INTRAVENOUS

8/6/2019 INTRAVENOUS

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INTRAVENOUS (INFUSION) THERAPY isthe insertion of a needle or catheter/ cannula

onto a vein, based on the physicians writtenprescription. The needle or catheter / cannula is

attached to a sterile tubing and fluid container

to provide medication and fluid.


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INDICATIONS OF IV THERAPHY

To maintain hydration and /or correct

dehydration in patients unable to tolerate

sufficient volumes of oral fluid / medications.

Parenteral Nutrition.

Administration of Cdrugs, i.e. chemotherapy,

other drugs

Transfusion of blood or blood components.


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CONTAINDICATION OF

PERIPHERAL I.V. FLUIDS Administration of irritant fluids or drugs

through peripheral access {i.e. highly

concentrated, high osmolarity solution like NaChloride, Hypertonic K Chloride, etc.}


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PROCESS:

A. STANDARD POLICIES AND PROCEDURESStandard operating procedure are established to secure

safe I.V. therapy , to protect the patient by maximizing

benefits and minimizing risk associated with this I.V.

therapy and to protect the practice of registeredprofessional I.V. therapy nurses. The I.V. therapy

policies and procedures are written and continuously

updated and reviewed as necessary.


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Key Points Prior To Initiation of

I.V. Therapy1. Physicians prescribed treatment.

The initiation of I.V. therapy is upon the written

prescription of a licensed physician which is checked

for the following :Type and amount of solution

The flow rate

The type, dose, and frequency of medications to be

incorporated/ pushedOthers affecting the procedures {X-ray, treatment to

the extremities,}


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I.V. Therapy2. Patient Assessments

Factors To Consider For I.V. Therapy

Duration of therapy

Cannula Size

Condition of the vein / skin.

Type of solution

Patients level of consciousness

Patients activity

Dominant arm

Clinical status of patient


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I.V. Therapy3. I.V. Set and equipment preparation

Check for expiration date

Check for clarity, any presence3 of holes on plastic

cover {packaging} plastic container (bag) orpresence of sediments or insects.

Check label against the physicians order

Label for any medication that are added; date,

time, medication and amount. Compatibility of drugwith the solution.

Functionality of Infusion Pump, Patients

Controlled Analgesia {Pt CA}


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I.V. Therapy4. Medications

Nurses administering I.V. therapy should have a

knowledge on all medications administered including

dosages, drug interactions and possible clinical effectson the vascular system.


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10 Golden Rules For

Administering Drugs Safely[from Nursing 88 Vol. 18. August 1988]

1. Administer the right drug.

2. Administer the right drug to the right patient.

3. Administer the right dose.

4. Administer the right drug by right route.5. Administer the right drug at the right time.

6. Document each drug you administer.

7. Teach your patient about the drug he is receiving.

8. Take a complete patient drug history. { There is a risk of adverse

drug reactions when a number of drugs are taken or when patient istaking alcohol drinks.}

9. Find out if the patient has any drug allergies.

10.Be aware of potential drug drug or drug food interactions To

protect your patient and your license, follow these guidelines for

avoiding medication error.


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PROCESS:

B. INITIATION OF I.V. THERAPY

The initiation of IV therapy shall be to provide

peripheral intravascular access for therapeutic

indications. This requires a physicians written

prescriptions.


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PROCESS:

C. CHOICE OF CANNULA FOR PERIPHERALINFUSION.

The factors to consider for the choice of cannula are;

Purpose of the infusion.

Type of infusion.

Size and condition of the patients vein.

Duration of treatment.

Condition of the patient.


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Nursing Alert: Choose the shortest catheter with thesmallest gauge. Appropriate for the type and

duration of the infusion. The higher the gauge

number, the smaller the bore of the catheter.


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D. SELECTION OF VENIPUNCTURE SITEThe patients condition and age, the size and vein

condition, type and duration of therapy and

functional utilization of the hand shall be assessed

to ensure ideal and safe IV access.

E. ANCHORING OF CANNULA AND TUBING

Good anchoring allows normal blood flow, preventsmovement of cannula and irritation of vein thus

protecting the puncture site.

PROCESS:


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F. IV CANULLA REMOVAL

Peripheral IV cannulas and yhe site are routinely

changed aseptically or re-sited every 48 72 hours

or when necessary.

G. EXPLAINING THE PROCEDURES TO THE

PATIENT AND SIGNIFICANT OTHERS.

H. QUALITY CONTROL OF IV SOLUTION

All IV fluids shall be inspected prior to use and

check for visible sediments, turbidity, discoloration,

leaks, cracks, damaged caps and expiration date.

PROCESS:


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I. DOCUMENTATION OF IV THERAPY

Proper documentation provides:

an accurate description of care that can serve as

legal protection.

a mechanism for recording and retrieving

information.

a record for health insurers and retrieving

information documenting the insertion of avenipuncture device or the beginning of therapy.

