Chapter 36 Administering Intravenous Solutions & Medications PDF

Chapter 36 Administering Intravenous Solutions and Medications Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Lesson 36.1 Overview of IV Therapy: Types and Equipment Used Theory 1)List four purposes for administering intr...

Chapter 36 Administering Intravenous Solutions and Medications Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Lesson 36.1 Overview of IV Therapy: Types and Equipment Used Theory 1)List four purposes for administering intravenous (IV) therapy. 2)Evaluate the advantages and disadvantages of using an infusion pump to deliver fluids or medications. 3)List three possible complications that can arise from the use of the IV route and the corrective actions you should take for each one. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Lesson 36.1 Overview of IV Therapy: Types and Equipment Used Clinical Practice 1)Prepare to give medications using each of the following methods: a. Using an infusion pump to deliver a primary infusion b. Using an infusion pump to deliver an IV piggyback c. Using a controlled-volume device d. Using an intermittent IV or a PRN (as-needed) lock e. Giving the medication as a bolus Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  IV Therapy  IVs are given to supply the body with:  Medications that are more effective when given by this route or cannot be given any other way  Fluids and electrolytes that the patient is unable to take orally in sufficient amounts  Blood, plasma, and other blood components  Nutritional formulas containing glucose, amino acids, and lipids Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-2: Intravenous solution containers Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  IV Therapy (cont’d)  The average adult needs 1500 to 2000 mL of fluids in each 24-hour period to replace those eliminated by the body  Fluids are lost by:  Hemorrhage  Severe or prolonged vomiting or diarrhea  Excessive wound drainage  Wounds (especially burn wounds)  Profuse perspiration Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Types of IV Solutions  Solutions most frequently used contain:  Glucose  Saline  Electrolytes  Vitamins  Amino acids  Blood and blood products Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Types of IV Solutions (cont’d)  Isotonic solutions  Have the same concentration, or osmolality, as blood  Used to expand the fluid volume of the body  Hypotonic solutions  Contain less solute than extravascular fluid  May cause fluid to shift out of vascular compartment  Hypertonic solutions  Have a greater tonicity than blood  Replace electrolytes; when given as concentrated dextrose solutions, produce shift in fluid from intracellular to the extracellular compartment Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Common IV Solutions and Tonicity  0.9% saline Isotonic  0.45% saline Hypotonic  5% dextrose in water Isotonic  10% dextrose in water Hypertonic  5% dextrose in 0.9% saline Hypertonic  5% dextrose in 0.45% saline Hypertonic  5% dextrose in 0.225% saline Isotonic  Ringer’s lactate Isotonic  5% dextrose in Ringer’s lactateHypertonic Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Administration Sets  Primary intravenous set  Consists of bag of solution, regular tubing set, needleless connector, and IV stand  Secondary or piggyback intravenous set  Medications to be given intravenously often added to an existing IV line by using the piggyback method  Parallel, or Y, intravenous set  A Y-type administration set used to infuse certain blood products Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-3: Intravenous fluid and medication administration sets Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-4: Luer-Lok needleless intravenous syringe and port Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-5: Y-type blood administration setup Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Administration Sets (cont’d)  Controlled-volume set  Infusion pump administers small volumes of fluid or medication  Intermittent intravenous device (saline or PRN lock)  Established by applying Luer-lock cap or an extension set to the IV cannula  Filters  Trap small particles such as undissolved medication or salts that have precipitated from solution Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-6: Controlled-volume set Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-7: Intermittent intravenous device Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Infusion Pumps and Controllers  An added safety measure used in many agencies to regulate the flow of routine IV fluids  Use is mandatory when patients receive total parenteral nutrition or for medications that require critical accuracy  Programmed infusion pumps more accurate and provide better control over the amount of solution being infused  Controllers reduce risk of infusing fluid too quickly  Patient-controlled analgesia pumps used in most hospitals and in the home setting Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-8: Intravenous infusion pump Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Infusion Pumps and Controllers (con’t)  Patient-controlled analgesia (PCA) pumps: used in both hospitals and home settings to allow patient to