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

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

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

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

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

Fluid Management Homeostatic Mechanisms Thirst to CNS Illness, LOC, age changes thirst mechanism Antidiuretic hormone (ADH) – hypothalamus Extracellular volume is concentrated Fluid retention by hemorrhage, cardiac output, trauma, pain, fear, surgery, dehydration Aldosterone – adrenal cortex Reabsorbs Na & H2O = changes electrolytes Na exchanges for K or H Kidneys and the angiotensin system Renin – angiotensin I – angiotensin II Renin circulates in the body, converts plasma proteins to in the liver to vasoconstrictor called angiotensin I, this enters the lungs and converts to angiotensin II – this works on the adrenal cortex to secrete Aldosterone

Fluid Management - Tonicity Hypertonic Increased solutes in relationship to plasma D5.9%NS D5LR D5.45%NS Hypotonic Decreased solutes in relationship to plasma .25%NS .45%NS 2.5%Dextrose Isotonic Same tonicity as plasma .9%NS D5W LR Renin circulates in the body, converts plasma proteins to in the liver to vasoconstrictor called angiotensin I, this enters the lungs and converts to angiotensin II – this works on the adrenal cortex to secrete Aldosterone

Venipuncture Site selection Gauge needle Supplies Procedure Charting – location and identify vein used Renin circulates in the body, converts plasma proteins to in the liver to vasoconstrictor called angiotensin I, this enters the lungs and converts to angiotensin II – this works on the adrenal cortex to secrete Aldosterone

Supplies The pump The drip factor (varies by manufacturer) Microdrop 60gtt/mL Macrodrop 20gtt/mL 15gtt/mL 10gtt/mL The volume control set The filter Renin circulates in the body, converts plasma proteins to in the liver to vasoconstrictor called angiotensin I, this enters the lungs and converts to angiotensin II – this works on the adrenal cortex to secrete Aldosterone

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

Secondary Infusions Piggybacks - IVPB Used for mediations Check medication Check capability Stop primary, flush, infuse, flush and restart primary Bactrim – don’t mix (usually D5W) Dilantin – only in NS

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

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

Insertion Sites Neck Chest Arm Jugular Subclavian Bacilic Cephalic Anticubital

SAFETY NO SCISSORS ONCE INSERTED PREVENT INFECTION

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

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

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

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

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

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

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

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

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

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

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

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

TPN precautions Check compatibility of medications Don’t play “catch-up” No blood