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Indications for IV Therapy

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¹ Fluid volume replacement and maintenance ² Electrolyte imbalance correction ³ Medication administration ⁴ Nutrition Support ⁵ Blood administration

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Causes of Fluid Volume Deficit

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vomiting, diarrhea, fistula drainage, GI suctioning, fever, **THIRD SPACE FLUID SHIFTING, diuretics, hemorrhage, anorexia or inability for oral intake

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Third fluid shifting -Examples

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occurs when fluid accumulates in a portion of the body (transcellular fluids) from which is not easily exchanged with the rest of the extra cellular fluid (ECF). it is trapped and unavailable for functional use. Examples: fluid in and cavity, peritoneal cavity, edema associated with burns

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Regulations for LPNs

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CAN: -insert peripheral IVs after training -administer pharmacy pre mixed antibiotics CANNOT administer: -IV chemotherapy -IVP meds -Heparin into saline locks -blood products

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Advantages of Infusion Therapy

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-administration route for emergency access -administration route for unconscious patient -administration route for NPO pt -route to counteract adverse medication reactions -**Quicker and faster absorption rate -ability to maintain serum levels -less discomfort

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Disadvantages of Infusion Therapy

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-invasive -potential for fluid overload -painful insertion and/or site -immediate effects from med "speed shock" -rapid occurring allergic reaction potential -break in skin integrity/potential for infection

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Speed Shock -Definition -s/sx

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def: immediate effects of medication s/sx: dizziness, drop in BP, redness, flushing

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population at greatest risk (with IVs)

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Very young and the elderly

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IV infusion methods

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IV push intermittent infusion continuous drip infusion

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Osmolality -Definition -function

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Def: the concentration of solutes in body fluids Funct: maintains ICF / ECF concetration

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Tonicity

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the osmolality of a solution -tonicity of a solution may cause a water shift from one compartment to another

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Types of IV solutions

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Isotonic Hypotonic Hypertonic

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Isotonic IV solution (Def)

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SAME osmolality as plasma No fluid shift, remains in vascular system (intravascular) RBC will not shrink or swell

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Types of Isotonic Solutions

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0.9% Normal Saline D5W (5% Dextrose in Water) Lactate Ringers

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Isotonic IV Solutions (Used for..)

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expand intravascular volume (dehydration) treat hypotension treat hypovolemia

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Isotonic 0.9% Normal Saline -Indications -Nursing Implications -Caution

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Indications: -hypovolemia -medication diluent (**most common solution used for) -**ONLY solution compatible with blood products -hyponatremia Nursing Implications: -assess for fluid volume excess/circulatory overload -check serum electrolyte levels Caution: -use cautiously with Renal disease and CHF

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Isotonic Lactated Ringer (LR) -Indications -Nursing Implications

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indications: -rehydration (water and electrolyte) -fluid replacement due to diarrhea or burns -treat (metabolic) acidosis; (once metabolized, it turns into bicarbonate-[base]) Nursing Implications: -I&O -Risk for hyperkalemia if given with K+ supplement -do not administer in case of alkalosis

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5% Dextrose in Water (D5W) -Indications -Nursing Implications

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Indications: -rehydration -fluid maintenance Nursing Implications: -assess for increased urine output -do not use on pt with CHF, FVE, or ICP -isotonic in bag only; insures becomes HYPO (once infused, dextrose metabolizes and becomes hypotonic)

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Hypertonic IV Solution -Def

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Has a higher osmolality (concentration) than plasma pulls water from cell into EC causing RBC to shrink

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Hypertonic IV solution -Types

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Types: -D5.45 NaCl -D5.9 NaCl -D5LR

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Hypertonic IV solution -Uses

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Uses: -Fluid loss from burns -hyponatremia -severe dehydration

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Hypertonic Glucose Solution -Types -Indication -Implications

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Types: -D10W up to 70% dextrose Indication: -provides calories ** parenteral nutrition -treat severe hypoglycemia Implications: -CVAD for solutions greater than 10% dextrose -assess for hypoglycemia -assess for sepsis

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Hypotonic IV Solution -def

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Osmolality (concentration) is less than plasma fluid moves from EC space to IC space, causing RBC to swell and burst

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Hypotonic IV Solution -types -Uses

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Types 0.45 NaCl 0.33 NaCl Uses: -cellular dehydration due to diuretics -DKA -rehydration and fluid maintenance

