INTRAVENOUS IV THERAPY for Nursing

INTRAVENOUS THERAPY

INTRAVENOUS THERAPY

IV Infusion
instillation of fluid, electrolytes, medication, blood, or nutrients into the vein
Physician is responsible for ordering the type, amount, & rate of solution to be given

Purposes of INTRAVENOUS THERAPY

– To supply fluids if unable to take fluids or nutrients orally
– To provide salt needed for electrolyte balance e.g., K+, Na-
– To provide glucose for metabolism (dextrose)
– To provide vitamins and medication
– To provide lifeline for blood and medications needed rapidly

Types of IV solutions

Isotonic Fluids:
– Solutions have the same osmotic pressure as that found within the cell (similar concentration of solutes as plasma)
– Used to expand intravascular compartment— increase circulating volume
Example:
NORMAL SALINE and LACTATED RINGERS

Types of IV solutions

Hypotonic Fluids:
– Solutions that have less osmotic pressure than the cell (less concentration of solutes than plasma)
– Administered for patients who need cellular hydration (extra hydration)
Example:
– 5% Dextrose in H2O (D5W)
– Half NS (0.45% Nacl)

Types of IV solutions

Hypertonic Fluids:
– Solutions that have greater osmotic pressure than the cell (greater concentration of solutes than plasma)
– Often administered to post- operative patients to maintain circulating volume and prevent edema
Example:
– 5% Dextrose in Normal Saline (NS)
– 5% Dextrose in Lactated Ringers

Vein Selection

– Use distal veins of arm FIRST
– Use non- dominant hand of pt. If possible

distal veins of arm FIRST

Use or select Veins that are:

– Easily palpated & feels soft & full
– Naturally splinted by bones
– Large enough to allow adequate circulation around the catheter

Avoid using the following veins

– In areas of flexion
– Highly visible veins; tends to roll away from needle)
– Veins that are damaged previously by phlebitis, infiltration, or sclerosis
– Veins of a surgically compromised or injured extremity; possible impaired circulation and discomfort for pt.

IV THERAPY OUTLINE

I.  Prepare IV Infusion
2.  Maintain IV Infusion
3.  Changing IV
4.  Discontinuing IV

Prepare IV Infusion

Equipment:
– Sterile IV catheter or needle
– Administration set
– IV solutions- sterile
– IV poles/ stand
– Arm splint

– Tray with swab, gauze, plaster & tourniquet
– Kidney basin/ receptacle

Intervention

Prepare pt.:
– Explain procedure
– Provide any scheduled care
– Pt’s gown can be removed over IV apparatus
– Wash hands

– Set up infusion equipment:
– Open and prepare set
– Spike solution container
– Hang solution container
– Partially fill drip chamber
– Prime tubing
– Apply label upside down
– Label IV tubing; date & time of attachment  & initials
– Label solutions: date , starting time, time to be finished, & initials

Select & prepare vein site:
– Apply tourniquet
– Start at distal end

– Don gloves & clean site

– Dilate the vein

– Insert needle or catheter
– Pull skin with thumb & taut below entry site
– Hold needle with bevel up
– Pierce 1 cm from site
– When blood flows back push up
– Secure needle with tape
– U method
– H. method
– Crisscross or chevron method
– Dress & label veni- site

Ensure appropriate infusion flow:
– Apply arm splint
– Adjust infusion rate of flow as ordered
– Document data
– Date & time of insertion
– Amount & type of solution used if with additives; drip rate
– Absorption time, needle #, site & general response

– One of nursing responsibilities is to calculate the correct flow rate & regulate the infusion
– Problems that can result from incorrectly regulated infusions include:
Hypovolemia & Hypervolemia

– The Nurse has to check infusions at least every hour

– Calculate Flow Rates for IV Therapy

– Milliliter per Hour (ml. per hr.)
Formula:
– Total Infusion Volume (ml)  = ML/HR
– Total Infusion Time (hr)
Example: 3000 ml is infused in 24 hrs.
3000ml     = 125 ml/ hr
24 hrs

Drops per minute:
Formula:
– Total Infusion Volume x drop factor
– Total Time of Infusion in min.

