Iv Therapy Part 1 Student F24 PDF

IV THERAPY Part I Basics of Intravenous Therapy and Intravenous Medication Administration Using a Secondary Set SLO’s, Competencies and Concepts SLO: Provide safe, patient-centered, evidence-based nursing care to adult patients at the basic level guided by t...

IV THERAPY Part I Basics of Intravenous Therapy and Intravenous Medication Administration Using a Secondary Set SLO’s, Competencies and Concepts SLO: Provide safe, patient-centered, evidence-based nursing care to adult patients at the basic level guided by the Caritas philosophy to diverse adult populations.  Competency: Use the nursing process at a basic level to deliver patient-centered nursing care to diverse patient populations experiencing common health care alterations.  Concept: Caring Interventions, Fluid and Electrolytes, Tissue Integrity, Clinical Decision Making SLO’s, Competencies and Concepts  SLO: Demonstrate a beginning level of critical thinking and clinical reasoning strategies to provide quality patient care.  Competency: Identify the rationale used to make clinical judgments that ensure accurate and safe patient care.  Concepts: Clinical Decision Making Unit Outcomes: IV Therapy Part 1  Examine principles of safe preparation, administration, and documentation of Intravenous Therapy including:  Equipment  Primary infusions  Secondary infusions  Demonstrate the ability to prepare and administer primary IV infusions.  Demonstrate the ability to prepare and administer IV medications via a secondary line  SLO Application  Think about the 2 SLO’s listed as important for the topic of IV Therapy  Think of ONE clinical example to support one part of the SLO Intravenous (IV) Therapy  Definition:  Administratio n of a substance directly into a vein IV Therapy  Purposes:  Correct or prevent fluid & electrolyte disturbances  Hypovolemia, dehydration  Provide for continuous infusion of fluids  Provide venous access for medication administration  Provide venous access for nutrition Fluid Volume Deficit = Hypovolemia  Loss of water and electrolytes from the ECF (extracellular fluid compartment)  Hypovolemia: intravascular fluid is also lost  Dehydration loss of water from the body without the loss of electrolytes  Think….. Fluid Volume Deficit You are caring for Mrs. M who is on a medical surgical unit in the local hospital. Mrs. M is showing signs of fluid volume deficit.  Name 2 possible causes of fluid volume deficit  Name 2 Signs & Symptoms you might assess  Write your answers down. Possible answers on next slides Causes: Fluid Volume Deficit  Causes Hypovolemia:  Causes Dehydration:  GI losses (vomit, n/g,  Hyperventilation diarrhea)  Prolonged fever  Diaphoresis  DKA  Diuretics, kidney  Enteral feeding disease without sufficient  Third spacing: ascites, water intake burns  Hemorrhage  Altered intake Assessment: Fluid Volume Deficit  V/S: Hypothermia, hypotension, tachycardia, thready pulse, tachypnea  Neuromuscular: Dizzy, syncope, confusion, weakness, fatigue  GI: thirst, dry mucous membranes and tongue, nausea, vomiting, anorexia, acute weight loss  GU: oliguria  Other: diminished cap. Refill, cool, clammy skin, diaphoresis, decreased skin turgor Fluid Volume Excess  Isotonic retention of water and sodium in excess proportions  Hypervolemia: increased blood volume  Overhydration is gain of more water than electrolytes  Think….. Fluid Volume Excess Mr. B is another patient you are caring for on the medical/surgical unit. Mr. M. is exhibiting signs of fluid volume excess  Name 2 possible causes of fluid volume excess  Name 2 Signs & Symptoms  Write your answers down. Possible answers on next slides Causes Fluid Volume Excess  Causes Hypervolemia  Causes Overhydration:  Chronic stimulus to  Strenuous exercise kidneys to conserve with profuse sodium and water diaphoresis (heart failure,  Head injuries – excess cirrhosis) release of ADH  Kidney failure  Anesthetics  Age related changes to CV system and kidney  Excessive sodium intake Assessment: Fluid Volume Excess  V/S: tachycardia, bounding pulse, tachypnea, hypertension  Neuromuscular: confusion, weakness  GI: weight gain, ascites  Respiratory: dyspnea, orthopnea, crackles  Other: edema IV Therapy in Older Adult  Older adult: increased risk for dehydration  There is a decrease in total body mass which includes total body water content  Assessment of skin turgor  May not provide reliable findings due to a natural loss of skin elasticity IV Therapy in Older Adult  Increased risk for fluid volume excess due to:  Age related changes in Cardiovascular and kidney function  Disease processes  Heart