Pharmacology: Chapter 38 Intravenous Therapy

extention 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 patient with more mobility or additional injection ports

Severed cannula

A piece of the IV cannula breaks off inside the vein

priming

removing air from IV tubing

liquid plasma

replace plasma proteins; liquid portion of blood

drop factor

represents the number of drops it takes for that specific tubing to equal 1 mL

Phlebitis and thrombophlebitis Nursing care

select correct size of cannula and vein, maintain strict aesepsis during IV initiation and maintenance, secure IV hub; stop IV flow and discontinue if develops; elevate affected arm on a pillow; apply warm moist packs for 20-30 minute intervals

speed shock

shock caused by rapid IV infusion of medication/solution

good veins should feel

slightly rounded, spongy, resilient or elastic, bouncy, not flat

D5NS

supplies calories; used to expand blood volume; Do not use in patients who are allergic to corn; can result in circulatory overload

primary IV tubing administration set

the long main tubing that allows continuous flow of IV fluids

cannulation

the process of advancing the IV cannula into the vein

tips for dilating a vein

use gravity: hang the arm lower than heart; apply BP cuff or tourniquet, have patient squeeze their hand, apply moist warm packs, use alcohol wipe and friction, use thumb and middle finger to flick skin over the vein; avoid slapping the patients skin, stings and is uncomfortable

Circulatory Fluid overload signs and symptoms

Anxiety without identifiable cause Cough Distention of neck veins Facial, hand, or foot edema Headache Increased BP Increased pulse rate Crackles in lungs Restlessness Shortness of breath

signs and symptoms of infiltration

Blanching or pallor of skin around site Complaint of tightness or discomfort around site Edema at site Lack of blood return upon lowering bag or aspirate with needle and syringe Site cool to touch Sluggish flow or lack of infusion Solution leakage at site Taut skin around site

documenting venipuncture

Date and time Gauge, length, and type of needle Site of placement Number of attempts it took Type of fluid and size of fluid container Flowing by gravity or pump Rate of infusion Site assessment Any difficulties experienced How the patient tolerated

Phlebitis and thrombophlebitis prevention

Do not use a vein that is too small Do not use a cannula too big Change IV site q72h secure cannula aesepsis when inserting cannula and during IV therapy

signs and symptoms of phlebitis

Edema of site Erythema at site Increased warmth at site compaired to surrouding area Reports of burning or discomfort at IV site/along vein track Sluggish infusion rate Vein feels like a hard cord when palpated

Speed shock signs and symptoms

Flushed skin Dizziness Headache Chest tightness Hypotension Irregular pulse Syncope or fainting Cardiac arrest

septicemia signs and symptoms

High fever Chills and shivering Diaphoresis Nausea, vomiting, and diarrhea Tachycardia Tachypnea Hypotension Confusion Backache

Infiltration nursing care

IV infusion should be discontinued immediately and restarted as needed; elevate extremity and position according to patient comfort; warm or cool packs may be applied to site

Lactated Ringer's solution; LR

Isotonic- Is most similar to electrolyte content of the blood and is used for fluid replacement in all types of dehydration and fluid volume deficits; Electrolyte replacement in intravascular fluid; Has some incompatibilities with medications; check for compatibility before administering medications; can result in fluid volume excess

NS or 0.9% NaCl

Isotonic-replacement of nutrients and electrolytes when no fluid shift is desired; Only fluid used to initiate and discontinue blood transfusion; Irrigant for IV access devices to prevent clotting; vascular expander Can result in fluid volume excess; use cautiously in patients with congestive heart failure; observe for early signs and symptoms of fluid overload; dilutes concentration of hemoglobin in the blood; may lower potassium levels

Purpose of Intravenous therapy

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

If IV stops infusing or alarm indicates occlusion

Make sure solution is not empty or infusion complete Inspect IV tubing from container to patient Make sure all clamps are open Tube is not pinched Patient is not lying on it No air bubbles Assess for signs and symptoms of infiltration or phlebitis

Air embolism

Obstruction of a blood vessel caused by an air bubble traveling though the circulatory system

safe administration of IV drugs

Patient's medication allergies Patient's disease or condition Sterile technique Integrity of the IV access Effects of the drugs Correct form of medication for IV use Correct dosage for specific patient's age or weight Type of diluent to use if needed Volume of dilution required Rate of safe administration Expected effects of the medication Possible drug-drug interactions Possible adverse reactions Appropriate nursing interventions to use if an adverse reaction occures

drug-drug interaction

Reaction that occurs when two or more drugs are administered at the same time

Severed cannula signs and symptoms

Sudden sharp pain at IV site Chest pain Cyanosis Tachypnea Tachycardia Hypotension

