IV Therapy Indications

fluid volume maintenance, fluid volume replacement, med

administration, blood administration, TPN, emergency

line,  

faster absorption, rapid distribution, emergency access, unconscious patient  

Advantages of IV Therapy  

70% isopropyl alcohol inhibits bacterial growth, apply with friction; Iodine, inhibits

bacterial growth, penetrates cell wall  

Infection Control in IV  

PICC-every 6 weeks, IV inserted by paramedic w/in 24 hours, Peripheral site every 72 hours, Blood and TPN every 24 hours, CVC every 48-72 hours or 3xper week.  

IV and Dressing Changes  

assess site whenever in room, document at least every 8 hours, site CDI (clean, dry, intact), sterile technique, changine tubing and solution, awareness of complications, awareness of fluid types, 5 rights  

Nursing Responsibilities for IV Sites  

Pain and irritation, infiltration and exravasion, occlusion, loss of patency, phlebitis, fluid overload  

Complications of IV Therapy  

increase amt of dilutent, arm board  

Pain and Irritation of IV-intervention  

seepage of IV fluids into tissue when IV cath penetrates vein  

Infiltration  

escape of irritating agent into tissue  

Extravasion  

swelling, pain, cool to touch, decreased flow, wet dressing, no back flow.  

Extravasion and Infiltration Assessment  

catheter permeates vein, poor taping of site, over manipulation  

Causes of Infiltration and Extravasion  

Intervention for Infiltration and Extravasion  

Remove IV, cold compress  

kinked tubing, patient lying on tubing, infusion too slow  

Occlusion Causes  

Occlusion Assessment   IV stops dripping  

milk IV, aspirate, irrigate (if no resistance OK, if resistance may be clot>  

Occlusion Intervention  

don't let IV run dry, flush periodically with 1-5 cc of NSS and before and after any

intermittent IV therapy.  

Occlusion Prevention  

bacterial, chemical, mechanical  

Phlebitis Causes  

Phelebitis Intervention  

remove IV, cold compress  

erythemia, pain or burning, warmth, edema, cordlike vein.  

Phlebitis Assessment  

IV left in too long  

Bacterial Phlebitis possible cause  

Chemical Phlebitis Cause   irritating fluids  

clot at tip of cannula, cath too large for vein.  

Mechanical Phlebitis  

clear fluids, dextrose of saline, can be Iso, Hypo or Hyper tonic  

Crystalloids  

cloudy, yellowish, used to raise osmotic pressure, Dextran is clearish  

Colloids  

Hypotension (increases BP), Hypovolemia  

Indications for Isotonic IV  

fluid overload  

Complications of Isotonic IV  

0,9% NSS, D5W(isotonic in bottle, hypotonic in body), Lactated Ringers  

Examples of Isotonic Solutions  

Will cause fluid to shift from intravascular to intracellular space.  

Indications for Hypotonic IV  

dehydration  

Indications for Hypotonic IV   

.45% sodium chloride, 5%dextrose water (becomes hypotonic in body)  

Hypotonic Solutions  

May cause edema  

Complications of hypotonic solution  

low bp, slight edema but not w/CHF, pulls fluid from intracellular space to intravascular space  

Indications for hypertonic IV  

Not as strong as Albumin, 10% Dextrose in Water D10W, 5% normal saline, D5 Ringers Lactate  

Hypertonic IV Solution  

more fluid in bloodstream can cause circulatory overload.  

Complications of Hypertonic IV  

Patient Controlled Analgesia  

PCA  

drug dosage, lockout period, basal rate  

3 settings of PCA  

inadequate vascular access, complex treatment regimes, hyperosmolar infustions ie parenteral nutrition, irritating or vesicant druges, (ie. dopamine cancause necrosis) rapid absorption, long term therapy.  

Central Venous Therapy Indications  

altered skin integrity, anomalies of central vasculature, cancer in area, coagulopathies, fractured clavicle, septicemia, radiation to insertion site  

Contraindications for Central venous therapy  

subclavian, jugular, femoral vein, cephalic vein(is peripheral but the line runs to central area)  

Common insertion pathways for Central Venous Therapy  

Air embolism, pneumothorax, sepsis,chest pain, confusion, hypotension, dyspnea, pallor, tachycardia, tachypnea, unresponsiveness  

Risks and Complications of Central Venous Therapy  

amino acids, carbohydrates, electrolytes, minerals, vitamins, lipids, other (ie insulin

Components of Intravenous Nutritional Support  

lipids are administered via Piggy back. (white, thin liquid)  

Lipids in Intravenous Nutritional Support  

not refrigerated, observe for spoilage (fat on top, discoloration), expiration dateNo filter. , must be infused on IV pump, glucose monitored, gradual weaning. Daily weights,  

Cautions for IV nutritional support  

hypoglycemia, hyperglycemia, dehydration, infection  

Complications for IV nutritional support  

bowel surgery, chronic weight loss, bowel rest, coma, excess nitrogen loss, hepatic or renal failure, malnutrition, low serum albumin, hypermetabolic states 

Indications for IV Nutritional Support