1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 15 Introduction to IV Therapy

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Typically connected to maintenance IV fluids Includes spike, drip chamber, and roller clamps for adjusting drip rate and ports for IV medications

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Set-Up: Step 1 Assumes IV fluid bag is ready Open package containing tubing Close all roller clamps on IV tubing to prevent air bubbles

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Set-Up: Step 2 Use sterile technique Pull cover off port on bag Pull cover off IV tubing spike Spike IV bag

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Set-Up: Step 3 Squeeze drip chamber Fill approximately half full with IV fluids –Or to mark provided by tubing manufacturer

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Set-Up: Step 4 Prime tubing with IV fluids to remove air Open roller clamp closest to drip chamber Air must be displaced to prevent client from experiencing air embolism

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Set-Up: Step 5 Close roller clamp

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Primary Line Set-Up: Step 6 Label tubing with the following information: –Date –Time –Initials

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Remember With gravity drip IV lines, pressure in line is created when fluid drop falls in drip chamber With electronic volumetric IV pump, pump maintains constant pressure in line to maintain patency of IV access

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Secondary Line Shorter tubing used to infuse small-volume medications Also referred to as IV piggybacks (IVPB) or minibags (IVMB)

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ADD-Vantage ® Bags Have powdered medication in vial in top of small-volume bag with IV fluid in it Vial opened within IV bag Medication mixes with fluid for infusion Used to package medications with short shelf life in solution

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Volume-Controlled Burettes For greater accuracy in measurement of small-volume IV medications or fluids, use calibrated burette chamber Used most often in intensive care unit (ICU) for frequent small-volume fluid replacement

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Indwelling Infusion Ports Used for intermittent IV medication administration, either IVMB or IV bolus Most often referred to as: –Saline locks –Heparin locks –Medlocks

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. IV Bolus/IV Push Medications administered directly through lock or into IV tubing port if IV fluids infusing

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Flush with IV Bolus When administering IV bolus medications, must flush before and after medication with 5 to 10 mL of compatible flush fluid

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Volumetric Pumps Electronic devices Force fluids into vein under pressure Maintain patency of IV Control infusion rates

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Volumetric Pumps Hospital or clinical in-service education required for use of all infusion pumps Programming of pumps must be double- checked IVs still should be checked every hour

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Syringe Pump Variations on electronic volumetric pumps Used to infuse drugs that cannot be mixed with other solutions or medications Used with very small volumes –e.g., infants, ICU clients

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Patient-Controlled Analgesia (PCA) Devices Allow client to self-administer medication to control pain Pre-filled syringe or medication bag containing analgesics (opioids) inserted into device

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PCA Pumps Items programmed into device include the following: –Dosage –Frequency –Lock-out time –Amount

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Introduction to IV Fluids Manufactured and packaged under sterile conditions Most prepared in plastic bags Volumes range from 25 to 1000 mL

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. IV Fluids Abbreviations –Dextrose (D) –Water (W) –Saline (S) –Normal saline (NS) Numbers identify percentage strengths

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluid Strengths Percentages mean grams of drug per 100 mL of fluid –e.g., 5% dextrose, 0.9% normal saline, 0.45% normal saline, 3% saline

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Parenteral Nutrition Administer nutrition solution via central vein through central venous access device (CVAD) Usually infused slowly Solutions usually changed every 24 hours to prevent spoilage and bacterial growth

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Parenteral Nutrition Total parenteral nutrition (TPN) Partial parenteral nutrition (PPN) Hyperalimentation