Nursing Management of IV Therapies: Blood Transfusions

Nursing Management of IV Therapies: Special Considerations - Blood Transfusions

• This presentation covers the nursing management of intravenous (IV) therapies, with a focus on blood transfusions.
• Objectives include describing indications for IV therapy, including blood products; discussing IV access devices, appropriate placement, and rationale for selection; recognizing signs and symptoms of potential complications; prioritizing nursing interventions before, during, and after IV therapies; and explaining the procedure for safely administering blood products.
• The nurse's role is to promote, advocate for, and protect the patient's rights, health, and safety (per ANA Code of Ethics, provision 3).
• IV therapy is utilized in various care settings, such as hospitals, extended care facilities, outpatient clinics, infusion centers, and home healthcare.
• Purposes of IV therapy include fluid and electrolyte replacement, medication administration, blood product administration, and nutritional support.
• IV fluids are used for maintaining adequate fluid intake, or when oral intake is insufficient. They are also used for replacement of fluids lost.
• Solutions used in infusion therapy can be classified as crystalloids (isotonic, hypotonic, hypertonic) or colloids (plasma expanders).
• Tonicity refers to the concentration of solutes in a solution. Isotonic solutions have a similar concentration to bodily fluids, hypotonic solutions cause fluid to move from the blood to cells, and hypertonic solutions cause cells to shrink due to fluid moving out of the cells.
• Proper IV orders include the route (IV), solution type, additives, and infusion rate or volume over a specific time. Examples include D5 0.45%NS IV at 100 mL/hr or D5 0.45% 500 mL over 1 hour.
• Factors influencing vein selection for IV therapy include vein size, patient condition, solution characteristics, infusion rate, and available IV access devices.
• Common veins in the upper extremities for IV insertion include cephalic, brachial, basilic, median cubital, radial, and ulnar veins.
• Peripheral venous access devices include short over-the-needle catheters, steel-winged devices, and midline catheters.
• IV catheter gauge size (e.g., 14G, 20G, 26G) affects the diameter of the hole. Smaller gauge numbers correspond to larger diameters.
• Central venous access devices include non-tunneled percutaneous catheters, tunneled catheters, implanted ports, PICCs (peripherally inserted central catheters), and intraosseous (IO) access.
• Examples of multiple-lumen central venous catheters have multiple ports/lumen for injection and withdrawing fluids.
• The management of IV therapy encompasses various administration styles like continuous infusion, intermittent infusion, bolus, and IV push.
• Routine IV care includes following facility protocols; scheduled saline flushing, cleaning of the hub; and dressing changes, along with proper documentation.
• Monitoring and preventing complications from IV therapy require observation of fluid status, I&O, weight, serum electrolytes, vital signs (blood pressure, heart rate, breathing rate, and lung sounds) for changes.
• Complications to watch for include fluid volume overload/circulatory overload, infiltration (the infused solution leaking into the surrounding tissue), phlebitis (inflammation of the vein), extravasation (a more serious type of infiltration), and infection.
• Recognizing and treating complications such as central line complications (infection, loss of patency, thrombotic occlusion, medication precipitation, or air embolism) and potential transfusion reactions (acute hemolytic reaction, febrile nonhemolytic reaction, allergic reaction, circulatory overload)
• Blood product selection and compatibility - O negative is the universal donor, AB positive is the universal receiver.
• Proper pre-checks such as verifying the order, consent, type and cross-match, patient assessment, medication administration (if required), essential equipment, as well as post procedure actions such as monitoring patient's response to the therapy.
• Starting an infusion slowly and carefully to prevent complications and remaining at the bedside for a while after an infusion is started.
• Monitoring for signs of a transfusion reaction (fever, itching, dyspnea).

This quiz focuses on the nursing management of intravenous (IV) therapies, particularly blood transfusions. It covers indications for IV therapy, IV access devices, potential complications, and safe administration procedures. Essential nursing interventions and ethical responsibilities in managing patient care are also discussed.