Example:
– 1000 ml in 8 hrs. DF = 20/ml
– 1000×20 gtts ml    = D/min.
480 min

Drop size
– Microdrip:
Rate of 60 drops/ml of soln

– Macrodrop:
When large quantities of solution or fast rates are required = 20 drops/ml of soln

Factors Influencing Flow Rate

– Position of the forearm
– Position and patency of tubing
– Height of infusion bottle
– Possible infiltration or leakage;
– Swelling, coldness, and tenderness in site

Reasons for Blockage in IV System

– Kink tubing
– Bevel is blocked against the wall of the vein
– Check tubing clamp if closed
– Height of the solution; not less than one meter above IV site
– Observe position of tubing, coil it if dangling below venipuncture
– Observe drip chamber

Infiltration

– Infiltration; the needle becomes dislodged from vein
– Fluid flows into interstitial tissues causing:
– Decrease rate of flow, swelling, pallor, coolness, and discomfort at/ or above insertion site
– If infiltration is present, IV site must be changed; apply warm compress to the site of infiltration

Phlebitis

– Can occur as a result from IV electrolytes such as K+ Magnesium & medications
Inspect IV site every 8 hrs
Clinical Signs:
– Redness, swelling, warmth, burning pain along vein
– If phlebitis indicated, discontinue IV & apply warm compresses at IV site

Dislodgement of needle from vein

– Pinch IV tubing gently to cause blood flow (flash back)
– Use sterile syringe of saline to withdraw fluid from IV tubing (rubber), if no blood return, discontinue IV
– Apply tourniquet 10 – 15 cm above IV site – open clamp widely; if infusion flows slowly, needle is in S/C tissue (infiltration) = D/C

-Teach your patient when to call you

– The flow rate changed suddenly
– The fluid container is almost empty
– Blood is in the tubing
– The site becomes uncomfortable

Reasons for changing IV Solution, Tubing, and Dressing

– To maintain the flow of required fluids
– To maintain sterility of IV system & decrease incidence of phlebitis & infection
– To maintain patency of the IV tubing
– To prevent infection at the IV site & the introduction of microorganisms into blood stream

– IV container
– To be changed every 24 hrs
– IV tubing/ dressing
– To be changed every 48 – 72 hrs
– Venipuncture site
– To be changed every 72 hrs

Changing an IV Container & Tubing

– Equipment
– Correct solution
– Administration set
– Tape, sterile gauze, swab
– Receptacle
– Gloves

Intervention

– Obtain the correct solution
– Assess pt. & IV system
– Set up IV equipment with new container & label
– Remove dressing to expose needle or catheter hub

– Disconnect used tubing
– Place swab under hub
– Hold needle with non- dominant hand
– Use twisting, pulling motion
– Connect new tubing, reestablish infusion
– Clean veni- site, apply dressing with label
– Clean from insertion outward
– Apply labeled tape over dressing; date, time applied & inserted size of needle & initials

– Regulate flow rate
– Document relevant information
– Record change of container/ tubing
– Record fluid intake
– Record number of container
– Record assessment

Discontinue IV Infusion

Reasons
– Oral fluid intake & hydration status are stable
– Problem with infusion that cannot be fixed
– IV medications no longer required

Intervention

– Clamp infusion tubing
– Loosen tape of veni- site
– Don gloves & hold swab above site
– Withdraw needle, pull in line of vein
– Apply firm pressure swab for 2 – 3 min.
– Hold arm above for any bleeding

– Check needle intact
– Apply sterile dressing
– Assess response to IV
– Discard IV container if discontinued
– Record I & O, time discontinue, & pt’s. response

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