Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 RN Skills Laboratory Intravenous Therapy West Coast University Week 7.

Similar presentations


Presentation on theme: "1 RN Skills Laboratory Intravenous Therapy West Coast University Week 7."— Presentation transcript:

1 1 RN Skills Laboratory Intravenous Therapy West Coast University Week 7

2 Objectives IV therapy overview IV therapy overview Type of fluids Type of fluids IV drop factors & calculations IV drop factors & calculations IVPBs IVPBs IVPs IVPs Central Lines Central Lines Blood and Blood Products Blood and Blood Products TPN TPN

3 IV Therapy IV therapy – peripheral IV therapy – peripheral Admission criteria in hospital Admission criteria in hospital Surgical, transfusion patients Surgical, transfusion patients Hydration, restoring fluids/electrolyte imbalance Hydration, restoring fluids/electrolyte imbalance Administration of drugs Administration of drugs Side affects Side affects Bleeding, infiltration, infection, hearing loss, bone marrow suppression, kidney and heart damage Bleeding, infiltration, infection, hearing loss, bone marrow suppression, kidney and heart damage Is not long-term therapy and more expensive than other routes Is not long-term therapy and more expensive than other routes

4 Fluid Management Thin people 50-70% water Thin people 50-70% water Obese people 50% water Obese people 50% water Elder 46-52% water Elder 46-52% water Two main compartments Two main compartments Intracellular (64%) Intracellular (64%) Extracellular (36%) Extracellular (36%) ¾ interstitial ¾ interstitial ¼ plasma ¼ plasma

5 Fluid Management Physiological homeostasis Physiological homeostasis Fluid movement done by osmotic pressure (holding on) Fluid movement done by osmotic pressure (holding on) Hydrostatic pressure (letting go) Hydrostatic pressure (letting go) Plasma uses osmotic pressure (why?) Plasma uses osmotic pressure (why?) Kidneys are the primary regulator of fluids Kidneys are the primary regulator of fluids Usually produces 1-2L/24h Usually produces 1-2L/24h Must produce a minimum of 500-600mL/24h Must produce a minimum of 500-600mL/24h

6 Fluid Management Homeostatic Mechanisms Homeostatic Mechanisms Thirst to CNS Thirst to CNS Illness, LOC, age changes thirst mechanism Illness, LOC, age changes thirst mechanism Antidiuretic hormone (ADH) – hypothalamus Antidiuretic hormone (ADH) – hypothalamus Extracellular volume is concentrated Extracellular volume is concentrated Fluid retention by hemorrhage, cardiac output, trauma, pain, fear, surgery, dehydration Fluid retention by hemorrhage, cardiac output, trauma, pain, fear, surgery, dehydration Aldosterone – adrenal cortex Aldosterone – adrenal cortex Reabsorbs Na & H 2 O = changes electrolytes Reabsorbs Na & H 2 O = changes electrolytes Na exchanges for K or H Na exchanges for K or H Kidneys and the angiotensin system Kidneys and the angiotensin system Renin – angiotensin I – angiotensin II Renin – angiotensin I – angiotensin II

7 Fluid Management - Tonicity Hypertonic Increased solutes in relationship to plasma D5.9%NSD5LRD5.45%NS Hypotonic Decreased solutes in relationship to plasma.25%NS.45%NS2.5%Dextrose Isotonic Same tonicity as plasma.9%NSD5WLR

8 Venipuncture Site selection Site selection Gauge needle Gauge needle Supplies Supplies Procedure Procedure Charting – location and identify vein used Charting – location and identify vein used

9 Supplies The pump The pump The drip factor (varies by manufacturer) The drip factor (varies by manufacturer) Microdrop Microdrop 60gtt/mL 60gtt/mL Macrodrop Macrodrop 20gtt/mL 20gtt/mL 15gtt/mL 15gtt/mL 10gtt/mL 10gtt/mL The volume control set The volume control set The filter The filter

10 Formulas Flow rate Flow rate Drops per minute Drops per minute Total Solution # of hours to run = mL/hr mL/hr x gtt factor 60 mins = gtts/min

11 Secondary Infusions Piggybacks - IVPB Piggybacks - IVPB Used for mediations Used for mediations Check medication Check medication Check capability Check capability Stop primary, flush, infuse, flush and restart primary Stop primary, flush, infuse, flush and restart primary Bactrim – dont mix (usually D5W) Bactrim – dont mix (usually D5W) Dilantin – only in NS Dilantin – only in NS

12 Intravenous Line Injection Pushes - IVPs Pushes - IVPs Dilute whenever possible Dilute whenever possible KNOW YOUR DRUG KNOW YOUR DRUG Digitalis – usually monitored Digitalis – usually monitored Benzodiazepines (do not mix or dilute) Benzodiazepines (do not mix or dilute) Clamp, flush, push, flush, unclamp Clamp, flush, push, flush, unclamp Flush, push, flush Flush, push, flush SASH SASH

13 Central Venous Access Types Peripherally Placed Peripherally Placed PICC PICC Tunneled Tunneled Groshong (same as PICC only tunneled) Groshong (same as PICC only tunneled) Triple Lumens Triple Lumens Hickmans, Boviacs Hickmans, Boviacs Ports Ports

