IV Unit 4
Blood and Blood Products
Adultshaveabout5litersofcirculating blood • Bloodisthemaintransportsystemfor - Oxygen - Nutrients - Hormones • Infusingbloodorbloodproducts - Restores circulating volume - Improves the ability of the blood to carry oxygen - Replaces blood components such as clotting factors
Air Embolus
Air enters the heart and causes it to work harder • Air can enter anytime the IV system when the tubing or catheter become separated. • More common in central lines than peripheral lines • Canleadtodecreasedcardiacoutput,shock,and death. • S/S:respiratorydistress,mid-chestandshoulder pain, nausea, lightheadedness • Treatment: Close off the catheter immediately by closing the clamp or kinking the tubing, place the patient on their left side, head down, start oxygen and notify MD or rapid response team, monitor vital sig
Hypersensitivity Reaction
Allergic reaction • Check with patient and medical record for information about allergies or family history of allergies. • S/S:rash,itching,tearingeyes,runnynose, bronchospasm (constriction of the airways), wheezing, anaphylaxis • Treatment: Stop the infusion, notify the MD or rapid response team, Maintain the IV device by hanging a continuous IV of saline or saline lock, maintain a patent airway, support respirations, May need epinephrine, antihistamines, steroids
Documentation During IV Therapy
Always document the IV site care that you give, include the appearance of the site, and patient's response. • Your facility may require hourly, daily, or shift assessments as well as any unusual signs and symptoms
Additives - Parenteral Nutrition- through IV
Anadditiveisanysubstancethatisnotpartofa commercially available product • ParenteralnutritionistheIVinfusionof - Amino acids - Dextrose - Fat - Electrolytes - Vitamins - Trace elements § MD must reorder TPN every 24 hours!
Preparation of Supplies and Equipment
AppropriateIVcannula - Type and size based on patient evaluation, order, and purpose for infusion - Have at least two cannulas available • Appropriatefluidadministrationset • Checkprescribedfluidagainsttheoriginalphysician's order • Checkexpirationdateoffluids • RecordonIVflowsheet,computer,orMARoncetheIV is started
Abbreviations in Documentation
Avoid using dangerous or ambiguous abbreviations which can lead to medication errors. • TJC has developed a list of abbreviations to be avoided. "The Do Not Use Abbreviation" list in National Patient Safety Goals
Special Populations - Geriatric
Avoidthebackofthehand - Lacks skin turgor - Limited subcutaneous tissue • Superficialveins - Weaker - More prone to infiltration • Mayonlyneedhandpressureratherthan tourniquet • CarefullymonitorinfusionrateandVS - Always use pump - Avoid fluid overload
Peripheral Veins
Basilic vein - Along ulnar portion of forearm - Fairly large - Numerous valves Median cephalic and median basilic veins - Antecubitalfossa - Not good for prolonged infusions Median antebrachial vein - Ulnar side of forearm - Not easily seen
Blood Label
Blood products come to your unit labeled for a specific patient. The bag itself is labeled with the unit number, the type of blood product, the type of donor, the preservative, the expiration date, the blood type, the Rh factor. • When blood is administered, 2 licensed healthcare personnel must check the label and patient identifiers. Checking the blood is within the scope of the Mississippi LPN
Preparation of Supplies and Equipment
Cannulation and site supplies - Disposable pad/towel - CHG prep pad - Antiseptic swab - Tourniquet - Tape - precut - Disposable gloves - Gauze - Clear dressing - Time strip for IV fluid bag - Label
Peripheral Veins
Cephalic veins - Forearm • Provide natural splint - Accommodate larger catheters • Accessory cephalic vein - Back of forearm - Accommodates larger catheters
Screening Before an IV Infusion
Check for allergies - Medications - Tape - Latex - Alcohol, chlorhexidine, or povidone iodine • Check for conditions affecting placement - Do not start distal to edema, cellulitis, burns, injury, etc. - Do not use arm with fistula for dialysis - Do not use extremity with paralysis or poor circulation - Do not use the arm on same side as mastectomy
Discontinuing an IV
Check the MD order • Gather supplies: cotton ball or gauze, bandaid, tape, exam gloves • Wash your hands • Explaintheproceduretothepatient • TurnoffIVfluids/pump • Loosenthetapeinthedirectionthatthehair lays and put on gloves • Remove the catheter smoothly • Applypressureonsitefor2-3minutes • Apply bandaid or dressing after bleeding stops
IV Access
Conditions that may lead to difficult venous access include: skin lesions, rashes, sclerosing (hard) veins, obesity, edema, elderly fragile veins, dark skin • Use smallest diameter catheter necessary for intention, stabilize the vein by holding the skin taut, remove tourniquets after 1-2 minutes, displace edema by pressing downward, for obese patients you may need a longer cannula
Documentation
Date and time of insertion • Size of catheter • Site of insertion • # of attempts • Patient's response to procedure • Patient education
