Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

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Timby/Smith: Introductory

Medical-Surgical Nursing, 10/e

Chapter 13: Intravenous

Therapy


Introduction

• IV Therapy– Parenteral administration of fluids,

additives; Requires continual assessment

– State nurse practice acts determine LPN role in IV therapy

– All RNs may administer IV therapy


Question

Is the following statement true or false?

The extent of an LPN’s practice with IV therapy is determined by education level and nurse practice act rules.


AnswerTrue.

The licensing state Nurse Practice Act and an LPN/VN’s personal certification determine their involvement in IV therapy administration.


Indications for IV Therapy• Maintain, restore fluid balance

– Oral intake inadequate, impossible• Maintain, restore electrolytes• Administer nutrients; Medications

– Specifically designated meds– Route with most rapid effect

• Replace blood, blood products

http://www.google.com/imgres?imgurl=http://www.qualityathome.com/images/iv2.jpg&imgrefurl=http://www.qualityathome.com/iv_therapy.htm&usg=__ORD5PV6A_bsicb9eJsf99f5Y-pY=&h=170&w=170&sz=19&hl=en&start=7&um=1&itbs=1&tbnid=3rLwXF_Mq53bvM:&tbnh=99&tbnw=99&prev=/images%3Fq%3Div%2Btherapy%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


Types of Solutions• Types of IV Solutions

– Crystalloid: Water and uniformly dissolved crystals

– Colloid: Water and molecules of suspended substances

• Crystalloid Solutions (Table 13-1, pg 129)– Isotonic, hypotonic, and hypertonic

solutions– Influences osmotic distribution of body

fluid


Types of Solutions• Crystalloid Solutions (Cont’d)

– Isotonic Solutions•Same concentration of dissolved substance as plasma•Maintains fluid balance when NPO

– Hypotonic Solutions•Fewer dissolved substances than plasma •Rehydrates fluid-deficit clients•Temporarily increases blood pressure


Question

Is the following statement true or false?

Hypotonic IV solutions increase blood pressure permanently.


Answer

False.

Hypotonic IV solutions may increase blood pressure temporarily.



– Hypertonic Solutions•More concentrated than plasma•Infrequent use•Uses: Reduces cerebral edema;

Expands circulatory volume rapidly; Parenteral nutrition



– Hypertonic Solutions (Cont’d)•Total parenteral nutrition (TPN)

•Complete nutrition; Instilled into central circulation only

•Lipid emulsion: Stabilized mixture of two insoluble liquids

•Provides essential fatty acids, additional calories

http://www.google.com/imgres?imgurl=http://img.tfd.com/MosbyMD/thumb/total_parenteral_nu.jpg&imgrefurl=http://medical-dictionary.thefreedictionary.com/total%2Bparenteral%2Bnutrition&usg=__n9kfcAcfx0jKB31jyIV4Zn1mVZ0=&h=235&w=250&sz=11&hl=en&start=20&um=1&itbs=1&tbnid=fZtIFEKTGK1usM:&tbnh=104&tbnw=111&prev=/images%3Fq%3DTPN%2Btherapy%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


Types of Solutions• Colloid Solutions (Table 13-2, pg 130)

– Replace circulating blood volume; Blood; Blood products; Plasma expanders

– Blood•Whole blood: Blood cells, plasma,

preservative, anticoagulant•Use: Restores fluid, blood cells

http://www.google.com/imgres?imgurl=http://www.centralmedical.co.uk/mainsite/images/BieglerBlood/BeiglerBlood2.jpg&imgrefurl=http://www.centralmedical.co.uk/mainsite/Biegler-Blood-Infusion-Automatic-Pressure-Infusor.htm&usg=__zkDZjl2bF4talePWkchfW4tnBtE=&h=326&w=243&sz=19&hl=en&start=2&um=1&itbs=1&tbnid=Gl2jCEBOmyljMM:&tbnh=118&tbnw=88&prev=/images%3Fq%3Dblood%2Binfusion%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


Types of Solutions• Colloid Solutions (Cont’d)