PROCESS:


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a. The following is written on the IV tape: size, type and length of cannula/ needle

name of person who inserted the IV catheter date and time of insertion

b. Label the IV solution specifying: type of IV fluid

medication additives and flow rate

use of any electronic infusion device duration of therapy nurses signature

c. In addition to the above documentation the following information isdocumented in the patients chart.

location of and condition of insertion site

complications, patients response and nursing interventions.

patient teaching and evidence of patient understanding{ for exampleability to explain instructions or perform a return demonstration

Signature of nurse

other observations


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TYPES OF IV FLUID1. ISOTONIC SOLUTION Has the same concentration

as body fluids. It is often used to restore vascular volume.

0.9% Na Cl (Normal Saline) - Isotonic solution NS and

LR initially remain in the

vascular compartment,

expanding the vascularvolume.

Watch out for: S/S of

hypovolemia such as

bounding pulse and shortness

of breath.D5W - isotonic on initial

administration but provide free

H2o when dextrose is

metabolized.


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TYPES OF IV FLUID

3. HYPERTONIC draws fluid out of the intracellular andinterstitial compartment into vascular compartment,

expanding of vascular volume. Do not administer to

clients with kidney or heart disease or clients who

dehydrated. Watch for the signs of hypervolemia.

Ex.. 5% Dextrose in NS ( D5NS )

5% dextrose 0.45 Nacl ( D51/2 NS ) D5LR


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LARGE VOLUME INFUSION

Mixing a medication into a large volume IV container is thesafest and easiest way to administer a drug intravenously.

The drugs are diluted in volume of 1,000 ml or 500ml of

compatible fluids. Fluids such as IV normal saline or

Ringers lactate are frequently used. Commonly added

drugs are potassium chloride and vitamin.

The main danger of infusing a large volume of fluid is

circulatory overload. The medication can be added to the

fluid container running or before it is hung and infusing.Label with name and dose of medication, date, time, and

nurses initials. Attach it upside down on the bag or bottle.


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INTERMITTENT INTRAVENOUS INFUSION

It is a method of administering a medication mixed in a small

amount of IV solution, such as 50 0r 100 ml. The drug isadministered at regular intervals such as every 4 hours, with the

drug being infused for a short period of time such as 30 to 60

minutes. Two commonly used additive or secondary IV set ups use

the tandem and piggyback.

In a tandem set up, a second container is attached to the line of the

first container at the lover, secondary post.

It permits medications set up to be administered

intermittently or simultaneously with the primary

solution.

In the piggyback alignment, a second set connects the second

container to the tubing of the primary container at the upper post.

This set up is solely for intermittent drug administration.


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INTRAVENOUS PUSH (IVP) (bolus) is theintravenous administration of undiluted drugs directly

into the systemic circulation. It is used when a

medication cannot be diluted or in an emergency. AnIV bolus can be introduced directly into a vein by

venipuncture or into an existing IV line through an

injection post or through an IV lock.


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2 MajorDisadvantages of Bolus:

a. Any error in administration cannot be

corrected after the drug has entered the

client.

b. The drug maybe irritating to the lining of

the blood vessels.


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COMPLICATIONS OF IV INFUSION

1. Infiltration the needle is out of vein, and fluidsaccumulated in subcutaneous tissues.Assessment pain, swelling, skin is cold at needle

site, flow of IV rate decreases or stops, absence of

back flow of blood into the tubing, as the IV fluid is

put down on the IV tubing is kinked.

Nursing Intervention

Change the site of needle.

Apply warm compress. This will reabsorb edema

fluids and reduce swelling.


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3. Drug Overload The patient receives anexcessive amount of fluid containing drugs.

Assessment

Dizziness

Shock

Fainting


Slow infusion to KVO and notify thephysician.



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4. Superficial Thromboplebitis It is due to overuse of a

vein, irritating solution of drugs, clot formation, large basecatheter.

Assessment

Pain along the course vein

Vein may feel hard and cordlike

Edema and redness at needle insertion site

Arm feels warmer than the other arm


Change IV site every 72 hours

Use large veins for irritating fluidsStabilize venipuncture at area of flexion

Apply cold compress immediately to relieve pain and

inflammation later follow warm compress to stimulate

circulation and promote absorption.

Do not irrigate the IV because this could push clot into

the systemic circulation.



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5. Air Embolism - Air manages to get into the circulatorysystem.

Assessment

Chest, shoulder or backpain

Hypotension

Dyspnea

Cyanosis

Tachycardia

Increased venous pressure

Loss of consciousness


Do not allow bottle to run dry

Prime IV tubing before starting infusion

Turn patient to left side in the trendelenbeirg position

to allow air to rise in the side of the heart. This

prevents pulmonary embolism.



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6. Nerve Damage May result from tying the arm tootightly to the splint.