Special Populations - Obese
Difficult to see and palpate veins • Tips - Warm compresses for vasodilation - Displace edema and extra tissue - Useanatomicallandmarks • Superficial vein on thumb side of wrist - Use multiple tourniquets
Peripheral Veins
Digitaldorsalveins - Lateral portion of fingers • Location is easily accessible - Small-gauge catheters • 22- or 24-gauge - Require support • Prevent loss of flow when finger bends - Not a primary choice
Peripheral Veins
Dorsalmetacarpalveins - Back of hand - Most distal site of extremity • Good first choice - Require support to prevent movement of catheter-hand board
Caring for the IV Site
Each time you enter the patient's room, you need to observe the patient's IV site. • Look for moisture, oozing, or bleeding around or on the dressing. • Ask about pain at the site. • Observe for swelling. • Make sure the dressing is not loose. • All loose, damp, or visibly soiled dressings need to be changed immediately
Ensuring Accurate I&O
Educate the patient on how to help keep record of I&O Write down everything they drink and the amount Show them how to measure urine or instruct them to call to have it measured Ask the family and visitors not to eat off the patient's tray
Documenting IV Therapy
Every healthcare facility requires accurate and complete documentation of IV infusion. • Forms and frequency will vary according to facility but the information to be documented is essentially the same.
Explain the procedure to the patient- have the patient turn their head away from the CVL site • Using non-sterile gloves, carefully remove the old dressing • Observe the insertion site for redness, edema, drainage, etc • Remove the non-sterile gloves. • Put a mask on the patient and yourself • Open the sterile dressing kit • Don sterile gloves
Explain the procedure to the patient- have the patient turn their head away from the CVL site • Using non-sterile gloves, carefully remove the old dressing • Observe the insertion site for redness, edema, drainage, etc • Remove the non-sterile gloves. • Put a mask on the patient and yourself • Open the sterile dressing kit • Don sterile gloves
Special Populations - Pediatric
Explaincarefullyifpatientisold enough to understand - Appropriate language - Be honest - DO NOT have parent restrain child - Immobilization - hold or
Site Selection for Peripheral IVs
General rules for site selection - Start distally (lowest) and work proximally (up the arm) - Avoid patient's dominant hand • Use feet or legs only if arms are inaccessible- needs MD order • Specific rules for site selection - Choose peripheral veins that are • Straight and large • Easily accessible • Surrounded by healthy subcutaneous tissue • No valves- look and feel like small knots in vein
TPN
Has to be reordered daily by MD • Tubing is changed daily with new bag of fluid • Due to high sugar content, finger- stick blood glucose is checked every 6 hours • Can not be d/c'd abruptly, must be tapered off • If the bag runs out, hang D10W until pharmacy delivers a new bag
IV Removal Problems
Hematoma: mass of partially clotted blood that has infiltrated into the tissues, usually accompanied by ecchymosis (bruising). • To prevent: hold direct pressure on IV site for 2-3 minutes with a sterile gauze pad, elevate arm over patient's head or on a pillow. Apply moist warm or cool compresses
Intake and Output Records
I&O sheet- keep in patient's room • Graphic sheet • I&O record in chart- always have the amounts recorded by the end of shift • Clear pump amounts at the end of shift (IV pumps and Feeding pumps) • Empty and measure all drains (wound drains, NG, catheters)
Shift to Shift Reports
IV care requires round the clock care. • During shift report you need to know what has occurred for a particular patient. • You need to know when an IV was started, the site, whether it is infusing on schedule, and the condition of the IV site. • You need to know what fluid is infusing and the amount left to co
Patient Identification and Screening
Identify the patient using two forms of identification - Ask the patient to tell you his or her name - Ask for date of birth or hospital number or other unique identifier - Never use room number as a form of identification • Alsocheckpatientidentityagainst - Hospital arm band - Fluid label - MARorIVflowsheet
Initiation of Peripheral IV Therapy
If successful with cannulization of the vein - Advance the catheter until the hub is touching the skin - Release tourniquet - Apply gentle pressure over the vein proximal to the entry site to prevent blood flow - Remove needle from catheter • NEVER reinsert needle into catheter - Dispose of needle appropriately - Connect tubing and begin infusion at appropriate rate
Pharmacy Label
If the pharmacy prepares the IV solution, the bag will be labeled with the patient's name and unique identifier, the type and amount of solution, the type and amount of the additive, the infusion rate, the date and time it is to be infused, the expiration date, and the initials of the pharmacist who prepared the admixture.
