IV and Blood Infusions Study Guide 2025 PDF

1 Nursing Management of IV Therapies Special consideration: Blood Transfusions HEATHER RUSHMORE, MSN, RN, CNE  2 Objectives After completion of this class and activities, the student nurse will be able to:  Des...

1 Nursing Management of IV Therapies Special consideration: Blood Transfusions HEATHER RUSHMORE, MSN, RN, CNE  2 Objectives After completion of this class and activities, the student nurse will be able to:  Describe the indications for IV therapy, including blood products.  Discuss IV access devises, appropriate placement and rationale for selection.  Recognize signs and symptoms of potential complications of IV therapies.  Prioritize nursing interventions for the management of patients before, during, and immediately following IV therapies.  Explain the procedure for safely administering blood products.  3 Provision 3 of ANA Code of Ethics ”The nurse promotes, advocates for, protects the rights, health, and safety of the patient.”  All care settings Hospitals, extended care, outpatient, infusion centers, the home Fluid and electrolyte replacement Why IV therapy? Medication administration Blood products Nutritional support  5 Purposes Maintenance IV Fluids When oral intake is not adequate Replacement When losses have occurred Solutions Used in Infusion Therapy Crystalloid Colloidal Isotonic, Plasma hypotonic, expanders hypertonic  7 Tonicity Review  8 Tonicity Review, Cont. Hypotonic Isotonic Hypertonic lower solution concentration Nearly same solution Higher solution concentration concentration Fluid moves out of the fluid to move from the cells into VASCULAR space into both the increase the amount of fluid the intravascular space - cells intracellular and interstitial circulating in the vascular shrink, extracellular expands spaces. system without causing movement of fluid in and out of cells Proper IV order  States route as: IV (intravenous)  Type of fluid/solution  Additives  The rate to be infused or volume to be infused in a specified amount of time  Example:  D5 0.45%NS IV at 100 mL/hr  D5 0.45% 500 mL over 1 hr  10 Intravenous (IV) Access Choosing the Vein to use for IV therapy:  Vein size  Patient condition  Characteristics of solution  Rate of solution  Type of intravenous access device available  12 Veins of the Upper Extremitie s Types of Intravenous Access Devices Where’s the tip? Periphera Central l  Peripheral Venous Access  Shortover-the-needle catheter  Steel-winged device  Midline catheter What’s the size? SMALLER THE GAUGE NUMBER, THE BIGGER THE DIAMETER OR HOLE!  Non-tunneled percutaneous central catheters Tunneled catheters Central Venous Implanted ports Access Peripherally inserted central catheters (PICC) Intraosseous (IO) Multiple-Lumen Central Venous Catheter Tunneled and Implanted Port Central Venous Access  PICC (Peripherally Inserted Central 19 Catheter)  Central venous catheter inserted into a vein in arm  Single or multilumen, nontunneled  For patients who need vascular access for 1 week to 6 months  Cannot use arm for BP or blood draw  20 PICC Intraosseous (IO) Access   Administration Styles: Nursing  Continuous infusion Management  Intermittent infusion of Infusion  Bolus Therapy I V push  23 Routine IV Care  Follow Facility Policy  Scheduled saline flushing if without continuous fluids  Care & cleaning of the Hub  Dressings  Documentation 24  Monitoring & Preventing Complications  FluidVolume Overload/ Monitor fluid status Circulatory Overload  Physical Assessment Findings Physical Assessment  Increased blood pressure  Dyspnea I&O  Wet cough, crackles, Weight rales  Increased HR Serum electrolytes  Distended neck veins  26 Monitoring & Preventing Complications:  Infiltration  Phlebitis  Inflammation of vein  the solution infused goes into the tissue surrounding the vein  Pain & erythema along vein  Blanched skin, skin cool to touch,  Graded 0-4 Phlebitis Scale (next slide) edema, unexpected pain/burning,  Causes: chemical, mechanical, leaking of fluid at insertion site bacterial  Extravasation is a type of infiltration,  May progress to cellulitis, thrombus, caused by solution/medication that is sepsis- need to remove & replace! a vesicant- stop IVF immediately if occurs Phlebitis  Monitoring & Preventing Complications Central Line Complications Infection: Safety Alert p. 174 Loss of patency Thrombotic occlusion Medication precipitation Air embolism*  29 Special Considerations: Blood Transfusions Types of Blood Products Whole Blood PRBCs Most common; improved O2 carrying capacity; trauma, surgeries, anemia FFP Second most common; improves blood clotting; Platelets Given for thrombocytopenia/pre-surgery if patient was on platelet inhibitors; DO NOT USE IV PUMP Albumin Volume expander; Used to improve protein levels; does NOT need type & cross TABLE 10.5- indications for blood product transfusion p. 177  31 Compatibility ABO Rh  O is the  Rh positive universal Donor can receive  either Rh +/- AB is universal recipient  Rh negative can only get Rh neg.  Administering Blood Product Pre-checks  Verify Order  Verify Consent Obtained/Signed by provider and patient  Type and Cross Match completed  Patent & appropriately sized IV  Gather supplies & equipment  Does patient need PRE-MEDICATION? At the bedside:  TWO nurse verification*: Blood to Order AND Patient to Blood includes ABO & Rh, expiration dates  Patient Assessment: VS, lung sounds, discussion of transfusion  Patient Education: s/s of concern: fever, chills, short of breath 33  34 Administering Blood Product  Start of Infusion  Start slow! (2mL/min or 120 mL/hr for first 15 min)  Remain at bedside for first 15 minutes  First set of infusion VS at 5 min  Monitor for concerns of reaction- fever, itching, dyspnea  Set infusion rate per order, however no greater than 4 hours (or hospital policy)  35 Potential Transfusion Reactions