IV Management PDF

IV Management ▪ IV’s, Parenteral Equipment, Needle Stick Injuries Learning Objectives Parts of a syringe and needle Different types of needle less systems Correct use of parenteral equipment Correct method of drawing up sterile solution from a vial and an ampoule Purposes an...

IV Management ▪ IV’s, Parenteral Equipment, Needle Stick Injuries Learning Objectives Parts of a syringe and needle Different types of needle less systems Correct use of parenteral equipment Correct method of drawing up sterile solution from a vial and an ampoule Purposes and guidelines for IV therapy Regulate drip rate for an IV system Set up and discontinue an IV Familiarize yourself with IV pumps Basic problem solving skills for IV’s and IV pumps Correct procedure in dealing with a needle stick injury Important terms Parenteral o Administered or occurring elsewhere in the body than the mouth and gastrointestinal system Intravenous o Within a vein or veins Intervenous o Between veins Venipuncture o Puncture of a vein, as for drawing blood, intravenous feeding, or the administration of medicine Air embolus o The presence of gas in blood vessels, which can cause an interruption of normal blood flow Bolus o A concentrated mass of pharmaceutical preparation NaCl o Sodium chloride (saline)  IV Catheter o Catheter that is inserted into a vein for supplying medications or nutrients directly into the bloodstream TKVO o * To keep vein open VTBI o * volume to be infused – total volume of fluid to be given Extravasation o To exude from a vessel into surrounding tissue Interstitial o Of, forming, or occupying interstices (small or narrow space, between things or parts) ‘extravasation’ and ‘interstitial’ are synonymous in IV therapy, and describe the IV solution going into the tissue, instead of the vein Symptoms include swelling, burning, discomfort, and edema (an accumulation of fluid under the skin) Luer lok Screw type connection between a male and a female fitting, which are less prone to leak Slip tip Graduated smooth tip that simply slides into the needle hub Parenteral Equipment Needles, syringes, cannulas and intravenous devices are some examples  * principles of surgical asepsis applied when working with IV therapy Medical asepsis - uses clean technique Surgical asepsis - utilizes sterile technique A few very basic principles of surgical asepsis Remember: sterile to sterile, clean to clean, dirty to dirty * a sterile area becomes contaminated when touched by an unsterile object Do not reach or cough /talk across a sterile field. Hold sterile items above waist level. If you suspect a break in technique, change the necessary equipment (even if that means starting over from scratch). Technologist’s role in the proper handling of parenteral equipment Technologists - o Draw up solutions and medications for X-ray and CT procedures o May be called upon to draw up solutions and medications in an emergency situation o Set up IVs o Discontinue IVs Drawing solution from an vile 1. Remove plastic cap from the top of the vial If this is a multi-dose vial that has been opened previously, check the date and time opened and cleanse the rubber top with an alcohol swab 2. Determine the dosage desired from the vial and draw up the equivalent amount of air into the syringe 3. Insert the needle into the vial and inject the air. The fluid will replace the air in the syringe rather quickly 4. Turn the vial upside down and draw the plunger back until the exact amount of drug is obtained 5. Remove the syringe from the vial, re-read the drug label, and set aside for the physician to see 6. After the dose has been administered and if there is contrast left in the vial, date and initial it before returning it to the storage area. Drawing solution from a ampule  1. Wash hands, and assemble supplies (always confirm medication and expiry) 2. Tap the stem of the ampule to ensure all medication is in the body 3. Grasp the stem of the ampule with a gauze pad, or alcohol swab and break it, away from the body If the ampule shatters, the medication must be discarded as there may be glass in it 4. Insert the needle into the ampule (a filtered needle is often used to ensure no glass enters the syringe) and pull back on the plunger to draw the medication into the syringe Maintain sterility- do not touch needle against outside of ampule 5. If necessary, turn the ampule upside down to get the last few drops of medication, as the entire contents are needed for a single does Avoiding Needle Stick Injuries * never recap needles while holding the cap ALWAYS ‘scoop’ cap with needle Have sharps container close by Gloves should be worn when working with patients who have open or draining or infected wounds. when giving injections. when coming in contact with IV lines, catheters and drainage tubes when coming in contact with any items soiled by body fluids. Why Intravenous (IV) Therapy is used As the quickest route to administer fluids to bloodstream primarily, to restore and maintain fluid balance so that fluids can be given in larger amounts over a period of time as a method of administering medications including x-ray contrast media Accessing the Venous system... A needle is used to place a cannula into the vein A cannula is a small tube/catheter that can be inserted into the body. For IVs, usually in the arm The cannula is then attached to tubing and a bag of fluid such as saline Fluid is dripped into the patient at a prescribed rate Basic Setup for an IV A. * Drip chamber: below IV bag can see fluid trip into tubing. Count number of drops per minute when half full. B. * Roller clamp: control rate that IV diffuses at. Can make it more narrow so less fluid goes through. Should be closed before adding bag to ensure no air in tubing C. * slide clamp: used to completely stop IV flowing without adjusting the roller clamp. Pinch tubing completely closed D. * injection port: other medications can be put in so it is administered with the IV fluid