Phlebitis
Inflammation of the vein due to mechanical or chemical causes. • Mechanical causes: using a large catheter in a small vein, improper securing of the IV, over-manipulation of the IV catheter, prolonged use of the same IV site • Chemical causes: irritating or vesicant medications that are acidic or alkaline or that have high osmolarity. (Erythromycin, Nafcillin, Vancomycin, Amphotericin B, Potassium)
Labeling
Labels must be legible, must provide all relevant information about the cannula, dressing, solution, medication, and administration set. • When you start a new IV, you must label the insertion site with the date and time the IV was started, the gauge and length of the catheter used, and your initials. • Short peripheral IV's are intended for short term use of less than 7 days • All tubing sets need to be labeled with date and time hung and your initials
Complications of IV Therapy
Localized complications: infiltration, phlebitis, extravasation of vesicants Systemic complications: Air emboli, fluid overload, sepsis, hypersensitivity reaction
Rh (Rhesus) Factor
Major inherited blood antigen - Blood is either Rh-positive or Rh-negative - Donor and recipient should match for Rh factor • Initial exposure of a Rh-negative recipient to Rh-positive blood generally does not cause a reaction • Future exposures to Rh-positive blood may result in a hemolytic reaction
Monitoring IV Therapy
Monitor the insertion site regularly. Document you observations and report problems to the MD or your supervisor. • Look for signs of infiltration, inflammation, phlebitis, pain, observe vital signs for signs of hypertension and shortness of breath.
Culturing an IV Catheter Tip
Occasionally, if the IV site must be d/c'd due to inflammation or infection, the MD will order that the catheter tip be sent for culture. • Cut off the tip of the catheter with sterile scissors and place the tip in a sterile container. Label the specimen and fill out any lab requisition forms. Take to lab. Document this procedure in your notes.
Extravasation
Occurs when vesicant drugs infiltrate into the patient's IV site and surrounding tissue. • Vesicant drugs can lead to major tissue damage and requires immediate treatment. • Extravasation is always graded as a Grade 4 on the Infiltration Scale. • Treatment: Stop the infusion immediately, do not remove the catheter because it may be needed to administer antidote into the tiss
Blood Administration
Oneunitofbloodmustgoinby4 hour time limit • INS recommends changing the blood tubing after 4 hours - 2 units can infuse through same tubing IF they can be infused in the 4 hour window
Changing the CVL Dressing
Open the sterile swabs. Use one swab to clean from the insertion site outward in circles. Repeat x 2. • Apply antibiotic disk over insertion site. • Apply sterile clear dressing. • If it is policy to change the injection ports, close the clamps on each line so that air will not enter. Remove the port. Without touching the sterile tip of the new port, attach it to the line. • Remove gloves and masks • Label the dressing and document
Preparation of Supplies and Equipment
OpenclamponadPreparation of Supplies and Equipmentministrationsetandflush tubing (priming the tubing) - Follow manufacturer's recommendations, especially for pump tubing • Closeclamp • Ifusinginfusionpump,programparameters • Takeallsuppliesandequipmenttobedside
Administration of Nutrients
Parenteral nutrition is IV infusion of nutrients, amino acids, dextrose, fats, electrolytes, vitamins and trace elements (TPN) • Requires the use of a large vein usually a central venous line • The LPN may not hang TPN- can observe flow rate and patient reaction (frequent glucose monitoring)
Patient Preparation
Patient preparation - Explain procedure and purpose for the IV • Use nonmedical terms when possible • Answer any questions • Teach about post-IV insertion care • Psychological preparation - Allow the patient/family member to express fears and concerns - Validate the patient's/family's feelings
Patient Preparation
Physicalpreparation - Ensure patient comfort and privacy - Change to an IV-style gown, if available - Clip hair - never shave - around the potential IV site - Apply topical anesthetic cream or prepare subcutaneous injection of local anesthetic such as Xylocaine, if used and if part of your scope of practice
Blood and Blood Products
Plasma - liquid component of blood • Cellular components of blood - Erythrocytes (red blood cells or RBCs) - Leukocytes (white blood cells or WBCs) - Thrombocytes (platelets) • Blood components that can be infused are - Whole blood - Packed red blood cells (PRBCs) - Leukocyte-poor RBCs - Platelets - Fresh frozen plasma (FFP)
