Nursing Chapter 36: IV Solutions & Medications

Chapter 36: Administering Intravenous Solutions and Medications

• This chapter covers the administration of intravenous (IV) solutions and medications.

Lesson 36.1: Overview of IV Therapy: Types and Equipment Used

• Theory:
  • IV therapy has four purposes: supplying medications that are more effective by this route, providing fluids and electrolytes for patients unable to take them orally, delivering blood components, and providing nutritional formulas (including glucose, amino acids, and lipids).
  • Infusion pumps provide advantages of controlled flow rates and accuracy, but disadvantages include cost and potential for malfunction.
  • Possible IV complications include infiltration (fluid leaking into tissue), phlebitis (inflammation of the vein), and bloodstream infections. Corrective actions are required for each.
• Clinical Practice:
  • Various methods for administering medications via IV include infusion pumps (primary or piggyback), controlled volume devices, intermittent IVs (often used as needed with a lock), and bolus administration.

IV Therapy

• IVs are used to deliver medications and fluids when other routes are ineffective or less desirable.
• Medications, fluids/electrolytes, blood components, and nutritional formulas (containing glucose, amino acids, and lipids) are commonly given via IV.

Figure 36-2: Intravenous Solution Containers

• This figure illustrates various intravenous solution containers.
• The diagram showcases examples of IV solution containers typically used (including dextrose solutions and saline solutions).

IV Therapy (cont'd)

• The average adult requires 1500-2000 mL of fluid per day to replace losses.
• Fluids are lost through hemorrhage, severe vomiting/diarrhea, excessive wound drainage (e.g., burn wounds), or excessive perspiration.

Types of IV Solutions

• Commonly used IV solutions include glucose, saline, electrolytes, vitamins, amino acids, and blood products.

Types of IV Solutions (cont'd)

• Isotonic solutions: Have the same concentration as blood, used to expand blood volume.
• Hypotonic solutions: Contain less solute than blood, causes fluid to move from the blood into the tissues.
• Hypertonic solutions: Have a higher concentration than blood, causes fluid to move from the tissues into the blood.

Common IV Solutions and Tonicity

• Various common IV solutions and their tonicity are displayed in a table format. (Specific solutions and their tonicity are listed in the provided text).

Administration Sets

• Primary intravenous set: Consists of a fluid bag, tubing, a connector, and IV stand.
• Secondary or piggyback intravenous set: Used to add an extra medication to an existing IV line.
• Parallel, or Y, intravenous set: Specifically designed to deliver multiple fluids, sometimes used with blood products.

Figure 36-3: Intravenous Fluid and Medication Administration Sets

• This illustrates different administration sets. (various kinds of IV sets).

Figure 36-4: Luer-Lok Needleless Intravenous Syringe and Port

• This figure illustrates a Luer-Lok needleless syringe.

Figure 36-5: Y-type Blood Administration Setup

• This illustrates a blood administration setup.

Administration Sets (cont'd)

• Controlled-volume set: Used with infusion pumps to deliver precise amounts of fluid or medication.
• Intermittent intravenous device (saline or PRN lock): Allows for the periodic administration of medications/fluids as needed.
• Filters: Used to remove small particles from the solution.

Figure 36-6: Controlled-volume Set

• Illustrates an example of a controlled volume set or infusion pump.

Figure 36-7: Intermittent Intravenous Device

• Illustrates example of an intermittent IV device.

Infusion Pumps and Controllers

• Infusion pumps are used to regulate the flow rate of IV fluids, particularly for critical needs (e.g., total parenteral nutrition) or medications that need precise dosing.
• They offer advantages in accuracy and control over fluid administration, minimizing potential risks.
• Patient-controlled analgesia pumps are used for pain management in hospitals and home settings.
• Mini-infusion (syringe pump) provides controlled delivery in smaller volumes.
• Insulin pumps are for delivering insulin doses.

Figure 36-8: Intravenous Infusion Pump

• Illustrations of various intravenous infusion pumps; specific models may be provided.

Infusion Pumps and Controllers (cont'd)

• Patient-controlled analgesia (PCA) pumps allow patients to regulate analgesia delivery.
• Mini-infusion (syringe pumps) use syringes for precise medicine delivery.
• Insulin pumps are used in controlling insulin administration.

Venous Access Devices

• Intravenous needles and catheters:
  • Winged-tip or butterfly needle: For short-term use, available in odd-numbered gauge sizes.
  • Over-the-needle catheters: Consists of a needle attached (then removed) to a flexible catheter.
• Common gauge sizes (various sizes of needles are used).

Figure 36-10: Placement of a PICC Line

• Diagram illustrating the placement of a Peripherally inserted central catheter (PICC).

Figure 36-11: Placement of a Subclavian Central Line

• Diagram illustrating the placement of a Subclavian central line.