IV needle cannula or catheter

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

transfusion reaction types

acute hemolytic bacterial allergic febrile circulatory overload anaphylactic reactions

winged butterfly

aka scalp-vein needle; steel needle with plastic wings at the base of the needle; used for shorter infusion times, usually less than 24 hours; for phlebotomy; and when the longer, larger IV cannulas cannot be successfully inserted into a vein

Extravasation Nursing care

as soon as suspected, stop the infusion, leave cannula in place, estimate the volume of extravasated vesicant fluid and notify the healthcare provider immediately; stat response and treatment must be carried out to reduce the amount of damage to tissues; the prescribed antidote is instilled into tissues after aspirating any residual vesicant solution from the cannula; elevate the affected extremity and apply either cold or heat packs according to the drug manufactures recommendation; document the situation in patient's medical record

Infiltration prevention

assess IV site for edema, erythema, and increased skin warmth, pallor, and coolness of skin; keep the IV site well secured to reduce movement of cannula

Extravasation prevention

assess site q2h for adults; assess prior to administering IV medications; be knowledgeable regarding all medications intravenously so you are aware of those that are vesicants

vesicant

causes blistering necrosis and sloughing of tissue

common veins used for IV therapy

cephalic, basilic, median cubital, median antebrachial, and accessory cephalic veins; dorsal side of hand

Isotonic IV Fluid

contains an amount of solute that produces a concentration of dissolved particles equal to that of the intracellular and extracellular fluids of the human body

Air Embolism signs and symptoms

cyanosis dyspnea chest or shoulder pain hypotension tachycardia loss of consciousness

hypovolemia

decreases in blood volume

nonvesicant

does not cause blistering and death of tissue

Circulatory fluid overload

excessive fluid volume within the cardiovascular system

precipitate

forms when one of the agents in a solution separates from the solvent and becomes a solid, insoluble product

Hypertonic Solution

has a higher concentration of particles dissolved in it than the concentration in fluids in the body; causes; e water to be pulled from the interstitial space into the intravascular space in an attempt to balance the solute concentration on both sides of the semipermeable membrane, the vessel wall; shrinks the cells

Hypotonic solution

has a lower osmolarity than body fluids; will cause a shifting of body fluids out of he intravascular space and into the interstitial spaces, then eventually into intracellular space rehydrating cells; good for use in patients who need simple water replacement because of lack of fluid intake

1/2 NS or 0.45% NaCl

hypotonic-water replacement; fluid and electrolyte replacement during gastric suction; hypertonic dehydration; depletion of Na and Cl; Avoid use in patients with liver disease, head trauma, or burns; can cause cerebral edema; should not be used in patients with hypotention because it will further drop BP

albumin

increased plasma volume

localized infection

infection at the IV cannula insertion site

Thrombophlebitis

inflammation of a vein in conjunction with the formation of a thrombus

Phlebitis

inflammation of the inner layer or intima of a vein

PRN Lock/saline lock

intermittent infusion device flush with 1-10 mL of sodium chloride or NS prior to administration of IV push medications and after administration of medications regardless of compatibility

Infiltration

leakage of nonvesicant IV fluid or medication into the tissue surround the IV insertion site

Extravasation

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

Septicemia

life-threatening infection of the bloodstream

hypertonic dehydration

loss of body water without loss of electrolytes; requires hypotonic IV solution

IV Piggyback IVPB

medication is added to a smaller volume of IV solution; then infused over a specified period of time between 15 and 90 minutes; specially designed shorter tubing connects solution container to the most proximal Y-injection port located on the primary IV line; aka secondary tubing

patent

open, allowing fluids to pass through or opposite of clogged

avoid selecting veins

over a flexible joint, feels sclerosed or hardened, is bruised, red or edematous, lies adjacent to an infected area, has recently been used for IV therapy or is distal to a recent stick site, too small for IV cannula, has a bump or birfurcation indication a valve, rolls

PRBC

packed red blood cells; acute blood loss, hemoglobin less than 8-10 g/dL, symptomatic anemia

Platelets

prevent/control bleeding related to low platelet count, acute leukemia, thrombocytopenia

Whole blood

rarely used but restores blood volume along with all its components; mostly broken down for use of its individual components