1. Intravenous fluids/non- pharmacologic pain interventions Lesson 20

2. Objectives The student will be able to explain the purpose of IV/PICC lines and the role of the Nursing assistant in caring for the resident with them The student will be able to list complications that can occur when residents have IV/PICC lines and the role of the Nursing assistant in observing and reporting. The student will be able to describe the sign/symptoms of pain and explain various interventions used to relieve it.

3. Types of IV’s Peripheral sites Located from the center of the body Arms Hands Feet Inner aspect of elbow Forearm Central venous sites Subclavian/jugular veins Close to heart Long catheter inserted into superior vena cava Also use cephalic and basilica veins in arm Physicians or specially trained nurses insert catheter into veins

5. IV/PICC lines uses Administer blood Fluids Nutritional substance Medications such as antibiotics

6. Basic equipment used in IV therapy Solution container IV needle/catheter IV tubing IV pole

7. Responsibility of Nursing Assistant Notify Nurse if No fluid is dripping Blood is anywhere in the tubing The tubing is disconnected The dressing over the site is wet The alarm sounds or the fluid container is empty Resident complains of pain or itching at the insertion site Site appears swollen or discolored Any signs of infection Special care Take extra care when moving or caring for a resident Be careful not to move the needle/catheter Move IV pole to side of bed resident is lying- allow some slack in tubing Never disconnect the IV/PICC lines from the pump Never lower the bag below the site DO NOT take blood pressure in the arm with the IV/PICC line Use good infection control technique and proper hand hygiene

8. Complications Bleeding, puffiness, or redness at the site Hot/cold skin near IV site Pain or itching at or near site Fever Drop in blood pressure Increase in heart rate Irregular pulse rate Cyanosis Mental status change Difficulty breathing Decreased urinary output Chest pain Nausea or vomiting

9. Pain recognition Change in vital signs Nausea or vomiting Sweating Facial grimacing of groaning Crying or tears in eyes Sighing, moaning, or groaning Difficulty breathing Increased Restlessness Difficulty moving Holding or rubbing a body part Tightening the jaw or grinding teeth Increased anxiety Information to gather before going to nurse Vital signs Ask resident to rate pain Determine location of pain Ask resident to describe pain Find out what the resident was doing when pain started Ask when pain started Ask if they have had same pain before

10. Other info on Pain Reasons residents deny pain Worry about becoming addicted to pain medications Dislike side effects of pain medications Residents worried about staff being annoyed with them Pain interventions Proper positioning of resident or repositioning Back rub Cool/warm wash cloth to place or forehead Assist resident to restroom or bedpan Encourage resident to take slow deep breaths Calm environment Be patient, caring, gentle and sympathetic Observe residents response to interventions Follow up on request for pain medications