Iv Therapy: Part 2 PDF

IV Therapy: Part Two  Administration Of IV Push Medications  Complications Of IV Therapy  Infusion Pumps  IV Therapy: Part 2 Unit Outcomes Examine principles of safe preparation, administration, and documentation of Intravenous Therapy including ◦Addition of me...

IV Therapy: Part Two  Administration Of IV Push Medications  Complications Of IV Therapy  Infusion Pumps  IV Therapy: Part 2 Unit Outcomes Examine principles of safe preparation, administration, and documentation of Intravenous Therapy including ◦Addition of medication to Primary IV Solution ◦IV push medications ◦Discontinue IV Demonstrate the ability to prepare and administer IV medications via IV push method. Identify complications of IV Therapy Explain principles of Infusion Pumps  IV Therapy: Part 2 Review of IV therapy - part 1 Primary and secondary bags: Review the following: Order IV access patent, without complications Bag solution, volume, label, expiration  Tubing type, length, label Flow rate drops/min or mL/hr Compatibility of secondary solution with primary solution Documentation—on the MAR, I/O sheet and in the narrative note if applicable  Intake and Output Example -The patient is first day post-op from abdominal surgery. The patient is presently NPO and has an IV of 0.9% NS infusing at 100 mL per hour. You are the oncoming nurse at 0700. When you checked the IV fluid bag, it contained 500 mL at 0700. -At 1200, you hung a new IV bag of 1000 mL -At 1500, there is 700 mL remaining in the IV bag. --What is the correct documentation on the Intake and Output record?  **Added by Pharmacy staff Nurse may need to add medication to IV fluid containers Emergency situations Adding No Pharmacy staff available Medication Remote location to an IV bag Preparation prior to administration Medication order, venous access site Allergies, availability of medication Collect necessary info about the med.- compatibility, timing for infusion Calculate dose and prepare medication in syringe  Adding medications to IV bag Adding medication to an IV bag ◦Cleanse port ◦Inject medication and gently mix Add label: immediately ◦ Name of medication, dosage, infusion rate, date, time, your initials  Medication Administration: IV Push Definition – Introducing a concentrated dose of drug directly into the systemic circulation via IV access: ◦injection port of primary IV tubing or ◦into a saline lock (capped angiocatheter) Can have serious consequences HCP Order  Medication Administration: IV Push Focused Assessment Review health care provider’s Assess patency of Primary order IV line Note medication allergies and IV line Note IV solution diagnosis infusing Assess Venous Access Site  Medication Administration: IV Push via a Primary IV line Knowledge of medication information Some medications require dilution prior to administration Determine amount of time required for injection Medication reference manual or online, pharmacist, institutional policy Check compatibility of medication with existing IV solution and additives Prepare and label syringe  Medication Administration: IV Push via a Primary IV line 1. Prepare medication as indicated ◦Label syringe (name and dose, initials) 2. Hand hygiene/Apply non-sterile gloves 3. Cleanse injection port (15 sec) 4. Attach syringe to port closest to patient 5. To administer: P - I – R (Pinch, Inject, Release) ◦Administer over determined amount of time ◦Continue to pinch primary IV tubing while injecting 6. Remove syringe when medication infused  Medication Administration: IV Push via a Primary IV line After injecting medication, recheck IV fluid infusion rate Observe for reactions to medication Document Re-assess patient within 30 minutes  Medication Administration: IV Push via Saline Lock Prepare medication in syringe (label) Prepare 2 syringes of flush solution (label) ◦Saline flush 1-5 mL (per agency policy) ◦May use pre-filled saline syringes ◦Flush before and after infusion of medication ◦Before: To insure patency of IV access ◦After: to flush medication into patient and ‘lock’ extension tubing with saline Determine time needed for infusion of medication Medication Administration: IV Push via Saline Lock Extension set with injection port  Medication Administration: IV Push via Saline Lock Infusion of medication into a saline lock Have 3 syringes ready: ◦1 with the medication and 2 for flush and 3 alcohol pads  Medication Administration: IV Push via Saline Lock 1. Hand hygiene/apply clean gloves 2. Cleanse saline lock cap with alcohol pad (15 sec scrub) 3. Cleanse injection cap with NEW alcohol pad prior to attaching each syringe (3) 4. Administer flush solution and medication ◦Remember: S – A – S or S – I – S ◦ Saline Flush: Administer at slow, steady rate and observe insertion site  ◦Administer or Inject: Medication at prescribed rate  ◦Saline Flush : Administer post saline flush at same rate as medication infusion  Electronic Infusion Devices: Infusion Pumps/IV Pumps Infuses/pumps fluid into vein by mechanical pressure Pumps a pre-determined volume into vein over set time measured as mL/hr Advantages of pump (over gravity flow) ◦fluid actively pumped ◦primary and secondary rates can be programmed ◦alarms notify of some problems  Electronic Infusion Devices: Infusion Pumps/IV Pumps Can set rate for primary and secondary line Will alarm if problems are detected Contain drug libraries with standardized concentrations for commonly used drugs Dose error reduction systems (DERS) to provide immediate feedback if a programmed infusion exceeds  Electronic Infusion Devices: Infusion Pumps/IV Pumps How to Determine Rate to Set on Pump HCP Order reads: - Infuse 1000 mL 0.9% NaCL at 100 mL/hr ◦Pump will be programmed to 100 mL/hr ◦Pump only understands mL/hr  Electronic Infusion Devices: Infusion Pumps/IV Pumps Sigma Spectrum Infusion Pump Lakeland Nursing Learning Lab https://www.youtube.com/watch?v=sA5R0g7xar0  Electronic Infusion Devices: Infusion Pumps/IV Pumps Nursing Responsibilities: ◦The same whether infusing by gravity or pump Ensure ordered IV solution is hanging Monitor patient regularly to verify safe infusion of IV fluids Monitor site for patency frequently Monitor for other complications  Loss of Patency/Catheter Occlusion Bubbles in tubing Close roller clamp below area of bubbles and Complicati tap tubing to move air bubbles up to drip chamber where air can be trapped ons of IV Drip chamber too full ¨ Close slide Therapy clamp, invert, squeeze If the IV is off schedule Verify rate (too fast or too slow); adjust roller clamp Note height of IV bag Identify any obstructions to flow  Other Complications *Blackboard handout: IV Complications Local Complications ◦Infiltration ◦Phlebitis ◦Older adult at increased risk for phlebitis ◦Cellulitis/infection ◦Severed catheter ◦Hematoma  Septicemia Air Embolism Systemic Circulatory Overload Complicati Older adults at increased risk Due to age related changes in ons cardiovascular and kidney function Disease process: Heart failure, kidney failure Allergic Reaction  Discontinuing an IV Equipment ◦Sterile 2x2 gauze, Clean gloves, tape Apply gloves Close roller clamp, remove IV tubing from extension tubing  Remove IV site dressing Withdraw catheter from vein ◦Observe that catheter is intact ◦Assess site for redness, swelling or drainage Apply continuous pressure to site for 2-3 minutes. Secure sterile dressing in place with tape.  IV Dressing Change Peripheral When catheter changed/replaced Every 96 hours Damp Loose Soiled As always, follow facility policy