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IV therapy

By Micheal Nichols,2014-04-29 19:45
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IV therapy

    IV therapy

    1/21/00

    S. Buckley

    The fastest delivery = IV therapy

     It puts it into circulation immediately

Key issues

1. You can kill the patient very easily if you make a mistake

    2. You have immediate access: BUT…

    - USE THE 5 RIGHTS

    - RIGHT PATIENT

    - RIGHT MEDICATION

    - RIGHT ROUTE

    - RIGHT TIME

    - RIGHT DOSE

    - TAKE IT SERIOUSLY

    - THINK SECRUITY/CONFIDENTIALITY

Why IV

    - continuous medication

    - replacement therapy

    - NPO or (dehydration)

    - Medication delivery of choice

    - Give a fluid challenge, also called bolus dose, (One time)

Complications

    - phlebitis

    - inflammation

    - contamination (TEST QUESTIONS BIG CHANCE ON

    CONTAMINATION)

    - infection

Types of patients who need IV therapy

     - Geriatrics

    - IV drug abusers

    - Children

    - Very sick people

    - People with no veins (blood volume)

Use aseptic technique

    - Follow policy and procedure by each individual agency

    - Patients watch what your doing, do it right and aseptic.

    - Remember if you break technique you start over

Things to think about

    - Use correct size needle for meds being infused

    - Choose correct size needle for insertion of IV access.

    - Place IV in appropriate site for client comfort/patency

    - Think of movement

    - Remember legs/feet last choice

    - Peripheral = arms

    - Central line and PIC line = larger veins

Causes of complications:

1. Infection/ infiltration

    - Remember to observe the whole arm

    - Starting a new IV it needs to be ABOVE the injured site (infiltrated IV

    site)

    - Look for blood return (assess for patency) 3. certain meds are caustic

    - high acidic value like potassium (never give this undiluted)

    - hypertonic solutions are caustic

    - Chemotherapy agents and other meds.

What does it look like? (Complication)

1. swelling

    2. pallor

    3. cool to touch

    4. painful

    5. IV behind in time

    6. Blanching

    7. Leakage around site

    8. Dressing wet/bed wet

    CDC GUIDELINES FOR TUBING/SITE CONTROLS ***test*******

72 hours for site and dressings, and tubing’s

    24 hours for all bottles and bags

    Fat emulsion and tubing’s change each time

    24 hours for High sugar (TPN)

What do you do with an infiltration?

# 1. Assess

    - stop IV? NO, NO, NO it could clot with in 5 minutes

    - Get RN? YES, YES, YES

    - Heat compresses

    - Compare arms

PHLEBITIS

Serious

    Can at come institutions be addressed with an incident report Extremely painful

    Hardened area (rope type feel to vein)

    Redness

    IT IS DUE TO A CLOT FORMATION AND SOMETIMES DUE TO CAUSTIC AGENT IN IV.

Ways to prevent phlebitis: change IV site, monitor s/s of impending phlebitis

    If it does occur, stop IV disconnect and go to a new site

INFILTRATION

    - Stop IV

    - Raise arm

    - Apply heat

    - Medicate with MD order for pain meds

    - *****DO NOT MASSAGE THE SITE,(THINK CLOT) ************

PYROGENTIC REACTION TO MEDICATION

1. look at solution

    - Is it clear?

    - Clean?

    - Intact?

    - Tampered with?

    - Nothing floating?

    - Discolored?

    - Cloudy?

    - Expired medication?

    Number 1 prevention: do not hang anything you feel is wrong, verify with lot

    number for any recall.

    Symptoms of possible pyrogenic reaction:

    - chills

    - headache

    - nausea or vomiting

    - temp

Make sure to rule out anaphylaxis

    SYMPTOMS:

    - trouble breathing

    - throat swelling

    - tongue swelling

    - respiratory failure

    - decreased blood pressure

SPEED SHOCK

    Infusion going to fast, out of control What is in the infusion?

    - is it just a bag of NS, what about potassium, or TPN

    - Can go into FVE (lungs (PE), or cardiac (CHF)).

Safest IV delivery system

IV pump = #1

    Dial a flow = #2

    Roller clamp = #3

    Speed shock can happen with all three. Things to think about:

    - are you always watching your patient

    - other staff may mess with your equipment

    - has your patient left the floor for other therapy or by self?

AIR EMBOLISM

RARE

    50 cc or more

    We just don’t infuse air!

    Be more concerned about a central line (close to right atrium)

    Lines need to be connected, (check, and be careful)

Start of shift check

    - bag, solution correct

    - follow lines down

    - check arm and site

What should you do in case of Air embolism?

TRENDELENBURG

    LIE ON LEFT SIDE

    INSTRUCT PATIENT TO DO VAL SALVA MANEUVER (slows circulation down)

    CODE THEM

Sighs/symptoms

Hypoxic

    Increased pulse

    Cyanotic

    Hypotensive

    Tachycardiac

    Unconscious

FVE

Patient unable to absorb fluid, heart borderline (what do they look like?)

    - high pulse

    - lethargic

    - peripheral edema

    - distended neck veins

    - anxious

    - SOB

    - Wet lungs

What do you do next?

Turn IV down

    Get vital signs

    Sit them up at 30 degrees or more Call the doctor

    Oxygen therapy with standing MD orders (remember is patient COPD or cardiac?)

What type of solutions would we normally see for different situations?

    Surgery LR

    Diabetic NS

    Used most D5 ? NS

    Nursing actions on flow rate

- Do we catch up on flow rate? NO NO NO

    We are concerned with the heart and lungs

     - What about antibiotics?

    Different than IV fluid, we need a therapeutic level to be effective.

     - Monitor patient urinary output while on IV therapy

    - Act quickly for increased fluids and no increase or presence of urine.

    - If patient is rehydrating the bladder may not be full encourage patient

    to pee to make sure there isn’t retention.

    - Intake helps decide how much output there should be

Equipment

    ; Check fluid is it clear? * is it on time ; date and time IV bottle or bag * date and time IV tubing ; check connections * check IV site

    ; Check tubing * Expiration dates

    ; Check IV every hour

    ; Correct solution

    ; Correct additive

    ; Correct level of solution

    ; Correct flow rate

Factors effecting flow rate

    ; needle position * lying, sitting on tubing ; infiltration * thrombophlebitis

    ; height of solution * patency of needle

    ; venous spasm

    ; change of position with patient

    ; extremity position

    ; kinked tubing

    Nursing actions

; adjust flow rate

    ; Too slow do not catch up.

    ; Too fast slow down

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