chap 36 IV

Drugs or substances that cannot be supplied by other means (orally/rectally)

Fluids and electrolytes—for patients who do not have adequate oral intake

Blood, plasma, and other blood components

Nutritional formulas containing glucose, amino acids, and lipids

Glucose
Saline
Electrolytes
Vitamins
Amino acids
Blood and blood products

Have the same concentration, or osmolality, as blood

} Used to expand the fluid volume of the body

Contain less solute than extravascular fluid

} May cause fluid to shift out of vascular compartment

Have a greater tonicity than blood

} Replace electrolytes; when given as concentrated dextrose solutions produce shift in fluid from intracellular to the extracellular compartment

Consists of bag of solution, regular tubing set, needleless connector, and IV stand

Medications to be given intravenously often added to an existing IV line by using the piggyback method

A Y-type administration set used to infuse certain blood products

Infusion pump administers small volumes of fluid or medication

Established by applying Luer-lock cap or an extension set to the IV cannula

Trap small particles such as undissolved medication or salts that have precipitated from solution

An added safety measure used in many agencies to regulate the flow of routine IV fluids

} Use is mandatory when patients receive total parenteral nutrition or for medications that require critical accuracy

Controllers reduce risk of infusing fluid too quickly

} Patient-controlled analgesia pumps used in most hospitals and in the home setting

Used in home IV therapy to administer pain medication

used at home to regulate TPN

used in hospitals to allow patient to regulate administration of IV analgesics

} Patient receives a preset bolus of medication when the button is pushed and/or a base amount of medication each hour

Meant for short-term therapy

} Supplied in odd-numbered gauges (17, 19, 23, and 25)

Consist of a needle with a catheter sheath over it

} The needle is removed, leaving the flexible catheter in the vein

} 18-, 19-, 20- to 22-gauge needles

Used for midline catheter insertion for long-term peripheral use

May be left in place for 6 to 8 weeks

} Positioned in right atrium or superior
vena cava

} Some are tunneled long-term catheters such as a Hickman or Broviac catheter

} PICC lines are the first choice in home IV therapy

} Correct placement is verified by x-ray

Review the drug’s action before administration and know possible side effects and nursing implications

} Assess for allergies and check for possible drug solution incompatibilities

} Ensure that IV line is patent before attempting to administer medication, and verify flow rate IV solution

Occurs when fluid or medication leaks out of the vein into the tissue

} Often will be edema around the site and the tissue will feel cool

} Infusion is discontinued and another site is initiated to continue therapy

} Fluid that is in the tissue will usually reabsorb within 24 hours

Caused by irritation of the vein by the needle, catheter, medications, or additives in the IV solution

erythema, warmth, swelling, tenderness

} IV must be discontinued and another site found

} Warm compresses to the inflamed site will decrease discomfort

Occurs when infectious pathogens introduced into the bloodstream

} May occur from breaks in sterile technique during cannula insertion or any time the system is opened to change the bag or tubing

fever, chills, pain, headache, nausea, vomiting, extreme fatigue

} Blood cultures ordered and aggressive antibiotic therapy is started

} IV site is immediately discontinued

Occurs when a piece of the catheter breaks off and travels in the vein until it lodges

Can occur when changing bags, or when opening the line of a subclavian catheter

Occurs when fluids or medications given by bolus are administered too rapidly

Risk for deficient fluid volume

} Imbalanced Nutrition: Less than body requirements, related to decreased oral intake

} Ineffective tissue perfusion, related to loss of red blood cells or volume

All medications are administered using the five rights, with the addition of the right rate

} Movement of the patient can affect the flow rate

Potassium is ALWAYS diluted and never given as a bolus

} Sterile technique is used when medications are added to IV fluids

} Most facilities require certification to administer chemotherapy drugs

The IV flow: the solution should drip into the chamber at regular intervals

} The rate of the infusion

} If a pump is used, check the programmed rate and volume; the dripping in the chamber will occur intermittently

} The insertion site

} Complaints from the patient

} The level of the fluid remaining in the bag

Adding medications to the primary bag of fluids

} Adding a secondary line or piggyback to the primary line

} Using controlled-volume burettes

} Directly injecting the medication into the vein

Many are very irritating to tissue

} Special precautions are used in preparing and administering these drugs

When an infusion is to be discontinued, the flow is stopped and the catheter is removed

} Discontinuation is documented on the IV flow sheet

A consent to receive blood must be signed by the patient

Mainly given through a central line

} The nutritional status of patients who are NPO and on IV therapy must be assessed every day

} IV solution contains dextrose but amount of calories supplied is below the total daily requirement

} Lacks other essential nutrients and bulk

} Supplemental calories may be provided by the use of amino acids and fat emulsions

Constant assessment of the patient

} Evaluation of the effect of IV therapy relates to the reason it was given

} If fluids are given to hydrate the patient, check for good skin turgor, adequate urine output, and moist mucous membranes

} If TPN is given, assess patient’s weight gain and monitor blood glucose level

} When a blood product is administered, monitor the blood count to see if values improve

} Monitor for signs/symptoms of transfusion reaction

is done on the MAR

} IV site is accessed every 1 to 2 hours according to agency policy and observations are entered on a flow sheet or in nurses’ notes

} IV fluid counted as intake and recorded on I&O sheet