– Packed cells: Plasma removed •Use: Cellular replacements when

additional fluid contraindicated•Inadequate oral fluid intake•Risk for CHF

•Laboratory test before administration

http://www.google.com/imgres?imgurl=http://medicalimages.allrefer.com/large/blood-in-a-bag-ready-for-infusion.jpg&imgrefurl=http://health.allrefer.com/pictures-images/blood-in-a-bag-ready-for-infusion.html&usg=__tsLP2eVt0rX7jVeapQGoJkQEsY0=&h=306&w=226&sz=15&hl=en&start=1&um=1&itbs=1&tbnid=xKCjxiSNtRT3_M:&tbnh=117&tbnw=86&prev=/images%3Fq%3Dblood%2Binfusion%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


Types of Solutions• Colloid Solutions (Cont’d)

– Blood Products •Use: Clients needing specific blood

substances– Plasma Expanders

•Nonblood solutions •Use: Hypovolemic shock

http://www.google.com/imgres?imgurl=http://www.connieore.com/wp-content/uploads/2009/01/transfusion_with_note.jpg&imgrefurl=http://www.connieore.com/2009/01/&usg=__DiLqDye64U5XOiTg6NLeyX25x2w=&h=347&w=434&sz=32&hl=en&start=15&um=1&itbs=1&tbnid=RprLIZYu9d3vSM:&tbnh=101&tbnw=126&prev=/images%3Fq%3Dblood%2Binfusion%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


Administering Intravenous Therapy• Common equipment: Solution; IV tubing;

IV pole; Infusion device • Equipment preparation; Infusion

technique– IV Solution preparation

•Intentionally reduce infection potential

– IV Tubing choice•Four options

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Administering Intravenous Therapy

Fig 13-4, pg 131



• Instillation of IV Solutions – Methods: Gravity;

Electronic infusion device•Rate of infusion

•Drops per minute; Milliliters per hour

Figure 13-5(Left) vented tubing and(right) unvented tubing


Administering Intravenous Therapy– Gravity Infusion

•Flow rate influences: Solution elevation; Roller clamp adjustment; Pressure infusion sleeve

•Electronic Infusion Devices: Programmed•Infusion pumps•Volumetric controllers

http://www.google.com/imgres?imgurl=http://www.buckeyemedical.com/images/T/baxter_as40_sm.jpg&imgrefurl=http://www.buckeyemedical.com/IV-Therapy/&usg=__0xIkQaI6w-jLR9EuXe1H2Dt73HQ=&h=282&w=255&sz=21&hl=en&start=4&um=1&itbs=1&tbnid=vPoTkz4sARiRXM:&tbnh=114&tbnw=103&prev=/images%3Fq%3DIV%2Btherapy%2Bpump%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://equipstat.com/catalog/images/BAXTER%2520Colleague%2520Pump%2520IV%2520Infusion.jpg&imgrefurl=http://equipstat.com/catalog/index.php%3FcPath%3D20&usg=__iwxz2HcWUFvNCgm4dVd0R_s0qVY=&h=352&w=470&sz=54&hl=en&start=12&um=1&itbs=1&tbnid=TUl0JuBE0jsKEM:&tbnh=97&tbnw=129&prev=/images%3Fq%3DIV%2Btherapy%2Bpump%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.waikatodhb.govt.nz/images/21597.jpg&imgrefurl=http://www.waikatodhb.govt.nz/news/pageid/2145848417&usg=__5VPCH-DSJmEUbcY2sPgIti401X0=&h=504&w=480&sz=42&hl=en&start=9&um=1&itbs=1&tbnid=lS6e3qiKW-P5mM:&tbnh=130&tbnw=124&prev=/images%3Fq%3DIV%2Btherapy%2Bpump%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