regulate administration of IV analgesics  Mini-infusion (syringe pump) uses an ordinary syringe to deliver small amounts of medication or fluid in a controlled time  Insulin pump is a small, self-contained pump device used to deliver doses of insulin Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Venous Access Devices  Intravenous needles and catheters  Winged-tip or butterfly needle Meant for short-term therapy Supplied in odd-numbered gauges (17, 19, 23, and 25)  Over-the-needle catheters Consist of a needle with a catheter sheath over it The needle is removed, leaving the flexible catheter in the vein 18-, 19-, 20- to 22-gauge needles Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-10: Placement of a PICC line Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-11: Placement of a subclavian central line Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Central Venous Catheters  May be left in place for 6 to 8 weeks  Positioned in right atrium or superior vena cava  Some are tunneled long-term catheters such as a Hickman, Broviac, Groshong catheter  PICC lines are the first choice in home IV therapy  Correct placement is verified by x-ray Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Things to Remember  When giving IV medications:  Review the drug’s action before administration and know possible side effects and nursing implications  Assess for allergies and check for possible drug solution incompatibilities  Ensure that IV line is patent before attempting to administer medication, and verify flow rate IV solution Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Question 1 The average adult needs how many mL of fluids in a 24-hour period to replace those eliminated by the body? 1)500 to 750 2)750 to 1000 3)1000 to 1500 4)1500 to 2000 Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Question 2 Different types of tonicity are found in intravenous therapy solutions. Ringer’s lactate and 5% dextrose are what type of solution? 1)Hypotonic 2)Isotonic 3)Hypertonic 4)None of the above Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Question 3 Richard is getting supplies ready to administer blood to his patient. Which type of administration set does he need? 1)Primary 2)Secondary 3)Y-type 4)Controlled-volume Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Question 4 One difference between the peripherally inserted central catheter (PICC) and a midline (ML) catheter is: 1)you can take a blood pressure on the arm that has a midline. 2)only a PICC line can be used in children. 3)only a midline is placed in the patient under sterile technique. 4)the ML sits inside the subclavian vessel; the PICC may be advanced to the subclavian vessel. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Lesson 36.2 IV Therapy Guidelines and Considerations Theory 3)List three possible complications that can arise from the use of the IV route and the corrective actions you should take for each one. (Continued) 4)State at least seven guidelines related to IV therapy of fluids or medications. 5)Summarize special considerations for older adults who need IV therapy. 6)Recognize the signs and symptoms of a blood transfusion reaction and describe the steps you should take if one occurs. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Lesson 36.2 IV Therapy Guidelines and Considerations Clinical Practice 2)Devise a care plan with patient-specific data for a patient who needs IV fluid therapy. 3)Calculate the IV fluid flow rate from various IV orders. 4)Initiate IV therapy by performing venipuncture with an IV cannula (catheter over the stylet) using aseptic technique, and starting the ordered infusion. 5)Add a new bag of fluid to replace one from which the solution has infused. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Lesson 36.2 IV Therapy Guidelines and Considerations Clinical Practice 6)Discontinue an IV infusion and evaluate the site and surrounding tissue. 7)Safely monitor a patient receiving a blood transfusion; document your actions and the patient’s response to therapy. 8)Collect data on a patient who is receiving total parenteral nutrition; document your findings and the patient’s response to therapy. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Complications of IV Therapy: Infiltration  Occurs when fluid or medication leaks out of the vein into the tissue  Often there will be edema around the site and the tissue will feel cool  Infusion is discontinued and another site is initiated to continue therapy  Fluid that is in the tissue will usually reabsorb within 24 hours Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Complications of IV Therapy: Phlebitis  Caused by irritation of the vein by the needle, catheter, medications, or additives in the IV solution  Signs: erythema, warmth, swelling, tenderness  IV must be discontinued and another site found  Warm compresses to the inflamed site will decrease discomfort Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Complications of IV Therapy: Bloodstream Infection  Occurs when infectious pathogens introduced into the bloodstream  May occur from breaks in sterile technique during cannula insertion or any time the system is opened to change the bag or tubing  Signs and symptoms: