Peripherally Inserted IV's (PIV)

Types of PIVs

-18 gauge (green)- largest -trauma, surgery, blood transfuions, CT w dye -20 gauge (pink) -most COMMON -22 gauge (blue) -older adults -slow rate infusions -NO blood products -24 gauge (yellow)- smallest -pediatrics or elderly adults -NO blood products

Beginning of each shift, what to check on IV:

-Check to determine if solution hanging is the solution ordered -Check to determine date and time of solution -How long has it been hanging? -Check pump functioning and settings -Plugged in -Check IV site -Check IV flow rate -Check IV tubing expiration dates/times

Intravenous Infusion Nursing Diagnosis

-Fluid Volume Deficient -High Risk for Fluid Volume Deficit -Fluid Volume Excess -Anyone getting fluids has risk of fluid volume excess -Excess fluid may cause peripheral edema -Skin Integrity Impaired -Risk for Infection

Complication with IV- Infiltration

-Most common complication -when cannula slips out of vein and is forced into vessel wall -Will have fluid excess because didn't go into vein, went into tissue instead -Causes PERFUSION problem -Fingers not able to get enough oxygen (cyanosis) -Signs and symptoms: -Coolness -Leaking -Swelling -Tenderness -Nursing action: -Remove IV and select new site -Document -What happened, what infiltration was, what did you do about it

Roles in IV Therapy (RN)

-Place PIV (size, location) -Initiating the infusion -Monitoring and maintaining the infusion -Completing system assessment of client -Documentation of infusion and I & O as appropriate -Delegation - LPN, UAP -LPN- cannot administer 1st bag, can administer after -UAP- do not administer, can unplug/plug

2 parts of Alaris IV Infusion Pump

-brain (middle piece) -channels (pieces on side) -determine how many bags of fluid to use w pump

Peripherally inserted IV's (PIV)

-heplock/heparin IV

Complication with IV- phlebitis

-infection -Signs and Symptoms: -Red -Swollen -Tender -Nursing action: -Remove IV -Notify provider -Warm soaks -Document

Complications with IV Therapy

-infiltration -phlebitis (infection) -extravasation (medication that infiltrates)

Complication with IV- extravasation

-medication that infiltrates -Signs and symptoms -Swelling -Erythema -Tender -Cool -Stage IV: necrosis, sloughing, blistering -Nursing Action: -Same as infiltration -Know which meds cause extravasation -Know antidote (NO warm packs) -Don't want to bring extra fluid (warmth pulls fluid) there

How to choose which gauge PIV example

-what is going on with pt? -ex. difficult time breathing -> low hemoglobin -> low O2 sat -> high HR -> blood transfusion (20 or 18 gauge)

Intravenous Infusion Client Goals

•Regain and/or maintain adequate fluid and electrolyte balance •Avoid complications associate with IV therapy •Outcome Evaluation: •Client has moist mucous membranes •Client is free from vomiting and diarrhea •Client has normal urine specific gravity •Client is free from edema •Client has intact skin •Client is from alteration in pulmonary status