Unit A
Intravenous Therapy
$ Indications
-to supply fluid when pts are unable to take in adequate volume
of fluids by mouth
-to provide
salts (electrolytes) needed to maintain electrolyte balance
-to provide
for glucose (dextrose), the main fuel for metabolism
-to provide
water-soluble vitamins & medications
-to establish
a direct line for rapidly needed medications
-blood &
blood product administration
$ Calculations
total mL
x drop factor
total hours
x 60 minutes
total mL
x drop factor
time in minutes
-drop factors:
-Macrodrop
(macrodrip) 10, 15, 20 gtt/min
-Microdrop
(microdrip) always 60 gtt/min
-mL/hour:
total mL
total hours
-calculation
of mL/hr when time frame is less than 1 hr:
volume ordered (mL) x 60 minutes
time in minutes
x 1 hr
-this equation
will equal mL/hr
$ Nursing Responsibility
-check infusion at least every hr, timetape IV, check entire
system: from bag to site or from site to bag
- if the IV is infusing by gravity & the IV is infusing too
fast or too slow, check the following:
-position
of the arm
-position
& patency of the tube
-height of
the infusion - should be at least 24-36 inches above site
-possible
complication of the site
$ Complications
-Infiltration
-Phlebitis
-Occlusion
-Nerve, tendon,
ligament damage
-Systemic
complications:
-circulatory
overload
-septicemia
-embolism
-medication
& fluid interactions
-hypersensitivity
reaction
$ Changing Container/Tubing/Site
-CDC recommends tubing be changed every 48-72 hrs
-tubing usually changed at time when container is also being
changed but it can be changed at other times
-IV containers are changed when needed, but at least every 24 hrs
-tubing & containers should be changed anytime contamination
is suspected
-changed of tubing & containers should be documented in the
pt chart & the tubing & containers should be clearly labeled w/date & time changed
-IV sites usually changed every 3-4 days if they are peripheral
sites (check institutional policy)
-PICC sites
& central lines are not changed every 3 days
-Routine site
changes will help prevent complications at the site
$ Discontinuing IV
-need a physician’s order to d/c permanently
-if discontinuing d/t site complication or routine site change,
do not need a Dr. order, as the intent is to restart the IV solution
$ Intermittent Infusion Device
-also called Saline Well/Saline Lock; Heparin Well/Herparin Lock
-used for pts who don’t require continuous IV infusion,
but may require intermittent IV meds or fluids
-Maintenance
of intermittent infusion devices; one technique (SASH)
-S - Saline
-A - Admix
(medication)
-S - Saline
-H - Heparin
(may/not use heparin)
$ Types of Solutions
-Isotonic - osmolarity of 250-375 mOsm/liter (may be 240-340)
-normal saline,
lactated ringers, D5W
-Hypotonic - less than 250 mOsm/liter
(water moves from less concentrated to more concentrated (moves from intravascular space into ICF))
- ½ normal
saline, 1/3 normal saline
-Hypertonic - greater than 375 mOsm/liter
(water moves from less concentrated to more concentrated (moves from intracellular & interstitial compartments to intravascular
space))
- D5/NS, D/5
½ NS
$ Assessing Fluid/Electrolyte Imbalance
-factors affecting fluid & electrolyte balance:
-age, environment,
diet, stress, illness
-Well Hydrated
Person:]
-stable weight from day to day, moist mucous membranes, appropriate
food intake, straw colored urine, elastic skin turgor, mentally oriented, no complaint of thirst, no evidence of dehydration,
no evidence of edema
-Fluid Restrictions:
-usually ordered
by physician
-nursing strategies: monitor what they got on food trays, save
fluids from trays & space throughout the day, ice chips (usually melt to ½ amount given), frequent mouth care w/non-drying
agents
