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IV Therapy LPN

IV Solutions, Types of Catheters

What is purpose of IV therapy? Provides H20, electrolytes, & nutrientsAdminister medications & blood products.
Two types of IV solutions 1. Crystalloids 2. Colloids
Able to pass through semipermeable membrane. Isotonic, hypotonic, hypertonic Crystalloids
Protein substances that cannot pass into extravascular space. Move fluid from interstitial space - Blood vessels Colloids
Ok to use in peripheral IV (PIC), Concentration close to ECF, Solution of choice. 1 L only expands plasma by 0.25 Isotonic Solutions
Normal saline solution, 0.9% sodium chloride, NaCl, NS Isotonic Solutions
Lactated Ringers (common for surgery) Isotonic Solutions
D5W 5% dextrose in water, becomes hypotonic rapidly Isotonic Solutions
Pull fluid out of vascular space & into cells. 0.45% sodium chloride (half-normal saline) Ok to use in PIV Hypotonic Solutions
Main use: Replaces cellular fluid. Administer cautiously: Fluid shift from vascular system to cells, may lead to intravascular fluid depletion, may result in CV collapse & increased intracranial pressure Hypotonic Solutions
Draw fluid from ICF to ECF. From cells to blood vessels. May cause fluid volume excess. Hypertonic Solutions
Should be administered via central vein. 50% dextrose (D50) Only emergency such as hypoglycemia, Hypertonic Solutions
TPN Total parental nutrition. Do not mix with meds. (Hypertonic solution)
Types of Venous Catheters Peripheral & Central
< 7 days 72-96 hrs. PIV
> 7 days Get order PICC, Midline
> 6 months Tunneled Catheter, Implanted port
Emergency IV Intraosseous (IO)
Over the needle catheter, most commonly used, lengths 0.75"-1.25", diameters: 12 gauge-24 gauge Peripheral IV
Disadvantages of peripheral IV's Site change every 72-96 hrs. Dressing change: gauze every 48 hrs. transparent 3-7 days.
Lower extremeties IV site? No might cause embolism
Warm pack, have them relax extremity, fear can result in venous constriction Peripheral IV's patient preparation
Not recommended for continuous infusions. Non-pliable, infiltrate easily. Uses: blood draws, short term infusions 1-4 hrs. Winged-Infusion Set
Peripheral insertion, still in arm, tip located in proximal portion of extremity, may stay in place 2-4 weeks. 7-8 inch. long Not a central line Midline Catheter
Midline Catheters should not be used for TPN, some antibiotics, chemotherapy, high pressure boluses, peripheral IV solutions only.
Confirm placement by x-ray Central venous catheters
Types of Central venous catheters Peripherally inserted central catheter (PICC), non tunneled catheter, tunneled catheter, implanted port
PICC Antecubital vein-most common insertion site, Tip located in superior vena cava, 20-24 inches long
PICC advantages Ease of insertion, low complication rates, low infection rates, multi-lumen access, comfortable for patients, easy to cover up, can be used long-term up to a year.