Site Dressings and Changes
PoliciesonchangingIVsites:ManyfacilitieshaveNOtime limit on leaving the IV in place as long as the site is without redness, edema, and flushes well • IVtubingischangedperinstitutionpoliciesand procedures- Intermittent IV tubings may change daily or even between uses to decrease the incidence of IV infections • Agauzedressingischangedevery48;atransparent semipermeable membrane dressing is not changed unless obviously soiled or if infection or inflammation is present • IVF'sarechangedevery24hourstopreventcolonization • IfyoucannotverifywhentheIVwashung,youneedtotake down the IVF and tubing and put up a new set.
Implantable Ports
Port-a-cath, Mediport, Infusaport • Inserted in surgery by MD • Small reservoir is implanted under skin of chest, tubing is threaded to superior vena cava or right atrium • Can be used for long-term use as in chemotherapy • Reservoir must be accessed by a trained RN using a special needle called a huber needle • Treated as a central line
Initiation of Peripheral IV Therapy
Prepare tape • Put on disposable gloves • Reapply tourniquet 4-6 inches above insertion site • Clean site using circular motion from inside outward - Follow facility policy/procedure- chlorhexidine used be used 0 unless the patient is allergic-alternatives to use are iodine or alcohol
Common Problems and Solutions
Problems can occur thoughout the process from insertion to removal. • Common problems include: difficult insertion, IV will not infuse at correct rate, the IV site develops problems after the IV catheter is removed. • Document the problem encountered, the actions taken, and the patient response
Common Problems and Solutions
Problems with IV therapy can occur throughout the process, from insertion to removal. • Common problems: difficult insertion, IV may not infuse at correct rate, IV site may develop problems after the IV is removed • Document the problem encountered, actions taken, and patient response.
Preparation of Supplies and Equipment
Provideforprivacyandassistpatienttoa comfortable position- best to have patient lying on back • Raisebedtocomfortableworkingheight • Washhandsoruseahandsanitizer • DO NOT use unfamiliar equipment; ask for assistance
Factors Affecting Flow
Raising the height of the container will improve a sluggish flow. • Flow is directly proportional to the diameter of the IV tubing, IV catheter, and vein. • The longer the tubing, the slower the flow. • Thicker solutions like blood require a larger cannula. • Higher BP makes the infusion go slower • Warmer solutions go faster than cold solutions
Blood and Blood Products
Replace components via transfusion - Infuse only with normal saline - Autologous • Blood obtained from the recipient • Decreases the risk associated with transfusions - Donor • More readily available • Must be carefully screened and tested to ensure safety • Typed and cross-matched with the recipient to confirm compatibility
Initiation of Peripheral IV Therapy
Select vein - Palpate to assess elasticity and rebound filling - If unable to locate vein • Gently stroke the vein - elicits a mechanical reflex dilation of vein walls- DO NOT slap, tap, or hit the vein!!! • May use an inflated BP cuff to distend the vein for these patients • Warm, moist compress - vasodilation • Move tourniquet to forearm or try other arm
Peripheral Veins
Similar to arteries - Transport blood at lower pressure - Thinner than arteries • Three layers - Outer layer of tissue - Middle layer of muscle - Smooth inner layer of epithelial cells • Receive waste-rich blood from capillaries and transport it back to heart and lungs
Site Selection for Peripheral IVs
Situations may dictate site selected - Emergency care • Forearms • Median cubital vein in the antecubital fossa - Trauma • Median cubital vein in the antecubital fossa - Accommodates large-bore needles - Easy to access in an emergency - Children and infants • Scalp veins - Newborns • Umbilical vessel- MD or NP must place
Prevention of Phlebitis
Slow down the infusion rate • Dilute the medication • Start with smallest catheter that will be appropriate for the solution. • S/S: erythema (redness), tenderness at the site, warm to touch, elevated temperature, can go into local infection and/or sepsis • Treatment: stop the infusion and remove the device, elevate, apply warm moist compresses
Site Selection for Peripheral IVs
