Intravenous%20Therapy

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Intravenous Therapy

• Brenda McLoud BSN, RN, CGRN

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Learning Objectives

• Describe the Nurses role in IV therapy care
• Explain IV supplies, type of vascular access
  devices, and administration of IV therapy

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GI nurses role in IV therapy

• Assessment
• Planning
• Implementation
• Evaluation.

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Competencies in IV Therapy for the GI Nurse

• Knowledge of Vascular Access Devices (VAD) used
• Skill in performing procedure competently
  safely
• Skill in inspecting insertion site
• Ability to problem solve
• Knowledge to monitor patients condition report
  changes
• Proper documentation and record-keeping skills

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Basic Principles of Fluid Electrolytes

• Water is 60 of the average adults total body
  weight
• In infants, body water represents about 80 of
  total body weight
• Solutions liquids (solvents) containing
  dissolved substances (solutes) are classified
  according to their concentration or tonicity and
  include
• Isotonic Solutions
• Hypotonic Solutions
• Hypertonic Solutions
• Body fluids are isotonic solutions

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Basic Principles of Fluid Electrolytes

• Body water is contained in two major body
  compartments
• Intracellular fluid (ICF)
• Extracellular fluid (ECF)
• Fluid balance is maintained when water intake
  equals water output
• Solutes are substances dissolved in a solution

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Basic Principles of Fluid Electrolytes

• Solutes are classified as
• Nonelectrolytes
• Electrolytes
• Cations
• Na, K, Ca, Mg, H
• Anions
• Cl, P, HCO3
• Electrolytes perform four essential functions
• Promote neuromuscular irritability
• Maintain body fluid osmolality
• Regulate acid-base balance
• Regulate distribution of body fluids among body
  fluid compartments

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Fluid Electrolyte imbalances

• Imbalances may result from
• Vomiting, diarrhea, suction, draining wounds,
  intestinal obstructions, draining fistulas,
  hemorrhage, infections, fever or prolonged use of
  enemas
• Infants are more vulnerable because of their
  higher proportion of body fluid, immature
  kidneys, increased heat production rapid growth
• Excessive loss of body water can lead to
  dehydration

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Administration of Fluids Electrolytes

• All IV solutions are considered medications
• Requires a Dr.s order
• Types of Solutions
• Isotonic Solutions
• 0.9 NS or LR
• Hypotonic Solutions
• 0.45 NaCl
• Hypertonic Solutions
• 3 NaCl or 10Dextrose

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Risks for the GI Nurse

• Primary risks due to needlesticks
• Injury
• Disease transmission
• Spills
• Splashes
• Because universal precautions require use of
  gloves when dealing with blood and body fluids,
  development of latex allergies pose a concern for
  health care workers and patients

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Latex allergies

• Individuals who develop burning or tingling
  around mouth after blowing up latex balloons
• Known allergy to
• Bananas
• Avocados
• Potatoes
• Tomatoes
• Poinsettias
• History of contact dermatitis
• History of asthma
• History of eczema

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Vascular Access Devices (VAD)

• Steel winged infusion set (butterfly winged
  device)
• Peripheral short IV catheters
• Peripheral long or midline catheters
• Peripherally inserted central catheters (PICC)
• Nontunneled central venous catheters (CVCs)
• Tunneled central venous catheters
• Totally implanted devices or ports

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IV Insertion sites

• Preferred sites
• Dorsum of hand
• Upper arm
• Avoid Extremities with
• Lymphedema, postop swelling, recent trauma,
  dialysis shunt, hematoma, axillary lymph node
  dissection, local infection or cellulitis,
  phlebitis or open wounds
• Best to begin with distal veins and proceed
  proximally towards the body
• Cannulation of lower extremities should be
  avoided in adults

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Complications

• Infiltration/extravasation
• Hematoma
• Phlebitis
• Pyrogenic reactions
• Air embolism
• Catheter embolism
• Pulmonary edema
• Speed shock/overload
• Nerve injury

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IV Medication Administration

• Techniques routes of administration
• Appropriateness of the prescribed therapy
• Patients age and condition
• Any medication allergies
• Dose, route and rate of the medication ordered
• Medications
• Indications
• Actions
• Side effects
• Appropriate nursing interventions with adverse
  reactions

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Indications for IV meds in GI

• Moderate sedation/analgesia
• Control of variceal hemorrhage
• Treatment of opioid-induced respiratory
  depression
• Treatment of benzodiazepine-induced respiratory
  depression
• Treatment of cardiac dysrhythmias
• Reducing peristalsis or intestinal spasms
• Treatment for increased risk of infection

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Blood Blood Components

• Whole blood
• Packed red blood cells
• Leukocyte-poor blood
• Platelets
• Fresh frozen plasma (FFP)
• Cryoprecipitates
• Factor VIII
• Factor IX
• Human albumin
• Autologous transfusion

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Adverse Reactions

• Circulatory overload
• Allergic reactions
• Hemolytic reactions
• Hepatitis B, hepatitis C and human immune
  deficiency viruses
• Other transfusion-related infectious agents
• Citrate toxicity

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When Adverse Reaction Occurs

• Stop the transfusion
• Keep vein open with normal saline
• Asses vital signs
• Notify Dr.
• Notify blood bank
• Send all transfusion containers administration
  sets to blood bank
• Treat patient symptomatically supportively
• Patient Education
• Documentation

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Review

• Salts that dissociate in solution into positive
  and negative ions are called
• A. Anions
• B. Cations
• C. Electrolytes
• D. Colloids

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Review

• Drugs should never be added to blood transfusions
  because
• A. They are incompatible.
• B. It complicates determination of the source of
  any adverse reaction.
• C. Drugs can cause clotting.
• D. The rate of infusion is too slow.

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Review

• The following may indicate a higher risk for
  latex allergy except,
• A. History of asthma.
• B. Use of powder-free gloves.
• C. Allergy to bananas
• D. History of multiple surgical procedures.

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Review

• Hemolytic reactions to blood transfusions usually
  occur
• A. Immediately
• B. Within the first 5 to 15 minutes of the
  transfusion.
• C. Within 24 hours.
• D. As long as 6 months after the transfusion.