iv therapy.pptx

Maintenance of Peripheral IV Therapy Shana Bouley – Skills III – Spring 2024 Perry & Potter Start Table of contents...

Maintenance of Peripheral IV Therapy Shana Bouley – Skills III – Spring 2024 Perry & Potter Start Table of contents Back Next  Purposes of IV Infusion Therapy Vascular access is established when patients require infusion therapy or hemodynamic monitoring. Infusion therapy is used to correct or maintain fluid and electrolyte balance; administer continuous or intermittent medications, blood or blood products, and diagnostic agents and anesthesia; and to correct or maintain nutritional status. Vascular access, one of the most common invasive procedures performed by health care providers worldwide, pose risks to patients; therefore, competence and dexterity are essential to safe patient care Start Table of contents Back Next  Advantages of IV Therapy  Used when other routes aren’t possible ie: unable to swallow  The medication or solution is rapidly absorbed  Patient will have a faster effect Disadvantages of IV Therapy  Once administered – no way of retrieving  Risk of fluid overload (ie: cardiac and renal patients)  Complications occur quicker and more systemic Start Table of contents Back Next  The physician will determine the type of solution and the rate the solution will be administered depending on: the amount of fluid the patient has lost the result of lab test that determine the patient’s electrolyte values the age of the patient the health history of the patient Start Table of contents Back Next  Most adults on average needs 2500mls/24 hours to replace fluids lost However fluid loss can be altered from many different experiences, such as: Increases in metabolism Hemorrhage Vomiting Diarrhea Excessive drainage from wounds Anyone receiving an intravenous solution is placed on intake and output!! This will ensure that proper fluid balance is maintained It is also to ensure the patient isn’t receiving too much fluid Start Table of contents Back Next  Iv Solutions 0 Types & Indications for Use 1 Start Table of contents Back Next  Intravenous Solutions  Isotonic solutions (0.9% Sodium Chloride “Normal Saline”, Lactated Ringer’s & Dextrose 5% in water) can cause increased risk for fluid overload in patients with renal or cardiac disease. Isotonic solutions have the same osmolality as body fluids  Hypotonic solutions (0.45 % Sodium Chloride “Half Normal Saline”) can exacerbate a hypotensive state  Hypertonic solutions (3-5% Sodium Chloride, Dextrose 5% in Lactated Ringer’s) are irritating to the vein and can cause increased risk of heart failure and pulmonary edema Start Table of contents Back Next  Isotonic solutions Isotonic solutions are solutions that contain the same concentration of solute as another solution. When a cell is placed in an isotonic solution, the water diffuses into and out of the cell at the same rate The fluid surrounding body cells are isotonic Isotonic solution when given, stay in the vessels because they are the same concentration as body fluids Fluids such as 0.9% sodium chloride solution, Lactated Ringer’s and D5W are isotonic solutions Uses for isotonic solutions are: To expand the fluid volume of the body They are the standard flush solutions used with blood transfusions. Start Table of contents Back Next  Hypertonic Solutions  Hypertonic solutions contain a high concentration of solute in their solution compared to another solution  When a cell is placed in a hypertonic solution, the water diffuses out of the cell, causing the cell to shrivel  Fluids such as D10W and 3% NaCl are hypertonic  Uses for hypertonic solutions are: To pull fluid from the cells Start Table of contents Back Next  Hypotonic solutions Hypotonic Solutions contain a low concentration of solute in their solution compared to another solution When a cell is placed in a hypotonic solution, the water diffuses into the cell, causing the cell to swell Fluids such as 0.45% sodium chloride solution and 0.33% NaCl Uses for hypotonic solutions are: To promote fluid to flow into cells To expand the intracellular compartment, such as cellular dehydration Start Table of contents Back Next  Possible Complications: Patients on an IV are closely monitored for complications, such as: Electrolyte imbalances Edema Fluid overload, especially in patients with a history of heart failure or hypertension This is why it is important that intake and output is measured on all patients receiving Intravenous Therapy Start Table of contents Back Next  IV Tubing & Administration 0 Sets 2 Start Table of contents Back Next  IV Tubing & Administration Sets  Macro (Primary): with a flow rate of 10 to 20 gtt/mL, it is for rapid infusion of large volumes  Micro (Primary): delivering 60 gtt/mL, is designed for precise administration in small amounts, especially for neonates or pediatric patients  Buretrol: may be used in lieu of the "Select-a-flow" administration device. It is not intended for use on trauma or fluid replacement/challenge. The Buretrol is to be considered as a fluid volume limiter  Secondary IV: often referred to as “IV piggyback” are used to intermittently administer a secondary medication, such as an antibiotic, while the primary IV is also running Start Table of contents Back Next  IV Tubing & Administration Sets  Primary IV administration sets are used to infuse continuous or intermittent fluids or medications. Primary IV tubing can be a macro-drip or micro-drip solution set. A macro-drip infusion set delivers 10, 15, or 20 drops per milliliter, whereas a micro-drip infusion set delivers 60 drops per milliliter. Start Table of contents Back Next  IV Tubing & Administration Sets Primary IV administration sets consist of the following parts: Sterile spike: This part of the tubing must be kept sterile as you spike the IV fluid bag Drip chamber: The drip chamber allows air to