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Intravenous Therapy (PowerPoint)

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									Intravenous Therapy


Insertion, Care, Maintenance
             And
       Troubleshooting
        Intravenous Therapy
               Indications
Fluid and Electrolyte maintenance and
 balance
Medication/Blood administration
Nutritional support for NPO status
Administer diagnostic reagents
         Intravenous Therapy
               IV Devices
 Butterfly Catheter
  Deliver small amounts of medicine
  Infants
  Draw blood samples
         Intravenous Therapy
Over the Needle catheter
  Peripheral IV catheter
    Medication administration
    Blood transfusion
        Intravenous Therapy
Gauges
 Smaller the gauge the greater the
  diameter
 Blood administration necessitates a 16-18g
           Intravenous Therapy
                    Fluids
Isotonic: maintained within the vascular
 space
  .9 NS (normal saline) LR (lactated ringers)
Hypotonic: pulled out of the vascular space
  D5.45NS (5% Dextrose with ½ normal saline)
Hypertonic: pulled into the vascular space
  9.0%NS; blood products; albumin
  *See Mrs. Hoover during med/surg for more
    “stuff”!!!
          Intravenous Therapy
               Fluids
Two main groups:
  Crystalloid: solutions which freely cross the
   semi-permeable membranes (.9ns, lactated
   ringers)
  Colloid: have large molecules, usually
   proteins, which are too large to cross the
   membrane (albumin, blood products,
   steroids)
        Intravenous Therapy
             Vein Selection
Locate the straightest portion of the
 vein
Choose a vein firm, round in
 appearance or feel when palpated
Avoid areas crossing joints
Whenever it is a non-emergency, limit
 IV access to the more distal areas
Intravenous Therapy
   Vein Selection

        Veins of the Hand
        1. Digital Dorsal veins
        2. Dorsal Metacarpal veins
        3. Dorsal venous network
        4. Cephalic vein
        5. Basilic vein
Intravenous Therapy
    Vein Selection
         Veins of the Forearm
         1. Cephalic vein
         2. Median Cubital vein
         3. Accessory Cephalic vein
         4. Basilic vein
         5. Cephalic vein
         6. Median antebrachial vein
         Intravenous Therapy
Dorsal digital vein
  Not very stable; needs supported
  22 gauge preferred
Metacarpal veins
  Ideal position for IV; primary choice
  Cannulate most distal end of vessel
  Veins are thin with inadequate tissue and
   muscle support in the elderly
         Intravenous Therapy
Cephalic vein
  Excellent choice due to size and position of
   vessel
  May use large bore catheters
  Is available in upper arm
Accessory cephalic vein
  May use large bore catheters
         Intravenous Therapy
Basilic vein
  Often overlooked as it is inconspicuous
Median antebrachial vein
  Not easily seen so easily forgotten
Median cephalic and median basilic
 veins
  Last resort for blood draws or prolonged
   therapy
         Intravenous Therapy
Though tempting, DO NOT cannulate
 the antecubital unless it is an
 emergency or no other veins are
 accessible. WHY?
  Occlusion due to patient positioning
  Uncomfortable for patient therefore a
   potential for non-compliance with therapy
  Used often in emergency situations
Intravenous Therapy
 Ready, Set, STICK…
        Intravenous Therapy
              As Always:
Right patient?
Right solution?
Right drug?
Right route?
Make sure you check the physicians
Order!!
          Intravenous Therapy
                      Supplies
Pad for the bed!!!
