IV Therapy Complications How to hang an IV

Fluid Balance Fluid intake Normal Fluids ingested Oral 1100-1400 mL Foods 800-1000 mL Metabolism 300 mL Total 2200-2700 Fluid output Skin (sweat) 500-600 mL Insensible (lungs) 400 mL GI 100-200 mL Urine 1200-1500 Ml Infants, patients with neurological or psychological problems, and some older adults who are unable to perceive or communicate their thirst are at risk for dehydration. The single best indicator of fluid status is the nurse’s assessment of the client’s: pt weight

Intravenous Therapy The goal of IV fluid administration is to Correct or prevent fluid and electrolyte disturbances Provide direct access to the vascular system

Types of Solutions Isotonic: Hypotonic Hypertonic Most common A fluid with the same concentration of normal blood Ex. 0.9% Sodium Chloride (NS), 5% Dextrose in Water (D5W) Used for volume replacement (eg. after prolonged vomiting); Hypotonic A fluid that is more dilute than blood Used to rehydrate the cells; eg. 0.45% NaCl, D5 0.45% NaCl Hypertonic A fluid that is more concentrated than normal blood Used to increase vascular volume, use with caution due to risk for fluid overload; eg. D10 W, D5 LR, 3% normal saline

Intravenous Therapy: Additives Potassium chloride (KCl): common 1000 ml D5 ½ NS with 20 mEq KCl at 125 mL/hr Potassium must be given carefully, since hyperkalemia can cause fatal cardiac dysrhythmias NEVER give KCl IV push KCl must be given slowly KCl is irritating to the veins and patients will complain of pain

Intravenous Therapy: Orders Should contain: specific solution Volume to be infused Rate Frequency additives time schedule Example: D5½ NS with 20 meq KCL Follow 7 rights of medication administration, same as with all medications

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: Central Line

IV Therapy: Implanted Ports Vascular access devices are designed for repeated access to the vascular system. Peripheral cannulas are for short term use. Central lines, PICCs are for long term use.

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 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.

IV Therapy: Equipment

Nexvia

Nexiva

Nexiva With your power point in full screen, click on movie icon for youtube.

IV Therapy: Dressing

Complications of Intravenous Therapy

Circulatory overload NI: Reduce IV flow rate and Notify HCP Iv Solution infused too rapidly or in too great an amount. If symptoms appear, reduce IV flow rate and notify pt’s HCP. Monitor VS and Labs NI: Reduce IV flow rate and Notify HCP Raise head of bed Monitor VS and labs Watch for new IV order

Infiltration or Extravastion If the infiltration is severe, you may consider the application of a compress in addition to elevating the affected limb. Check your institution’s policy regarding which type of compress (warm or cold) should be applied. Generally speaking, if the infiltration solution was isotonic, a warm compress is used to alleviate discomfort and help absorb the infiltration by increasing circulation to the affected area. However, sloughing can occur from the application of a warm compress to an area infiltrated with certain medications such as potassium chloride. In certain situations, a cold compress is recommended."

Phlebitis

Local infection

Bleeding at IV Site

Alaris® Pump module Preparing an Infusion

Alaris® Pump module Preparing an Infusion

Alaris® Pump module Preparing an Infusion

Alaris® Pump module Preparing an Infusion

Alaris® Pump module Preparing an Infusion

Alaris Pumps

Remove the IV administration set (tubing) from the package and close the roller clamp; attach add-on devices if required. i.e. extension tubing, filter. Remove the plastic protector from the IV solution bag administration set insertion port Remove the plastic protector from the spike end of the administration set (tubing) Insert the spike into the IV solution insertion port using aseptic technique Hand the bag on the IV pole

Alaris Pumps

Secondary Tubing