IV Therapy and Nursing Management

IV Therapy

IV Therapy Indications

• To maintain fluid & electrolytes balance.

• To restore circulating volume.

• To administer medications.

• To transfuse blood & blood products.

• To correct or maintain the patient’s nutritional status.

TYEPS OF IV FLUIDS

There are three main types of fluids:

Isotonic fluids

Cautions:

use with caution with congestive heart failure, renal dysfunction & circulatory insufficiency.

Examples:

  • Sodium chloride 0.9 % solution.
  • Lactated Ringer’s Solution.

Hypotonic fluid

Cautions:

hypotonic solution should not be given to hypervolemic patients or patients with increased intracranial pressure.

Examples:

  • Sodium chloride 0.45 % solution.
  • D 5% in 0.45 % NS.

Hyper Tonic Fluid

Cautions:

these fluids must be administer cautiously & only when the serum osmolality has decreased to dangerously low levels.

Examples:

  • D 10 % in water.
  • D 50 % in water.

 

GROUPS OF IV FLUIDS:

Crystalloid ,NR + Colloid ,blood products

 

IV Therapy and  VEIN SELECTION

veins of the hand

• veins of the hand

1- digital dorsal veins.

2- dorsal metacarpal veins.

3- dorsal venous network.

4- cephalic vein.

5- basilic vein.

 

 veins of the forearm

• veins of the forearm

1- cephalic vein.

2- median cubital vein.

3- accessory cephalic vein.

4- basilic vein.

5- cephalic vein.

6- median anterbrachial vein.

 

Veins of Lower Extremity

Veins of Lower Extremity:

Always use veins in the upper extremities in preference to lower extremity sites for IV cannulation. Because the superficial veins of lower extremity connected directly to the deeper veins in the leg there is a high risk of DVT & phlebitis. This site should be restricted to short term administration only and changed as soon as other site can be established elsewhere.

 

Selection Of IV Sites

Factors to be consider when choosing an IV site:

  • Condition of the vein.
  • Types of IV therapy.
  • Duration of IV therapy.
  • Patient’s age & size.
  • Whether the patient is right or left handed.
  • Skills of person performing the vein puncture.

Sites To Be Avoided

  • Bruised veins.
  • Area of swelling.
  • Area below traumatizes tissue.
  • Red, swollen veins.
  • Veins distal to previous IV infiltration or phlebitic area.
  • Arm with AV fistula or shunt.
  • Arm on the site of a mastectomy.
  • Area of flexion over the joints.

 

Veins Dilation Techniques

  • Tourniquet application.
  • Blood pressure cuff.
  • Dangling the arm.
  • Warming the limb for 5 to 10 minutes.
  • Gentle tapping of the vein with one finger.
  • Relaxation techniques.

 

Over The Needle Catheter (ONC)

This type of IV catheter consists of a needle inside a plastic catheter. The needle is used to inter the skin & the vein & it is removed once the cannulation is accomplished. The soft & flexible plastic catheter is the only thing left within the vein. Its having advantage of being secure & stable in the vein.

It is available in a variety of designs & sizes, with wings or without wings.

 

Factors To Be Considered When Selecting The Size Of ONCThe Size Of ONC

  • 16 g. For trauma patient & major surgery.
  • 18 g. For blood transfusion.
  • 20 g. For most adult patients.
  • 22 g. For pediatric & elderly patients with fragile veins.
  • 24 g. For neonatal, pediatric or elderly patients.

 

Butterfly Needle

Butterfly needle is compose of a steel needle, plastic wings & a flexible extension tube that varies in length from 3 to 12 inches. The needle size is ranging from 0.5 to 1 inch, & gauges from 17 to 27.

It is suitable for short term IV therapy (less thane 24hrs), obtaining blood sample, with infants, pediatric, & elderly patients.

 

TECHNIQUE

EQUIPMENTS:

  • Alcohol swaps , Betadine swab ,Tourniquet..
  • Absorbent disposable sheet.
  • IV catheter.
  • IV fluid & tubing.
  • Tape & transparent dressing.
  • Disposable gloves.
  • Gauze (several pieces of 2×2 or 4×4).
  • 10 CC Syringe with normal saline.

Prepare the IV fluid administration set:

  • Inspect the fluid bag to be certain it contains the desired fluid, the fluid is clear, the bag is not leaking, and the bag is not expired.
  • Select either a mini or macro drip administration set.
  • Attach the IV tubing to the fluid bag.
  • Flush the air out of the tubing.

Perform the venipuncture

  • Explained the procedure.
  • Apply a tourniquet high on the upper arm.
  • Select the appropriate vein.
  • Don disposable gloves. Clean the entry site carefully with the alcohol swab.
  • To puncture the vein, hold the catheter in your dominant hand. at about a 30 to 45 degree angle.
  • Advance the catheter to enter the vein until blood is seen in the "flash chamber" of the catheter.
  • Advance the plastic catheter into the vein while leaving the needle stationary.
  • Release the tourniquet.
  • Apply gentle pressure over the vein just proximal to the entry site to prevent blood flow. Remove the needle from within the plastic catheter. Dispose of the needle in an appropriate sharps container.
  • flush with normal saline then connect to IV tubing.
  • Tape the catheter in place using the strips of tape and/or a clear dressing.
  • Label the IV site with the date, time, and your initials.
  • Monitor the infusion for proper flow into the vein (watch for infiltration).

