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Brenda McLoud BSN, RN, CGRN

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1 Brenda McLoud BSN, RN, CGRN
Intravenous Therapy Brenda McLoud BSN, RN, CGRN

2 Learning Objectives Describe the Nurse’s role in IV therapy care
Explain IV supplies, type of vascular access devices, and administration of IV therapy The primary goal of IV therapy is to provide safe & effective care to patient’s, while maintaining a safe work environment for the nursing staff.

3 GI nurse’s role in IV therapy
Assessment Planning Implementation Evaluation. 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.

4 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 patient’s condition & report changes Proper documentation and record-keeping skills Identifying the patient and verifying the prescription Checking the infusion fluid, drug and container for any obvious faults or contamination Ensuring the administration of the prescribed drug or fluid to the correct patient via correct route Establishing that VAD is patent and comfortable for the patient Inspecting the insertion and acting on findings, problem solving as necessary Controlling the rate of flow as prescribed, using gravity or appropriate infusion device Monitoring the condition of the patient and reporting any changes Maintaining appropriate records.

5 Basic Principles of Fluid & Electrolytes
Water is 60% of the average adult’s 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

6 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 The ICF, representing fluid inside the cells, is the largest body compartment The ECF is divided into three separate body compartments: interstitial fluid (ISF), intravascular fluid (IVF), and Transcellular water (TSW)

7 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 Nonelectrolytes are solutes without an electrical charge Nonelectrolytes found in body fluids include glucose, protein, lipids, oxygen, carbon dioxide, and organic acids Electrolytes are solutes that generate an electrical charge when dissolved in water Positively charged electrolytes are called cations Major cations in body fluid include sodium, potassium, calcium, magnesium and hydrogen Negatively charged electrolytes are called anions Major anions in body fluid include chloride, phosphorus, and bicarbonate Certain 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

8 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 The 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 include Changes 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.

9 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 10%Dextrose One 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.

10 Risks for the GI Nurse Primary risks due to needlesticks Spills
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 The 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.

11 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 Latex 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.

12 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 (CVC’s) Tunneled central venous catheters Totally implanted devices or ports Steel 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 veins Peripheral short IV catheters made 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 to Peripheral long or midline catheters Peripherally inserted central catheters (PICC) Nontunneled central venous catheters (CVC’s) Tunneled central venous catheters Totally implanted devices or ports

13 IV Insertion sites Preferred sites Avoid Extremities with
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

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

15 IV Medication Administration
Techniques & routes of administration Appropriateness of the prescribed therapy Patient’s 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

16 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

17 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

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

19 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

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

21 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.

22 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.

23 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.


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