rle finals (3)

• Intravenous therapy

  The aseptic installation of fluid, electrolyte, nutrients, and medication through a needle into a vein
• Intravenous therapy

  • For clients who can't take food or fluid orally
  • Dependent nursing action
  • Faster than P.O., used more in emergency
  • A dependent intervention
• Needs a Medical order
• Types of nursing interventions

  • Dependent- Require instruction from doctors, a nurse cannot initiate these interventions alone
  • Independent- A nurse can initiate these interventions alone
  • Interdependent- Collaborative intervention not only for the nurse but other members of the health team
• IV Fluids

  • Solution given, it is most often clear, but can be other colors
  • May be in a glass bottle or a plastic bag
  • In a various size
  • Sometimes a dark colored plastic bag may cover the IV fluid to protect it from the light
• IV Fluids

  • TPN, Dextrose
• Tonicity

  The ability of fluid to move around in the solution, measure of the effective osmotic pressure gradient
• Types of fluids based on tonicity

  • Isotonic fluids- having the same concentration of solutes as blood plasma, remain inside the intravascular compartment, thus expanding it
  • Hypotonic fluids- lesser concentration of solutes, dilutes the serum, which decreases serum osmolarity, solutes enter the cells, causing swelling of cells
  • Hypertonic fluids- has a greater concentration of solutes, pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment, fluid exits the cells, causing cells to shrink

  
• Isotonic solution

  Does not alter the cell as the solution has the same concentration of solutes as with the blood plasma
• Hypotonic solution

  Tends to swell the cell as fluids are being drawn inside the cell due to the cell's higher concentration of solutes
• Hypertonic solution

  Tends to shrink the cell and eventually dehydrating it due to its higher solute concentration thus drawing the fluids inside the cell outside
• Selected IV solutions

  • Isotonic Solutions: 0.9% NaCl (PNSS), Lactated Ringer's (PLR)/ Plain Lactated Ringer's, 5% Dextrose in Water (D5W)
  • Hypotonic Solutions: 0.45% NaCl, 0.33% NaCl
  • Hypertonic Solutions: 5% Dextrose in normal saline (D5NSS), 5% Dextrose in 0.45% NaCl (D5 ½ NSS), 5% Dextrose in Lactated Ringer's (D5LR)

  
• Total Parenteral Nutrition (TPN)

  For malnourished patients, for patients who cannot eat, for patients who have difficulty reaching a certain amount of calories
• Classifications of TPN

  • Nutrient: Contains some CHO (carbohydrate which consists of C-carbon, H-hydrogen, and O-oxygen) and H2O, useful in preventing dehydration, insufficient calories
  • Electrolyte: Contains varying number of cations and anions
  • Volume Expanders: Used to increase the blood volume following severe blood loss or loss of plasma
• Vesicant

  Drugs that can result in tissue necrosis or formation of blisters when accidentally infused into tissue surrounding a vein
• Sites of IV Therapy

  • Dorsal metacarpal vein
  • Cephalic vein
  • Basilic vein
  • Great saphenous vein and dorsal plexus
  • Dorsal metacarpal veins (used for children)
• Steel needles/Butterfly needles

  Small gauge needles with plastic wings on the shaft to facilitate placement, plastic tubing of various lengths extends behind the needle, used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants and sometimes to draw blood samples
• Parts of Butterfly Needle

  • Cap for needle
  • Stem(metal needle)
  • Wings(Butterfly)
  • Plastic tubing
  • Plastic adapter
• Parts of an IV Cannula

  • Cap for needle (plastic)
  • Metal needle
  • Catheter/cannula (plastic)
  • Catheter hub with wings
  • Injection port
  • Needle grip
  • Preview chamber/flashback chamber
  • Luer lock plug
• Macroset

  Macro-drip, delivers 1cc of IV fluid at 10, 15,20 gtts/ minute, for faster fluid infusion but has increased risk of fluid overload

  
• Microset

  Micro-drip, has a small needle connecting the spike and the drip chamber, delivers 1cc of IV fluid at 60 gtts/min, easier to regulate and has lesser risk of fluid overload

  
• Measured Volume Sets

  Delivers specifically measured volumes, e.g. Burette set, SoluSet, and Dial flow set, can have 150cc, has a safety flow valve to prevent backflow of the blood

  
• Electromechanical Infusion Devices/Electronic Infusion Device (EID) (INFUSION PUMP)

  A device for monitoring intravenous infusions, may have an alarm in case the flow is restricted because of an occlusion of the line, used for chemotherapy drugs and pain relievers, used if the patient is delicate or needs a specific amount of fluid

  
• Intravenous Flow Rate Calculation

  1. Drip Rate = volume over time

  2. Volume = the amount of IV Solution ordered

  3. gtt = drops

  4. gtt factor = drop factor (either macro set or micro set)

  5. Duration = hours to administer the solution

  6. Rate (dpm) = drip rate in drop per minute

  
• Drop factor (gtt factor) and 60min/hr are constant variables; cc and ml are interchangeable units
• Intravenous Flow Rate Calculation Examples

  • 1000ml Lactated Ringers to infuse over 8 hours, macrodrip tubing with a drop factor of 15 gtts/mL
  • 500mL of D5NSS to run for 12 hours with a microdrip set
  • Ancef 1gm in 100ml normal saline to be infused over 30 minutes, macrodrip tubing with a drop factor of 20gtts/ml
  • 1L bag of IV Normal Saline to infuse at a rate of 50mL/hr

  
• Factors that affect flow rate

  • Flow is directly proportional to the height of the liquid column
  • Flow is directly proportional to the diameter of the tubing
  • Flow rate is inversely proportional to the length of the tubing
  • Flow is inversely proportional to the viscosity of the fluid
• Other factors affecting flow rate

  • Age
  • Condition of patient
  • Solution used
  • Manufacturer's drop factor
  • Patency of the needle
  • Position of the site
  • Height of the IV pole
  • Kinking of the tube
• Common complications of intravenous therapy

  • Infection: Redness, swelling and drainage at the IV site
  • Infiltration: Leakage of IV fluid, discomfort, fluid flow becomes slow or ceased, sometimes absence of blood backflow
  • Extravasation: Similar to infiltration, with an advertent administration of vesicant solution or medication into the surrounding tissue
  • Phlebitis: Redness, warm area, pain, tenderness

  
• Nursing care for complications of intravenous therapy
• Vein selection guidelines

  • Use distal veins of the arms first
  • Non dominant hand whenever possible
  • Avoid using veins that are: Areas of flexion, Highly visible, Damage by previous use, Continually distended, Surgically compromised or injured extremity
• Equipment for starting an intravenous solution

  • IV tray containing: IV solution ordered, needle(butterfly / Vasocan), Tourniquet, IV pole
• Always remember to use the right color of pen when transcribing in the IVF sheet. Information regarding the patient's name, ward, and room number should be written using BLACK or BLUE pen. Make sure to write your full name with signature over printed name.