Wk+1+Unit+12+IV+Therapy.pdf

IV Fluids Nursing B43 Hoffman and Sullivan 2 Chap 10 ATI skill module IV therapy and Med Admin #4 1 Objectives Discuss the purpose of IV Discuss nursing interventio...

IV Fluids Nursing B43 Hoffman and Sullivan 2 Chap 10 ATI skill module IV therapy and Med Admin #4 1 Objectives Discuss the purpose of IV Discuss nursing interventions in IV therapy Identify complications of IV therapy Differentiate between peripheral line, PICC line, and central line Explain the purpose of IV medication: IV push and IV piggyback 2 1  IV Therapy Restore previous loss of body fluids Replace current loss of body fluids Maintain daily fluid requirements – Restore electrolyte balance – Carrier fluid for medication – Pt unwilling or unable to swallow – Med adversely affected by GI secretions or Meds would irritate GI tract – Anesthesia/sedation – Only available IV – Precise accurate dosing – Emergency – Drug requires monitoring and accurate blood levels 3 Serum Osmolality Serum osmolality – solute concentration in serum Higher osmolality means greater pulling power for water Normal serum osmolality is 275 to 295 mOsm/kg IV fluids are described as: – Isotonic – same osmolality as serum – Hypotonic – lower osmolality than serum – Hypertonic – higher osmolality than serum 4 2  Isotonic Same osmolatily as plasma Fluid remains in ECF Used to increase ECF Isotonic IVF: – Normal Saline (NS, 0.9% NaCl) – Ringer’s solution – Lactated Ringer’s (LR) 5 Hypotonic Lower osmolality than plasma Water is pulled from blood vessel into cells Hypotonic IVF: – 5% dextrose in water (D5W) starts as isotonic but becomes hypotonic. – 0.45% saline (1/2 NS) – 0.33% saline (1/3 NS) – 0.225 saline (1/4 NS) 6 3  Hypertonic Higher osmolality than plasma Water pulled from cells into vessels Hypertonic IVF: – D5NS, D5LR – Saline solutions > 0.9% Used infrequently – Dextrose solutions > 5% – Nursing implications: IV infusion pump Vital signs Neuro + Resp assessment I&O Labs 7 Fluid Replacement Products Crystalloids – – Isotonic solutions – NS, LR – Hypotonic solutions – D5W, ½ NS, ¼ NS – Hypertonic solutions – D5NS, D5LR Colloids – proteins or starch, do not cross the capillary semipermeable membrane – Blood products including Albumin – TPN 8 4  Total Parenteral Nutrition - TPN Contains water, protein, carbohydrates, fats, vitamins, and trace elements Very strong hypertonic solution. Must be given through a central venous catheter to allow rapid mixing and dilution. 9 TPN Nursing Consideration: – Check MD order daily – Monitor infusion rate – NO meds given through designated TPN line!!! – Daily weight – I&O – Tubing changes Q 24 hrs – Requires filter – Blood glucose monitoring q 4h or q6h 10 5  Vascular Access Devices Peripheral line Central line – Peripherally Inserted Central Catheter (PICC) – Midline Access Device – Other central catheters (discussed in detail 3rd sem.) Triple or Double Lumen Subclavian Internal Jugular Femoral line Hickman – Broviac or Groshong Port-a-cath 11 Peripheral line 12 6  Veins to access 13 Peripheral IV insertion Gather supplies – Start kit, Clean gloves – J-loop, saline flush – Smallest angiocath appropriate for patient Prepare supplies – Flush your j-loop (soft extension) – aseptically!!!!! Don gloves Place tourniquet Select a vein 14 7  Peripheral IV insertion Disinfect site!!! – asepsis key to preventing infection!!! Do NOT touch site once cleaned!!! Cannula inserted in direction of blood flow with bevel up 15 Peripheral IV insertion Once flashback advance needle 1/8” then catheter only Retract needle, release tourniquet, attach IV Flush with NS and close clamp Apply sterile transparent dressing Secure tubing Assess site every 2-4 hours!!! 16 8  PICC Line Peripherally Inserted Central Catheter Indications – IV therapy > 2 weeks – Limited peripheral access – TPN – Outpatient IV therapy Ends in superior vena cava – Multiple ports = multiple exit points on catheter Can stay in for months 17 PICC Line Inserted by specially trained RN or radiologist Nursing consideration – No BP – Assess site Every shift Every 2 hours Every time you give meds – Change dressing routinely – Close clamps when not in use 18 9  PICC line Complications – Infections – Thrombosis – Non-thrombotic occlusion – Phlebitis – Mal-position – Air embolism 19 Midline Access Device Midline catheter – 8 inches – Up to 4 weeks – Used for antibiotic therapy – No TPN 20 10  Other central lines Triple Lumen Catheter Tunneled catheter Femoral Triple Lumen Port – a - Cath 21 Central Line dressing Frequency – Per hospital policy – When dressing detaches – When dressing is soiled Equipment – Sterile gloves – Mask – Chloraprep – Biopatch – Transparent dressing – tape 22 11  IV Infusion Safest way to admin IV – Program rate – Decrease incidence of air embolism FDA regulations apply Primed tubing connected 23 IV infusion Tubing Set-up – Ordered Solution and tubing – Check patient ID – Hand hygiene – Leave caps on both ends until ready to attach! – Do not touch ends – sterile!!!! – Prime expelling all air – leave caps in place. – Attach aseptically – Chart on MAR 24 12  Administering IV Meds IV Push through continuous infusion IV – Check MAR/Orders – Ensure medication compatibility – Hand Hygiene – Patient ID – Inspect site – Select injection port closest to client – Prepare