Alcohol prep
Tourniquet
IV catheter
IV tubing
Tape
Gloves
Bag of IV fluid
Gauze
           Intravenous Therapy
     “Spiking” and preparation of fluids
Check IV bag and fluid
  Right fluid
  Leaks
  Clarity
  Expiration
Select correct tubing
  Macro versus micro
     Macro: 10-15 drops/ml; kvo, rapid and routine fluid
      delivery
     Micro: RX administration; pediatric fluid delivery
         Intravenous Therapy
Close flow regulator (clamp)
Remove covering of entrance port of
 fluid bag and remove covering from
 spike of administration set (tubing)
Insert the spike into port of fluid bag
 (push and twist)
           Intravenous Therapy
Hold the fluid bag higher than drip chamber
Squeeze drip chamber to fill 1/3 full
Open the clamp and flush(purge) all air from
 tubing
  Run into sink or trash can taking care to maintain
   sterility of tip
Turn off clamp and have available to connect
 after successful venipuncture
         Intravenous Therapy
               The “Stick”
Introduce yourself and explain the
 procedure to the patient
Apply tourniquet high on upper arm;
 lower the extremity
  These actions promote venous
   engorgement
  Make sure tourniquet is not twisted and is
   taught
         Intravenous Therapy
Select the vein
  Palpate using fingers (not thumb)
  Feels like elastic tube filled full
  Stay away from pulsating arteries
         Intravenous Therapy
Put on gloves
Clean the chosen site with alcohol in a
 circular motion starting at the entry site
 and extending outward about 2 inches
          Intravenous Therapy
To puncture vein:
  Hold catheter in dominant hand
  Pull skin taught with nondominant hand just below
   entry site (prevents “rolling” of vein
  With bevel up, enter the skin at about a 30-45
   degree angle IN THE DIRECTION OF THE VEIN
  Use a quick, short, jabbing motion
  Upon entering skin, reduce the angle of catheter
   until it is nearly parallel to skin
Advance catheter to enter vein until blood
 (“flashback”) is seen in chamber
          Intravenous Therapy
If unsuccessful, DO NOT remove
 catheter
  Slowly withdraw while watching for
   flashback
  If not in vein, make another attempt; may
   manipulate several times
  If unsuccessful, release tourniquet, place
   gauze over puncture, remove catheter,
   tape down gauze, try other arm
         Intravenous Therapy
If successful:
  After entering vein, advance plastic
   catheter (which is over the needle) off of
   needle and into vein
  Hub of catheter should be at insertion site
  Should slide in easily; DO NOT FORCE
Release tourniquet while applying
 pressure over vein proximal to entry
 site
           Intravenous Therapy
New catheters are safety systems:
  At this point, you will push a button on the needle
   end which will withdraw the needle into a sheath
     Take great care that the catheter is secure within the
      vein under the pressure of your fingers
Never reinsert a needle into the catheter
 while it is in the patients arm!
Dispose of needle in sharps container
Connect purged administration set to catheter
 and adjust flow rate
         Intravenous Therapy
Secure the IV per hospital policy
  “Chevron” technique is not recommended
Label IV site with date, time and initials
If you hit an artery, the pressure in the
 artery will cause back flow if a gravity
 system is being utilized.
  Stop fluid flow, remove catheter and hold
   pressure for at least 5 minutes
          Intravenous Therapy
                Discontinuing IV
Utilize standard precautions
Clamp fluids
Peel tape towards IV site
Stabilize catheter and remove remaining tape
Place gauze over site and slide catheter out
Use direct pressure to control any bleeding
Place band-aid over site
         Intravenous Therapy
          Heparin/Saline “Locks”
Utilized for:
  Potential emergency situations
  Intermittent medication administration
Attaches to catheter hub
Patency maintained by Q 8 hour flush
 with 3 cc’s of normal saline or heparin
 flush (10u heparin/cc ns)
           Intravenous Therapy
                Maintenance
Monitor catheter site every shift and with all
 medication administration or change of IV
 bags
  Check for signs or symptoms of infiltration or
   infection
     Redness, swelling, streaks, pain, drainage
Change catheter site and tubing Q 72 hours
 or per hospital policy
Change IV fluid bags Q 24 hours or per
 hospital policy
Intravenous Therapy
YIKES!! Complications!
