Def: administration of fluids or meds thru a vein. This route is the fastest and poses the greatest danger.
RN to give meds thru.
RN to draw blood from.
RN to d/c.
LPN to give meds thru.
LPN to draw blood from.
LPN to d/c.
Reasons for IV fluids:
An intravascular access can also be started to a KVO state. This is used to administer meds. Usually 50-30 cc/hr. This is called Hep-lock or Saline well.
Know all when MD orders fluids:
2 types of fluids:
Volumes come in 50, 100, 250, 500, and 1000. Smaller are sued to administer meds or for peds.
Extracellular fluid compartment: interstitial and intravascular.
Intracellular fluid compartment: in the cells. Most of the bodyís fluid is intracellular.
Osmolarity: concentration of electrolytes and other osmotically active particles in blood and other body fluids.
Ĺ normal saline
1/3 normal saline
D2 Ĺ W
This would be ordered for the dehydrated person.
D5 Ĺ NS
Before using, inspect your bag.
Micro set has 60gtt/ml.
Macro set has 10 - 20gtt/ml.
Back check valve will not allow anything to go past it.
Filter: some lines will need one for TPN.
Purpose for adding meds to large volumes: to maintain a constant level of med used or administer meds that need diluting. Ex: KCL is irritating to the veins.
Correct IV solution
Sterile syringe (5-10cc)
1 to 1 Ĺ inch, 20 to 21 gauge needle
Confirm med and solution compatible
Locate injection port
Clean with alcohol
Attach a med lable
Add meds :
For glass bottleà take top off or remove cap on vent to insert without needle.
Purpose of priming is to replace air with fluid.
Tubing is changed q 24-72 hours (so are the sites).
Bag of fluid can only hang for 24 hours.
Starting the IV:
Have all equipment ready.
Give brief discription.
Give restriction on activities.
Put in non-dominant hand if able.
Allow client to express concerns.
24g à peds or NB
18g à best for blood
16g à trauma
20g à most commonly used
Tourniquet should be 2 to 6 inches above the injection site.
Clean with alcohol in circular motion.
Make sure needle comes apart from catheter.
Stick direct (on top) or indirect (to the side).
Blood return lets you know you are in.
Advance ľ inch more.
Put 2x2 under hub.
Push in cath and remove needle at same time while occluding vein.
Make sure it runs and them clamp.
Apply tegaderm over hub.
Loop other tubing up and tape.
Procedure to maintain:
If you find an error, check order first.
Observe your rates every hour.
If rate is too fast, slow it down and ovserve for fluid overload (edema, increased BP, increased HR, crackles, SOB) and call MD.
If too slow, recalculate gtt rate and put it where it should be, never try to catch it up.
May use a time strip for a gravity infusion. Put a piece of tape on the bag and put the time for how ever much should be out at that time.
Note condition of the site.
Can lower bag to see blood in line.
If bleeding you may just need to tighten the fluids to the hub.
Teach client to avoid twisting and call when infusion stops.
Changing IV tubing:
Typically all changed at one time every 3 days if no problems arise.
Prime new bag
Cut off infusing IV
Occlude vein so wonít bleed back
Put on new tubing
Know how to calculate cc/h using your watch.
Reason for hanging a piggy back: to be able to administer different meds at different times, maintain peak med levels, administer slow and dilute in large volume.
Reason for IV pushes: to get fast results and is administered in the port closest to the client. Be sure to look up med to know how fast it needs to be pushed. If doing thru a hep-lock use the SAS method. If you piggy back thru a hep lock, use the primary tubing set.
Use clean gloves.
Close roller clamp.
Put 2x2 over site.
Pull catheter straight out.
Examine catheter tip.
Document if catheter in tact.
Also document site appearance and intake.
Anatomy of the vessels:
Remember the arteries pulsate. Veins are superficial and arteries are deeper.
There are 3 layers.
Must have an order to start an IV in the feet or legs. More problems with phlebitis and blood clots.
Metacarpal à good place. The veins lie between bones and joints that give a natural splint.
Cephalic à radial side of forearm. Accomadates a large catheter.
Basilic à on pinky side of forearm.
Median à another good choice.
Anticubital à not a good choice because you will bend it. Located in joint flexion, dislodge easily, and infiltrate easily. However, they are large and used in emergencies.
When selecting a vein, try to put in non dominant hand. Choose one that is naturaly splinted by a bone. Do not use mastectomy side, or fracture side. Inspect by palpation. Should not feel hard.
S&S: SOB, edema, increased RR, abnormal lung sounds, increased BP, cough, neck vein distention, variance for I&O (more in than out).
Prevention: monitor I&O, be aware of client history. Carefully monitor infusion flow rates, may need to use pump or volutrol or hang smaller bags.
Treatment: slow IV down, do assessment, elevate HOB, call MD. MD may order Lasix.
S&S: dyspnea, cyanosis, hypotension, weak rapid pulse, loss of consciousness, chest, choulder or low back pain.
Prevention: be sure connections are tight, lure locks should be tight.
Treatment: clamp central line and get new tubing.
S&S: chills, fever, general mallaise, h/a, backache, increased pulse and resps.
Prevention: sterile technique, inspect fluids, donít hang over 24 hours, use sterile technique for add mixtures, good handwashing.
S&S: facial flushing, h/a, chest tightness, symptoms of shock.
Prevention: use a pump.
Treatment: show IV down and call MD.
1. Infiltration à leakage of luid from a vein into surrounding tissue. Most common complication. First sign is complaints of tightness. Discomfort, swelling, and cool to touch. Chemo will cause tissue to slough off if infiltrated.
Treatment: d/c and relocate.
Elevate extremity and fluid should absorb in 2 or 3 days. Be sure to tell your client this. Also known as extravasation.
Prevention: monitor IV closely, use appropriate size catheter, donít start at joint flexions, securing well with tape, relocate according to policy, if in doubt, relocate.
2. Phlebitis à inflammation of the vein r/t a chemical or mechanical irritation. Causes: meds, irritating drugs, not anchoring correctly. Incidence increases the longer it has been in.
S&S: redness and warmth.
Prevention: same as infiltration.
Treatment: warm compress (must have MD order) and take it out.
3. Thrombo phlebitis: presence of a clot plus inflammation. An get a thrombosis from any injury to inner lining of the vein.
S&S: local pain, redness along vein path, warmth, fever, malaise, immobility of extremity.
Prevention: prevent trauma during insertion, observe sites q hr, check med additives for compatability, never irrigate an IV.
Treatment: d/c, relocate, elevate, MD may order heat.