MED SURG CHAPTER 19 by img20336

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									MED SURG CHAPTER 19
CARING FOR CLIENTS REQUIRING IV THERAPY
USES
Maintain or restore fluid balance when oral replacement is inadequate or impossible
Maintain or replace electrolytes
Administer water soluble vitamins
Provide a source of calories and nutrients
Administer drugs – box 19-1
Replace blood and blood products
CRYSTALLOID SOLUTIONS-fig 19-2
Consist of water & uniformly dissolved crystals such as salt or sugar
 Isotonic-same concentration of solutes as in normal plasma; does not change the fluid
distribution
Use with temporary NPO
 0.9% saline or NS
 5% dextrose in water or D5W
 Ringers solution or Lactated ringers
CRYSTALLOID SOLUTIONS
Hypotonic-fewer dissolved substances than plasma; more dilute
Rehydration such as with n/v/d
 0.45% Sodium Chloride or ½ saline
 5% dextrose in 0.45% saline or D5 ½ NS
CRYSTALLOID SOLUTIONS
Hypertonic- more concentrated than plasma
 Rarely used; to reduce cerebral edema, rapidly expand circulatory volume or
administer nutrition parenterally; TPN
10% dextrose in water or D10W
 3% saline,
20% dextrose in water


COLLOID SOLUTIONS
Used to replace circulating blood volume
Fig 19-3 Whole blood – 1 unit contains 475 ml blood cells & plasma, + 60 – 70 ml
preservative & anticoagulant
Used for those who need the cells + extra fluid
Packed red blood cells (PRBCs) used for those who do not need the extra fluid, but do
need the RBCs
SALVAGED BLOOD-FIG 19-4
Blood collected from a person during a surgical procedure & reinfused during the
procedure or shortly thereafter
Commonly done during cardiothoracic & orthopedic procedures
Protects against blood-borne pathogens
Frees stored blood in the blood bank for those who may require a blood transfusion
COLLOID SOLUTIONS
Blood products – administered to clients who need specific blood parts: platelets,
plasma
Plasma expanders – non-blood solutions; for clients with hypovolemic shock;
economical, virus free
IV THERAPY EQUIPMENT
Preparing solutions
 stored in plastic bags mostly
 change solutions at least every 24 hours
IV tubing
Primary, secondary and Y tubing
Vented vs Unvented tubing
Drop size:
• macrodrip – 10, 15, 20 gtt/ml
• microdrip – 60gtt/ml
Administering IV Therapy
Filters – removes air bubbles, undissolved drugs, bacteria, & large molecules; used with
TPN, blood & packed cells, immunocompromised & pediatric clients
Gravity infusion
Electronic infusion devices
 infusion pump
 volumetric controller

VENIPUNCTURE
Nurses with special training
Venipuncture Sites-fig 19-11
 peripheral- superficial veins of the arm or hand
• midline catheters – used for clients with limited peripheral veins and/or those who need
extended IV therapy; may be used for up to 4 weeks
• midclavicular catheters – can be used for up to 2-3 months
CENTRAL VENOUS SITES
Deliver solutions into a large, central vein for TPN, monitoring CVP, administration of
concentrated or irritating IV solutions; when peripheral veins are no longer useable or for
long term IV therapy
MD inserted into jugular or subclavian vein – fig 19-12
Specially trained nurse may insert peripherally inserted central catheter or PICC line to
similar location
IV Therapy (cont)
Nursing Guidelines 19-1
Complications of IV therapy -Table 19-4
Complications of Blood Transfusions – table 19-5
Site care – inspect routinely for s/s of complications, document findings; change
dressing q 24-72 hours or as per agency policy & prn
Medication locks, saline locks – fig 19-14

General Nutritional Considerations
Dextrose IV only provides 3.4cal/g, not 4cal/g such as when consumed orally
1 L of 5% dextrose in water only provides 170 calories
TPN formulas are individualized as much as possible
Cyclical TPN is preferred over continuous infusion
General Pharmacological Considerations
Read labels very carefully on vials containing flush solutions for medication locks to
prevent medical mistakes such as infusion of potassium chloride
Do not add medications to whole blood or the normal saline used to start the infusion
Only use drugs labeled for IV use
Carefully check for special dilution instructions for IV meds and possible cross
reactions with other medications
General Gerontologic Considerations
IV solutions are usually given at a slower rate for older adults due to cardiac or renal
disorders
Application of tourniquets to older adults skin may cause trauma
Older adults are prone to fluid overload; closely monitor them for s/s of this
complication

								
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