INTRAVENOUS THERAPY

Dale Brian T.Gaviola,WOCN

PROCEDURE I

SETTING UP / CHANGING / DISCONTINUING I.V. INFUSION

Indications
1. Establish or maintain a fluid or electrolyte balance. 2. Administer continuous or intermittent medication. 3. Administer bolus medication. 4. Administer fluid to keep vein open (KVO).

5. Administer blood or blood components. 6. Administer intravenous anesthetics. 7. Maintain or correct a patient's nutritional state. 8. Administer diagnostic reagents. 9. Monitor hemodynamic functions.

IV Devices
Types of IV needles and catheters: STEEL NEEDLES

Example: Butterfly catheter. They are named after the wing-like plastic tabs at the base of the needle. They are used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples (although not routinely, since the small diameter may damage blood cells). These are small gauge needles (i.e. 23 gauge).

OVER THE NEEDLE CATHETERS

Example: peripheral IV catheter. This is the kind of catheter you will primarily be using.

INSIDE THE NEEDLE CATHETERS

Example: midline and extended dwell catheters This is a typical catheter over the needle arrangement
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This is an inside the needle catheter arrangement

AND NOW, A WORD ABOUT GAUGES: Catheters (and needles) are sized by their diameter, which is called the gauge. The smaller the diameter, the larger the gauge. Therefore, a 22-gauge catheter is smaller than a 14-gauge catheter. Obviously, the greater the diameter, the more fluid can be delivered. To deliver large amounts of fluid, you should select a large vein and use a 14 or 16-gauge catheter. To administer medications, an 18 or 20-gauge catheter in a smaller vein will do.

16G

18G

20G

22G

24G

24G**

3 MAIN TYPES OF IV FLUIDS

ISOTONIC FLUIDS HYPOTONIC FLUIDS HYPERTONIC FLUIDS

ISOTONIC FLUIDS
CLOSE TO OSMOLARITY AS SERUM. STAY INSIDE INTRAVASCULAR COMPARTMENT THUS EXPANDING IT CONTAINS APPROXIMATELY EQUAL NUMBER OF MOLECULES AS SERUM SO FLUID STAYS WITHIN INTRAVASCULAR SPACE CAN BE HELPFUL IN HYPOTENSIVE AND HYPOVOLEMIC PTS. CAN BE HARMFUL. RISK OF FLUID OVERLOADING ESP IN PTS WITH CHF AND HPN

EX. LR, NS

HYPOTONIC FLUIDS
HAVE LESS OSMOLARITY THAN SERUM DILUTES SERUM WHICH DECREASES SERUM OSMOLARITY CAN BE HELPFUL WHEN CELLS ARE DEHYDRATED SUCH AS A DIALYSIS PT. ON DIURETIC THERAPY MAY ALSO BE USED FOR HYPERGYCEMIC PTS. LIKE DIABETIC KETOACIDOSIS CAN BE DANGEROUS TO USE BECAUSE OF THE SUDDEN FLUID SHIFT FROM THE INTRAVASCULAR SPACE TO THE CELLS WHICH CAN LEAD TO CARDIOVASCULAR COLLAPSE AND INCREASED ICP

 CONTAIN LOWER NUMBER OF MOLECULES THAN SERUM SO THE FLUID SHIFTS FROM THE IV SPACE TO THE INTERSTITIAL SPACE THIS DECREASES THE INTERSTITIAL SPACE OSMOLARITY WHICH THEN CAUSES THE FLUID TO MOVE INTO THE CELLS

EX. D5 NS .45

HYPERTONIC FLUIDS
HAVE A HIGHER OSMOLARITY THAN SERUM PULLS FLUID AND ELECTROLYTES FROM THE INTRACELLULAR AND INTERSTITIAL COMPARTMENTS IMTO THE INTRAVASCULAR COMPARTMENT CAN HELP STABILIZE BLOOD PRESSURE, INCREASE URINE OUTPUT, AND REDUCE EDEMA CARE MUST BE TAKEN WITH THEIR USE DANGEROUS IN THE SETTING OF CELL DEHYDRATION

EX. 9.0% NS, BLOOD PRODUCTS, ALBUMIN

 CONTAIN A HIGHER NUMBER OF MOLECULES THAN THE SERUM SO THE FLUIDS SHIFT FROM THE INTERSTITIAL SPACE TO THE INTRAVASCULAR SPACE THIS DECREASES THE INTERSTITIAL SPACE OSMOLARITY THAT THEN CAUSES FLUID TO LEAK OUT OF THE CELLS

