IV Therapy Vema Sweitzer, MN,RN

Vascular Access Devices (VADs) Peripheral catheters: short term use (after surgery or a procedure)

Vascular Access Devices (VADs) Central Catheters: long-term use (chemo therapy, PN) More effective than peripheral catheters for administering large volumes of fluid, PN and medications

IV Therapy: Implanted Ports

Vascular Access Devices (VADs) Central Catheters: long-term use (chemo therapy, PN) PICC: Peripherally inserted central catheters

IV Therapy: Peripheral Sites Avoid starting IV sites on an extremity with a dialysis graft. Use distal veins prior to distal proximal veins. Use the Non dominant arm You must obtain an order specifying that you can use a site other than the upper extremities Do not select sites on mastectomy side, dialysis, paralyzed. Caution with hard veins, valves, skin bruising or other abnormalities, do not go below previous IV sites. Feet not recommended for adults

IV Therapy: Starting an IV Review order Get supplies Explain to patient Find best vein Start distally Perform venipuncture, secure, start fluids Document Dressing should be transparent

Complications of Intravenous Therapy

Circulatory overload Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions to rapidly, failure to monitor the IV infusion or too rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal disease

Circulatory Overload

Circulatory Overload NI/Treatment Plan ahead if patient is to receive a lot of fluid Stop the fluids and contact the HCP immediately for new orders. Continue to monitor the patient and anticipate doctor’s orders: Oxygen Diuretics

Infiltration Occurs with IV becomes dislodged or a vein ruptures and IV fluids enter subcutaneous tissue Nursing Assessment:

Infiltration Remove the IV catheter NI/Treatment Prevention Remove the IV catheter Apply warm soaks to aid in absorption (check hospital’s policy) Elevate the limb Notify the HCP if severe Assess circulation Restart the infusion in the other arm Document the patient’s condition and your interventions Check the IV site frequently Don’t obscure area above site with tape Teach the patient to report discomfort, pain swelling

Documentation Infiltration Scale

Extravasation The inadvertent administration of a vesicant solution into surrounding tissue Signs/symptoms

Extravasation Immediately stop the infusion and remove the device NI/Treatment Prevention Immediately stop the infusion and remove the device Elevate the affected limb Apply cold compress to decrease edema and pain Apply moist heat to facilitate the absorption of fluid at grossly infiltrated site Check the IV site frequently Don’t obscure area above site with tape Teach the patient to report discomfort, pain swelling Drugs that can cause Necrosis Calcium chloride Calcium gluconate Vancomycin Cancer Chemotherapy drugs

Phlebitis An inflammation of the vein in which the endothelia cells of the venous wall become irritated and cells roughen, allowing platelets to adhere and predispose the vein to inflammation- induced phlebitis Causes Injury during venipuncture Prolonged use of the same IV site Irritation/incompatible IV additives Use of vein that is too small for the flow rate Use of needle size too large for the vein size

Phlebitis Upon assessment of phlebitis, remove the needle Signs/symptoms: NI/Treatment Upon assessment of phlebitis, remove the needle Avoid multiple insertion attempts Application of warm compress Continuously monitor the patient’s vital signs

Documentation Phlebitis Scale

Local Infection Caused by poor aseptic technique during catheter insertion Signs/symptoms

Hematoma at the IV Site Hematoma: formations resulting from the infiltration of blood into the tissues at the venipuncture site Causes: nicking the vein during an unsuccessful venipuncture attempt, discontinuing the I.V. cannula or needle without pressure, applying a tourniquet too tightly above a previously attempted venipuncture site

Hematoma at the IV Site Signs/symptoms: Discoloration Site swelling and discomfort Prevention and treatment

Blood Seepage into the Extravascular Tissue Causes Coagulation defects Inappropriate use of tourniquet Unsuccessful insertion attempts Little pressure upon removal of IV catheter