April 21, 2005

CARE OF PATIENTS WITH INTRAVENOUS THERAPY

Intravenous Therapy the administration / introduction of fluids directly into the vein Purposes / Rationale / Goals: a. Maintain & replace body stores of water, electrolytes, vitamins, proteins, fate & calories when patient or client cannot maintain an adequate intake by mouth b. Restore acid-base balance c. Restore volume of blood components d. Provide avenue for the administration of medication e. Provide nutrition while resting the GI Tract Equipment Needed: a. IV Fluid in bottle or plastic container b. Tubing c. Needle / Catheter in different sizes (gauge 14 25) or winged, butterfly needle d. IV Pole / IV Infusion Pump e. Others dressing (transparent gauze); tape / plaster; splint / armboard Advantages: a. used when patient cannot take oral medication b. permits accurate dose c. acts instantly absorbed quickly by the body Disadvantages: a. Carries risk like bleeding, infiltration, infection, and allergic reactions b. Limits patient activities c. Costly costs more than any other drug Adult contain 60% of fluids in the body Functions of Fluid: 1. Intracellular 55% of total body fluid 2. Extracellular 45% of total body fluid a. Interstitial Fluids b. CSF Cerebro Spinal Fluid c. Plasma Kinds of IV Solutions: 1. Isotonic solution has the same osmolarity as serum and other body fluids, hence, it stays where it is infused (intravascular space). It expands this compartment without pulling the fluid from other compartments (intracellular & interstitial). Example: LR, NSS (0.9 NS). Indication: Blood loss or hypovolemia 2. Hypertonic solution osmolarity is higher than the serum. When infused, it initially increases osmolarity causing the fluid to be pulled from the interstitial & intracellular compartments into the blood vessel (intravascular space). Example: D50.5NS, D5LR, D5NS. Indication: Regulate urine output; stabilize blood pressure; reduce risk of edema; Post-op Patients 3. Hypotonic solution osmolarity is lower than the serum. When infused, fluid shifts out of the blood vessels (intravascular space) into the cells while reducing the fluid in circulatory system. Example: D0.45NS; 0.33NS; Dextrose 2.5% in Water. Indications: Dehydration; DKA; HHNK

NCM 100 LEC / LAB

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Summer 2005

 Osmolarity no. of particles in a Liter of Water Osmolality no. of particles per Kg. of Water Crystalloid clear IV fluid - Hypotonic - Hypertonic - Isotonic Colloid Murky / Black IV Fluid Parts of IV Tubing: a. Piercing spike b. Drop orifice c. Drip chamber d. Roller clamp e. Y-injection site / port direct injection to the blood vessel f. Luer-Lock site Volume Control Set patients at risk with circulatory overload (e.g. infants) - controls the volume of solution that goes through / the amount of medication you give to the patient Location: Adult Children Infant Frontal Superficial Temporal Occipital Great Saphenous vein Dorsal venous network Use Peripheral, Superficial veins Metacarpal veins dorsal aspect of hand Cephalic veins in line with thumb Basilic veins ulnar side Median Cubita vein vein that crosses in the cubital region Great Saphenous vein Dorsal venous network Frontal Superficial temporal Occipital

Factors Affecting Rate of Flow 1. Pressure gradient the difference between two levels in a fluid system 2. Friction the interaction between fluid molecules & surfaces of inner wall of tubing 3. Diameter & Length of tubing, gauge of cannula 4. Height of infusion container ideal height is 36 or 3 ft. from insertion site 5. Size of opening through which fluid leaves receptacle 6. Characteristic of fluid a. Viscosity b. Temperature refrigerated fluids may cause diminished flow & venous spasm Intervention: Administer fluid at room temperature 7. Vein trauma, clots, plugging of veins, venous spasm a. Vasoconstriction result from anxiety; cold IV fluids; sever vein irritation from irritating drugs or fluids 8. Flow control clamp derangement a. Some clamps may slip & loosen resulting in rapid or runaway infusion b. Plastic tubing may distort causing creep or cold flow

NCM 100 LEC / LAB

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c. Marked stretching of tubing may cause distortion of tubing & render clamp ineffective (may occur when patient turns over & pull on the short tubing). 9. Manipulation of the clamp by the patient or significant others April 23, 2005 How To Terminate IV Therapy: 1. Check the doctors order for IV termination 2. Wash hands 3. Prepare the equipment needed - plaster - cotton balls (3 wet, 3 dry) - bandage scissors - waste receptacle 4. Explain procedure to the client 5. Clamp the IV line 6. Put on gloves as necessary 7. Lift the tape from skin to expose the insertion site using wet cotton balls 8. Apply dry cotton ball directly over the insertion site. Using the other hand, quickly remove the device and tape from the skin 9. Maintain direct pressure on the IV site for 1 to 2 minutes 10. Put plaster over the insertion site, hold limb upright for 5 minutes 11. Instruct patient to restrict activity for about 10 minutes and leave the site with a plaster in place for at least 8 hours as necessary 12. Dispose used venipuncture device, tubing and solution containers in their designated garbage bin, according to agency policy.

NCM 100 LEC / LAB

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Summer 2005