IV Therapy Indications, Complications
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| IV Therapy is used for: | fluid volume maintenance, fluid volume replacement, med administration, blood administration, TPN, emergency line,
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| Advantages of IV Therapy | faster absorption, rapid distribution, emergency access, unconscious patient
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| IV and Dressing changes | 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.
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| 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
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| Complications of IV therapy | Pain and irritation, infiltration and exravasion, occlusion, loss of patency, phlebitis, fluid overload
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| Infliltration | seepage of IV fluids into tissue when IV cath penetrates vein
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| Extravasion and Infiltration Assessment | swelling, pain, cool to touch, decreased flow, wet dressing, no back flow.
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| Causes of Infiltration and Extravasion | catheter permeates vein, poor taping of site, over manipulation
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| Intervention for Infiltration and Extravasion | Remove IV, cool compress
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| Occlusion causes | kinked tubing, patient lying on tubing, infusion too slow
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| Occlusion assessment | IV stops dripping
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| Occlusion intervention | milk IV, aspirate, irrigate (if no resistance OK, if resistance may be clot>
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| Occlusion Prevention | don't let IV run dry, flush periodically with 1-5 cc of NSS and before and after any intermittent IV therapy.
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| Phlebitis Causes | bacterial, chemical, mechanical
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| Phelebitis Intervention | remove IV, cool compress
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| Phlebitis Assessment | erythemia, pain or burning, warmth, edema, cordlike vein.
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| Phlebitis possible causes: | IV left in too long, irritating fluids, clot at tip of cannula, cath too large for vein
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| Crystalloids | clear fluids, dextrose or saline, can be Iso, Hypo or Hyper tonic
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| Colloids | cloudy, yellowish, used to raise osmotic pressure, Dextran is clearish
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| Isotonic IV | same tonicity as body 0.9% NSS
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| Reasons to give an Isotonic IV | Hypotension (increases BP), Hypovolemia
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| Complications of Isotonic IV | fluid overload
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| Examples of Isotonic Solutions | 0,9% NSS, D5W(isotonic in bottle, hypotonic in body), Lactated Ringers
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| Reasons to give a Hypotonic IV | Will cause fluid to shift from intravascular to intracellular space.
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| Indications for Hypotonic IV | dehydration
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| Hypotonic Solutions | .45% sodium chloride, 5%dextrose water (becomes hypotonic in body)
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| Complications of hypotonic solution | May cause edema
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| Reasons to give a hypertonic IV | low bp, slight edema but not w/CHF, pulls fluid from intracellular space to intravascular space
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| Hypertonic IV Solution | Not as strong as Albumin, 10% Dextrose in Water D10W, 5% normal saline, D5 Ringers Lactate
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| Complications of Hypertonic IV | more fluid in bloodstream can cause circulatory overload.
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| PCA stands for: | Patient Controlled Analgesia
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| 3 settings of PCA | drug dosage, lockout period, basal rate
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| 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.
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| Contraindications for Central venous therapy | altered skin integrity, anomalies of central vasculature, cancer in area, coagulopathies, fractured clavicle, septicemia, radiation to insertion site
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| Common insertion pathways for Central Venous Therapy | subclavian, jugular, femoral vein, cephalic vein(is peripheral but the line runs to central area)
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| Risks and Complications of Central Venous Therapy | Air embolism, pneumothorax, sepsis,chest pain, confusion, hypotension, dyspnea, pallor, tachycardia, tachypnea, unresponsiveness
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| Components of Intravenous Nutritional Support | amino acids, carbohydrates, electrolytes, minerals, vitamins, lipids, other (ie insulin)
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| Lipids in Intravenous Nutritional Support | lipids are administered via Piggy back. (white, thin liquid)
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| 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,
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| Complications for IV nutritional support | hypoglycemia, hyperglycemia, dehydration, infection
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| Reasons to give IV Nutritional Support | bowel surgery, chronic weight loss, bowel rest, coma, excess nitrogen loss, hepatic or renal failure, malnutrition, low serum albumin, hypermetabolic states
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