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

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

3. 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

4. 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

5. 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 mL/24h

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

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

14. Insertion Sites Neck Chest Arm Jugular Subclavian Bacilic Cephalic
Anticubital

15. SAFETY
NO SCISSORS ONCE INSERTED
PREVENT INFECTION

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

17. 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

18. 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??)

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

20. 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)

21. 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

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

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

24. 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

25. 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

26. 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)

27. 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”

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