Central Venous Catheters

• Can be left in place for 6-8 weeks.
• Positioned in the right atrium or superior vena cava.
• Some are tunneled (Hickman, Broviac, Groshong).
• PICC lines are often preferred for home IV therapy.
• Placement is verified by X-ray.

Things to Remember

• When administering IV medications, review the drug's action, possible side effects, and nursing implications.
• Assess for drug allergies and solution compatibilities.
• Ensure the IV line is patent and verify the flow rate.

Question 1

• The average adult needs 1500-2000 mL of fluids daily.

Question 2

• Ringer's lactate and 5% dextrose are isotonic solutions.

Question 3

• To administer blood, a Y-type administration set is needed.

Question 4

• One difference between a PICC and a midline catheter is that a blood pressure can be taken on an arm with a midline, whereas a PICC is advanced to the subclavian vessel; the midline stays within more peripheral vessels.

Lesson 36.2: IV Therapy Guidelines and Considerations

• Theory:
  • Complications related to IV therapy and corrective actions are outlined, including infiltration, phlebitis, bloodstream infection, catheter embolus, air embolus, and speed shock.
  • Guidelines related to IV therapy of fluids or medication are described.
  • Important considerations for older adults receiving IV therapy are suggested.
  • Blood transfusion reaction symptoms and treatment are defined.
• Clinical Practice:
  • Care plans are developed for specific patient needs related to IV fluids.
  • IV flow rates are calculated from orders.
  • IV therapy is initiated with proper aseptic technique.
  • Fluid bags are replaced when needed.
  • Proper procedures for discontinuing IVs are highlighted.
  • Monitoring blood transfusion reactions and documenting patient response to IV therapy are emphasized.
• Patient evaluation includes monitoring the IV site, flow/rate, the insertion site, and any related patient complaints. Regularly recording I&O (intake and output) is necessary.
  • Monitoring vital signs and response to therapy is critical.

Complications of IV Therapy:

• Infiltration: Fluid leaks into surrounding tissue, causing swelling, edema, and coolness.
• Phlebitis: Inflammation of the vein, characterized by redness, warmth, swelling, and tenderness. Blood flow is restricted.
• Bloodstream infections: Pathogens enter the bloodstream, causing symptoms like fever, chills, pain, nausea, vomiting, and extreme fatigue. Blood cultures are obtained, and aggressive antibiotic treatment is administered
• Further details about other types of complications such as catheter embolus, air embolus, and speed shock are described.

Common Nursing Diagnoses for Patients Undergoing IV Therapy

• Risk for deficient fluid volume: Patients may lose fluid due to conditions like vomiting, diarrhea, or hemorrhage.
• Imbalanced Nutrition: Less than body requirements: Malnutrition may occur due to decreased oral intake in patients receiving IV fluids and/or total parenteral nutrition.
• Ineffective tissue perfusion: Problems with fluid and/or blood circulation and flow. This is especially relevant in the context of various conditions resulting in fluid loss or reduced blood flow.

Initiating IV Therapy

• Considerations for IV site selection include vein accessibility, condition, type of fluid, duration of therapy, and location of the vein.
• Common IV sites are distal to the antecubital area (cephalic, basilic, or antebrachial veins of the lower arm, along with veins on the back of the hand).

Administering IV Medications

• Always use the Six Rights (including right rate) when administering IV medications.
• Potassium is always diluted and never given as a bolus injection.
• Sterile techniques are essential when mixing medications, especially IV fluids.

Calculation of Flow Rate

• The formula for calculating drops per minute for IV administration is provided (mL/time x drops/mL).

Application of the Nursing Process

• Monitoring IV flow rate and solution levels are key parts of patient assessment. Insertion site monitoring and patient complaints are also critical to IV care.

Implementation

• Administering IV medications: Medications may be added to the primary fluid bag or a secondary line (piggyback). They can also be administered directly into the vein via controlled-volume burettes. Specific protocols and medication administration records (MAR) are important.
• Administering antineoplastic medications: Special precautions are needed due to their tissue-irritating nature.
• Discontinuing an IV infusion: involves stopping the flow and removal of the catheter and documentation.

Implementation (cont'd)

• Administering blood and blood products: Patient consent is crucial. If a reaction occurs, the blood infusion is immediately stopped. Saline is administered to maintain IV access.
• Total parenteral nutrition (TPN): Daily assessment of nutritional status is vital for patients receiving TPN. Assessing daily needs is needed to see if there are gaps in the necessary nutritional needs.

Evaluation

• Constant assessment of the patient's response to IV therapy, including vital signs, I&O, and insertion site monitoring.
• Documenting IV medication administration and monitoring the IV site frequency are important for patient care.

This quiz explores the principles of administering intravenous solutions and medications as outlined in Chapter 36. It covers the purposes of IV therapy, types of equipment used, potential complications, and the clinical practices involved. Test your understanding of IV therapy and its applications in patient care.