2Learning Objectives Describe the Nurse’s role in IV therapy care Explain IV supplies, type of vascular access devices, and administration of IV therapyThe primary goal of IV therapy is to provide safe & effective care to patient’s, while maintaining a safe work environment for the nursing staff.
3GI nurse’s role in IV therapy AssessmentPlanningImplementationEvaluation.The first step is patient assessment, which includes the patient’s knowledge an experiences with Intravenous therapy, diagnosis, co-morbid conditions, activity level and mental state, as well as duration and type of therapy.Planning includes identifications of the appropriate person to place the vascular access device (VAD), the type of VAD, and the dressing necessary for the VAD.Implementation includes preparing the patient, the environment and the equipment.Evaluation includes determining the patient’s response/outcome to the IV therapy administered and revising the plan of care to achieve desirable outcomes.
4Competencies in IV Therapy for the GI Nurse Knowledge of Vascular Access Devices (VAD) usedSkill in performing procedure competently & safelySkill in inspecting insertion siteAbility to problem solveKnowledge to monitor patient’s condition & report changesProper documentation and record-keeping skillsIdentifying the patient and verifying the prescriptionChecking the infusion fluid, drug and container for any obvious faults or contaminationEnsuring the administration of the prescribed drug or fluid to the correct patient via correct routeEstablishing that VAD is patent and comfortable for the patientInspecting the insertion and acting on findings, problem solving as necessaryControlling the rate of flow as prescribed, using gravity or appropriate infusion deviceMonitoring the condition of the patient and reporting any changesMaintaining appropriate records.
5Basic Principles of Fluid & Electrolytes Water is 60% of the average adult’s total body weightIn infants, body water represents about 80% of total body weightSolutions – liquids (solvents) containing dissolved substances (solutes) – are classified according to their concentration or tonicity and includeIsotonic SolutionsHypotonic SolutionsHypertonic SolutionsBody fluids are isotonic solutions
6Basic Principles of Fluid & Electrolytes Body water is contained in two major body compartmentsIntracellular fluid (ICF)Extracellular fluid (ECF)Fluid balance is maintained when water intake equals water outputSolutes are substances dissolved in a solutionThe ICF, representing fluid inside the cells, is the largest body compartmentThe ECF is divided into three separate body compartments: interstitial fluid (ISF), intravascular fluid (IVF), and Transcellular water (TSW)
7Basic Principles of Fluid & Electrolytes Solutes are classified asNonelectrolytesElectrolytesCationsNa, K, Ca, Mg, HAnionsCl, P, HCO3Electrolytes perform four essential functionsPromote neuromuscular irritabilityMaintain body fluid osmolalityRegulate acid-base balanceRegulate distribution of body fluids among body fluid compartmentsNonelectrolytes are solutes without an electrical chargeNonelectrolytes found in body fluids include glucose, protein, lipids, oxygen, carbon dioxide, and organic acidsElectrolytes are solutes that generate an electrical charge when dissolved in waterPositively charged electrolytes are called cationsMajor cations in body fluid include sodium, potassium, calcium, magnesium and hydrogenNegatively charged electrolytes are called anionsMajor anions in body fluid include chloride, phosphorus, and bicarbonateCertain solutes are more abundant in certain body compartments and tend to be limited to this compartment under normal conditions; for example,K is more abundant in the ICF and Na is more abundant in the ECF
8Fluid & Electrolyte imbalances Imbalances may result fromVomiting, 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 growthExcessive loss of body water can lead to dehydrationThe goal of nursing in dehydrated patients is to restore the circulating volume of fluid without causing overload.Careful observation, recording and reporting of the patient’s signs & symptoms and fluid intake and output are essential in such patients.Patients should also be monitored for electrolyte disturbances.The most common electrolyte imbalance occurring in GI patients are excesses or deficits of chloride, magnesium, sodium, potassium, bicarbonate, calcium and hydrogen ions.Systemic observations to detect fluid and electrolyte imbalances includeChanges in temperature, pulse rate, respirations and blood pressure.Changes in skin & mucous membranes, and/or changes in speech, behavior, facial appearance, skeletal muscle, sensations, fatigue and body weight are also significant.
