Intravenous Therapy

General principles………. use strict aseptic technique when initiating, changing bag, changing tubing direct access to circulatory system examine solution for type, amount, expiration date, character of solution and integrity of container

IV solutions should be at room temperature type of solution ordered by physician always close clamp when changing bag, pt’s gown, equipment etc.

always close clamp when removing from pump for any reason!!!! always check tubing from patient to container at least q4h NEVER PLAY “CATCH UP” IF BEHIND SCHEDULE!!!!!

check 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!!!!

Types 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 normal saline)

Lactated Ringers - contains electrolyes similar to plasma , used for burns, hypovolemia 2/3 &1/3 – contains 3.3% dextrose and 0.3% NaCl - one of most commonly used solutions

Hypotonic: 0.33% NaCl - contains Na, Cl and free water - 1/3 strength normal saline 0.45% NaCl - similar to above - 1/2 strength saline - dilutes plasma Na without letting it drop too much

Hypertonic: 5% dextrose in 0.45% NaCl - commonly used to treat hypovolemia and maintain fluid intake D10W - high calorie count - 10 % dextrose 5%D in 0.9% NaCl - replaces nutrients and lytes,

Site selection……... accessibility of vein condition of vein type of fluid being infused duration of infusion in general, use the smallest catheter and the largest vein available and practical use site naturally splinted (back of hand)

keep site between damaged vein and heart

Possible 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

Sepsis 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.

Phlebitis :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

:d/c IV, apply warm, moist compress to site, notify physician

Thrombus : 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!!!!!

Fluid 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

Air 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

Causes of Obstruction/Decrease in Flow Rate………. height of container in relation to patient patient’s blood pressure patent’s position height of bed patency of IV catheter infiltration kink in tubing

Monitoring rate of infusion……. rate is determined by amount of fluid to be infused over one hour this is called the “drip rate” drop factor or “drops per mL” is determined by the size of the tubing macrodrip = 10, 15 or 20 gtts/mL microdrip = 60 drops per mL blood tubing = 10 drops per mL

usually using microdrip tubing for small volumes may use buretrol/pediatrol for children sometimes put tape strip on tubing with amount to be infused per hour this is a guideline only and does not replace hourly rate checks

Calculating drip rate……... gtts/min = volume(mL) X drop factor (gtts/mL time in minutes eg. IV D5W 1000 mL over 10 hours (microdrip) gtts/min = 1000 mL X 60 = 100 gtts/min 600 mins

Alternate formula using mL/hr gtts/min = mLs /hour X drop factor time (60 mins) ie. 1000 mL D5W over 10 hours (microdrip) gtts/min = 100 X 60 = 6000 = 100 gtts/min 60 60

Setting up an IV……... gather equipment and bring to bedside check solution and additives with order wash hands maintain aseptic technique clamp tubing insert spike into IV solution squeeze chamber and allow to fill 1/2 way

remove cap at end of tubing (keep sterile) release clamp allowing fluid to flow through tubing expel all air from tubing (invert and tap as necessary) recap label with meds added if necessary

Electronic infusion control devices……. many different types know your equipment DON’T ALWAYS TRUST THE EQUIPMENT!!!! check drip rate the “old fashioned” way at least q4h to validate regulates drip rate and alarms if error or bag empty

Dressing changes……... usually tubing is anchored with tape and covered with transparent dressing should be changed q48-72 hours depends on hospital policy automatically change any dressing that is soiled, damp or loosened USE STRICT ASEPTIC TECHNIQUE

Discontinuing an IV infusion…... clamp tubing remove dressing and tape withdraw catheter in line with vein apply pressure to site with sterile gauze don’t use alcohol wipe as this burns and won’t stop bleeding examine catheter to ensure intact

Document date time reason for discontinuing infusion type of solution and amount remaining any adverse reactions your name