rise out from a fluid so that it is not passed onto the patient. It is also used to calculate the rate at which fluid is administered by gravity (drops per minute). It should be kept ¼ to ½ full of solution Backcheck valve: A backcheck valve prevents fluid or medication from travelling up into the primary IV bag Access ports: Access ports are used to infuse secondary medications and to administer IV push medications. These may also be referred to as “Y ports.” Roller clamp: A roller clamp is used to regulate the speed, or stop, an infusion by gravity Start Table of contents Back Next Start Table of contents Back Next  0 3 Drop Factors Start Table of contents Back Next  The drop factor is located on the packaging of the IV tubing and is important to verify when calculating medication administration rates. Macro-drip sets are used for routine primary infusions for adults. Micro-drip IV tubing is used in pediatric or neonatal care where small amounts of fluids are administered over a long period of time  IV Tubing & Administration Sets  Primary IV administration sets are used to infuse continuous or intermittent fluids or medications. Primary IV tubing can be a macro-drip or micro-drip solution set. A macro-drip infusion set delivers 10, 15, or 20 drops per milliliter, whereas a micro-drip infusion set delivers 60 drops per milliliter.  The drop factor is located on the packaging of the IV tubing and is important to verify when calculating medication administration rates. Macro-drip sets are used for routine primary infusions for adults. Micro-drip IV tubing is used in pediatric or neonatal care where small amounts of fluids are administered over a long period of time Start Table of contents Back Next  Spiking Bag & Priming Tubing 0 Start Table of contents Back Next  Spiking Your IV Bag  Perform hand hygiene  Gather your supplies: IV bag and appropriate tubing  Check solution for colour and clarity. Check bag for leaks  Sterility may be compromised if any of the following are observed: Leaking of the bag, discoloration of solution, precipitate is visible and/or solution is beyond use date or expiration has passed. DO NOT USE IF CONTAMINATION IS SUSPECTED  IV bag may be in an outer plastic covering. If so, peel off the outer packaging  The IV bag will typically have two “ports” at the bottom. These will look like small pieces of tubing that are part of the IV bag. One is used to inject medications into the bag and has a beige or white stopper on the end. This stopper does not come off. You will not be using this one, you will be using the IV tubing Start portTable of contents Back Next Start Table of contents Back Next The cap of the IV tubing port pulls off. It may be blue or clear plastic. This is the port you will use to insert the end of the tubing. Hang your bag on the IV pole and pull off the cap (don’t worry, the fluid will stay in the bag). Do not let the tip of the port touch anything else once the cap is off Open the package with the IV tubing You will see a roller clamp on the tubing. It will be open. Slide the roller to the bottom until it pinches the tubing. That is the “off” position Some types of tubing have a pinch clamp instead of a roller clamp. If this is the case, pinch the clamp closed  Identify the end of the tubing that attaches to the IV bag. The drip chamber will be on that end. This is the part of the tubing where you can watch the fluid dripping Remove the plastic cap that is on the end of the tubing. This exposes a plastic “spike.” Do not let the “spike” touch anything once you have removed the cap. It should stay sterile, as it will go into the IV bag (Note: There may be a vent on the drip chamber. Do not manipulate that; it is not necessary for your type of therapy) Start Table of contents Back Next  While holding the port on your IV bag with your non-dominant hand, insert the spike. It will take some pressure, and you should continue to insert it until it will go no further Squeeze the drip chamber a few times until it is 1/3 – 1⁄2 full of fluid Start Table of contents Back Next  Remove the cap on the other end of the tubing. Don’t throw this away, as you will need to replace it momentarily. It is important that the end of the tubing not touch you or any other surfaces. It will attach to your IV access and must remain sterile. Now open the roller clamp on the tubing with one hand while holding the tip of the tubing with your other hand. You may want to hold this over a receptacle. Watch the fluid come out the end – when the air is out of the line you may close the roller clamp. Removing the air from the line is called “priming” your tubing. A few “champagne bubbles” in the line is fine, however, you should not have large bubbles in your line. Keep running the fluid through the line until they are gone If you have bubbles 1⁄2 inch (1.3 cm) or larger, keep running fluid through the line until they are gone. Replace the cap on the end of the tubing  0 5 Programming & Clearing IV Pumps Start Table of contents Back Next IV Infusion Pumps Whenever possible, it is best practice to have an IV infusing on a programmable infusion pump. They deliver the fluid at an accurate rate, and have built-in safety features, such as detection of air in the lines Infusion Pumps: · Reduce the risk of fluid running in too fast · Assist in detecting infiltration or occlusions Pumps are set at a rate of mls/hour, which is stated in your physician’s order. You simply program your pump for the volume ordered per hour Physician’s order for Ms. Ellis: IV therapy 0.9% NaCl, 500 ml bag, infuse at 100 ml/hr on infusion pump My pump display would be programmed to look like the picture below On the screen above, note that below “rate”, you will see “VTBI”. This means volume to be infused, which tells us how much fluid is left in the bag. When a new bag is spiked, this number will be changed to indicate the volume in the bag. At the end of the shift, the “total volume infused” will be recorded from the pump and entered as IV fluid intake for the patient. This number then reverts to zero and begins counting for the next shift.  