Specific rules (cont.) - Use largest, most prominent vein for first attempt - Use upper extremities in order of preference • Dorsal surface of hand • Radial and ulnar veins of forearm • Cephalic vein • Basilic vein • Avoid the antecubital space - Lower extremities in order of preference (Last resort only!) • Dorsal surface of foot • Saphenous vein of ankle
Initiation of Peripheral IV Therapy
Stabilize vein with your nondominant hand below insertion site- pull the skin taut - Prevents vein from rolling - Facilitates cannulation by increasing surface tension • Insert catheter, bevel up- at 10-15 degree angle - Quick, short, jabbing motion till resistance is met - Avoid penetrating vein - Lower needle angle - Piercevein-youshouldfeelapop - Advance catheter slightly
Initiation of Peripheral IV Therapy
Starting an IV is a skill that improves with practice • Ask for assistance if you think you will be unable to start an IV on a particular patient - Prevents undue discomfort for the patient - Prevents frustration for you 0 • Assess veins on nondominant arm
Treatment for Infiltration
Stop the IV from infusing and remove the catheter. Elevate the arm and apply cool compresses for the first 24 hours for hyperosmolar solutions or moist heat for isotonic or hypotonic fluids • Some healthcare institutions require that an occurrence form (incident report) be filed. • A new IV should be started in the patient's other arm if possible
Initiation of Peripheral IV Therapy
T ape catheter in place • Applytransparent dressing over site - Label site • Recheckflowrate • Disposeofsupplies appropriately • Document procedure
Flow Rates
The most common problems with IV infusions are related to infusion (flow) rate. • Poorly regulated infusions can lead to fluid overload, overdosing, or underdosing of medication, clogged catheters, phlebitis, and infiltration. • Factors can be equipment related, patient related, or vein related.
Changing the Dressing
The procedure for applying or changing an IV dressing varies depending on the facility policy and on the type of equipment you are using. • Avoid using nontransparent unsterile tape over the entry point of the catheter. The site should remain visible so you can check it for complications. • Stabilize the IV with tape and/or Stat-lock to prevent accidental removal.
Factors that Affect Slowing of Infusion
Thesolutionbagislowerthan36inches above the IV site • TheIVsiteistapedtootightly • Theclamponthetubingisclosed • Thetubingiskinked • The gauge of the catheter is too small to accommodate the fluid being infused • Bloodhasbackedupinthetubing • The line contains air bubbles • The patient has bent the elbow or wrist • The IV is infiltrated
Peripheral Veins
Valves in the veins - Prevent backflow - Allowbloodtoflowagainst force of gravity • Avoid - Accessing a vein near a valve • Catheter can be come occluded when the valve closes if the tip lies within the valve - Locations at which veins cross over joints - Areas near previous IVs or venipunctures
Special Populations - Pediatric
Venipuncture sites - Upper extremities preferred • 1st choice - forearm veins • 2nd choice - tributaries of cephalic and basilic veins, dorsal venous arch • 3rd choice - ventral surface of wrist on inner aspect of wrist • Alternative sites - Scalp veins for infants less than 1 year old - Saphenous vein - last resort site - Check facility policy before using these sites
Preparation of Supplies and Equipment
Washhands • Closeclamponadministrationset • Spikebagwithquicktwist - Do not contaminate spike • Filldripchambertomark,about1⁄2-1/3full
Documentation of IV Discontinuation
When you d/c an IV, look closely at the insertion site and document what you observe. • Include: 1. The date and time of discontinuation 2. The reason for discontinuation 3. The condition of the catheter 4. Whether the catheter was intact 5. Follow-up measures 6. Any S/S of infection or inflammation
IV Initiation
When you insert an IV, you must document: size and type of catheter, the number of attempts, the date and time, the site of insertion, the type of solution and additives or medications, the flow rate, the pump information, the type of dressing applied, your name and initials. Include any patient education that you provide. Only the person who starts the IV should chart this information
Infiltration
• A localized complication that occurs when the IV catheter is improperly placed or secured or becomes dislodged or because the veins are too thin and fragile. Fluids leak into surrounding tissues. • S/S: swelling, discomfort, burning, tightness, cool skin, and blanching, the IV stops running or slows down. Can lead to nerve and muscle damage if severe.
