1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128 Chapter 13: Intravenous Therapy By: P.K. Williams, RN VH-71 Seats 14 0 liters

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 38 Words to Know 02/370 Pg 128 ABO SystemBlood productsCentral venous sites Colloid solutionsCrystalloid solutions Drop factors Drop sizeEmulsionInfusion pump Electronic infusion deviceIn-line filter Hypotonic solutionsIntravenous(IV) therapy Isotonic solutionMacrodrip tubingMidclavicular catheter Midline catheterPacked cellsPeripheral venous sites k

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 38 Words to Know 03/37 Pg 128 PhlebitisPlasma expanders Secondary tubing Pressure infusion sleeve Primary tubing Total parenteral nutritionUniversal donor Universal recipientUnvented tubing Volumetric controllerWhole blood Y-administration tubing Microdrop tubing Medication loc Salvaged blood Total parenteral nutrition

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives 04/37 Pg 128 On completion of this chapter, you will be able to: Explain common indications for intravenous (IV) therapy. Differentiate between crystalloid and colloid solutions and give examples of each. Describe the difference between isotonic, hypotonic, and hypertonic solutions. Explain the difference between whole blood, packed cells, blood products, and plasma expanders. Describe nursing responsibilities for preparing intravenous solutions, selecting tubing, and selecting an infusion technique. Identify nursing responsibilities when preparing the client for IV therapy

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives 05/37 Pg 128 Describe nursing actions involved in performing a venipuncture, including sites and devices commonly used. Explain the equipment that must be replaced during IV therapy. List complications of IV therapy and signs and symptoms for which the nurse monitors. Explain how the nurse discontinues IV therapy. Discuss the purpose of a medication lock. Describe the nursing process for the client requiring IV therapy. Discuss the purpose of total parenteral nutrition, and name one solution often administered concurrently

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction 06/37 Pg 128 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

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 07/37 Pg 128 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.

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 08/37 Pg 128 True. The licensing state Nurse Practice Act and an LPN/VN’s personal certification determine their involvement in IV therapy administration.

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Indications for IV Therapy 09/37 Pg 128 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

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 10/37 Pg 129 Types of IV Solutions –Crystalloid: Water and uniformly dissolved crystals –Colloid: Water and molecules of suspended substances Crystalloid Solutions –Isotonic, hypotonic, and hypertonic solutions –Influences osmotic distribution of body fluid

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 11/37 Pg 130 Figure: 13-1 Crystalloid solution Figure: 13-2 Osmotic distribution of fluid

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 12/37 Pg 128 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

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 13/37 Pg 130 Is the following statement true or false? Hypotonic IV solutions increase blood pressure permanently.

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 14/37 Pg 130 False. Hypotonic IV solutions may increase blood pressure temporarily.

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 15/37 Pg 130 Crystalloid Solutions (Cont’d) –Hypertonic Solutions More concentrated than plasma Infrequent use Uses: Reduces cerebral edema; Expands circulatory volume rapidly; Parenteral nutrition

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 16/37 Pg 130 Crystalloid Solutions (Cont’d) –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

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 17/37 Pg 130 Colloid Solutions –Replace circulating blood volume; Blood; Blood products; Plasma expanders –Blood Whole blood: Blood cells, plasma, preservative, anticoagulant Use: Restores fluid, blood cells

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 18/37 Pg 130 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

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 19/37 Pg 130 Colloid Solutions (Cont’d) –Blood Products Use: Clients needing specific blood substances –Plasma Expanders Nonblood solutions Use: Hypovolemic shock Dextran Hespan

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 20/37 Pg 133 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

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 21/37 Pg 131

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 22/37 Pg 132 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

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 23/37 Pg 132 –Gravity Infusion Flow rate influences: Solution elevation; Roller clamp adjustment; Pressure infusion sleeve Electronic Infusion Devices: Programmed Infusion pumps Volumetric controllers

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 24/37 Pg 133 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

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 08/37 Pg 134 Is the following statement true or false? The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter.

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 26/37 Pg 134 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.

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy*** 27/37 Pg 134 Figure 13-9 Examples of venipuncture devices. (A) Butterfly needle. (B) Over-the-needle catheter

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 28/37 Pg 134 Figure 13-8 Venipuncture sites

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 29/37 Pg 133 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

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 30/37 Pg 133 Venipuncture Sites (Cont’d) –Peripheral Venous Sites (Cont’d) Midclavicular catheter Peripherally inserted Extends from superficial to proximal axillary veins Current controversy: Thrombosis

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 31/37 Pg 134 Venipuncture Sites (Cont’d) –Central Venous Sites Delivers solution: Vena cava Physician inserts into jugular; subclavian vein Trained nurses: Insert PICC Post insertion procedures: Chest radiograph for placement confirmation

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 32/37 Pg 135 Equipment Replacement –Reduce infection potential –Solutions Upon completion; q24h –IV tubing Per policy; per solution –Venipuncture devices

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 08/37 Pg 135 Site Care –Venipuncture site: Frequent inspection; Document appearance –Dressing change Per agency’s infection control policy

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Complications of IV Therapy 34/37 Pg 135 Potential Complications*** –Risk for infection; Phlebitis; Thrombus formation –Air bolus; Site infiltration –Circulatory overload Potential Complications: Blood transfusions –Same as crystalloid solutions –Reactions: Nonautologous donor cells; Additives; Preservatives

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Complications of IV Therapy 33/37 Pg 135 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

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Discontinuing Intravenous Therapy 36/37 Pg 137 IV Infusions –Infusion complete –Medication lock: Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only Figure 13-14 Attaching a lock device with extension tubing to the IV catheter hub

37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation NOW ENCLEX By: P.K. Williams, RN 37/37 [$400 mil] pkwilliams@DNI.edu