PICC Disadvantages Mechanical phlebitis, frequency of dressing change
Non-Tunneled Central Lines Used for therapy <2 weeks, generally limited to 5-7 days, Commonly used in ICU/ER, Multi-lumen access, Neck, chest or groin
Non-Tunneled Central Lines Advantages Infuse large volumes quickly, any medication or blood, hemodynamic monitoring, multi-lumen access
Non-Tunneled Central Lines Disadvantages High infection rate, limited time of use (1 week) Increased complications with insertion, pneumothorax, bleeding, air embolus
Designed to be permanent, but may be removed, Healed after 6-8 weeks, inconspicuous under clothing, may perform all daily activities except swimming (infection) Skin-Tunneled Catheters
Commonly called: Broviac, Hickman Tunnel provides distance between entry site in vein and exit site in skin Skin-Tunneled Catheters
Indicated for frequent or continuous administration of IV substances, commonly called Port-a-Cath Central, long term Implanted Ports
Surgically inserted under skin, minor surgical procedure, usually upper chest, sometimes in arm or abdomen Implanted Ports
Port, Septum: silicone bubble for needle insertion, self sealing, may be punctured up to 1,000 times. Implanted Ports
Implanted Ports Uses: Delivery of TPN & other fluids, including blood products, chemotherapy & other drugs, obtaining blood specimens
Implanted Port Risks: Infection, thrombosis, mechanical failure, age- can grow out of
Systemic IV complications Fluid overload/pulmonary edema, embolism, infection, allergic reaction
Fluid overload s/s Dyspnea, tachypnea, crackles, tachycardia, edema, weight gain, pulmonary edema
Pulmonary edema s/s Restlessness, tachycardia, dyspnea, cough, crackles on auscultation, frothy sputum
Fluid Overload Treatment High fowler's position, Notify RN/MD, Frequent vital signs, frequent assessment of breath sounds
Fluid Overload Intervention Slow or stop infusion rate, O2, diuretics
Fluid Overload Prevention Infusion pump, close monitoring check every hr., patient teaching: report dizziness, pain at IV site, short of breath
Accidental entry of air into vasculature. Piece of catheter breaks off & enters circulation, can block major vessel, blood clot into heart & pulmonary artery Embolism
Air embolism s/s Usually associated with central line, chest, shoulder, low back pain, dyspnea, weak pulse, hypotension, cyanosis, sudden loss of consciousness, cardiac arrest
Air embolism treatment Clamp cannula, ABC'S, left-sided trendelenburg position, Notify RN/MD, Frequent assessment & vital signs, High-flow O2 if ordered
Air embolism Prevention Use air filters, clamp tubing when changing administration set, use luer lock connection, prime all tubing
Intracellular fluid Inside of cells
Extracellular fluid Outside of cells
Catheter related blood stream infection Septicemia
Bacteria on skin enters on catheter insertion, catheter movement at insertion site, external sources Septicemia
Septicemia s/s Fever, backache, headache, malaise, tachypnea, signs of poor perfusion: delayed cap. refill, poor color
TPN can't hang longer then 24 hrs. due to infection
#1 cause of CRBSI's Hub contamination, wipe vigorously every time accessed, change cap every 7 days
Biopatch Designed to continually release chlorhexidine over 7 days (antimicrobial & antifungal) Provides one inch zone of inhibition, infection decreased 60%
Stat-lock Preferred method of stabilization PICC lines
Allergic reaction s/s Chills & fever, erythema, itching, dyspnea or wheezing, anaphylatic shock, cardiac arrest
Allergic reaction treatment Stop infusion immediately, maintain vascular access, notify RN/MD, frequent assessment including VS
Allergic reaction interventions O2, antihistamines, epinephrine, steroids
Local complications Infilltration & extravasion, phlebitis, thrombophlebitis, hematoma, clotting & obstruction
IV solution enters surrounding tissues, occurs when IV cannula dislodges or perforates wall of vein Infiltration
Infiltration s/s Edema at insertion site, leaking at site, pain, site cool to touch, decreased rate of infusion, drip rate, blanching, can cause permanent damage
Extravasation Similar to infiltration, Inadvertent adminstration of chemo, vesicant or irritant
Extravasation s/s Pain, Burning, redness at site, blistering, inflammation, tissue necrosis
Extravasation treatment Don't take IV out. Leave in place to administer antidote
Phlebitis s/s Reddened, warm area around site or along vein path, pain, vein may feel hard when palpated
Plebitis treatment Stop infusion, assess site, notify RN/MD, disinfect site and remove catheter, restart IV opposite extremity, warm moist compress
Phlebitis prevention Aseptic technique during IV insertion, clean gloves ok, sterile for central line
Phlebitis Inflammation of vein r/t chemical or mechanical irritation or both, catheter moving in and out
Hematoma Blood leaks into tissues surrounding IV insertion site
Hematoma possible causes Opposite wall of vein perforated, catheter slipping out of vein, insufficient pressure to site after catheter removal
Hematoma s/s Ecchymois-bruising, immediate swelling, blood leaking at site
Catheter Occlusion possible causes Clot or precipitate, kinked tubing, very slow infusion rate, allowing IV bag to run dry
Created by: angienoriega