Initiation of Peripheral IV Therapy
• Advance catheter - Till flash of blood is observed - Tilt needle slightly backward and advance to ensure that it is in the vein • If you do not see a flash of blood - Slowly withdraw catheter slightly and attempt to reposition - DO NOT pull all the way out of the skin unless you are unable to access the vein - Remove tourniquet before pulling out the catheter - DO NOT try more than two times
Rate Label
• All parenteral solutions are labeled with a rate label or a time-strip label. • The label lists the name of the patient, the type of solution, and any additives, the initials of the person hanging the bag, and the time the solution started. • Most IV's are administered through IV pumps, but the time-strip is a good back-up to have on the bag.
Administration of Blood
• Blood must be hung within 30 minutes of pick-up from lab • Prime blood tubing with Normal Saline (9% NACL) • Double check all patient and blood id with another licensed nurse at the patient's bedside-both sign blood adm. form • Take vitals signs before starting blood, 10-15 minutes after starting, then according to facility P&P and record
Blood and Blood Products
• Careful cross-matching for blood type and Rh compatibility can prevent transfusion reactions - Transfusion reactions can be caused by other antigen/antibody reactions that were introduced during prior blood transfusions • Know your role in the transfusion process - Verification - Patient identification - Hanging/starting transfusions of blood or blood products - Monitoring for reaction
Documenting the D/C
• Chart the time of discontinuance, the condition of catheter, and condition of site • For example: 0930 IV d/ced from right forearm with catheter tip intact. Pressure held till bleeding stopped. Bandaid applied. No redness or swelling noted at site. N. Nurse SPN
Patient Identification and Screening
• Compare the medication or fluid with the physician's order - When you obtain it from the pharmacy or from the supply area - During preparation - Immediately prior to starting the infusion • Scanning, if available, assists in verifying patient identification and in ensuring that the correct medication/solution is given
CVL Dressing
• Consult Facility policy for due date for changing the dressing on a CVL- INS recommends a change every 7 days • If the facility uses an antibiotic impregnated disk over the CVL insertion site, the dressing is typically changed weekly. • The CVL dressing change is a STERILE procedure. • RN's and LPN's can change the CVL dressing
Common Problems that you will Encounter
• Container is empty • Solution is infusing faster or slower than scheduled • Site is red, sore, or swollen • Tubing is disconnected or leaking • Needle is out of place
Screening and Monitoring During IV Administration
• Follow identification process for each new IV fluid container - Prepare solutions and/or IV medication for only one patient at a time • Review medical record and physician's orders for any changes • Reassess patient and answer any further questions • Monitor fluid container and infusion pump to ensure accurate delivery rate
Fluid Overload
• IV infuses too rapidly or patient cannot tolerate increased amounts of fluids • S/S: respiratory distress, neck vein distention, increased BP • Treatment: slow the IV rate to KVO and notify physician, place patient in Semi-Fowler's position, MD may order diuretics to pull off excess fluid and order O2 to improve respiratory status
IV's and Anticoagulants
• If your patient has received aspirin, coumadin, or heparin, they may have increased tendency to bleed. • Therefore when you d/c their IV, hold pressure for as long as necessary to stop bleeding.
