INTRAVENOUS THERAPY

INTRAVENOUS THERAPY
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DEFINITION

Intravenous (IV) therapy is the administration of a fluid substance (solution) directly into a vein as a therapeutic treatment.

PURPOSE and USES






a. Used to sustain clients who are unable to take substances orally
b. Replaces water, electrolytes, and nutrients more rapidly than oral administration
c. Provides immediate access to the vascular system
d. provides a vascular route for the administration of medication or blood components

TYPES OF SOLUTIONS
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Isotonic solutions:
• have the same osmolality as body fluids
• increase extra cellular fluid volume
• do not enter the cells because no osmotic shift exists
• EG: O.9% saline (NS), D5 W, RL
Hypotonic solutions
• have lower osmolality than body fluids
• cause movement of water into cells by osmosis
• EG:1\2 NS, 1\4 NS, 1\3 NS
Hypertonic solutions
• have higher osmolality than body fluids
• cause movement of water from cells into extracellular fluid by osmosis
• EG: D10 W, D5 W\NS, 3%NS, 5%NS, D5W\1\2NS
Colloids
• also called plasma expanders
• pull fluid from the interstitial compartment into the vascular compartment
• used to increase vascularvolume rapidly
• EG: dextran, albumin

INTRAVENOUS GAUGES

• The gauge refers to the diameter of the lumen of the needle or cannula
The smaller the gauge number ,the larger the diameter of the lumen i.e gauge is inversely proportional to diameter

IV CONTAINERS

• Container may be glass or plastic
• Squeeze the plastic bag for intactness and assess glass bottle for any cracks before hanging
• Do not write on plastic iv bag with a marking pen beacause the ink may be absorbed through the plastic in
to the solution
• Use a label and ballpoint pen for marking the bag, placing the label onto the bag

INTRAVENOUS TUBING
General guidelines for tubing
• Change IV tubing, including piggyback tubing ,no more frequently than at 72 hour intervels
• Change tubing used for blood or blood products within 24 hours of completing infusion
• Do not leave TPN fluids hanging more than 24 hours

DRIP CHAMBERS

• Macrodrip chamber: the chamber is used if the solution is thick or is to be infused rapidly. Drop factor varies from 10 -20 drops\mL
• Microdrip chamber: used if the solution contains potent medication that needs to be titrated or used if fluid will be infused at a slow rate(less than 50 mL\hr). Drop factor is 60 drops\mL.

 

• DROP FACTOR: How many drops per milliliter are delivered

METHODS OF INTRAVENOUS ADMINISTRATION

– IV push
– Intermittent venous access device
– Intermittent infusion (or piggyback)
– Continuous infusion
– Electronic pumps and controllers
– Patient-controlled analgesia

IMPORTANT NURSING OBSERVATIONS DURING INTRAVENOUS THERAPY

• Close monitoring of weight gain/loss
• Accurate I and O (normal urine output is approximately 1 Ml\kg of body weight per hour)
• Assessing for signs of edema (skin that is tight and shiny)
• Assessing for skin turgor that when pinched takes longer than 3 seconds to return to normal
• Assessing lung sounds (crackles will be heard with Fluid volume over load)
• Notification to physician if urine output is < 30cc for two consecutive hours

• Monitor sodium and hematocrit levels.

CRITICAL FACTORS

• Assess IV site every two hours and prn.
• Verify patency.
• Observe the Six Rights of IV fluid administration.
• Prime tubing, clearing air.
• Identify tubing parts that are to remain sterile and maintain sterility
• Apply principles of sterile technique throughout procedure
• Document tubing change and site care.
• Secures IV catheter with sterile dressing per agency policy




IV DRIP RATE CALCULATION

• Calculate an IV drip rate based on the volume of fluid to be infused over time:

Gtt/min=volume to be infused(mL) x drop factor(gtt/mL) / time (minutes)

• Calculate an IV drip rate for a medication that is administered based on a specific dosage to be infused per minute:

Gtt/min=dosage per minute to be administered x dropfactor/concentration of medication per mL

IV SITE ASSESSMENT

Note the location (hand, wrist, forearm, antecubital fossa?).
Site should be visually inspected and palpated every 2hr.
The IV site should be free of redness, swelling, tenderness.
The IV dressing should be clean and secure.
For adults, change catheter and rotate site every 48 – 72 hours.Replace catheter inserted under emergency conditions with in 24 hours.

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