Presentation on theme: "NUR 1021 Marion technical College Spring Semester Intravenous therapy"— Presentation transcript:
1 NUR 1021 Marion technical College Spring Semester 2016 Intravenous therapy
2 I. Introduction to IV Therapy Indications for IV therapyTo provide water, electrolytes, and nutrients to meet daily requirementsTo replace water and correct electrolyte deficitsTo administer medications and blood products
3 What Do IV solutions consist of? IV solutions containdextrose or electrolytes mixed in various proportions with waterCan electrolyte-free water can be administered by IV?NOO! it rapidly enters red blood cells and causes them to rupture
4 IV Solutions There are several types of IV fluids type of fluid used selected according to the client and the reason for its useIV solutions are clearly labeled with the exact components and amount of solutionIV solutions orders – often written with abbreviations
5 Remember the Abbreviations! “D” is for dextrose“W” is for water“S” is for saline“NS” is for normal salineRinger lactate (lactated Ringer)- commonly used electrolyte solutionabbreviated “RL” or “LR”
6 Solution Strength IV’s often identified with abbreviation letters These indicate the components in the IV solutionthe numbers indicate the solution strength or concentration of components in the IV fluidnumbers written as subscriptsfor example, D5W (dextrose 5% in water).
7 Let’s Practice:What is the full name of the IV’S from these abbreviations?NS = Sodium Chloride 0.9%D5W = Dextrose 5% in waterRL = Lactated Ringer solution (electrolytes)D5 and ½ NS (0.45%) = Dextrose 5% in 0.45% sodium chloride
8 Components of IV Solutions D5W/0.45NS - solution contains 5 g of dextrose & 0.45 g (or 450 mg) of NaCl per 100 mL solutionD5W- each 100 mL of solution contains 5 g dextroseD5W/0.9NS - solution contains 5 g of dextrose & 0.9 g (or 900 mg) of NaCl per 100 mL solution
9 IV Solution Additives- Potassium Potassium chloride (KCl) –common additive to IV fluidsPotassium chloride- measured in milliequivalents (mEq)order usually written to indicate the amount of milliequivalents per literIV solutions are often available with Potassium premixed in them
10 SAFETY ALERT! Remember the following when adding potassium to an IV: It should be compatible with the solution and well-dilutedMonitor client during infusion, rapid infusion of potassium can cause death due to cardiac depression, arrhythmias, and arrest.Check IV site frequently, medication is extremely irritating.Administer IV using an infusion control device.Never administer potassium concentrate IV push.DO NOT add potassium to an IV bag that is already infusingthis would cause the medication to concentrate in the lower portion of IV bagresults in client receiving a concentrated medication solution- can be harmful.
11 IV Fluid 3 main types: Isotonic Hypotonic provides more water than electrolytes- diluting the ECFHypertonic
13 Isotonic fluids Close to the same osmolarity as serum Isotonic fluids expand the ECF volumeexpand the intravascular spaceWhat implications does this have for a patient with Hypertension or Heart failure if they receive isotonic IV’s?Risk of fluid overload
14 Isotonic Solutions Provides Benefits OF: Hydration maintain electrolytesUsed during and after surgery
15 D5/W -Helpful for:Provides free water necessary for renal excretion of solutesUsed to replace water losses and treat hypernatremiaProvides 170 calories/L
16 3. 5% dextrose in normal saline 4. 5% dextrose in lactated Ringer’s NCLEX Practice:The nurse recognizes requires fluid replacement with isotonic solution. One of the isotonic solutions that may be ordered by the health care provider is:% saline2. Lactated Ringer’s3. 5% dextrose in normal saline4. 5% dextrose in lactated Ringer’sANS: 2Lactated Ringer’s is an isotonic solution. 0.45% saline is a hypotonic solution. 5% dextrose in normal saline and 5% dextrose in lactated Ringer’s are both hypertonic solutions.
17 Hypotonic Fluids – Purpose Replace cellular fluidProvides free water for excretion of wastesOften use 0.45% NS – Rx hypernatremia or other hyperosmolar conditionsLess osmolarity than serumDilutes the serum
18 Excessive Use of hypotonic Solutions Leads to intravascular fluid depletionDecreased blood pressureCellular edema
19 0.45% NS - Hypotonic Provides free water in addition to Na+ and Cl– • Used to replace hypotonic fluid losses• Used as maintenance solutiondoes not replace daily losses of other electrolytes• Provides no caloriesA hypotonic solution that provides Na+, Cl−, & free waterUsed as a basic fluid for maintenance needs
20 Helpful for: Cellular dehydration: Fluid shifts out of blood vessel (less concentrated) to the tissue cells (more concentrated)Ex: dry mucous membranesHyperglycemic conditions:Diabetic ketoacidosis
21 Can be harmful:Sudden shift of fluid from blood vessel to the cells – cardiovascular collapseHypotonic solutions - potential to cause cellular swellingMonitor for changes in mentation →indicate cerebral edemaExamples- Hypotonic IV solutionsD5NS.45 (5% dextrose in ½ normal saline)5% Dextrose and water (D5W)- Provides calories and water
22 3. 5% dextrose in lactated Ringer’s 4. Dextrose 5% in NS NCLEX PRACTICE:A client experiences a loss of intracellular fluid. The nurse anticipates that the intravenous (IV) therapy that will be used to replace this type of loss is:% normal saline (NS)2. 10% dextrose3. 5% dextrose in lactated Ringer’s4. Dextrose 5% in NSANS: 1The client will need a hypotonic solution, such as 0.45% NS. A hypotonic solution has an osmolality that is less than body fluids, so the cells will draw the fluid in, which is the desired effect when the client has experienced a loss of intracellular fluid. Dextrose 5% in NS, 10% dextrose, and 5% dextrose in lactated Ringer’s are all hypertonic solutions that will draw fluid into the vascular space by osmosis. The client needs a hypotonic solution to rehydrate the cells.
