sheath with the arteries; an arteriovenous anastomosis may occur as a result of past penetrating injury with risk for pain, complication, and loss of time resulting from repeated unsuccessful venipuncture attempts.

Fluids and Electrolytes

• An understanding of electrolyte balance and fluid offers an essential basis for proper patient care.
• The body fluid is water with dissolved substances that provides a vital environment for chemical and physical reactions.
• Changes to balance the electrolyte and bodily fluids will impact all the rest of the bodily procedures
• The body has a system that maintains homeostasis.

Fluid Distribution

• The body of an adult is about 50-60% water, with females having less percentage of body water.
• Body water distributed in three compartments: extracellular, intracellular and intravascular.
• Fluid compartments interchange via a semipermeable membrane.
• Electrolytes and water can pass freely between the compartments of the extracellular fluid (ECF).
• Change in one compartment will be reflected by changes in the other.
• The ECF compartment is water outside the cells that makes up 20% of the body fluid including interstitial fluid surrounding the body cells, connective tissue fluid, fluids in bones and transcellular fluid.
• Fluid inside the red blood cells are considered to be the ICF or fluid within the cells.

Solutes

• Solutes are dissolved chemical compounds, as ions in electrolytes that are electrically charged.
• Anions have a negative charge
• Positive charge = Cations
• Sum of cations should = sum of anions
• The quantitative expression of ions is milliequivalent (mEq/L).
• Intracellular concentration of magnesium is ten to fifteen times greater.
• Chloride is almost non-existent in ICF only about 2mEq/L

ECF Solutes

• Sodium (Na+) is the principal cation of ECF at a normal concentration is 142 mEq/L
• ECF other consists of Potassium (K+) at 5mEq/L
• Calcium (Ca) at 5 mEq/L
• Magnesium (Mg++) at 3 mEq/L
• While Chloride (Cl-) is the major anion having its normal concentration in plasma at 105 mEq/L the remainders are Bicarbonate (HCO3-) at 25 mEq/L
• Sulfate (SO4-) and Phosphate (PO4-) at 9mEq/L
• Proteins (Prot-) at 16 mEq/L

Electrolyte functions

• In general, they have 3 functions. They:
• Play vital part in osmotic pressure by water distribution
• help electrical impulses be transmitted
• vital in acid base balance

Osmosis

• Osmosis is water movement across a semipermeable membrane in order to balance solute concentration by dissolving, not exchanging, electrolytes.
• Osmotic Pressure is related to the dissolved particles present.
• Osmolatitity is the milliosmoles per kilogram of liquid, where as osmolarity is the number of milliosmoles per liter of solution.
• Tonicity is the concentration of a substance dissolved in the water, increasing with the concentration of the solute.

Isotonic, Hypotonic and Hypertonic

• A isotonic fluid infusion has no effect on cell volume
• In contrast, a hypotonic infusion will burst them and a Hypertonic infusion causes the cells to shrink

IV solutions characteristics and when to use

• Normal plasma has = 290 + 50 osmolarity - D5W: 250 mOsm (isotonic) - 0.9% NS: 308 - 310 mOsm (isotonic)
• When the pt presents Dehydration hypotonic solution is needed (D2.5W or D5W)
• When you are doing maintenance use isotonic or slightly hypertonic (D5W or D5 1/3NS) -Replace volume w/ Diuretics (D10W) via slightly hypertonic (D5 1/2NS) -Or 0.9% normal saline due to dehydration or metabolic alkalosis from blood transfusion or fluid loss.

Active Transport vs Diffusion vs Filtration

• Diffusion is molecules and ions are moved randomly from one concetation until its equal
• While Active transport is achieved via the cell membrane with the aid of a carrier system called a Sodium Pump
• Filtration is water with dissolved substances passing through a permeable membrane.

Fluid and Electrolyte Therapy Goals

• The body’s main goal is to regulate electrolyte balance via: - Kidneys - Skin - Lungs
• To achieve homeostasis electrolyte and fluid imbalances must be corrected and maintained by oral or parenteral routes

Types of Dehydration

• In Isonatremic loss water and solute are proportional leaving serum and osmolality normal with a loss of tissue turgur and oliguira. It is treated with NS via hemorrage, NG suctioning enemas, or other causes
• In Hypernatremic Osmotic pressure pulls water out of cells creating Skin and mucous membranes being dry and erythematou, is common in Insipidus Pt treated primarily with D5W for hydration then 1/3 or 1/2 NS
• Hyponatremic water is drawn into cells, with Na loss being greater, caused diuretics, burns, fistulas and treated with NS or Hypertonic NS

Overhydration

• Is defined by water excess due to input, or decreased loss -Isotonic or Hypotonic caused heart failure, renal failure aldosterone Hyptonic or rare usually due to post op oliguria

Electrolyte Ranges to Memorize

• Know that there is a scale between Phosphate, Calcium, Magnesium, Potassium and Sodium
• Sodium: 135 - 145
• Potassium: 3.5 - 5.3
• Chloride: 95 - 105
• In imbalance recognize s/sx and causes and always treat source of the imbalance

Blood and Blood Component Therapy

• Blood products are commonly ordered as specific individual component to allow specific treatment that saves the complete available blood supply.

