IV Therapy Part One PDF

IV Therapy Part One Basics Of Intravenous Therapy And Intravenous Medication Administration Using A Secondary Set  Examine principles of safe preparation, administration, and documentation of Intravenous Therapy including:...

IV Therapy Part One Basics Of Intravenous Therapy And Intravenous Medication Administration Using A Secondary Set  Examine principles of safe preparation, administration, and documentation of Intravenous Therapy including: ◦Equipment Unit ◦Primary infusions Outcomes: ◦Secondary infusions IV Therapy Demonstrate the ability to prepare Part 1 and administer primary IV infusions. Demonstrate the ability to prepare and administer IV medications via secondary infusion (will perform in NURS 1250) Intravenous Therapy Definition: ◦Administration of a substance directly into a vein ◦Purposes—Why do we administer intravenous fluids and medications?  IV Therapy in the Older Adult Older adult: increased risk for dehydration ◦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  Pertinent Information Nurses Need to Know About IV’s Initiate venous Determine Prepare How to: access correct and hang (NURS solution 1250) Identify Troublesho Maintain/ Discontinu complicatio ot care for e ns problems  Intravenous Catheters – Types Peripheral Short term, hand/forearm, inserted by RN, LPN, paramedic *ONC: “Over-the-needle” catheter – usually Teflon or polyurethane (not metal) *Angio-catheter NIH and CDC recommend site change when clinically indicated Peripheral IV Catheter Peripheral Catheters: Common Sites for IV Insertion Peripheral IV Site with Transparent Dressing Types of Catheters: Midline and PICC Types of Catheters: Midline Less risk of complications, 3-8” long Inserted in veins of upper arm ◦Catheter tip to be level with axilla Intermediate term therapy – up to 6 weeks  Types of Catheters: PICC (Peripherally Inserted Central Catheter) 35-60 cm length Inserted by physician, specially trained RN; usually in a vein above the antecubital fossa Tip is in superior vena cava Indicated when duration of IV therapy will exceed a week or more—long term therapy May be used in home setting  Types of Catheters: Central Venous Catheters Site of insertion: Internal jugular, subclavian, femoral veins 1 to 3 lumens Inserted by physician Complications ◦pneumothorax ◦infection  IV Solutions: Types HYPERTONIC A hypertonic solution is any external solution that has a high solute concentration and low water concentration compared to body fluids. ◦D5/ 0.45% NaCl (D5 ½ NS) ◦D5/Lactated Ringers ◦D5/ Normal Saline  IV Solutions: Types ISOTONIC HYPOTONIC An isotonic solution is any external A hypotonic tonic solution is any solution that has the same solute external solution that has a low concentration and water solute concentration and high concentration compared to body water concentration compared to fluids. In an isotonic solution, no net body fluids. In hypotonic movement of water will take place solutions, there is a net movement of water from the D5W solution into the body. Lactated Ringer’s 0.45% NaCl 0.9% NaCl (Normal Saline)  IV Solutions: Orders and Documentation Fluid orders written by HCP every 24hrs. Fluid order requirements: same as a medication order Name of solution Volume Date/time Rate of flow Route Duration HCP signature Example: 3/27/20 - 1730 IV 1000 mL D5 ½ NS @ 150 mL/hr continuously. J.Smiley, MD Fluid order must be written/renewed daily  IV Solutions: Containers Bags: Bottles: Sterile Sterile Bag collapses on self Sizes: 50mL-500mL as it empties Use vented tubing Sizes: 50mL-1000mL IV Solutions: Containers Aspects 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 CDC recommendations: Hang time- how long a solution bag can hang before changing the bag Maintenance IV Fluids : insufficient evidence - follow hospital policy and manufacturer ‘s suggestions Total Parenteral Nutrition and Lipids: 12 – 24 hrs. Blood : 4 hrs.  IV Administration Sets: Primary and Secondary Tubing Primary Tubing Secondary Tubing In your supply bag. Do not open  IV Tubing Extension Tubing  IV Administration Sets: Other Factors Vented vs. Non-vented Blood Tubing 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 76-112” Secondary 37”  IV Administration Sets: Vented vs Non- Vented Non Vented Vented  IV Administration Set Drop factors Macrodrip: usually 10 or 15 drops/mL Microdrip: usually 60 drops/mL Check manufacturer packaging  Primary Line IV: Preparation **Think about Universal Steps Provider Order Hand hygiene Identify self and patient; explain procedure Focused Assessment ◦IV insertion site ◦Assess for signs of infiltration; phlebitis  Primary Line IV: Preparation Assessing the 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  Primary Line IV: Preparation Assessing the Insertion Site Phlebitis Infection Inflammation of the inner layer Infection at catheter entrance of vein due to: site ◦Chemical, mechanical or ◦Erythema, heat, swelling, bacterial causes pain/tenderness; possible ◦Heat, erythema, purulent drainage pain/tenderness along the vein How to Prime tubing: Video https://www.youtube.com/watch?v=k8ilZwi3oVY Primary Line IV Preparation: Label Tubing  Primary Line IV Preparation: Set Up Hang and Label the Bag Regulate the rate/flow of fluid with the roller clamp  Regulate the Rate: Gravity Drops Per Minute ◦Volume to be delivered x drop factor time in minutes ◦Example: Order reads 100mL/hr. 100 mL (volume) x 10gtt/min (drop factor) =16.6 or 17 gtts/min 60 (time in minutes)  Secondary IV Line: IVPB (IV Piggyback) IV Piggyback: smaller bag with volume 50- 200mL Always check for compatibility with the primary IV fluid Connecting Secondary IV (IVPB) to Primary IV 1. Determine the correct flow rate for the Secondary infusion 2. Connect IVPB tubing to primary line a. Maintain sterility/hand hygiene/clean gloves/cleanse injection port for 15 seconds 3. Reposition bag(s) – a. Lower primary bag b. Raise secondary bag Connecting Secondary IV (IVPB) to Primary IV 4. Establish flow and set rate 5. Roller clamp a. Secondary tubing-open roller clamp ALL THE WAY b. Primary tubing roller clamp-used to regulate drip rate 6. Pump - (open clamps, program pump)  How does the IV Piggyback work? Lowering and raising bags ◦Principle of gravity 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  Review Be sure to watch all the videos on Blackboard prior to class week 13 The information from this presentation and video will be included on the NURS 1090 Final Exam. Dosage calculation of IVPB rates will be included. A supervised practice lab will be held in NURS 1250 and a Competency Evaluation will be required. Bring you supply bag to class week 13