IV Pumps
• Instruct the patient and the family members about the function of the IV pump and what to do if the alarm sounds. • Explain that the pump should not be turned off, the settings changed, or alarms silenced. • TJC patient safety goal #6 Alarms should be loud enough for nurses to hear and should be attended to immediately
CVL's and LPN's
• LPN's cannot access CVL's, draw blood from, or hang medications to CVL's. • LPN's can change CVL dressings and monitor flow rate • Must have a RN to hang IVF's and medications and to draw blood for labs • An MD must insert a CVL under sterile conditions
Peripheral Veins
• Less commonly used sites - Veins of legs and feet - Veins on ventral surface of wrist • Not ideal choice because of nearness to arteries - Scalp veins • Children and infants • Small-gauge, short-length, winged scalp vein need
Cellulitis
• Localized infection-can lead to sepsis (bloodstream infection) • S/S: extremely red and/or purulent drainage • Treatment: stop infusion, remove the catheter, notify the physician, elevate, apply moist warm compresses
ABO Blood Groups
• Mismatched donor blood/recipient - Hemolytic reaction • Can occur with as little as 10 mL of blood/blood product • Antibodies to blood antigens attach to red blood cells, causing clumping - This activates the body's immune system, which destroys the red cells and releases hemoglobin - Hemoglobin can lead to renal failure • Symptoms - Rash/Hives - Headache - Chest pain - Chills and fever - Back pain/flank pain - Shortness of breath
Screening and Monitoring During IV Administration
• Monitor I & O and vital signs - Report fluid imbalances • Observe the IV site - Check at regular intervals and whenever you enter the room - Check for signs of phlebitis and infiltration • Redness • Swelling • Warmth - Check for moisture around site
Documenting Fluid Balance
• Most adults should take in 1500-2000 ml/24 hours • Fluid intake and output will not be equal, since fluids are lost in sweat, respirations, defecation etc. Urine output should be 1/3 to 1⁄2 of fluid intake. • Intake: Oral fluids, IV fluids, enteral feedings • Output: urine, wound drainage, tube drainage, diarrhea, vomiting • All patients on IV's need to be on I&O
Administration of Blood
• Need written consent of patient in most facilities • Need to order Type and Crossmatch for type of blood product order • Lab will apply a blood ID band to patient • Make sure patient has a patent IV with a catheter size of 18 or 20g • When the unit (s) are ready, follow facility procedure for picking up blood from lab
IV Acess
• Not all patients have easily accessible veins. • Conditions making venous access difficult: skin lesions, rashes, sclerosing (hard) veins, obesity, edema, dark skin. • Uses smallest catheter for IV intention, may need longer cannula for obese patients, fluid can be displaced by pressing downward over access site, remove the tourniquet after 1-2 minutes, do not apply tourniquet tightly
Administration of Blood
• Observe patient for signs of blood reaction- sudden spike in temperature, hives, rash, shortness of breath, rapid change in BP and/or pulse • If s/s of reaction-STOP BLOOD! Notify MD and lab- take down all tubing and Blood-send to lab • Hang an IV of 9%NS • Follow facility P&P after reaction
PICC's
• Peripherally inserted central catheter (PICC) - uses a large vein in the arm and catheter line is threaded into the superior vena cava or right atrium • Can be inserted by radiologist or nurse trained in insertion • Can be left in place for weeks or months • Considered as a central line • X-ray is taken after insertion to determine position before use
Central IV's
• Permits infusion of fluids or medications into a large vein usually the superior vena cava or right atrium • EX: Subclavian, Hickman, Broviac • Can be single lumen or multi-lumen • Useful for long-term therapy, infusion of large volumes of fluids, infusion of irritating medications, multiple infusions, or to measure central venous pressure • Chest x-ray is taken to determine if CVL is in correct position before using
Administration of Blood
• This is NOT within the scope of LPN IV therapy • The LPN can check-off blood with the RN, they can monitor vital signs and patient reaction, and notify the RN of adverse reactions • Watch for: itching, rash, shortness of breath, increased temperature, increased BP, chills
ABO Blood Groups
• TypeA - A person with type A blood can receive type A or type O in an emergency • TypeB - A person with type B blood can receive type B or type O in an emergency • Type AB - Universal recipient - because it carries neither anti-A or anti-B antibodies a person with type AB blood can receive any of the four types of blood • TypeO - Universal donor - because this type has no antigens, it can be transfused in an emergency into anyone regardless of blood type - Can only receive type O bloodABO Blood GroupsABO Blood Groups
Accidental Needle Sticks
• Wash the puncture wound with soap and water • Squeeze out a few drops of blood • Notify the supervisor ASAP • Follow up with employee health nurse • Complete an incident report ASAP
IV Calculations
• ml/hr= volume to infuse/time (hours) • gtts/min= gtts/ml x volume/hours x hr/60 min (must know drop factor of tubing) • Milliunits (OB) 1 unit =1000 mu, convert units to mu by multiplying by 1000 (Ex: 6 units=6000 mu). THAT's not the end of it! • Dilute so many units of Pitocin in whatever volume of IVF
