chapter 3 IV piggyback
safety alert intravenous Solutions safety
a plastic bag of solution maybe squeeze to check for leaks any solution that has discolored or has small particles a white cloud or film in it should not be used if there is no vacuum in a bottle when it is open the solution may be contaminated gently invert the bag or bottle and hold it up to the light so you can see if there are any particles floating in it always wash your hands just before handling IV fluids and Equipment the port on the IV tubing into which the administration set of a piggyback medication is to be attached must be carefully and thoroughly wiped with the first alcohol swab scrubbing thoroughly for 15 seconds before the tubing is attached to the container the IV administration of fluids requires the same safety precautions as any other medication follow the six rights and the additional rules for Drug Administration the label must read and compared with the order of the mar 3 times to ensure that the correct solution is being given to the correct patient the patient's ID band must be checked each time a solution is administered used to Patient identifiers before Administration older people and those either renal or cardiac conditions cannot tolerate rapid administration of fluids check IV infusions for these patients every 30 minutes whenever a patient who is receiving an IV Fusion his out of bed recheck the drop rate once he is back in bed the fluid drop rate often changes when the patient is up and moving around
the six rights apply to intravenous therapy
be sure you have the right solution with or without additives as ordered the correct solution to follow what has been infusing the right dose amount of solution and additive as ordered the right route perfume intervene is for fully inserted Central catheter PICC central line Port the right time to infuse the right patient as identified with two identifiers the right documentation additionally teach the patient the reason for administration of the fluid and or drug and signs and symptoms of the problem to report to you check for drug and latex allergies be aware of potential interactions with IV medications or irrigating Solutions maintain sterile Italy of all solutions tubing and connections
complications of intravenous therapy and nursing interventions
infiltration- arm swollen tender cool to the touch IV catheter may or may not have blood return- nursing intervention remove IV catheter and restart IV Fusion in the other extremity extravasation- pain at insertion site tender and cool to the touch IV flow slows edema burning pill fluid leaking around catheter tissue slogging may occur in one to four weeks- nursing intervention stop infusion immediately if drug is involved aspirate from short canola then remove the IV catheter after injecting an antidote through the IV catheter if one is available and restart in the other extremity apply cold compresses if not contradicted photographs site monitor site for 24 hours provide written instructions for patient and family phlebitis- laying hardwood skin red swollen tender warm blood return present IV infusion may or may not be sluggish- nurse intervention remove IV catheter document apply warm moist pack to the IV site restart IV infusion and other extremity monitor frequently thrombophlebitis- site red tender warm IV infusion sluggish- nurse intervention never irrigate the IV catheter removed IV catheter notify the provider restart IV infusion and opposite extremity apply cool compresses initially followed by warm compresses IV site skin infection- site hot red painful but not hard or swollen IV infusion sluggish- nurse intervention remove IV catheter restarting opposite extremity change and tired ministration system cleanflight with alcohol apply warm compresses May send tip of the catheter for culture venous spasm- flowing of infusion rate cramping or pain at or above the insertion slight numbness in the area and ability to withdraw peripherally inserted Central catheter pic or midline catheter- nursing intervention slow infusion rate and add apply warm compresses do not apply tension to catheter or forcibly remove it encourage consumption of warm liquids keep extremity covered and dry nerve damage- tingling pins and needles feeling or numbness at or below the catheter insertion site- nursing intervention immediately stop the canola insertion if patient complains of severe pain is Sensations do not go away at once the catheter is secured remove the catheter catheter embolus- decrease in blood pressure BP pain along vein weak rapid pulse cyanosis of nail beds loss of consciousness- nursing intervention remove IV catheter and inspect place the tourniquet high on the limb of IV site notify provider obtain x-ray prepare for surgery to remove pieces systemic complication infection- fever chills General malaise- nursing intervention change the infusion system notify the provider obtain cultures as ordered Speed shock- lightheadedness or dizziness flushed face their regular pulse decrease blood pressure loss of consciousness cardiac arrest- nursing intervention stop the infusion notify the provider monitor Vital Signs frequently run dextrose 5% and water a day keep vein open rate circulatory overload- shortness of breath tachypnea increase blood pressure moist cough crackles puffiness around eyes and dependent edema- nursing intervention Elevate head of the bed keep patient warm as this for edema slow the infusion rate notify the provider administer oxygen and diuretic as ordered
safety alert no margin for error
intravenous therapy may become such a commonplace procedure to nurses that they are tempted to be complacent about it however it should never be thought of as a routine procedure that requires little attention any fluid or medication that enters the vein has an immediate effect there is no margin for error and it's a ministration safety alert flushing intravenous catheters do not use more than 30 ml's of bacteriostatic normal saline within a 24-hour period to flush the catheter always use single those files or syringes of solution for flushing do not use multi-dose vial for this purpose because it may be contaminated and could cause infection safety alert Total parenteral Nutrition safety precaution the flow rate for t-pn solution has never changed to ketchup on the amount of fluid that should have been infused if the flow has slowed for some reason the hypertonic solution can draw fluid into the vascular system causing fluid overload
intravenous therapy guidelines
keep intravenous IV fluid sterile make sure that everything coming in contact with the solution is sterile including the inside surface of the canola Hub and all connecting points between the bag and the drip chamber and between the tubing in the needle protect a canola site from contamination to prevent possible infection an airtight transparent dressing is used over the canola site keep tubing free of air clear tubing of air before connecting to the canola do not allow the current bag to run dry before changing to the next one hang fluids at the correct height fluid flow through the tube by the force of gravity if there is any negative pressure in the IV line blood will flow back into the tubing keep the bag of fluids efficiently above the level of the canola site to maintain float but a boy having it too high because the significant increases the effect of gravity carefully regulate the rate of flow if the IV infusion is behind schedule do not open up the clamp and run it in a large amount of fluid at one time to catch up rather recalculate either the span of time for the infusion or the rate of drops per minute for the fluid to run and the ordered rate track and take nap put when a patient is receiving IV fluids or blood keep accurate intake and output records and compare intake and output over 24 hours the solution to run Inn first should be hung the highest when a second bag is attached piggyback to a primary IV line lower the primary bag without clamping the tube so it will begin to flow when the piggyback has run in attached the piggy back underneath the roller clamp on the primary tubing assessor site frequently for signs of complications infiltration swelling of the IV site irritation of the vein formation of a clot stopping the flow or systemic reaction should be identified quickly signs of infiltration or pain and discomfort at the site caused by dislodgement of the needle or puncture the vein Vital sign should be taken several times a day to detect early signs of infection and adverse reaction
safety alert intravenous lawn connection safety
when connecting an IV solution or disconnecting a line always trace the line to where it connects to the patient to make certain that the IV line and connects to the ivy any IV device many mistakes have been made when IV fluids have been connected to the wrong device
clinical Clues
when heparinized saline is required to keep the Lumen of the catheter Peyton use the volume of the solution that is equal to twice the volume of the catheter lumen with the extension set or connectors added on this will usually be between 5 and 10 mL check your facilities policy