           Intravenous Therapy
Circulatory overload       Interventions
  JVD @ 45 degrees           Stop infusion
  Respiratory distress       Semi-fowlers position
  Increased blood            Administer oxygen
   pressure                   Call physician
  Crackles                   Anticipate diuretic
  Positive fluid balance      therapy
          Intravenous Therapy
Hypersensitivity           Interventions
  Itching                     Stop infusion
                               Maintain patent airway
  Rash
                               Call physician
  Tearing eyes/runny          Anticipate epinephrine,
   nose                         antihistimine, steroid,
  Bronchospasm                 and bronchodilator
                                administration
  Anaphylactic reaction       Monitor vital signs
Intravenous Therapy
     Infiltration
           Intravenous Therapy
Infiltration        Interventions
   Swelling           Stop infusion
   Discomfort         Remove catheter
   Burning            Apply cold compress
   Tightness          Elevate limb if
   Cool skin           possible
   Blanching          Check pulse and CR
   Slow flow rate     Restart IV in other
                        arm
Intravenous Therapy
      Phlebitis
             Intravenous Therapy
Phlebitis                Interventions
  Redness or               Stop infusion
   tenderness at tip of     Remove catheter
   catheter                 Apply warm pack
  Puffy tissue over        Restart IV
   vein
  Elevated
   temperature
Intravenous Therapy
  Cellulitis/Infection
            Intravenous Therapy
Cellulitis/infection   Interventions
   Warm/hot              Stop infusion
   Swelling              Remove catheter and
   Possibly febrile       culture tip
   malaise               Call physician
                          Anticipate antibiotic
                           administration
                          Monitor vital signs
Intravenous Therapy
    Extravasation
Intravenous Therapy
      Bruising
         Intravenous Therapy
             Odds and Ends
To drip or to pump?
  Medications whose measurements need to
   be precise must be on a pump
   (hemodynamic stabilizers, cardiac,
   bronchodialators, etc…)
  All pediatric fluids and medications must
   be on a pump
  Antibiotics and kvo may flow to gravity
           Intravenous Therapy
                   Terminology
An IV Push is a medication delivered via a
  syringe with the nurse “pushing” it; the speed
  of the delivery is different for all medications
 Piggyback is a small amount of diluted fluid
  (up to 250cc’s) delivered via gravity over a
  short period of time
A Bolus is a large amount of fluid (250-
  1000cc) given rapidly usually to increase
  blood pressure or urine output
         Intravenous Therapy
Flushing catheters and heplocks
  Always flush catheters before and after
   medication administration whether it is a
   push or a piggyback
  If difficulty flushing, do not force as a
   thrombus might be present; do not
   aspirate as may cause damage to vessel
   wall (in a perfect world…)
         Intravenous Therapy
Tape allergies
  Utilize paper tape
Latex allergies
  Use latex free gloves and tourniquet (most
   tourniquets are latex free…)
Utilize vented tubing for glass bottles
        Intravenous Therapy
              Doc’s Orders
Begin infusion of NS at kvo rate
Infuse bolus of 500cc LR over 1 hour;
 resume maintenance 100 cc NS/hr
D5.45 @ 150cc/hr for 8 hours and then
 75cc/hr for 24 hours
10meq KCl in 100cc NS over 1 hour
D5.45 with 20meq KCl per liter at KVO
         Intravenous Therapy
                  Sources
Martin, S. (2001). Intravenous Therapy.
  Retrieved January 02, 2002, from Nova
  Southeastern University PA Program Web
  Site:
  http://www.nova.edu/~smartin/IV/IVTherapy
  Printout.html
PHTLS: Basic and advanced (1994). NAEMT 3rd
  edition.
        Intravenous Therapy
AAOS(2001). Intravenous therapy for
  prehospital providers. Jones and
  Bartlett Publishing.
IV Therapy made incredibly easy (1998).
  Springhouse Corp, Springhouse
  Pennsylvania Retrieved January 02,
  2002, Web Site:
  http://www.findarticles.com/cf_dlsm323
  1/9-30/65801777/print.jhtml

								
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