Procedure I
A. Setting up IV infusion

1. Verify doctors order and make IV label.

2. Observe ten (10) Rs when preparing and administering IVF

10 GOLDEN RULES on drug administration

Obtain a complete drug history Identify if the client has any drug allergies Know potential drug effects, drug-drug interactions and compatibilities. Teach your client about the drug he is receiving Administer the right drug Administer the right drug to the right patient

Administer the right dose Administer the right drug at the right route Administer at the right time and frequency Right documentation of each drug you administer * to protect your patients and your license as a nurse, follow these guidelines for avoiding medication errors.

3. Explain procedure to the patient and/or significant others , secure consent if necessary. 4. Assess patients vein; choose appropriate vein ;location,size condition

VEINS OF THE HAND

DIGITAL DORSALIS VEIN

DORSAL METACARPAL VEINS

DORSAL VENOUS NETWORK BASILIC VEIN CEPHALIC VEIN

VEINS OF THE FOREARM

CEPHALIC VEIN

MEDIAN CUBITAL VEIN

ACCESORY CEPHALIC VEIN

BASILIC VEIN

CEPHALIC VEIN

MEDIAN ANTEBRACHIAL VEIN

5. Wash hands and maintain asepsis throughout the preparation during the therapy .

6. Prepare the necessary materials for procedure

1. IV tray with solution 2. Administration set 3. IV cannula 4. Forceps soaked in antiseptic solution 5. Alcohol prep pads, cotton balls with alcohol 6. Plaster 7. Tourniquet 8. Gloves 9. IV splint 10. IV hook 11. 2x2 gauze or transparent dressing

7. Check the sterility and integrity of the IV solution , IV set and other devices 8. Place IV label on IVF bottle Patients name Room number Solution, drug incorporation Bottle sequence Duration

9. Open the seal aseptically of the solution and disinfect rubber port with cotton ball with alcohol. 10. Open administration set aseptically and close the IV clamp

11. Spike the infusate aseptically. 12. Fill drip chamber to at least half and prime tubings. 13. Remove air bubbles any and pull back the cover to the distal end of the I.V. tubing. ( get ready for IV insertion)

B. Changing an IV infusion

14. Verify doctors order ; countercheck the ff:

a. IV label b. IV Card c. Infusate sequence d. Type e. Amount f. Additives g. Duration of infusion

15. Observe ten (10) Rs. 16. Explain procedure to the patient and assess IV site for redness, swelling, pain , etc. 17. Check date of IV insertion; re-site if 48-72 hours has lapsed 18. Check date of changing IV tubings, change if due for changing (change IV tubings within 72 hours)

19. Wash hands before and after the procedure 20. Prepare necessary materials
a. b. c. d. e. IV solution IV label Disinfectant Kidney basin IV tray

21. Check sterility and integrity of IV solution. 22. Place IV label on the IV bottle 23. Calibrate new IV bottle according to duration of infusion.

24. Open and disinfect rubber port of IV solution to follow. 25. Close IV clamp or kink tubing and spike the container aseptically 26. Regulate the flow rate based on duration of infusion . Remove air bubbles (if any) 27. Reasure patient and significant others.

Nurse Alert !
28. Discard all waste materials according to MMDA Ordinance # 16 29. Document accordingly and endorse to incoming shift,

C. Discontinuing an I.V. Infusion

30. Verify written doctors order to discontinue IV including IV medicines. 31. Observe ten (10) Rs 33. Assess and inform the patient of the order and of any ordered medicines

33. Prepare the necessary materials : a. IV tray or injection tray b. Cotton balls with alcohol c. Plaster d. pick-up forceps in antiseptic solution e. Kidney basin

34. Wash hands before and after procedure 35. Close IV clamp of the tubing . 36. Moisten adhesive tapes around the IV catheter with cotton ball with alcohol.

37. Use pick-up forceps to get cotton ball with alcohol and without applying pressure , remove needle or IV catheter then immediately apply pressure over veni puncture site. 38. Inspect IV catheter for completeness 39. Place dressing over venipuncture site.

40. Discard all waste materials including the IV cannula according to MMDA Ordinance # 16 41. Reassure patient. 42. Document time of discontinuance, status of insertion site and integrity of IV catheter and endorsee accordingly.

NURSE ALERT !: Dont forget to document your actions!

Thank you for your Attention!