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IV orders include

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-amount -solution -additives -rate -tonicity Ex. 1000ml D5.45NS c 20mEq KLC at rate of 125 ml/hr hypertonic

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Patient Teaching for IV Therapy

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-explain procedure -length of IV therapy -rationale for IV therapy -client benefits -any discomfort, immobility and inconvenience -s/sx to be reported immediately to nurse ¹pain ²swollen ³redness along vein ⁴tenderness

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IV Solution Initiation -how RN/LPN verify order-

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-date/time -Rx solution with or without additives -VTBI=volume to be infused -rate of administration (ml/h or total vol/# of hrs) -physicians signature -math formula

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IV Solution Initiation -equipment

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-container -tubing (primary, secondary, y-tubing) -IV pole/hangers -IV pump -tape, dressings (transparent) and labels -gloves -IV start kit

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Primary tubing -used for

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continuous drip infusion

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Secondary tubing -used for

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intermittent infusion attached to primary "piggyback" -abx

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Y-Tubing -used for

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blood products -one end of blood product and one for normal saline

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What to look for on an IV bag

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Solution name Volume Expiration date

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Drip Chamber

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visual aid for amount of drips per minute

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Roller clamp

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determines rate of infusion

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3 Labeling sites

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IV bag tubing IV site on patient (label with RN initial, time, and date bag was hung)

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Flow rate with IV pump

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ml/hr amount of solution/# of hours

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Flow rate by gravity

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gtts/min Amt ml/hr X gtt factor / time (minutes)

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IV solution initiation -assess

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-assess solution -assess allergies -assess compatibility -assess potential site

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Assessing Solution

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-clarity -particles -leaks -expiration

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Assessing compatibility

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drug with drug drug with fluids fluids with d/ fluids

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Most common IV additive

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KCl & magnesium

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IV additives

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-do not add to hanging bag

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K+ additive

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-never give K+ IVP - MAX 60mEq/L or 10mEq/hr (cannot infuse faster than 10meq/hr)

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How long should an IV bag hang for?

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no more than 24 hours

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when should you monitor a pts and their IV site?

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Hourly

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IV flow depends on:

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-patency and diameter of IV cannula -patency of IV tubing -IV bag height -viscosity of solution -position of extremity -Site of IV -infiltration

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Height of IV on gravity

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3feet (36in) above heart

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Saline Lock Flush

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-Flush with 2-3 mL of NS q8h -do not flush if resistance is met

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Saline Lock is used to

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-maintain venous access without continuous IV infusion - Access for IV Push medication -Access for intermittent med administration (abx IVPB)

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Complications of IV Therapy

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-Phlebitis -Occlusion -Infiltration -Extravasation -Circulatory Overload (FVE)

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Phlebitis S/Sx

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-Redness, warmth, and tenderness at site and along vein -puffy area over vein -possible fever -palpable venous cord -can advance to thrombophlebitis

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Phlebitis Interventions

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-STOP infusion -apply warm packs -avoid further use of that vein -may need to dilute solution or slow rater per pharmacy/physician orders -perform venipuncture using large vein from irritating solution -document

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Occlusion commonly caused by:

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-improper flushing (know cath needs) -kinked tube -IV flow interrupted (do not let bag run dry) -Blood backup inline -precipitation from incompatible drugs Other: hypercoagulability of patient

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Occlusion of IV site

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-usually preventable -when attempting to flush DO NOT force if resistance is met

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Infiltration -def -caused by -population at R/F

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-**Most common complication of IV Therapy -IV fluid leaks into surrounding tissue -commonly caused by penetrated vein wall or dislodgment of cath from poorly secured IV device -R/F increases in elderly d/t thin and fragile veins

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Infiltration S/Sx

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-swelling @ or around site, may extend to entire limb -tightness -cool skin -blanching: may appear translucent -discomfort, burning, or pain -slowed IV rate

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Infiltration Implementations

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- STOP infusion -remove catheter - elevate extremity -check pulse, cap refills, parathesia -perform venipuncture preferably in another extremity or above infiltrated site; restart infusion -document

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What solution can only be administered through Central Vessel Access

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Solutions greater than 10% dextrose

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When administering medication via IV pump through a saline lock, which type of tubing will you use

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Primary tubing

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