IV Therapy Part Two

IV Therapy: Part Two

• Administration of IV Push Medications: Procedures for giving medications directly into an IV line.
• Complications of IV Therapy: Potential problems like infiltration, phlebitis, infection, and air embolism.
• Infusion Pumps: Devices that deliver fluids at a controlled rate.

IV Therapy: Part 2 Unit Outcomes

• Safe preparation, administration, and documentation of intravenous therapy is essential.
• Adding medications to primary IV solutions is a key procedure.
• IV push medication administration requires specific training and technique.
• IV discontinuation procedures involve proper steps to prevent complications.
• Identifying potential IV therapy complications is critical for patient safety.
• Understanding infusion pump principles is essential for safe IV management.

Review of IV Therapy - Part 1

• Reviewing primary and secondary IV bags is necessary.
• IV access patency (without complications) is a crucial initial assessment.
• Bag solution details (volume, label, expiration), tubing type, length, and label information should be reviewed.
• Flow rates (drops/min or mL/hr) should be assessed.
• Compatibility of secondary solutions with primary solutions is necessary.
• Documentation on the MAR, I/O sheet, and narrative note should be verified.

Intake and Output Example

• Patient is post-op abdominal surgery, NPO, with IV 0.9% NS infusing at 100 mL/hr.
• IV bag contained 500 mL at 0700.
• A new 1000 mL IV bag is hung at 1200.
• 700 mL remaining at 1500.
• Correct documentation of intake and output is required.

Adding Medication to an IV Bag

• Pharmacy staff may add medication to IV fluid containers.
• Emergency situations or remote locations may require nurses to add medications.
• Medication order, venous access site, allergies, medication availability, compatibility, timing, and infusion are essential considerations.
• Medication dose calculation and syringe preparation for IV administration are critical skills.

Adding Medications to IV Bag

• Clean the port before injecting medication.
• Mix medication gently into the IV fluid.
• Add a label with medication name, dosage, infusion rate, date, time, and initials.

Medication Administration: IV Push

• Concentrated drug doses are administered directly into the systemic circulation.
• This can involve injection directly into the primary IV tubing or a saline lock (capped angiocatheter).
• Serious consequences can result from improper administration.

HCP Order Medication Administration Record

• Patient information (Name, DOB, Age, Gender) is crucial for medication records.
• Medical history including diagnosis, allergies, and attending physician is important for medication safety.
• Medication order details, including medication, special instructions, date administered, and administering physician, must be accurately documented.

Medication Administration: IV Push Focused Assessment

• Review provider's orders.
• Note medication allergies and diagnosis.
• Assess primary IV line patency.
• Note IV line, solution, and infusion components.

Medication Push via a Primary IV Line

• Assess medication information prior to administration.
• Identify time required for injection.
• Verify compatibility of medication with existing IV solution and additives.
• Prepare and label syringe for medication administration.

Medication Administration: IV Push via a Primary IV Line (Procedure)

• Prepare medication as indicated and label syringe with name, dose, and initials.
• Perform hand hygiene and apply non-sterile gloves.
• Cleanse injection port for 15 seconds.
• Attach syringe to port closest to patient.
• Administer medication using the Pinch, Inject, Release method over determined time while maintaining continued pressure on IV tubing.
• Remove syringe when infusion is complete.

Medication Administration: IV Push via a Primary IV Line (Post-Procedure)

• After injecting medication, recheck IV fluid infusion rate.
• Observe for patient reactions to the medication.
• Document the procedure, including any observations or reactions.
• Reassess the patient within 30 minutes.

Medication Administration: IV Push via Saline Lock

• Prepare 2 syringes.
• Label syringes (medication and flush solution).
• Saline flush: 1-5 mL (per agency policy). Pre-filled syringes can be used.
• Flush before and after medication infusion.
• Ensure patency of IV access and flush medication into the "lock" and extension tubing with saline.
• Determine required infusion time.

Medication Administration: IV Push via Saline Lock (Procedure)

• Have 3 syringes ready: 1 for medication, 2 for flush, and 3 alcohol pads.
• Hand hygiene and clean gloves.
• Clean saline lock cap with alcohol pad for 15 seconds.
• Clean injection port with NEW alcohol pad for each syringe insertion.
• Administer flush solution and medication using S–A–S, or S–I–S technique and observe the insertion site.
• Administer medication and saline flush at a prescribed rate.

Electronic Infusion Devices: Infusion Pumps/IV Pumps

• Mechanical pressure infuses fluids into veins.
• Predetermined volume delivered over time is measured as mL/hr.
• Advantages over gravity flow include active fluid delivery and controlled primary/secondary rates.
• Alarms alert to problems.

Electronic Infusion Devices: Infusion Pumps/IV Pumps (Additional Features)

• Programmable rates for primary and secondary IV lines.
• Drug libraries and standardized concentrations for commonly used medications.
• Dose error reduction systems for immediate feedback if programmed infusion exceeds limits.

Electronic Infusion Devices: Infusion Pumps/IV Pumps (Rate Setting)

• HCP order specifies volume (1000 mL 0.9% NaCl) and infusion rate (100 mL/hr).
• The pump will be programmed for the prescribed rate (100 mL/hr).
• Pumps only understand mL/hr.

Electronic Infusion Devices: Infusion Pumps/IV Pumps (Nursing Responsibilities)

• The same nursing responsibilities apply whether infusing via gravity or pump.
• Ensure ordered IV solutions are hanging.
• Continuously monitor patients for safe infusion of fluids.
• Frequent monitoring of the IV site for patency.
• Monitoring for other complications.

Complications of IV Therapy: Loss of Patency/Catheter Occlusion

• Bubbles in tubings: Close roller clamp below bubbles and tap tubing to move bubbles upward.
• Drip chamber too full: Close slide clamp, invert, and squeeze.
• IV off schedule (too fast or slow): Adjust roller clamp, check IV bag height, and identify obstructions promptly.

Other Complications of IV Therapy

• Local complications: Infiltration, phlebitis, cellulitis/infection, and hematomas are potential complications.
• Older adults are at higher risk for phlebitis.
• Severed IV catheter: Assess for and address immediately.

Systemic Complications of IV Therapy

• Septicemia and air embolism: Address these potentially life-threatening situations promptly.
• Circulatory overload: Especially concerning for older adults who have cardiovascular or kidney difficulty.
• Allergic reactions: Thoroughly assess for allergies and implement response measures as needed.

Discontinuing an IV

• Gather equipment (sterile gauze, clean gloves, and tape).
• Apply gloves.
• Close roller clamp and disconnect tubing.
• Remove dressing.
• Withdraw catheter; assure catheter is complete and intact.
• Assess IV insertion site for any redness, swelling, drainage, or other issues. Apply continuous pressure on the site for 2–3 minutes.
• Apply sterile dressing and secure with tape.

IV Dressing Change

• Peripheral IV dressing changes should occur when a catheter is changed or replaced, every 96 hours, and as needed for damp, loose, or soiled dressings.

This quiz covers advanced topics in IV therapy, including the administration of IV push medications, potential complications, and the use of infusion pumps. Understanding these components is critical for safe patient care and effective IV management. Test your knowledge on best practices and procedures related to intravenous therapy.