Fundamentals of Nursing Care Chapter 38 Peripheral IV Therapy

Transfusion reactions

1. Acute hemolytic 2. Febrile 3. Mild Allergic 4. Anaphylaxis (severe allergic) 5. Circulatory overload 6. Bacterial contamination

vein sites to ignore

1. Extends over a flexible joint 2. Feels sclerosed or hardened 3. Is bruised, red, or edematous 4. Lies adjacent to an infected area 5. Has been recently used for IV therapy or is distal to a recent stick site. 6. Is too small for the IV cannula 7. Has a bump or bifurcation indicating a valve 8. rolls

IV therapy purposes

1. Maintaining or providing daily body fluid and electrolytes because of inability to ingest fluids and nutrients by mouth 2. Replacing abnormal or excessive loss of fluids and electrolytes 3. Providing an avenue for IV administration of medications

Safe administration of IV drugs

1. Patient's medication allergies 2. Patient's disease of condition 3. Sterile technique 4. Integrity of the IV access 5. Effects of the drug 6. Correct form of medication for IV use 7. Correct dosage for specific patient's age or weight 8. Type of diluent to use if needed 9. Volume of dilution required 10. Rate of safe administration 11. Expected effects of the medication 12. Possible drug-drug interactions 13. Possible adverse reactions, including the most common and those that are life threatening.

IV tubing styles

1. Primary IV tubing administration set 2. Primary IV administration set by gravity 3. Primary IV administration set by pump 4. Secondary medication (or IVPB) tubing administration set 5. Blood administration Y-set

Winged butterfly

1. also known as "scalp-vein needle" 2. used for shorter infusion times

medication incompatibility

1. flow must be stopped by pinching off the tubbing just proximal to the injection port to be used. 2. 3-10 mL of NS is injected through injection port 3. medication is flushed out of line with another 3-10 mL of NS

puncturing vein

1. may result in damage valve 2. Any time blood pools, there is an increased risk of thrombosis (blood clot)

Glucose

1. required for production of energy 2. Provides calories, or fuel, that will be burned during all cellular functions.

Venous access devices

3-10 mL of sodium chloride or normal saline (NS), prior AND after to administration of IV push medications

Extension tubing

6-24-inch length of tubing inserted between the patient's IV cannula and the primary IV tubing, for the purpose of extending the length of tubing to provide the patient with more mobility or to provide additional injection ports where medications can be injected directly into the patient's IV line.

Thrombus

A blood clot

IV needle cannula or catheter

A needle covered with a flexible plastic cannula that is used to access a peripheral vein and through which IV fluid can enter the vein.

Isotonic IV Fluids

A solution that contains an amount of solute that produces a concentration of dissolved particles equal to that

tape

To secure the VAD

Vitamins

required for various cellular functions such as growth of new tissue.

riding piggyback

similar to y-injection port located on the primary line (IVPB)

tourniquet

to block venous blood return while selecting a vein and making the initial stick.

Antiseptic prep pad

to cleanse the skin site to be punctured.

IV tubing

tubing through which IV fluids may infuse from the IV bag to the patient.

Hypertonic IV Fluids

A solution that has a higher osmolarity or lower concentrations of particles dissolved in it than the concentrations

Precipitate

A substance that forms when one of the agents in a solution separates from the solvent & becomes a solid, insoluble product.

IV infusion pump or controller

An electronic or computerized pump/controller that is manually set to control the volume of solution to be infused and the rate of infusion.

10/mL

Drop factor of 10

15/mL

Drop factor of 15

20/mL

Drop factor of 20

60/mL

Drop factor of 60

increased intracranial pressure

Early signs: 1. Change in level of consciousness 2. Confusion 3. Disorientation 4. Headache increasing in severity 5. Pupillary changes 6.Purposeless movements 7. Restlessness

piercing pin

IV tubing spike

IV Piggyback

IVPB 1. The medication is added to a smaller volume of IV solution, usually a volume between 50-250 mL of either 0.9% NS or dextrose 5% in water (D5W) 2. Infused over 15-90 minutes, depending on medication

INS

Infusion Nurses Society

Extravasation

Leakage of vesicant IV fluid or medication into the tissue surrounding the IV insertion site.

Plasma

Liquid portion of blood

Hypotonic IV Fluids

Lower osmolarity or, lower concentration of particles dissolved in it than the concentration in fluids of the body

IV Push

Many medications must be diluted in 1-10 mL of NS prior to IV push administration

Flange

On the proximal end of an IV tubing just below the piercing pin the hard plastic projecting that provides a place for your fingers to push IV solution bag without contaminating the sterile piercing pin.

Label

Placed on the site dressing with date and initials to indicate when the IV access was started

Packed red blood cells (PRBCs)

RBC separate from plasma

Speed shock

Shock caused by the rapid IV infusion of medication/solution

Vesicant

Something that causes blistering, necrosis, and sloughing tissue.

Nonvesicant

Something that does not cause blistering and the death of tissues

patent

Something, such as a PRN device that is open

IV push safety

The administration of IV push medication requires that the medication be compatible with the IV solution as well as any medications that have been added to the solution.

hypovolemia

The dropping of oxygen levels in the blood below the normal range.

Drug-drug interaction

The interaction of two drugs that causes a change in the activity or components of one or more drugs.

infilitration

The leakage of nonvesicant IV fluid or medication.

Cannulation

The process of advancing the IV cannula into the vein.

hypertonic dehydration

This process makes a hypotonic solution good for use in patients who need simple water replacement because of lack of fluid intake or loss of body water without loss of electrolytes.

IV push

This route is commonly used in emergencies, surgery, and other situations in which immediate results are desired.

bifucartions

Veins separate into two branches

VADs

Venous access devices

rate of infusion

Volume x dropfactor ----------------------- Time

IV start kit

a small kit containing generic supplies required to initiate an IV access device.

IV push

advantages AND disadvantage IF incorrect drug or dosage is administered, the unintentional blood level and effects of the wrong drug are IMMEDIATE, sometimes harmful to patient.

slide clamp

allows solution to flow or stops the flow

roller clamp

allows you to not only start or stop the solution flow but also regulate the rate of infusion by rolling the clamp either tighter or looser.

IV components

common: glucose, electrolytes, vitamins, and amino acids

good vein

feels slightly rounded, spongy, resilient or elastic, and bouncy, but not flat

IV start kit

includes: 1. Tourniquet 2. Antiseptic prep pad 3. sterile 2x2-inch (5x5-cm) gauze pad 4. Sterile 2x3-inch (5x7.6-cm) transparent occlusive, semipermeable adhesive dressing (TOD) 5. Label 6. Tape

PRN lock

intermittent infusion device

Intravenous Fluids

made of water to which various percentages of components have been added.

IV push

medication is injected directly into the vein using a needle and syringe.

y-injection port

nearest the insertion site of a primary IV line with continuous infusion of IV fluids.

electrolytes

necessary to maintain homeostasis of fluids and electrolytes, which contribute to correct function of all body systems.