 

IV THERAPY INSERTION TECHNIQUE

IV THERAPY INSERTION TECHNIQUE

 

FOLLOWUP PHASE

  • Frequent inspection of venipuncture site for infection ( redness, swollen, pain, discharge, warmth)
  • Make sure the site is labelled by date, type & size of catheter.
  • Change IVF every 24h or PRN.
  • Change gauze dressing & IV tubing every 48h or PRN.
  • Change P.I.V.C every 72h or PRN.
  • Change C.V.C every 2 weeks or PRN.

 

IV Therapy COMPLICATION

Local complications:

  • Hematoma.
  • Infiltration.
  • Thrombphlibitis.

Hematoma

Hematoma Causes:

  • The needle slipping out of the vein.
  • Perforation of opposite vein wall during venipuncture .
  • Infusion pressure applied to he site after removing the needle or cannula .

Hematoma Clinical manifestation :

  • Immediate swelling .
  • Leakage of blood at the site.
  • Ecchymosis.

Hematoma Nursing management:

  • Remove the cannula .
  • Applying pressure with a sterile dressing warm compress.
  • Document intervention, assessment.

 

Infiltration:

Infiltration Causes:

  • Dislodgment of the IV cannula from the results in infusion of fluid into the surrounding tissues.

Infiltration Clinical manifestation :

  • Swelling. Coolness of surrounding skin and tissues.
  • Discomfort.
  • Fluid flowing more slowly.
  • Absence of blood backflow IV catheter and tubing.

Infiltration Nursing management:

  • Stop infusion immediately and remove Iv needle or catheter.
  • Restart IV in the other arm.
  • Documentation intervention and assessment.

 

Thrombophlebitis

Thrombophlebitis Causes:

  • Injury to vein during venipuncture, large-bore needle / catheter use, prolonged
  • needle.
  • Irritation to Vein due to raped infusion to irritation solution ( eg. Hypertonic
  • glucose Solution, potassium).
  • Clot formation at the end of the needle or catheter due to slow infusion rate.

Thrombophlebitis  Clinical manifestation :

  • Tenderness at first, then pain along course of the vein.
  • Swelling, warmth and redness at infusion site.

Thrombophlebitis Nursing management:

  • Apply clod compresses.
  • Warm compresses to stimulate circulation and promote absorption.
  • Documentation, intervention and assessment.

 

Systemic complications:

  • Fluid overload.
  • Air embolism.
  • Infection (bacteremia or septicemia).
  • Venous thrombosis.

 

Fluid overload

Fluid overload Causes:

  • Overload or delivery excessive amount of IV cause increased blood pressure and central venous pressure.

Fluid overload Clinical manifestation :

  • Increase blood pressure and pulse.
  • Increase CVP, venous distention.
  • Headache, anxiety.
  • Shortness of breath, tachypnea, coughing.
  • Pulmonary crackles.
  • Chest pain.

Fluid overload Nursing management:

  • Slow infusion to a “ keep open “ rate and notify the doctor.
  • Monitor closely for worsening condition.
  • Raise patient’s head to facilitate breathing.
  • Document interventions and assessment.

Air embolism

Air embolism Causes:

  • Enter of air to catheter during tubing changes.
  • Air in tubing delivered by IV push or infusion pump.

Air embolism Clinical manifestation :

  • Drop in B/P, elevated heart rate.
  • Cyanosis, tachypnea.
  • Rise in CVP.
  • Change in mentation , loss of conscious.

Air embolism Nursing management:

  • Immediately turn patent on left side and lower head of bed ( in this position the air will
  • rise to right atrium.)
  • Notify the doctor.
  • Administer oxygen as needed.
  • Reassure patient.
  • Document interventions and assessment.

 

Infection

Infection Causes:

  • Contaminated equipment of infused solution. Prolonged placement of an IV device (catheter/needle/tubing / solution container).
  • No aseptic IV insertion or dressing change.
  • Cross-contamination by patient with other infected areas of body.
  • The critically ill immunosuppressed patient.

Infection Clinical manifestation :

  • Elevated temperature chills. Nausea, vomiting. Increase pulse. Backache, headache.

Infection Nursing management:

  • Discontinue infusion and IV cannula .
  • IV devise should be aseptically removed.
  • Check vital signs and obtain blood cell count.
  • Start appropriate antibiotic as order.
  • Document intervention and assessment.

 

IV Fluid Calculation

IV Fluid Calculation

Example:

1500 x 15

__________ = 94 drop / min

4 x 60

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