Assessment

Numbness of fingers and hand


Massage area and move shoulder through its ROM

Instruct the patient to open and close hand

several times each hour.

Physical therapy maybe required.

NOTE: Apply splint with the finger free to move



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7. Speed Shock May result from administration ofIV push medication rapidly.

To avoid speed shock and possible cardiac

arrest, give most IV push medication over 3 to 5

minutes.



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Purposes:

To administer required blood components by thepatient.

To restore the blood volume.

To improve oxygenation carrying capacity of the

blood.

BLOOD TRANSFUSION THERAPY is the

introduction of whole blood or components of the blood ( ex.Plasma or erythrocytes ) into the venous circulation


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Nursing Intervention:

1. Verify doctors order. Inform the client and explain the purpose of the

procedure.2. Check the cross matching and blood typing. To ensurecompatibility.

3. Obtain and record baseline vital sign.

4. Practice strict asepsis.

5. At least 2 nurses check the label of the blood transfusion.

Check the following:

Serial number

Blood component

Blood Type

RH factor

Expiration Date Screening tests (VDRL for sexually transmitted disease, HBsAg

for Hepatitis B, malarial smear for malaria

6. Warm blood at room temperature before transfusion, to preventchills.

7. Identify client properly.


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Nursing Intervention:

8. Use needle gauge 18 or 19. This allows easy flow of blood.

9. Use BT set with filter, to prevent administration of blood clots andother particulates.

10.Start infusion slowly at 10 gtts./min .Remain at bedside 15 to 30min. Adverse reaction usually occurs during the first 15 to 20 minute.

11.Monitor VS. Altered V/S indicates adverse reaction.

12.Do not mix medications with blood transfusion. To prevent adverseeffects.

Do not incorporate medication into blood transfusion

Do not use the BT line for IV push of medications.

13.Administer 0.9% NaCl before during or after BT. Never administer IVfluid with dextrose. Dextrose causes hemolysis.

14.Administer BT for 4 hours (whole blood, packed RBC) for plasmaplatelets, cryo precipitate, transfuse quickly (20 min.) clotting factorscan easily be destroyed.

15.Observe for potential complications. Notify the physician.


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COMPLICATIONS OF BLOOD

TRANSFUSION1. Allergic Reaction It is caused by sensitivity to plasma protein

or donor antibody, which reacts with recipient antigen.

Assessment

Flushing

Rash, hives

Pruritus

Laryngeal edema

2. Febrile, Non hemolytic It is caused by hypersensitivity todonor white cells, platelets or plasma protein. This is the most

symptomatic complication of blood transfusion.

Assessment

Sudden chills with fever

Flushing

Headache

Anxiety


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TRANSFUSION3. Septic Reaction It is caused by blood transfusion of blood

components contaminated by bacteria.

Assessment

Rapid onset of chills

Vomiting

HypotensionHigh fever

4. Circulatory Overload It is caused by administration of bloodvolume at a rate greater than the circulatory system can

accommodate.

AssessmentRise in venous pressure

Dyspnea

Crackle or rales

Distended neck vein

Elevated B/P


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TRANSFUSION5. Hemolytic Reaction It is caused by infusion of incompatible

blood products.

Assessment

Low back pain (first sign) this is due to inflammatory

response of kidneys to incompatible blood.Chills

Feeling of fullness

Tachycardia

Flushing

Tachypnea

Hypotension

Bleeding

Vascular collapse

Acute renal failure


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NURSING INTERVENTION WHEN

COMPLICATIONS OCCURS IN BT

Stop the blood transfusion immediately.

Start on IV line ( 0.9% NaCl ).

Collect urine specimen. To detect presence of bacteria, which may

be causing the adverse reaction to BT.

Monitor V/S. Send unused blood and blood set to the blood bank for lab exam.

Administer antihistamine, diuretics and bronchodilator as ordered.

Make relevant documentation.


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TOTAL PARENTERAL NUTRITION (TPN) alsoreferred to as intravenous hyperalimentation ( IVH ), is the parenteral

administration of solution of dextrose, H20, fat, protein, electrolytes,

vitamins and trace elements, it is the provision of all needed calories.Because TPN solutions are hypertonic (highly concentrated in

comparison to the solute concentration of the blood) they are injected

only into high flow central veins, where they are diluted by the clients

blood.

TPN are given to clients; with severe malnutrition, severe burns, bowel

disease disorders, acute renal failure, hepatic failure, metastatic

cancer, major surgeries when nothing may be taken by mouth for more

than 5 days.

Because TPN solutions are high in glucose infusions are graduallystarted to prevent hyperglycemia, and when TPN therapy is to be

discontinued, the infusions rate s are decreased slowly to prevent

hyperinsulinemia and hyperglycemia. Weaning clients from TPN may

take 48 hours but can occur in 6 hours if patient receives adequate

carbohydrates either orally or intravenously.

INTRAVENOUS

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