9Administration of Fluids & Electrolytes All IV solutions are considered medicationsRequires a Dr.’s orderTypes of SolutionsIsotonic Solutions0.9% NS or LRHypotonic Solutions0.45% NaClHypertonic Solutions3% NaCl or 10%DextroseOne way of correcting fluid & electrolyte disturbances is by IV administration of solutions containing necessary electrolytes & nutrients.Isotonic solutions have the same concentration of solutes as the ICF or ECF. These include normal saline solution and lactated ringers.Hypotonic solutions have a lower concentration of solutes and are more dilute than body fluids, causing water to pull into the cells. An example of a hypotonic solution is 0.45% NaCl.Hypertonic solutions contain a higher concentration of solutes than the intracellular space, and cause water to be pulled from the cells.
10Risks for the GI Nurse Primary risks due to needlesticks Spills InjuryDisease transmissionSpillsSplashesBecause 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 patientsThe Needlestick Safety and Prevention Act became law in April This law required healthcare facilities to select and implement safer medical devices to protect health care workers from needlestick injuries.
11Latex allergiesIndividuals who develop burning or tingling around mouth after blowing up latex balloonsKnown allergy toBananasAvocadosPotatoesTomatoesPoinsettiasHistory of contact dermatitisHistory of asthmaHistory of eczemaLatex allergies have become a serious health issue among health care workers at all levels. Nurses must also be aware that patients have the potential of being allergic to or developing latex allergy, particularly those patients with spina bifida or those with a history of multiple surgical procedures.The following list of allergies put patients at a higher risk for an allergy to latex.
12Vascular Access Devices (VAD) Steel winged infusion set (butterfly winged device)Peripheral short IV cathetersPeripheral long or midline cathetersPeripherally inserted central catheters (PICC)Nontunneled central venous catheters (CVC’s)Tunneled central venous cathetersTotally implanted devices or portsSteel winged infusion set (butterfly)are limited to short-term or single dose administration. These metal needle devices pose a higher risk of needlestick injury for the healthcare worker, as well as a greater incidence of dislodgement and infiltrations. They are used in cooperative adult patients and for therapy in infants and children, or in elderly patients with fragile veinsPeripheral short IV cathetersmade of radiopaque Teflon, silastic or polyvinyl chloride. Over-the-needle catheters are routinely used for IV infusion or IV medication administration. The flexible catheters are associated with lower infection rates and should be used for routine peripheral IV therapy. A 16 toPeripheral long or midline cathetersPeripherally inserted central catheters (PICC)Nontunneled central venous catheters (CVC’s)Tunneled central venous cathetersTotally implanted devices or ports
13IV Insertion sites Preferred sites Avoid Extremities with Dorsum of handUpper armAvoid Extremities withLymphedema, postop swelling, recent trauma, dialysis shunt, hematoma, axillary lymph node dissection, local infection or cellulitis, phlebitis or open woundsBest to begin with distal veins and proceed proximally towards the bodyCannulation of lower extremities should be avoided in adults
15IV Medication Administration Techniques & routes of administrationAppropriateness of the prescribed therapyPatient’s age and conditionAny medication allergiesDose, route and rate of the medication orderedMedicationsIndicationsActionsSide effectsAppropriate nursing interventions with adverse reactions
16Indications for IV meds in GI Moderate sedation/analgesiaControl of variceal hemorrhageTreatment of opioid-induced respiratory depressionTreatment of benzodiazepine-induced respiratory depressionTreatment of cardiac dysrhythmiasReducing peristalsis or intestinal spasmsTreatment for increased risk of infection
18Adverse Reactions Circulatory overload Allergic reactions Hemolytic reactionsHepatitis B, hepatitis C and human immune deficiency virusesOther transfusion-related infectious agentsCitrate toxicity
19When Adverse Reaction Occurs Stop the transfusionKeep vein open with normal salineAsses vital signsNotify Dr.Notify blood bankSend all transfusion containers & administration sets to blood bankTreat patient symptomatically & supportivelyPatient EducationDocumentation
20ReviewSalts that dissociate in solution into positive and negative ions are called:A. AnionsB. CationsC. ElectrolytesD. Colloids
21Review 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.
22ReviewThe following may indicate a higher risk for latex allergy except,A. History of asthma.B. Use of powder-free gloves.C. Allergy to bananasD. History of multiple surgical procedures.
23Review Hemolytic reactions to blood transfusions usually occur : A. ImmediatelyB. Within the first 5 to 15 minutes of the transfusion.C. Within 24 hours.D. As long as 6 months after the transfusion.