2General principles………. use strict aseptic technique when initiating, changing bag, changing tubingdirect access to circulatory systemexamine solution for type, amount, expiration date, character of solution and integrity of container
3IV solutions should be at room temperature type of solution ordered by physicianalways close clamp when changing bag, pt’s gown, equipment etc.
4always close clamp when removing from pump for any reason!!!! always check tubing from patient to container at least q4hNEVER PLAY “CATCH UP” IF BEHIND SCHEDULE!!!!!
5check site at least q4h for signs of complications in general, if you get in the habit of checking an IV infusion from pt. (noting site/dressing condition) to bag (noting rate, proper solution etc.) q1h you will stay on top of things!!!!
6Types of solutions………. Isotonic: D5W - does not contain Na so should not be used in large volumes (dilutes Na in serum)0.9% NaCl - provides only Na and Cl so not desirable for long term use either (also called normalsaline)
7Lactated Ringers - contains electrolyes similar to plasma , used for burns, hypovolemia 2/3 &1/3 – contains 3.3% dextroseand 0.3% NaCl- one of most commonly usedsolutions
8Hypotonic:0.33% NaCl - contains Na, Cl and free water- 1/3 strength normal saline0.45% NaCl - similar to above- 1/2 strength saline- dilutes plasma Na without letting it drop too much
9Hypertonic:5% dextrose in 0.45% NaCl - commonly used to treat hypovolemia and maintain fluid intakeD10W - high calorie count- 10 % dextrose5%D in 0.9% NaCl - replaces nutrients and lytes,
10Site selection……... accessibility of vein condition of vein type of fluid being infusedduration of infusionin general, use the smallest catheter and the largest vein available and practicaluse site naturally splinted (back of hand)
12Possible complications……... Infiltration : escape of fluid into subcutaneous tissue due to dislodged needle or penetration of vessel wall: swelling, pallour, coldness or pain around site, decrease in infusion rate: check site frequently during shift, discontinue IV if this happens
13Sepsis at site : usually due to poor insertion technique : area will be red and tender: pt. may have chills, fever, malaise, other VS changes: assess for this daily, notify physician if noted, follow agency policy re culturing site, discontinuing etc.
14Phlebitis :inflammation of a vein : may be due to mechanical trauma from needle moving, chemical trauma from medications or sepsis: will have local, acute tenderness, redness, warmth and slight edema of vein above site
15:d/c IV, apply warm, moist compress to site, notify physician
16Thrombus : blood clot formation due to trauma of vessel : s & s similar to phlebitis, IV flow rate may stop if clot blocking vessel: dc infusion, notify physician, apply warm compress to site: DO NOT RUB OR MASSAGE SITE!!!!!
17Fluid overload : too large volume of fluid infused into circulatory system : engorged neck veins, increased BP, dyspnea: slow rate of infusion, notify physician, monitor vital signs, carefully monitor flow rate
18Air embolism : break in IV system allowing air to enter circulatory system as a bolus : respiratory distress, increased heart rate, cyanosis, decreased BP, change in LOC: pinch off catheter, place pt. In left trendelenburg, monitor VS, SaO2, call physician
19Causes of Obstruction/Decrease in Flow Rate………. height of container in relation to patientpatient’s blood pressurepatent’s positionheight of bedpatency of IV catheterinfiltrationkink in tubing
20Monitoring rate of infusion……. rate is determined by amount of fluid to be infused over one hourthis is called the “drip rate”drop factor or “drops per mL” is determined by the size of the tubingmacrodrip = 10, 15 or 20 gtts/mLmicrodrip = 60 drops per mLblood tubing = 10 drops per mL
21usually using microdrip tubing for small volumes may use buretrol/pediatrol for childrensometimes put tape strip on tubing with amount to be infused per hourthis is a guideline only and does not replace hourly rate checks
22Calculating drip rate……... gtts/min = volume(mL) X drop factor (gtts/mLtime in minuteseg. IV D5W 1000 mL over 10 hours (microdrip)gtts/min = 1000 mL X = 100 gtts/min600 mins
23Alternate formula using mL/hr gtts/min = mLs /hour X drop factortime (60 mins)ie mL D5W over 10 hours (microdrip)gtts/min = 100 X 60 = = 100 gtts/min
24Setting up an IV……... gather equipment and bring to bedside check solution and additives with orderwash handsmaintain aseptic techniqueclamp tubinginsert spike into IV solutionsqueeze chamber and allow to fill 1/2 way
25remove cap at end of tubing (keep sterile) release clamp allowing fluid to flow through tubingexpel all air from tubing (invert and tap as necessary)recaplabel with meds added if necessary
26Electronic infusion control devices……. many different typesknow your equipmentDON’T ALWAYS TRUST THE EQUIPMENT!!!!check drip rate the “old fashioned” way at least q4h to validateregulates drip rate and alarms if error or bag empty
27Dressing changes……...usually tubing is anchored with tape and covered with transparent dressingshould be changed q48-72 hoursdepends on hospital policyautomatically change any dressing that is soiled, damp or loosenedUSE STRICT ASEPTIC TECHNIQUE
28Discontinuing an IV infusion…... clamp tubingremove dressing and tapewithdraw catheter in line with veinapply pressure to site with sterile gauzedon’t use alcohol wipe as this burns and won’t stop bleedingexamine catheter to ensure intact
29Documentdatetimereason for discontinuing infusiontype of solution and amount remainingany adverse reactionsyour name