Solution Na Cl (Sodium Chloride) Aka Saline IV Pumps Used when infusion needs to be strictly controlled Technologists are usually not responsible for changing a patient’s IV bag however they should be aware of the hospital’s policy about changing bags and tubing. Volumetric pumps force fluid into the vein under pressure and against resistance o do not depend upon gravity to force the fluid into the vein * check IV site regularly as the pump will keep pumping even if the fluid is interstitial If alarm sounds check o that battery is operating, o for occlusion, o for rate accuracy o if alarm still rings, silence alarm and call nursing staff Factors affecting flow rate Height of IV bag o All non-pump IV infusions work on the gravity principle. o Standard procedure is to hang the IV bag * 1.5-2 feet above the injection site o Changing the height of the IV bag changes the gravitational pressure on the fluid- ▪ ↑ bag height over a patients heart = * increase of gravitational force = increased rate ▪ ↓ bag height over a patients heart = * decreased gravitational force = decreased rate ▪ Below the heart may stop or reverse the flow  Patient movement Position of needle in the vein Interruption of IV solution flow Viscosity of the IV fluid Drop factor The drop factor is the- number of drops in one mililiter used in IV fluid administration o * also called drip factor o normally given to you by the manufacture on the IV administration set. Unit: gtts (guttae-Latin for drops) Microdrip -60 drops/ml Macrodrip vary with manufacturer o Cutter-20 drops/ml o Abbott-15 drops/ml o Baxter-10 drops/ml Calculating the IV Flow Rate * The amount of fluid that flows in a given time o important information to ensure correct dosage of medication is administered over the correct time frame Calculation formula (Be sure to know this): Total volume to be given (ml) X Drop factor = Drops per minute (gtts/min) Time (minutes) 1 Example: The physician has ordered 1200mls be administered over 10 hrs, the drop factor of the administration set you will be using is 20 drops/ml ▪ Total volume to be given (ml) * X Drop factor *drops/ml Time (minutes) (* hrs x 60 min) 1 ▪ *1200mls x * * ▪ = * gtts/min TKVO TKO (TKVO) rates can vary between references In Torres 15-20 drops per minute are suggested o This reference does not take into account the drop factor which affects the total ml/hr for a given number of drops As per the Fraser Health Authority (2014) the minimum flow rate is 20 to 50 ml per hour, or according to physician’s orders Best practice is to require a physicians order when setting a flow rate Push or Bolus Medications can be injected by hand in the form of a “push” or “bolus” Medications are delivered all at once by inserting a syringe into one of the injection ports (primary fluid tubing is pinched to momentarily stop flow) Piggyback or Secondary IV Second IV medication or fluid is hung alongside the first, “Piggyback” because it is hitching a ride on an established IV line Attached to the first set of IV tubing through one of the injection ports that is below the drip chamber of the primary IV, works on a gravity principle * primary bag must be lower than the secondary Generally used for medications given in smaller quantities than the primary IV back X-ray Technologists and IV’s ▪ Be aware of the ▪ Level of solution (when patient arrives in dept) ▪ Drip Rate (level of solution after 30 minutes) ▪ Type of fluid being infused ▪ * injection site and tubing (no kinks, blood backing up or reddened due to IV going interstitial  ▪ If secondary IV is complete, open primary accordingly Maintaining the IV line is a primary concern Patient IV attachment For the patient who only needs medications administered intermittently, a cannula is left inserted into a vein, securely taped in place, and they will only need to be connected to an IV when they actually need to receive the infusion of drugs or fluids. A saline lock (sometimes called a “hep-lock”), is an intravenous (IV) catheter that is threaded into a peripheral vein, flushed with saline, and then capped off for later use. Flushing A Saline Lock 1. Wash hands, collect equipment 2. Locate end of saline extension and clean with alcohol swab. Allow site to dry. 3. Collect the prefilled syringe with 3mls of sterile normal saline and attach it to the end of extension tubing by twisting onto extension. 4. Unclamp blue clamp on extension tubing 5. Slowly inject normal saline into the saline lock over 30 seconds. Once all the fluid is injected close the clamp. 6. Remove the syringe and dispose in designated garbage can. Peripheral vs Central Lines Attached to peripheral vein in an Attached to vein in chest, neck extremity or groin Smaller gauge for smaller vessel Much larger gauge for larger Takes longer for meds to work volume Easily irritated, more likely to go Closer to heart for quicker interstitial delivery Easy to insert Choice for harsher chemicals (ie chemo)  More risk to insert and maintain asepsis Discontinuing an IV i. Perform hand hygiene ii. Stop the solution that may be continuing to be distilled iii. Prepare a sufficient strip of tape to cover a small pressure dressing iv. Loosen the tape that holds the needle or catheter in place make certain the hub, and needle or catheter are visible and still in the patient. Do NOT untape the actual insertion site v. Open the sterile gauze sponge pack using aseptic technique vi. Put on clean gloves vii. Gently withdraw the needle or catheter from the vein completely viii. Inspect the needle or catheter making sure it has remained intact ix. Apply pressure to the site with the dry, sterile sponge until bleeding stops- about 2 minutes x. When the bleeding stops, use a sterile gauze sponge folded in 1/2 , place it over the site of insertion, and tape it in place using some pressure over the sponge Inform the patient the dressing may be removed in 1-2 hours xi. Dispose of the materials correctly xii. Remove gloves and wash hands.