IV Therapy Part One

IV Therapy Part One

• IV therapy involves administering substances directly into a vein.
• Purposes for IV fluids and medications include, but are not limited to, hydration, replenishing fluids, and administering medications quickly.
• Older adults are at increased risk of dehydration due to decreased total body water content.
• Skin turgor assessment may not be reliable in older adults due to natural loss of skin elasticity.

Unit Outcomes: IV Therapy Part 1

• Safe preparation, administration, and documentation of IV therapy are essential.
• Equipment, primary infusions, and secondary infusions are crucial aspects of IV therapy.
• Students must demonstrate the ability to prepare and administer primary IV infusions.
• Students must demonstrate the ability to prepare and administer IV medications via secondary infusion in NURS 1250.

Intravenous Therapy

• Definition: Administration of a substance directly into a vein.
• Purposes: Reasons for administering IV fluids and medications, for example, hydration, rapid medication delivery, and electrolyte balance.

IV Therapy in the Older Adult

• Older adults are at higher risk for dehydration due to reduced total body water content.
• Skin turgor assessment might not be reliable in older adults due to age-related changes.

Pertinent Information Nurses Need to Know About IV's

• Venous access (NURS)
• Determining correct solution
• Preparing and hanging IVs
• Maintaining care for IVs
• Identifying complications
• Troubleshooting problems with IVs
• Discontinuing IVs

Intravenous Catheters - Types

• Peripheral: Short-term catheters inserted into hand/forearm veins by RN, LPN, or paramedic.
• Types of peripheral catheters include: Over-the-needle (ONC) catheters, usually made of Teflon or polyurethane; and Angio-catheters.
• NIH and CDC recommend site changes when clinically indicated.

Peripheral IV Catheter

• Drawings and labels explaining the parts of a peripheral IV catheter.

Peripheral Catheters: Common Sites for IV Insertion

• Diagrams illustrating common vein sites for IV insertion in the arm and leg, including the cephalic, median cubital, basilic, and radial veins.

Types of Catheters: Midline and PICC

• Midline catheter: 3-8 inches long, inserted in a vein of the upper arm, with the catheter tip positioned at the level of the axilla. Used for intermediate-term therapy.
• PICC (Peripherally Inserted Central Catheter): 35-60 cm long, inserted by a physician into a vein above the antecubital area, the tip placed in the superior vena cava. Used for long-term therapy, potentially used at home.

Types of Catheters: Central Venous Catheters

• Insertion sites: Internal jugular, subclavian, or femoral veins.
• Lumens typically range from 1 to 3.
• Inserted by physicians.

IV Solutions: Types

• Hypertonic: Solutions with a higher solute concentration than body fluids; water moves out of the cells. Examples include D5/0.45% NaCl (D5 1/2) and D5/Lactated Ringers, D5/ Normal Saline.
• Isotonic: Solutions with a similar solute concentration to body fluids; no net water movement. Examples include D5W, Lactated Ringer's, or 0.9% NaCl (Normal Saline).
• Hypotonic: Solutions with a lower solute concentration than body fluids; water moves into the cells. Example is 0.45% NaCl

IV Solutions: Containers

• Bags: Sterile bags collapse as they empty. Sizes: 50mL, 100mL. Considerations include the correct solution name, bag size/volume, expiration date, clarity, and foreign material check.
• Bottles: Sterile bottles, with sizes from 50mL to 500mL, often use vented tubing.

IV Solutions: Hang Time

• CDC recommendations regarding the maximum time that a solution bag can be hung before changing it.
• Maintenance IV Fluids: Follow hospital policy and manufacturer’s suggestions depending on the fluid types.
• Total Parenteral Nutrition and Lipids: 12-24 hours.
• Blood products: 4 hours.

IV Administration Sets: Primary and Secondary Tubing

• Diagrams representing primary tubing and secondary (IV piggyback) tubing.

IV Tubing

• Diagrams explaining the components of primary and secondary IV tubings, including clamps and connections.

IV Administration Sets: Other Factors

• Vented vs. Non-vented IV tubing.
• Drop factors (macrodrip and microdrip).
• Drip chamber (macrdrip/microdrip).
• Clamps (slide and roller).
• Injection ports.
• Filter or check valve.
• Length of tubing (Primary tubing: 76-112 inches, and Secondary tubing: 37 inches).

Primary Line IV: Preparation

• Universal steps: Provider order, hand hygiene, identifying self and patient, explaining procedures.
• Focused Assessment: assessing the IV insertion site for signs of infiltration or phlebitis.

Primary Line IV: Preparation Assessing the Insertion Site

• Infiltration: IV fluid leaking into surrounding tissues. Signs may include coolness, paleness, and swelling.
• Phlebitis: Inflammation of the vein. Signs may include erythema, heat, swelling, and pain/tenderness.
• Infection: signs of infection at the insertion site including erythema, heat, and swelling. Potentially purulent drainage.

How to Prime Tubing: Video

• Providing a YouTube video link for instruction and demonstration.

Primary Line IV Preparation: Label Tubing

• Important steps for labeling IV tubing.

Primary Line IV Preparation: Set Up

• Hanging and labeling the IV bag.
• Regulating the rate of flow.

Regulate the Rate: Grav

• Calculating drops per minute for an IV solution based on volume and rate.

Secondary IV Line: IVPB (IV Piggyback)

• IV piggybacks are smaller bags containing IV solutions with volumes ranging from 50-200mL.
• Crucial to check compatibility of IVPB solution with the primary IV fluids.

Connecting Secondary IV (IVPB) to Primary IV

• Determining the correct flow rate for the secondary infusion.
• Connecting the IVPB tubing to the primary line.
• Repositioning bags (lowering the primary and raising the secondary appropriately).
• Establishing flow and setting the rate.

How Does the IV Piggyback Work?

• Gravity-dependent flow process for secondary (piggyback) infusions. The flow rate is regulated by the primary intravenous tubing flow clamps.

Review

• Review videos prior to class.
• Information covered in the presentation included on the NURS 1090 Final.
• IVPB rates dosage calculations are part of the exam.
• Supervised practice lab in NURS 1250 and a Competency Evaluation required.

This quiz covers the essential aspects of IV therapy, including safe preparation, administration, and documentation. Focused on the needs of older adults, it emphasizes the importance of hydration and the assessment of fluid status. Students will demonstrate their skills in preparing and administering both primary and secondary IV infusions in NURS 1250.