1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 13: Intravenous Therapy

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction 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

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 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.

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

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Indications for IV Therapy 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

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions Types of IV Solutions –Crystalloid: Water and uniformly dissolved crystals –Colloid: Water and molecules of suspended substances Crystalloid Solutions (Table 13-1, pg 129) –Isotonic, hypotonic, and hypertonic solutions –Influences osmotic distribution of body fluid

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 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

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

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Hypotonic IV solutions may increase blood pressure temporarily.

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

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 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

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions Colloid Solutions (Table 13-2, pg 130) –Replace circulating blood volume; Blood; Blood products; Plasma expanders –Blood Whole blood: Blood cells, plasma, preservative, anticoagulant Use: Restores fluid, blood cells

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Solutions 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

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

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 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

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy Fig 13-4, pg 131

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 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

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

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy 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

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

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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.

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

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy Figure 13-8, pg 134 Venipuncture sites

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

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

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy Venipuncture Sites (Cont’d) –Central Venous Sites (Fig 13-11, pg 135) Delivers solution: Vena cava Physician inserts into jugular; subclavian vein Trained nurses: Insert PICC Post insertion procedures: Chest radiograph for placement confirmation –REVIEW: Stop, Think and Respond, 13-2, pg 135

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

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Intravenous Therapy Site Care –Venipuncture site: Frequent inspection; Document appearance –Dressing change Per agency’s infection control policy REVIEW: Nursing Process for Client requiring IV Therapy, pg 137 - 139

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Complications of IV Therapy Potential Complications (Table 13-3 pg 137) –Risk for infection; Phlebitis; Thrombus formation –Air bolus –Site infiltration; REVIEW Pharmacy, pg 135 –Circulatory overload; REVIEW Gerontologic, pg 136

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Discontinuing Intravenous Therapy IV Infusions –Infusion complete –Medication lock: Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only REVIEW: Nursing Guidelines 13-1, pg 137 - 139 Figure 13-14, pg138 Attaching a lock device with extension tubing to the IV catheter hub

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Considerations for IV Therapy TPN –REVIEW: Box 13-2, pg 139 Candidates for TPN –REVIEW: Nursing Guidelines 13-2, pg 140

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Complications of IV Therapy Potential Complications: Blood transfusions –Same as crystalloid solutions –Reactions: usually occur within the first 5 – 15 minutes –REVIEW: Pharmacy, pg 140 –REVIEW: Table 13-5 pg 142

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Complications of IV Therapy 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

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter End