PICC-every 6 weeks, IV inserted by paramedic w/in 24 hours, Peripheral site every 72 hours, Blood and TPN every 24 hours, CVC every 48-72 hours or 3xper week.
Nursing responsibilities for IV sites
assess site whenever in room, document at least every 8 hours, site CDI (clean, dry, intact), sterile technique, changine tubing and solution, awareness of complications, awareness of fluid types, 5 rights
Complications of IV therapy
Pain and irritation, infiltration and exravasion, occlusion, loss of patency, phlebitis, fluid overload
Pain and irritation of IV-intervention
increase amt of dilutent, arm board
Infliltration
seepage of IV fluids into tissue when IV cath penetrates vein
Extravasion
escape of irritating agent into tissue
Extravasion and Infiltration Assessment
swelling, pain, cool to touch, decreased flow, wet dressing, no back flow.
Causes of Infiltration and Extravasion
catheter permeates vein, poor taping of site, over manipulation
Intervention for Infiltration and Extravasion
Remove IV, cool compress
Occlusion causes
kinked tubing, patient lying on tubing, infusion too slow
Occlusion assessment
IV stops dripping
Occlusion intervention
milk IV, aspirate, irrigate (if no resistance OK, if resistance may be clot>
Occlusion Prevention
don't let IV run dry, flush periodically with 1-5 cc of NSS and before and after any intermittent IV therapy.
Phlebitis Causes
bacterial, chemical, mechanical
Phelebitis Intervention
remove IV, cool compress
Phlebitis Assessment
erythemia, pain or burning, warmth, edema, cordlike vein.
Bacterial Phlebitis possible cause
IV left in too long
Chemical Phlebitis Cause
irritating fluids
Mechanical Phlebitis
clot at tip of cannula, cath too large for vein.
Crystalloids
clear fluids, dextrose of saline, can be Iso, Hypo or Hyper tonic
Colloids
cloudy, yellowish, used to raise osmotic pressure, Dextran is clearish
Isotonic IV
same tonicity as body 0.9% NSS
Indications for Isotonic IV
Hypotension (increases BP), Hypovolemia
Complications of Isotonic IV
fluid overload
Examples of Isotonic Solutions
0,9% NSS, D5W(isotonic in bottle, hypotonic in body), Lactated Ringers
Indications for Hypotonic IV
Will cause fluid to shift from intravascular to intracellular space.
Indications for Hypotonic IV
dehydration
Hypotonic Solutions
.45% sodium chloride, 5%dextrose water (becomes hypotonic in body)
Complications of hypotonic solution
May cause edema
Indications for hypertonic IV
low bp, slight edema but not w/CHF, pulls fluid from intracellular space to intravascular space
Hypertonic IV Solution
Not as strong as Albumin, 10% Dextrose in Water D10W, 5% normal saline, D5 Ringers Lactate
Complications of Hypertonic IV
more fluid in bloodstream can cause circulatory overload.
PCA
Patient Controlled Analgesia
3 settings of PCA
drug dosage, lockout period, basal rate
Central Venous Therapy Indications
inadequate vascular access, complex treatment regimes, hyperosmolar infustions ie parenteral nutrition, irritating or vesicant druges, (ie. dopamine cancause necrosis) rapid absorption, long term therapy.
Contraindications for Central venous therapy
altered skin integrity, anomalies of central vasculature, cancer in area, coagulopathies, fractured clavicle, septicemia, radiation to insertion site
Common insertion pathways for Central Venous Therapy
subclavian, jugular, femoral vein, cephalic vein(is peripheral but the line runs to central area)
amino acids, carbohydrates, electrolytes, minerals, vitamins, lipids, other (ie insulin)
Lipids in Intravenous Nutritional Support
lipids are administered via Piggy back. (white, thin liquid)
Cautions for IV nutritional support
not refrigerated, observe for spoilage (fat on top, discoloration), expiration dateNo filter. , must be infused on IV pump, glucose monitored, gradual weaning. Daily weights,
Buen Viaje lv.2 ch 8
