Intravenous Fluid Administration B260 Fundamentals of Nursing

IV Fluid Administration: Objectives Discuss purposes and procedures for initiation, maintenance and discontinuing an infusion. Explain the importance of infection control in the management of intravenous solutions, tubing, and dressings. Discuss the complications of intravenous therapy. Discuss the procedure for initiating a blood transfusion and interventions to manage a transfusion reaction.

Intravenous Therapy Goal: Correct or prevent fluids and electrolyte disturbances Allow direct access to the vascular system Requires close monitoring Knowledge required: solutions, equipment, procedures, regulating flow, maintenance, identifying and correcting problems, and how to discontinue

Intravenous Therapy: Types of Solutions Isotonic: same concentration as body fluids including Blood, most common use for volume replacement (eg. after prolonged vomiting); NaCl 0.9% normal saline, D5W 5% Dextrose in water Hypotonic: concentration lower than body fluids  Use to rehydrate the cells;  0.45% NaCl or ½ normal saline Hypertonic: concentration higher than body fluids  Used to increase vascular volume, use with caution due to risk for fluid overload  D5 0.45% NS  D10W  D5LR http://www.youtube.com/watch?feature=player_detailpage&v=_slUL3kMZlU

Intravenous Therapy: Additives IV Fluids may contain additives: Hyperalimentation or Total Parenteral Nutrition Lactated Ringers, D5LR Dextrose and saline combinations, with added KCL KCL is commonly added to IV solutions when patients are NPO; body cannot conserve K Never give KCL IV push directly as it may be fatal! KCL: administer slowly over several hours and diluted

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

Review: Seven Rights Right Person Right Drug Right Dose Right Route Right Time Right Documentation Right to refuse

IV Therapy: Equipment

Intravenous Therapy: Equipment Butterfly Angiocath Saline lock

IV Therapy: Peripheral

IV Therapy: Peripheral 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: Angle of Entry

IV Therapy: Insertion with Flashback http://www.youtube.com/watch?feature=player_detailpage&v=DHuOIcxJTIY

IV Therapy: Dressing

Intravenous Therapy: Equipment Bottles, Bags IVPB Tubing

IV Therapy: Administration Sets

IV Therapy: Administration Sets

Intravenous Therapy: Equipment Central lines PICC lines Implanted ports

IV Therapy: Central Line

IV Therapy: Central Line

IV Therapy: Central Line Dressing

IV Therapy: PICC Line

IV Therapy: PICC 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.

IV Therapy: Implanted Ports

IV Therapy: Implanted Ports

IV Therapy: Hyperalimentation

IV Therapy: Lipids

IV Therapy: Assessment Important areas to assess: Daily wt I&0 Labs=Na+, K+, Cl, glucose, BUN Skin turgor Breath sounds Daily wts are the best way to assess fluid status. 1 kg (2.2 lbs) of fluid = 1 L of fluid Wts same time of day, same scale, same amt of clothes

IV Therapy: Assessment Psychological responses Independence Condition of vein and surrounding tissues Infiltration Phlebitis Infection Bleeding Circulatory overload Severe untoward reactions Phlebitis: is inflammation of the vein. Sx include pain, edema, erythema, heat, redness may occur along the path of the vein Infiltration: fluid entering the subcu tissue; sx = swelling, pallor and coolness, pain possible

IV Therapy: Complications Extravasation Infiltration of drugs into tissues surrounding the infusion site causing local tissue damage.

IV Therapy: Complications Swelling-Edema from Infiltration

IV Therapy: Complications Phlebitis This child's IV site was completely wrapped, preventing proper assessment.

IV Therapy: Complications Redness and Swelling

IV Therapy: Complications Phlebitis

IV Therapy: Complications This child’s antibiotic infiltrate went untreated for a few days.

IV Therapy: Complications Bruising

Intravenous Therapy: Discontinue IV Review order Explain to patient Stop IV fluids, remove dressing Stabilize the cannula and clean site Cover with sterile gauze, gentle pressure and remove cannula Apply pressure 2-3 minutes and secure dressing

IV Therapy Blood Administration

IV Therapy: Blood Administration Blood transfusion includes any of the following : Whole blood Packed RBC’s Plasma Platelets

IV Therapy: Blood Products

IV Therapy: Whole Blood

IV Therapy: Blood Administration Purpose: Increase blood volume Treat anemia Replace blood components (clotting factors, platelets, albumin)

IV Therapy: Blood Administration Blood Grouping “O” is universal donor AB is universal recipient A blood B blood Rh factor If mismatched, transfusion reaction may occur (mild  severe)

IV Therapy: Blood Transfusion Guidelines for Safe Blood Administration Blood tubing has an in-line filter Prime with 0.9% normal saline Educate patient Assess patient for history of reaction Consent signed Checked by 2 RN’s Vital signs: baseline, 15 minutes after starting the infusion, when complete, and prn.

IV Therapy: Blood Transfusion Guidelines for Safe Blood Administration Stay with patient during first 15 minutes IV gauge: 18-19 preferred, 20g or less. Start blood within 30 minutes from blood bank Administer slowly in first 15 min, then increase rate as ordered or within 2 - 4 hours. Not longer than 4 hours - risk bacterial contamination Use gloves to prepare and administer

IV Therapy: Transfusion Reactions Acute Hemolytic: Incompatibility to antibodies causing RBC breakdown Signs & Sx: chills, fever, pain, flushing, tachycardia, tachypnea, etc. Febrile nonhemolytic: Sensitization to specific blood components Signs & Sx: chills, fever, headache, flushing, etc. Mild allergic: sensitivity to plasma proteins Signs and Sx: flushing, itching, hives

IV Therapy: Transfusion Reactions Anaphylactic: reaction to blood proteins Signs & Sx: anxiety, itching, wheezing, cyanosis, shock, etc. Circulatory Overload: fluid administered faster than the circulation can accommodate Signs & Sx: cough, dyspnea, pulmonary congestion, headache, hypertension, tachycardia, distended neck veins Sepsis: contaminated blood Signs & Sx: chills, high fever, vomiting, diarrhea, hypotension, shock

IV Therapy: Transfusion Reactions Management: stop transfusion! keep IV line open with 0.9% normal saline notify provider stay with patient and monitor (vitals, observe and treat)