1. IV Therapy Complications
How to hang an IV

2. Fluid Balance
Fluid intake
Normal
Fluids ingested
Oral mL
Foods mL
Metabolism
300 mL
Total
Fluid output
Skin (sweat) mL
Insensible (lungs)
400 mL GI mL
Urine 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

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

4. 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

5. 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

6. 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

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

8. 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

9. IV Therapy: Central Line

10. 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.

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

12. 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

13. 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.

14. IV Therapy: Equipment

15. Nexvia

16. Nexiva

17. Nexiva
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18. IV Therapy: Dressing

19. Complications of Intravenous Therapy

20. 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

21. 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."

22. Phlebitis

23. Local infection

24. Bleeding at IV Site

25. Alaris® Pump module Preparing an Infusion

26. Alaris® Pump module Preparing an Infusion

27. Alaris® Pump module Preparing an Infusion

28. Alaris® Pump module Preparing an Infusion

29. Alaris® Pump module Preparing an Infusion

30. Alaris Pumps

31. 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

32. Alaris Pumps

33. Secondary Tubing