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2431 Unit One IV

2431 Unit One IV Therapy

Isotonic Solutions Have the same concentration, or osmoality as blood. Used to expand the fluid volume of the body.
Info needed prior to starting the IV Order for IV, Selection of IV Site, Accessibility of vein, its general condition, Type of fluid to be given, Any allergies or contraindications, Duration of IV therapy.
Blood transfusions Asses VS before admin to have a baseline in case a reaction occurs. Y admin set/blood and NS. Saline started first then blood. Saline stopped while blood is running. Flush tube after blood. Consents!
If a reaction occurs during a blood transfusion stop and NS started with fresh tubing to keep IV open.
Infused blood over a period of 4 hours
How to keep IV Patent flush with normal saline
Crystalloid solutions Isotonic, Hypotonic and hypertonic. Influences osmotic distribution of body fluid.
Hespan Pulls fluid into vascular space to increase circulatory volume.
How often do you change primary tubing Q72H
Nursing interventions for IV site infection Remove all catheters, Restart in opposite extremity and change entire administration set.
How to keep the IV patent flush every 8 hours
Veins of older adults are fragile. Use BP cuff instead of tourniquet to assist in successful venipuncture. Place BP cuff 6 inches above selected site. Inflate to 10 dist. to restrict blood flow. Only 2 attempts.
Crystalloid solution isotonic hypotonic and hypertonic solutions. Influences osmotic distribution of body fluid. Water and uniformly dissolved crystals.
Hespan A colloid solution; pulls fluid into the vascular space to increase circulatory volume.
Assessing IV site Check: IV flow, Rate of infusion, Prgrammed rate and volume. Insertion site, complaints from pt.
Primary tubing Changed ever 72 hours. Date and time. Consists of bag of solution, regular tubing set, needleless connector and iv stand.
Secondary tubing Good for 24 hours. Meds to be given iv often added to an existing iv line by using piggyback method. USE GRAVITY by setting the secondary higher than the primary.
When to check pts status during infusion Constantly assess pt.
Monitoring Hydrating fluids check for good skin turgor, adequate urine output and moist mucous membranes.
Monitoring TPN assess pt weight gain and monitor blood glucose levels every 6 hours
Monitoring IV antibiotics Check the leukocyte, temp, and any wound for signs of infection cleaning s/s of allergic reaction.
What is TPN? Total parenteral nutrition, given through a central line. Accuchecks.
Y administration tubing used to transfuse blood. 9% saline is the only solution that is compatible with blood.
Hypertonic solutions More concentrated than plasma. used to decrease cerebral edemal expands circulatory volume rapidly; parenteral nutrition.
Intermittent infusion supplies gloves, iv cannula, and inj cap, ns, iv start kit, underpad, syringe, needleless port or snap connector, MAR, commercial device for securing site.
Why would you need an intermittent infusion? Used with elderly and pedi pt, when pt does not need large quantities of IV fluid but does need IV meds intermittently (duh).
How often to change IV site every 72 hours or if it looks infected or infiltrated.
PICC lines Sterile procedure, Correct placement verified by xray. 3 ports: red(blood), pushing drugs, extra if needed. Avoid taking BP in the same arm and done at bedside.
Change Picc line every 3 days
1st choice in Home iv therapy Picc line
Central Lines may be left in place for 6-8 weeks. Positioned in rt atrium or superior vena cava, or large subclavian vein.
If pt needs IV therapy longer than 8 weeks, a long-term cath such as tunneled Broviac, Hickman, or Groshong is inserted via surgery.
Infiltration fluid or med leaks out of vein into the tissue. often will be edema around the site and tissue will feel cool.
Treatment for infiltration Infusion is discontinued and started at different site. Fluid that is in the tissue will usually reabsorb within 24 hours.
Phlebitis Irritation of the vein by the needle, cath, meds, or additives in the iv solution
Signs of phlebitis erythema, warmth, swelling, tenderness.
Treatment for phlebitis discontinue IV, start at a different site. Warm compreses to the inflamed site will reduce discomfort. Blood cultures are ordered and agressive antibiotic therapy for treatment.
Bloodstream infection infections pathogens introduced to the bloodstream may occur from breaks in sterile technique during cannula insertion or anytime the system is opened to change tubing.
S/S Bloodstream Infection Fever, chills, pain, ha, n/v, extreme fatigue,
Bloodstream infection treatment blood cultures ordered, agressive antibiotic therapy is started. IV site is immediately discontinued.
Sites preferred to receive intermittent doses of meds IV those distal to the antecubital area, cephalic, basilic, and antebrachial veins of the lower arm and the veins on the back of the hand are the sites of choice for most adult pt. Use non-dominant hand.
PCA Pump used in hospitals to allow pt to regulate admin of iv pain meds; pt receives a preset bolus of med when the button is pushed and or base amount of meds each hour. Used in home iv therapy to admin pain meds.
IV lipid emulsions contraindications acute pancreatitis
Troubleshooting sluggish IV flow 1st thing to look at is site for infiltration - work your way up to check if line is clamped - remove tubing and flush site
Catheter embolus a piece of the catheter breaks off and travels in the vein until it lodges
Air embolus can occur when changing bags, or when opening the line of a subclavian catheter.
Speed shock occurs when fluids or meds given by bolus are administered too rapidly. Leads to wet and crackling lung sounds, check every 4 hours - i&o every shift.
Protonix, nexium are examples of meds given through IV in given in small intervals
0.9% saline isotonic (trauma, diabetic, ketoacidosis with blood transfusion)
5% dextrose in water isotonic most commonly used to mix IV pb
5% dextrose in .45% saline hypertonic
Pumps can malfunction: assessment of site and equipment every 1-2 hours is typical hospital policy.
The advantage of the piggyback system is that when the solution in the smaller bag has been infused, the primary IV begins to flow again wtihout further adjustments.
Remember not to take the blood pressure on the arm that has PICC or ML catheter in place
Correct placement of subclavian catheters must be veified by radiographic studies before any fluid is infused through them.
No other type of needle should be used because other needles cause damage to the port. Huber needle
Always assess the pt for adverse or s/e of previously administered doses of IV or piggyback meds before administering the next dose
When caring for a pt with a peripheral IV plan additional time for bathing, turning and assisting with daily activiites.
The elderly must be frequently assessed to determine that fluid overload is not occuring. Auscultate the lungs at least once each shift for sounds of crackles that can indicate fluid overload. rapid pulse, SOB, and distended neck veins are other possible signs.
To distend the vein and make it easier to insert the cannula, place the extremity in a dependent position and gently pat the skin. For very difficult veins, pack the area of the vein with warm packs prior to placing the tourniquet.
POTASSIUM is always diluted in fluid and never given as a bolus because it can cause cardiac arrhythmia and arrest.
As a courtesy to the oncoming shift and to ensure that the pts iv continues to flow, check the amount of solution remaining in the bag at the end of your shift and hang a new bag if needed.
Nursing students should not adjust the dosage or change the pump settings of heparin infusions. however, you are responsible for monitoring for bleeding signs such as bruising, bleeding of gums, or blood in stool or urine.
Created by: christinego