23 Hypertonic (hyper-osmolar) Higher osmolarity than serumPulls fluids and electrolytes from the intracellular & interstitial compartments into the intravascular compartmentExamplesD5/0.9NS and D5/0.45NSUse Postop when some sodium is neededD5LR
24 Helps to: ↓ edema urine output Stabilize BP Used to maintain fluid intakeCan temporarily be used to treat hypovolemia if plasma expander is not availableSolutions with concentrations greater than 10% must be administered through a central lineAllows adequate dilution to prevent shrinkage of RBCs
25 1. Expand the volume of fluid in the vascular system A client is prescribed 0.9% sodium chloride (normal saline), which is an isotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:1. Expand the volume of fluid in the vascular system2. Pull fluid from the cells3. Keep protein levels normal4. Move fluid into the cellsANS: 1Isotonic solutions such as normal saline, 0.9% sodium chloride, expand the body’s fluid volume without causing a fluid shift from one compartment to another. The remaining options describe the function of other types of fluids.
26 1. Expand the volume of fluid in the vascular system A client is prescribed 3% sodium chloride, which is a hypertonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:1. Expand the volume of fluid in the vascular system2. Pull fluid from the cells3. Keep protein levels normal4. Move fluid into the cellsANS: 2A hypertonic solution (a solution of higher osmotic pressure), such as 3% sodium chloride, pulls fluid from cells, causing them to shrink. The remaining options describe the function of other types of fluids.
27 1. Expand the volume of fluid in the vascular system A client is prescribed 0.45% sodium chloride, which is a hypotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:1. Expand the volume of fluid in the vascular system2. Pull fluid from the cells3. Keep protein levels normal4. Move fluid into the cellsANS: 4Hypotonic solutions (a solution of lower osmotic pressure), such as 0.45% sodium chloride, move fluid into the cells, causing them to enlarge. The remaining options describe the function of other types of fluids.
28 IV sitesPeripheralSuperficial veins of forearm, hand, and scalp of childrenarm veins - commonly usedrelatively safe and easy to enterChose site - does not interfere with mobilityUse most distal site of the arm or hand firstThis permits subsequent IV access sites to be moved progressively upwardIS the antecubital fossa a preferred IV site?NO - Limits mobility
29 Other IV sites to be Cautious OF: Leg veins should rarely be usedhigh risk of thromboembolismavoid vein access distal to a previous IV infiltrationAvoid sclerosed or thrombosed veinsAvoid an arm with an arteriovenous shunt or fistulaAvoid arm affected by edema, infection or blood clotAvoid arm on the side of a mastectomy - impaired lymphatic flow.
30 PICC line (peripherally inserted catheter) Can be inserted by nurses who have had special trainingLong catheter inserted into antecubital vein with tip positioned in superior vena cavaUse for IV antibiotics for several weeks or TPNLess risk of complications
31 Central Line IV Therapy Centrally inserted catheters - special catheter inserted into a large vein in the neck or chest (subclavian or jugular)threaded through into the right atriumtip rests in distal end of superior vena cava
32 Use of CVC’s (Central Venous Catheters) Medication administration• Cancer• Chemotherapy- infuse irritating or vesicant medications• Infection• Long-term administration of antibioticsNutritional replacement• Infusion of parenteral nutrition (PN)• Able to infuse higher dextrose solutions through central line than peripheral line
33 Administration of IV Fluids Use an IV infusion setA drip chamber is connected to the IV bottle or bagflow rate is adjusted to drops per minute (gtt/min) with roller clampInjection ports - located on the IV tubing & on most IV solution bagsallow for injection of medications directly into IV bag or IV lineinjection ports also allow for attachment of secondary IV lines for IVPB medications
35 Phlebitis : inflammation of a vein Signs & symptoms of phlebitisredness, swelling, pain, and edema at the insertion site and/or along the veinTreatment - removal of catheter & application of warm soaks
36 Infiltration : venipuncture device is dislodged from the vein S & S:local edemaskin blanchingskin coolnessleakage at the puncture sitePain & feelings of Tightnessblanching at the siteabsent backflow of bloodTreatment:DISCONTINUE THE iv & MONITOR SITE
37 Which is it? Infiltration redness Swelling pain and edema at the insertion site and/or along the veinPhlebitisedemaskin blanchingskin coolnessleakage at the puncture siteabsent backflow of bloodInfiltration