Administering Intravenous Therapy• Preparing Client for Venipuncture

– Client education; Answer questions– Site selection– Piercing a peripheral vein: Various

devices; Differing gauge or diameter•Greater gauge number = smaller

diameter; Diameter: Smaller than vein

http://www.google.com/imgres?imgurl=http://www.nexternal.com/medtech/images/Introcan1.jpg&imgrefurl=http://www.gomed-tech.com/catalog/monoject-prefill-iv-syringe-flush.htm&usg=__uCq7uRISRrsqN3qdWBqqLKg-1xE=&h=260&w=260&sz=31&hl=en&start=2&um=1&itbs=1&tbnid=maG1CuezQYqLkM:&tbnh=112&tbnw=112&prev=/images%3Fq%3DIV%2Bneedle%2Bsyringe%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://image.made-in-china.com/2f0j00CBNaeKTrfPqn/Intravenous-Injection-Needle-JB4415-.jpg&imgrefurl=http://www.made-in-china.com/showroom/jing26228/product-detailboNJeKmrAPVC/China-Intravenous-Injection-Needle-JB4415-.html&usg=__x7mFOkJm4W-txK6AdVbdv9a6dCY=&h=452&w=382&sz=28&hl=en&start=8&um=1&itbs=1&tbnid=ssIHK2JNsMBmZM:&tbnh=127&tbnw=107&prev=/images%3Fq%3DIV%2Bneedle%2Bsyringe%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-Address%26rlz%3D1I7ADSA_en%26tbs%3Disch:1


QuestionIs the following

statement true or false?

The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter.


Answer True.

The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter. Conversely, the lesser the gauge number, the larger the catheter’s diameter.



Figure 13-9, pg 134 Examples of venipuncture devices. (A) Butterfly needle. (B) Over-the-needle catheter



Figure 13-8, pg 134Venipuncture sites


Administering Intravenous Therapy• Venipuncture Sites

– Peripheral venous sites; Central veins– Vein selection factors

•Peripheral Venous Sites•Most common: Superficial veins of

arm, hand•Infants: Scalp veins; Avoid feet •Midline catheter: Peripherally

inserted venous access device


Administering Intravenous Therapy• Venipuncture Sites (Cont’d)

– Peripheral Venous Sites (Cont’d) •Midclavicular catheter

•Peripherally inserted•Extends from superficial to

proximal axillary veins•Current controversy: Thrombosis

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Administering Intravenous Therapy• Venipuncture Sites (Cont’d)

– Central Venous Sites (Fig 13-11, pg 135)• Delivers solution: Vena cava

• Physician inserts into jugular; subclavian vein

• Trained nurses: Insert PICC• Post insertion procedures: Chest

radiograph for placement confirmation– REVIEW: Stop, Think and Respond, 13-2, pg

135


Administering Intravenous Therapy• Equipment Replacement

– Reduce infection potential– Solutions

•Upon completion; q24h– IV tubing

•Per policy; per solution– Venipuncture devices


Administering Intravenous Therapy• Site Care

– Venipuncture site: Frequent inspection; Document appearance

– Dressing change•Per agency’s infection

control policy• REVIEW: Nursing Process for Client

requiring IV Therapy, pg 137 - 139


Potential Complications of IV Therapy

• Potential Complications (Table 13-3 pg 137) – Risk for infection; Phlebitis; Thrombus formation– Air bolus– Site infiltration; REVIEW Pharmacy, pg 135– Circulatory overload; REVIEW Gerontologic, pg

136


Discontinuing Intravenous Therapy• IV Infusions

– Infusion complete– Medication lock:

Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only

• REVIEW: Nursing Guidelines 13-1, pg 137 - 139

Figure 13-14, pg138Attaching a lock device with extension tubing to the IV

catheter hub


Special Considerations for IV Therapy• TPN

– REVIEW: Box 13-2, pg 139 Candidates for TPN

– REVIEW: Nursing Guidelines 13-2, pg 140


Potential Complications of IV Therapy

• Potential Complications: Blood transfusions– Same as crystalloid solutions – Reactions: usually occur within the first

5 – 15 minutes– REVIEW: Pharmacy, pg 140– REVIEW: Table 13-5 pg 142


Potential Complications of IV Therapy• Potential Complications: Blood Transfusions

(Cont’d) – Incompatibility reaction: Life threatening– Delayed reactions: Immune response– Nonimmune complications: Septic;

Symptoms - shaking chills and a fever– Hypocalcemia: Citrate in donor blood– Blood-borne infections: Hepatitis A, B, and

C; HIV; MFE


Chapter End

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

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