injection site and cleanse – Connect syringe to IV line – needleless systems! – Inject med slowly – per guidelines – Dispose properly – Hand hygiene – Chart MAR 25 Administering IV Meds IV push through saline lock – Check MAR – Obtain 10 ml syringe of Normal Saline – Hand hygiene – Cleanse injection port with alcohol – Insert NS syringe through injection port of IV lock + Aspirate – Flush with at least 2-3 ml’s of normal saline – Detach NS syringe and cover with sterile cap – Swab injection port with alcohol again – Inject med – Swab site w alcohol – Flush with NS again – Hand hygiene – Chart on MAR 26 13  IVPB Used for a variety of meds: – ABX – Electrolyte replacement – Others Ensure compatibility with MIV Asepsis! Use back prime technique Always hang higher than primary IV Check MAR/hygiene/chart 27 Air in IV line Causes – No fluid in drip chamber – Fluid trapped near port Solutions – Aspirate air from port – Push up into drip chamber – Disconnect and re- prime as last resort 28 14  IV Therapy Example orders: – D5NS @ 75mL/hr – D5LR 1 liter over 8 hours – Pantropazole 40 mg IVP daily – Vancomycin 1 gm IVPB every 12 hours – Famotidine 20 mg IV every 12 hours – Unasyn 3 gm IV every 8 hours Which of these are intermittent? Which is continuous? No specific order to start IV 29 Nursing Assessment IV site Assess site: – Beginning of every shift – Every time you give IV meds – Every time you enter pt room Assess for: – Location and type – Dressing dry and intact – Redness, tenderness swelling, warmth, drainage – Bruising not = bad IV 30 15  Infiltration Accumulation of fluid in tissue surrounding IV Catheter site. Usually caused by penetration of vein wall by catheter itself. Signs & Sx: – Site cool, hard, – Pale, swollen – May be painful – IV pump beeps occlusion 31 IV infiltration - Nursing actions Stop IV infusion immediately Remove IV Catheter Elevate extremity Apply warm compress to help absorption of fluid Document findings and actions Restart IV in an alternative location This link has a list of how to manage infiltrations/extravasation depending on the drug: https://pedsrx.johnshopkins.edu/wp-content/uploads/2017/08/Infiltration- extravasation-chart-Update-2_03_2016-1.pdf 32 16  Preventive Measures to Avoid IV Infiltration: Securing catheter Stabilize extremity Avoid areas where flexion occurs Frequent assessment of IV site Keep flow rate at the prescribed rate Change IV site per hospital policy 33 Phlebitis Signs and Symptoms: – Pain or discomfort at site – Sluggish flow rate – Swelling around infusion site – Redness and warmth along vein – Prevention: maintain asepsis – Treatment as for infiltration 34 17  Thrombophlebitis Presence of a blood clot and vein inflammation – Treatment is same as infiltration 35 Infection Bacteria in bloodstream via IV therapy Asepsis should be maintained at insertion, during clinical use, and at removal of the device. Remove device Elevate arm Warm compress 36 18  Circulatory Overload Cause: infusion of fluids at rate greater than patient can tolerate Symptoms: SOB, cough, engorged neck veins, moist lung sounds, and edema Treatment? 37 Extravasation Leakage of a vesicant IV solution or medication into extra-vascular tissue – Signs and symptoms: same as infiltration – Tissue sloughing appears in 1- 4 weeks https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431942/ 38 19  NCLEX Prevention of a local infection with an IV catheter is best obtained by doing what? – A. Careful advancement of the catheter during IV insertion. – B. Monitoring the IV site – C. Stabilizing the IV and avoiding areas of flexion. – D. Maintaining strict asepsis 39 NCLEX 75 year old patient was admitted for a UTI. She has IV fluids running at 125 ml/hr. The nurse notices that she seems to have trouble breathing. What is the first thing the nurse needs to do? – A. Call MD – B. Stop IV – C. Raise HOB – D. Give Furosemide to diurese patient – E. check her labs for acidosis 40 20  Math Order: Prednisone 15 mg PO daily. Available Prednisone 10 mg tabs. What will the nurse administer? The provider of care (POC) prescribes Gentamycin 40 mg IVP. Gentamycin comes as powder in an 80 mg vial. The directions are to add 1.8 ml dilutent to make 2 ml. How many ml does the nurse give? MD orders Vancomycin 675 mg IV every 12 hours. Vancomycin comes in powder in 1 gram vial. Instructions are to add 1.5 ml dilutent to make 2 ml. How much prepared solution does the nurse give? 41 IV Calculation The primary care provider (PCP) orders 1000 ml of NS to be given over 6 hours. What is the hourly rate? Using set factor 15 gtts per ml, how many gtts/min will the NS infuse? PCP orders patient to receive 1 unit FFP over 2 hours. The unit of FFP contains 450 ml. What it the hourly rate? Using the set factor of 10 gtts/ml how many gtts/min will each unit of blood infuse? Ordered LR 1000 mL over 12 hrs. Using set factor 60 gtts/mL how many gtts/min will the LR infuse? 42 21  IV Calc The MD orders LR 1000 ml to be given over 4 hours. What is the hourly rate? Using set factor 15 gtts/ml, how many gtts/min will LR infuse? MD orders antibiotic 2gm/100ml to be given over 30 minutes. What would your hourly rate be? Vancomycin 1750 mg IVPB q 6 hours has been ordered for a 70 y/o client weighing 70 kg. Safe dose is 40 mg/kg/day. Is this safe to give? 43 22