failure, kidney failure What the nurse needs to know about IV’s  How to:  Initiate venous access (NURS 1250)  Determine correct solution  Prepare and hang  Maintain/care for  Identify complications  Troubleshoot problems  Discontinue Intravenous Catheters – Types  Peripheral  Short term, hand/forearm, inserted by RN, LPN, paramedic  ONC: “Over-the-needle” catheter – usually Teflon or polyurethane (not metal)  ‘Angiocatheter’  CDC recommends site change every 72-96 hours Peripheral IV Catheter Peripheral IV Catheter Peripheral Catheters: Common Sites for IV Insertion Peripheral IV site with Transparent Dressing Types of Catheters - (continued)  Midline  Less risk of complications, 3-8” long  From antecubital fossa  Catheter tip to be level with axilla  Intermediate term therapy – up to 6-8 www.pda.rnao. ca wks.  Types of Catheters (continued)  PICC:  (Peripherally Inserted Central Catheter)  35-60 cm (13”-23”) length  Inserted by physician, LIP, specially trained RN usually in a vein above the antecubital fossa  Tip is in superior vena cava  Indicated when duration of IV therapy will likely exceed 6 days  May be used in home setting PICC vs. Midline  Types of Catheters - (continued)  Central  Site of insertion: internal jugular, subclavian, femoral veins  1 to 3 lumens  Inserted by physician  Complications Pneumothorax, infection Central Venous Catheter Solution used for IV therapy  Fluid orders written by provider every 24hrs.  Fluid order requirements: like a medication order Name of solution Volume Date/time Rate of flow Route Duration Physician’s signature  11/13/18 - 1730 IV 1000 mL D5 ½ NS Example: @ 150 mL/hr E. Prior, MD  Fluid order must be written/renewed daily  Types of IV Solutions  Isotonic  0.9% NaCl (Normal  Electrolyte content same as body Saline [NS]) fluids ~ 310 mEq (osmolality)~ no  D5W movement of fluid between cells and tissue  Lactated Ringer’s  Hypotonic  0.45% NaCl (1/2 NS)  Electrolyte content less than body fluids ~ causes fluid to move into  Hypertonic cells  D5 0.9% NaCl (D5NS)  D5 0.45% Na Cl (D51/2 NS)  Electrolyte content greater than  D5 Lactated Ringers body fluids ~ causes fluid to move out of cells  Solution Containers  Bags  Sterile  Bag collapses on self as it empties  Sizes: 50mL-1000mL Solution Containers  Bottle  Sterile  Sizes: 50mL-500mL  Use vented tubing Rubber stopper Solution Containers (continued)  What to check when selecting an IV bag Name of solution Size of bag / Amount of solution Expiration date Color/clarity of solution Presence of foreign material Signs of leakage IV Solutions Hang time- how long a solution bag can hang before changing the bag CDC recommendations Maintenance IV Fluids : no recommendations - follow hospital policy and manufacturer ‘s suggestions Total Parenteral Nutrition and Lipids 12 – 24 hrs. Blood : 4 hrs. IV Administration sets (tubing) Primary Secondary (IVPB or piggyback) Extension (with injection cap) Blood administration (2 spikes; one for blood; one for saline) Primary IV Tubing Secondary IV Tubing Comparing Primary Tubing and Secondary Tubing IV Extension Set Ex te w ns it io h n ca s p et Blood Tubing Administration sets (continued)  Other factors Vented vs. Non-vented Drop factor macrodrip vs. microdrip How many drops = 1 mL Drip chamber Clamps (roller and slide) Injection ports Filter or check valve Length of tubing Primary 105” Secondary 37” IV Tubing Vented Tubing Non-vented tubing  IV Tubing ng e ni op Mi cr  Macrodrip vs od g. r ip -L -S m Microdrip ip.o r pe od ni ng cr  Drop factors Ma  Macrodrip: usually 10 or 15 drops/mL  Microdrip: usually 60 drops/mL  Check manufacturer packaging Drop Factors = Number of drops in 1 mL Microdrip or Macrodrip Tubing Macrodrip Microdrip  Usually 10 drops/minute  60 drops/minute  Usually used for volumes to  Usually used for volumes be infused greater than 60 to be infused 60 mL/hour mL/hour or less Primary IV Line: Preparation (think about Universal Steps)  Healthcare Provider Order  Hand hygiene  Identify self and patient; explain procedure  Focused Assessment  IV insertion site  Assess for signs of infiltration; phlebitis color, swelling, pain, leaking, temperature  Assessing IV Insertion Site  Infiltration – IV catheter becomes dislodged or the vein ruptures and the IV fluid enters the subcutaneous tissue instead of the vein  Coolness, paleness and swelling of the area Assessing IV Insertion Site  Phlebitis – inflammation of the inner layer of vein due to:  Chemical, mechanical or bacterial causes  Heat, erythema, pain/tenderness along the vein Assessing IV Insertion Site  Infection – infection at catheter entrance site  Erythema, heat, swelling, pain/tenderness; possible purulent drainage Primary IV Line: Preparation Gather Equipment Correct solution Tubing IV pole/hanger Know desired drop or flow rate  mL/hr. or drops/min.  