Possible components:

• Volume for Whole Blood is 500 mL, containing red blood cells, white blood cells, platelets, and electrolytes, for indication where there is acute blood loss, infused for 4 hours with type and Rh compatibility.
• One unit of PRBCs (Red blood cells) gives similar oxygen at a lower volume 250-350 ml that is used during Anemia and blood loss.
• Fresh Frozen Plasma (FFP) contains plasma and all clotting factors that replaces them
• Volume for Platelet is 50ml mixed with a small amount of plasma indicated for bleeding issues.
• Cryoprecipitate aids in in correct deficiencies of von Willebrand's and the DIC, given with the most plasma compatibility, otherwise infuse with 1- 2ml.
• Granulocytes can be obtained through leukopheresis, containing WBC mixed with RBC or platelet via ABO compatibility.

Transfusions and Blood

• With Leukocyte reduced the same as packed RBC are processes specially removing protein or cell parts usually due to prior medical tx.
• Preoperative patient will give blood Autologously.
• During intraoperative there is blood removal device that will re infuse the components. -Blood drainage requires collection and filtration. -Blood cannot re infused if malignant lesions are present. -The re-infusion must be completed within 6 hours.

Devices

• Use filters to remove debris after circulation
• Regular filters need 170 to 260
• While micro aggregators need 20 to 40 microns
• Remember to review the manufacturer instructions.

Pump safety actions:

    -Do not over 300mm mercury.
    -Patient should only perform this if they are known to have normal function.

If transfusion is needed the RN must be in contact with, and observe Pt status:

    -Monitor for vitals.  
    -Observe for complications. 
    -Use only IV for transfusions.
    -Must start within 30min of receiving.  
    -Take record in what is done completely per policy

Transfusion Reactions

• Reactions can range from mild to death such as in the presence of Fever Non Hemolytic by platelet or proteins treated with medicine that must not restart transfusion due to risk of thrombocytopenia -Allergic Reactions from blood are treated by antihistamine
• Anaphylactic reaction has to initiate stop to save lungs while possibly needing CPR with O2 and Epinephrine

Systemic Reaction and How They Occur

• Hemolytic reaction
• All done as an antigen-antibody reaction so we use 0.9 saline w/ id of the Pt first! -Use with the FULL Pt name + DOB as well and do not infuse anything you did not prep, and check with another nurse. -If the PT is going to go into reaction their will be fever.
• TRALI has lung damage during some conditions.
• Any size emboli create some form of pulmonary embolism
• Pulmonary edema occurs when administration too high .
• The body will need high support.

RN actions during suspected rx:

• First put tubing back in, find other staff and verify . If reaction occurs: stop blood, save bags and do more per policy with Pt care + check reaction records! Know if it occurs on someone who had prior rx. + know it if it occurs.

General Concepts Of IV Medications

• The best practices of medication is the result of combined expertise with the RN pharmacy and doctor at side. As a practice is safe, but the other option can put Pt life at risk + the RN license etc. This is all under the same authority.
• With the right actions done + documented well we can make Pt better !
• IV products can be hard on patients by formation of various combinations of specific drugs . Its critical that the nurse follows best practices for ultimate responsibility of knowledge for compatibility problems.
• Know the type and if in doubt contact the resources at the moment!
• With the use of a solution it effects the rate of delivery- that can effect Pt with changes in P.h. If you are doing it at best practices will use other solutions to help it if needed that has to be made too.

3 types of categories to know:

    -therapeutic
    -physical - visible to eye
    -chemical- only noted by expert analysis + not to normal

When Mixing Med:

• Check with each solution does not have adverse pH -Each thing added must have what will work best in those pH
• Also all solutions are not the same to mix within them
• Vitamins and medications together must be taken care too and often only for short limited time with what they provide during limited time. All that is needed is only the required.
• As IV are to assist the process but if there is anything off make records if you think something is wrong !

Method of admin

• Solution used during IV how fast to send + for howlong?
• Have a solid amount of basic data for dx as a basis
• What are the dosages or expectations with the hydration? What are the compatibilities between the existing solutions?
• PDR - will determine how what what it is for to do the side effects etc.

Know about all the issues it the Pt is to suffer as they get the dose wrong even it is at all small amount

Intravenous Access

• Be sure to sterilize the area --Clean the IV tubing area --Use an IV port

Peripheral Intravenous

• You will be guided to IV site -Check for Pt comfort as to if they will co operate if they are un clear about what is to be done. -To be aware of what a Pt is going through.

IV Therapy

• Try to avoid in upper extremities!
• Make sure IV site is clean during check.
• If Pt is confused or will not take the IV please use arm restraints.

Complications

• Hematoma due to fluid leaking blood when the wall the vein perferates the membrane when there is pressure + happens mostly from anti coagulants.
• Be gentle on people
• Check before you inject the area.

Infiltration

• The site which comes from needle / catheter dislodge.
• You will notice swelling coolness or blanching area

Extravasation

• Inadvertent administration of vesicles solutions into the surrounding area.

Other Conditions in the Vein

• Phlebitis is the inflammation so look for poor cleaning + large cannulas
• Be sure to stop the IV immediately.
• Thrombosis occurs from clot formation where there is damaged intima. Must be aware of clotting, and DO NOT IRRITATE.
• Venous spasm is the response where there is irritation do be aware of how to calm the vein.
• Injury has happened to any ligament.

Catheter related

• Watchout as infection into arteries or more sensitive tissue.

Things the to know about when the body has issues on its own

• Is Embolism caused by air + pressure as the pressure is not being used and is usually a slow onset. So PT is to always remain on L side for embolism
• Pulmonary or blood has issue. If severe you can give steroids.

Conclusion

• The CVAD site and infusion and flow will determine the actions needed. Check with your own location to decide.

This lesson covers key aspects of an IV therapy course, including study questions, exam details, estimated study time, and the target audience of nurses. It also touches on the course structure, learning tools, and focus areas like potential complications and relevant policies.