Gravity Drip 0 Rate Calculation 6 Start Table of contents Back Next Identify the drop factor of your IV administration set (tubing) found on the label of the tubing package. Macrodrip sets are either 10, 15 or 20 drops to deliver 1 mL of fluid in a minute. Microdrip sets are commonly 60 Formula to calculate gravity flow rates: mL/hr divided by 60 minutes (I hour) x drop factor = drops/minute (rounded off) Examples using Macrodrip drop factors: A. IV fluid of 125mL/hr using tubing with drop factor of 10 125mL/hr divided by 60 minutes = 2.08mL/min 2.08mL/min X 10 drop factor = 21 drops/min B. IV fluid of 125mL/hr using tubing with drop factor of 15 125mL/hr divided by 60 minutes (1 hour) = 2.08mL/min 2.08mL/min X 15 drop factor = 31 drops/min C. IV fluid of 125mL/hr using tubing with drop factor of 20 125mL/hr divided by 60 minutes = 2.08mL/min 2.08mL/min X 20 drop factor = 42 drops/min  Calculation of IV 0 Infused & To Be Absorbed 7 Start Table of contents Back Next  How to Regulate IV Fluids The following factors affect the infusion rate if an infusion pump is not used: Size of the catheter. A catheter with a larger bore allows solution to flow faster Height of the IV bag. The higher the IV bag, the faster the infusion will flow Position of the insertion site. A change in the position of the client’s arm may decrease the flow, while elevation on a pillow may increase flow rate. If the IV is inserted into the antecubital area, the solution can flow freely if the client extends the arm and can be obstructed if the client bends the arm at the elbow Monitoring and regulating the rate of the infusion is a responsibility of the nurse A slower rate is usually necessary for older adults or those who are at risk of fluid overload (e.g., heart disease or client with head injury) A faster IV flow rate is therapeutic for patients who have lost large amounts of body fluids and those who are severely dehydrated Never increase the rate of infusion if it is running behind schedule. Check for obstructions and collaborate with primary care providers to determine the patient’s ability to tolerate an increased flow rate Start Table of contents Back Next Nursing Considerations Monitor for infiltration or irritation. Inspect the insertion site for fluid infiltration. If present, stop the infusion and remove the catheter. Restart the infusion at another site and start supportive treatment by elevating or applying heat to the site Look for signs of infiltration. Infiltration occurs when the IV fluid is not flowing into the client’s vein but into surrounding tissues. Signs of infiltration include swelling or puffiness, coolness, pain at the insertion site, and tenderness in the area Monitor for signs of phlebitis. Phlebitis is the inflammation of the vein. Signs include pain and tenderness, swelling, and warmth in the area. If phlebitis occurs, stop infusion and restart at another site. Do not use the injured vein again Start Table of contents Back Next Nursing Considerations Regularly monitor IV flow rate. Monitor IV flow rate regularly (every hour) even if the solution is administered through an IV pump Assess for fluid overload. Regularly assess the patient for signs of fluid overload: increased heart rate, increased respirations, and increased lung congestion Risk for fluid overload. IV flow-control devices should be used for older and pediatric patients when administering IV fluids. These age groups are at risk for complications of fluid overload Proper documentation. Document all findings including the total amount of fluid administered, and any adverse responses of the client Start Table of contents Back Next  Complications 0 For Intravenous Therapy 8 Start Table of contents Back Next  CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon, and infographics & images by Freepik Please keep this slide as attribution Start Table of contents Back Next Infiltration Infiltration occurs when IV fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen Signs and symptoms: Swelling, discomfort, burning, and/or tightness, cool skin and blanching, decreased or stopped flow rate Management: Stop the infusion and remove the device. Elevate the limb to increase patient comfort; a warm compress may be applied. Check the patient's pulse and capillary refill time. Check the site frequently. Document your findings and interventions performed. Start Table of contents Back Next Start Table of contents Back Next  Phlebitis Phlebitis is inflammation of a vein. This complication of peripheral IV therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Phlebitis can also occur because of vein trauma during insertion, use of an inappropriate IV catheter size for the vein, or prolonged use of the same IV site Signs and symptoms: Redness or tenderness at the site of the tip of the catheter or along the path of the vein. Puffy area over the vein and warmth around the insertion site Management: Stop the infusion at the first sign of redness or pain. Apply warm, moist compresses to the area. Document your patient's condition and interventions. Start Table of contents Back Next  Phlebitis Start Table of contents Back Next  Infection of IV Site Local or systemic infection is another potential complication of IV therapy Signs and symptoms: Redness and discharge at the IV site and elevated temperature Management: Stop the infusion and notify the prescriber. Remove the device, and culture the site and catheter as ordered. Monitor the patient's vital signs. Start Table of contents Back Next  Documentation 0 9 Start Table of contents Back Next  But How Would you Documen t That? Start Table of contents Back Next