Need to calculate this based on drop factor, volume & time  Primary IV Line: Set Up Prepare solution container (bag)  Tear perforated corner of outer packaging  Check solution name, volume  Label as necessary  Apply time tape on bag Prepare Tubing Prepare Tubing  Check type  Check for sterility – both ends of tubing  Clamps: roller and slide - close roller clamp  To prevent loss of fluid while priming tubing Primary IV Line set up: (continued)  Attach tubing to bag and prime  Maintain Sterility  Spike port on bag  Squeeze the drip chamber Approximately 1/2 full  Flush/prime tubing to eliminate in-line air bubbles  Label tubing Date, time hung, initials CDC recommendations for hang time of tubing  72-96 hr. for primary tubing (refer to hospital policy) Spiking and Squeezing Drip Chamber Prime the Tubing Label Tubing Primary IV Line set-up: (continued)  Hang the bag – Height: 36” from insertion site  Connect tubing to angiocatheter or extension set  Secure connections – maintain sterility  Set the drip rate, manually using roller clamp (drops/min.) or in a pump (mL/hr)  Documentation  Primary IV Set up (continued) Regulate Flow Label and Hang Time Tape with Roller Clamp Drops Per Minute (Gravity)  Volume to be delivered x drop factor time in minutes  Example: Order reads 100mL/hr. 100 x 10 (1000) 60 = 16.6 or 17drops/min Correctly Setting Drip Rate Secondary IV Line: IVPB (IV Piggyback) Definition: IV Piggyback is IV solution/medication that connects to the upper injection port of primary line (usually 25-250 mL) to be infused through the primary line  Secondary IV Line: IVPB (IV Piggyback) Universal Steps:  Review Provider Order (MAR)  Checkallergies, pt. diagnosis, right reason for medication  Hand hygiene Secondary IV Line: IVPB  Identify self & patient C he C om c k pata  Explain procedure bilit y  Focused Assessment  Checksolutions and medication for Compatibility  Primary IV solution, Secondary IV solution, Medication  Patent IV - check existing line and assess site  Secondary IV Line: IVPB  Gather equipment Correct Medication Where stored Properly labeled Check compatibility with Primary IV Solution Check against MAR Perform 3 checks and 6 rights Tubing Select correct length for IVPB  Check Primary IV solution for Example of IVPB compatibility Medication Secondary IV Tubing and ‘Hanger’  Secondary Line set-up (continued) Calculate/know desired drip rate  Drop factor of equipment  Time interval for infusion  Amount of solution to be infused  Calculate using drop factor:  Gravity: drops/minute  Pump: mL/hour Compatibility check -  can these two solutions be infused together?  Secondary (IVPB) Line set-up  Attaching & Priming Tubing  Maintain sterility  Open outside package of tubing  Remove tubing and close roller clamp – be sure to close NOW so medication is not lost while priming  Spike medication bag  Fill drip chamber ½ full  Flush/prime tubing, eliminating in-line air  Do not allow more than 1 or 2 drops of medication to exit the tubing  Label tubing: Initials, date, time hung Secondary Line set-up Fill drip chamber Slowly open clamp ½ full and prime tubing Connecting Secondary IV (IVPB) Line to Primary IV Hang IVPB on pole/hanger Select upper port on primary line for attachment of IVPB Determine if using gravity flow or pump Connecting Secondary IV (IVPB) to Primary IV  Connect IVPB tubing to primary line  Maintain sterility/hand hygiene/clean gloves  Cleanse injection port for 15 seconds  Reposition bag(s)  Lower primary bag  Raise secondary bag Connecting Secondary IV (IVPB) to Primary IV  Gravity: Establish flow and set rate  Roller Clamps: Secondary tubing: open roller clamp ALL THE WAY Primary tubing roller clamp is used to regulate drip rate Principle of Gravity Flow for IVPB  Lowering and raising bags is the principle of gravity and pressure  Gravity flow  As the piggyback bag empties, the primary bag will begin to flow  Roller clamp selection  Open secondary tubing roller clamp ALL THE WAY  Regulate the secondary flow rate by using the PRIMARY TUBING ROLLER CLAMP  Be sure to come back AFTER the IVPB has infused to re-regulate the primary flow rate Documentation 6th right of medication administration  E-Mar  Solution  Time fluid initiated or replaced  Rate of flow  Any rate changes  Every time checked during the shift  Site  Where is catheter insertion site  Assessment  No redness, swelling, pain, drainage, pallor  Intake & output record