fever, chills, pain, headache, nausea, vomiting, extreme fatigue  Blood cultures ordered and aggressive antibiotic therapy is started  IV site is immediately discontinued Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Other Complications of IV Therapy  Catheter embolus  Occurs when a piece of the catheter breaks off and travels in the vein until it lodges  Air embolus  Can occur when changing bags, or when opening the line of a subclavian catheter  Speed shock  Occurs when fluids or medications given by bolus are administered too rapidly Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Common Nursing Diagnoses for Patients Undergoing IV Therapy  Risk for deficient fluid volume  Imbalanced Nutrition: Less than body requirements, related to decreased oral intake  Ineffective tissue perfusion, related to loss of red blood cells or volume Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Initiating IV Therapy  Selection of the IV site  Consider: Accessibility of the vein, its general condition Type of fluid to be given Duration of IV therapy  Veins preferred for infusions and intermittent doses of medications are those distal to the antecubital area  Cephalic, basilic, and antebrachial veins of the lower arm and the veins on the back of the hand are the sites of choice for most adult patients Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Administering IV Medications  All medications are administered using the Six Rights, with the addition of the right rate  Movement of the patient can affect the flow rate  Potassium is ALWAYS diluted and never given as a bolus  Sterile technique is used when medications are added to IV fluids  Most facilities require certification to administer chemotherapy drugs Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Calculation of Flow Rate  To calculate drops/minute:  Amount of solution in mL x number of drops/mL / time (in minutes) Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 36-13: Time tape label for an IV fluid container Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Application of the Nursing Process  Keeping the IV solution running  Assess: The IV flow: the solution should drip into the chamber at regular intervals The rate of the infusion If a pump is used, check the programmed rate and volume; the dripping in the chamber will occur intermittently The insertion site Complaints from the patient The level of the fluid remaining in the bag Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Implementation  Administering IV medications  Methods Adding medications to the primary bag of fluids Adding a secondary line or piggyback to the primary line Using controlled-volume burettes Directly injecting the medication into the vein  All medications are administered following the Six Rights and are documented on the medication administration record (MAR) Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Implementation (cont’d)  Administering antineoplastic medications  Many are very irritating to tissue  Special precautions are used in preparing and administering these drugs  Discontinuing an IV infusion  When an infusion is to be discontinued, the flow is stopped and the catheter is removed  Discontinuation is documented on the IV flow sheet Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Implementation (cont’d)  Administering blood and blood products  A consent to receive blood must be signed by the patient  If a reaction to the blood occurs with the Y administration system, the blood should be instantly shut off Start the saline (with fresh tubing) to keep the IV access open, in case emergency drugs are needed Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Implementation (cont’d)  Total parenteral nutrition  Mainly given through a central line  The nutritional status of patients who are NPO and on IV therapy must be assessed every day  IV solution contains dextrose but amount of calories supplied is below the total daily requirement  Lacks other essential nutrients and bulk  Supplemental calories may be provided by the use of amino acids and fat emulsions Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Evaluation  Constant assessment of the patient  Evaluation of the effect of IV therapy relates to the reason it was given  If fluids are given to hydrate the patient, check for good skin turgor, adequate urine output, and moist mucous membranes  If TPN is given, assess patient’s weight gain and monitor blood glucose level  When a blood product is administered, monitor the blood count to see if values improve  Monitor for signs/symptoms of transfusion reaction Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Evaluation (cont’d)  Documentation  Documentation of IV medication is done on the MAR  IV site is accessed every 1 to 2 hours according to agency policy and observations are entered on a flow sheet or in nurses’ notes  IV fluid counted as intake and recorded on I&O sheet Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Question 5 Which action by the nurse is incorrect when hanging intravenous therapy? 1)Hang the solution to run first at the lowest point. 2)Observe closely for transfusion reactions. 3)Keep the tubing free from air. 4)Keep IV fluids sterile. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.