14 Insertion Sites Neck Neck Jugular Jugular Chest Chest Subclavian Subclavian Arm Arm Bacilic Bacilic Cephalic Cephalic Anticubital Anticubital

15 SAFETY NO SCISSORS ONCE INSERTED NO SCISSORS ONCE INSERTED PREVENT INFECTION PREVENT INFECTION

16 Site Care First 7 days (or if discharge) First 7 days (or if discharge) Use 2x2 gauze Use 2x2 gauze NO betadine ointment NO betadine ointment Then q72h or if soiled Then q72h or if soiled Check policy Check policy

17 Tubing & Cap changes Both q72h with fluids Both q72h with fluids Blood change both Blood change both After 2-3 units After 2-3 units TPN (PPN) change both TPN (PPN) change both q24h q24h Change caps q blood draws Change caps q blood draws NO LABEL – change both NO LABEL – change both

18 Blood drawing Access line with prefilled 10cc NS Access line with prefilled 10cc NS Flush Flush Draw back 10cc blood in same syringe (discard) Draw back 10cc blood in same syringe (discard) New syringes – draw up sample New syringes – draw up sample Change cap Change cap Flush with 10cc NS (heparin??) Flush with 10cc NS (heparin??)

19 CVC Side Effects Phlebitis Phlebitis mechanical vs bacterial mechanical vs bacterial Infection Infection Pheumothorax Pheumothorax Superior vena cava syndrome Superior vena cava syndrome

20 Flushing Know the following for all Know the following for all Manufactures Manufactures Guidelines Policy/Protocol Guidelines Policy/Protocol Peripheral Lines Peripheral Lines 3cc NS 3cc NS Central Lines Central Lines PICC: 10cc NS (No Heparin) PICC: 10cc NS (No Heparin) Central Line: 10cc NS & Heparin 100u/cc (3cc) Central Line: 10cc NS & Heparin 100u/cc (3cc) Tunneled: Same as Central Line (Groshong see PICC) Tunneled: Same as Central Line (Groshong see PICC) Ports (Should have primary line) Ports (Should have primary line) Needles Needles -Huber (non-coring) -Huber (non-coring) -Change every Friday -Change every Friday -Flush when needle remove and not reinserted -use Heparin 100u/cc (5cc) -Flush when needle remove and not reinserted -use Heparin 100u/cc (5cc)

21 Blood Administration Have saline infusing with Y-set up Have saline infusing with Y-set up Use 170 micron filter Use 170 micron filter Double check Double check At lab/blood bank At lab/blood bank At bed side At bed side Monitoring Monitoring Prior, 5min after start, 15min after start then q30m until completed Prior, 5min after start, 15min after start then q30m until completed Should infuse over 1-2 hours Should infuse over 1-2 hours

22 The Blood System ABO blood group system ABO blood group system Universal Donor Universal Donor O lacks A & B antigen O lacks A & B antigen Universal Recipients Universal Recipients AB lacks anti-A & anti-B antibodies AB lacks anti-A & anti-B antibodies

23 Blood Products Whole blood Whole blood Packed red cells Packed red cells Granulocyte concentrates Granulocyte concentrates Platelet concentrates Platelet concentrates Fresh frozen plasma Fresh frozen plasma Cryoprecipitate Cryoprecipitate Clotting factors - Factor VIII / IX Clotting factors - Factor VIII / IX

24 Complications of Transfusions Complications of blood transfusion Complications of blood transfusion Haemolytic reactions (immediate or delayed) Haemolytic reactions (immediate or delayed) Bacterial infections from contamination Bacterial infections from contamination Allergic reactions to white cells or platelets Allergic reactions to white cells or platelets Pyogenic reactions Pyogenic reactions Circulatory overload Circulatory overload Air embolism Air embolism Thrombophlebitis Thrombophlebitis Clotting abnormalities

25 Anaphylaxis Reaction Reaction Usually occurs soon after start of transfusion Usually occurs soon after start of transfusion Presents with circulatory collapse and bronchospasm Presents with circulatory collapse and bronchospasm Management Management Discontinue transfusion and remove giving set Discontinue transfusion and remove giving set Maintain airway and give oxygen Maintain airway and give oxygen

26 Autologous transfusion Is the use of the patients own blood Is the use of the patients own blood Particularly useful in elective surgery Particularly useful in elective surgery Accounts for 5% of transfusions in USA Accounts for 5% of transfusions in USA Reduces the need for allogeneic blood transfusion Reduces the need for allogeneic blood transfusion Reduces risk of postoperative complications (e.g. infection, tumor recurrence) Reduces risk of postoperative complications (e.g. infection, tumor recurrence)

27 Total Parenteral Nutrition Pharmacist may do formulation Pharmacist may do formulation If dextrose >10% - need CVC If dextrose >10% - need CVC Monitor blood glucose Monitor blood glucose Monitor electrolytes Monitor electrolytes Weigh qd Weigh qd Use filters Use filters 1.2micron with lipids 1.2micron with lipids.2micron without lipids.2micron without lipids Know who to ramp up and down Know who to ramp up and down

28 TPN precautions Check compatibility of medications Check compatibility of medications Dont play catch-up Dont play catch-up No blood No blood


Download ppt "1 RN Skills Laboratory Intravenous Therapy West Coast University Week 7."

Similar presentations


Ads by Google