IV THERAPY Presenter Dr Lamiaa Moustafa OBJECTIVES 1
IV THERAPY Presenter: Dr / Lamiaa Moustafa
OBJECTIVES 1. Define IV therapy. 2. Determine the indications for IV therapy. 3. Describe the different access for IV therapy. 4. Define tonicity and actions of the different types of IV fluids. 5. Understand osmosis as it pertains to water movement with IV therapy. 6. Knows the complications of intravenous therapy. 7. Implement safely and correctly IV cannulation.
INDICATIONS: v Establish or maintain fluid or electrolyte balance. v Administer bolus medication and/or emergency drugs. v Administer fluid to keep vein open. v Administer blood or blood components. v Administer intravenous anesthetics. v Administer diagnostic reagents. v Maintain or correct a patient’s nutritional status. v Monitor hemodynamic functions.
IV Therapy - is giving of liquid substances directly into a vein. It can be intermittent or continuous. - The word “intravenous” simply means within a vein, but is most commonly used to refer to IV therapy.
INTRAVENOUS ACCESS DEVICE v Needle and Syringe
PERIPHERAL IV LINES v A peripheral IV line consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein.
CENTRAL IV LINES v Central IV lines flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart.
A WORD ABOUT GAUGES v Catheters (and needles) are sized by their diameter, which is called the gauge. The smaller the diameter, the larger the gauge. Therefore, a 22 -gauge catheter is smaller than a 14 gauge catheter. Obviously, the greater the diameter, the more fluid can be delivered.
IV FLUIDS COME IN DIFFERENT FORMS Ø Colloids – are IV fluids that contain solutes in the form of large proteins or other similarly sized molecules. Ø Crystalloids – are the primary fluid used for pre hospital IV therapy which contains electrolytes but lack the large proteins and molecules found in colloids.
IV FLUIDS There are three main types of crystalloids Isotonic Fluids: Ex. LR, NS Hypotonic Fluids: Ex. 0. 45% Na. Cl Hypertonic Fluids: Ex. 5% 0. 9 Na. Cl
Isotonic Fluids v Close to the same osmolarity as serum.
Hypotonic Fluids v Lesser osmolarity than serum (it has less sodium ion concentration than serum
Hypertonic Fluids v Has Higher osmolarity than serum. Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.
P & P of IV Cannulation 1. Inserting cannula for intravenous therapy must be performed by a competent nurse with IV therapy course certification. 2. The patient file must be reviewed for the diagnosis and medical plan for IV therapy. 3. Only two attempts of cannulation shall be made by one person. 4. Assistance from a senior nurse or head nurse must be enough, if necessary.
5. Always start cannulation on distal branches before using the proximal veins. 6. Never reinsert stylet back into catheter once it has been removed. 7. Blood specimen may be drawn at the time of catheter insertion.
1. A. Procedure 1. Verify order of IV therapy. 2. Observe the 7 rights when preparing and administering IVF. 3. Explain the procedure to the patient.
4. Assess patient’s vein; choose appropriate site, location, size/condition. Veins of the Hand 1. Digital Dorsal veins 2. Dorsal Metacarpal veins 3. Dorsal venous network 4. Cephalic vein 5. Basilic vein
Cephalic vein Accessory Cephalic vein Median Cubital vein Basilic vein Cephalic vein Median antebrachial vein
5. Do hand hygiene before and after the procedure. 6. Prepare completeness of the equipment.
7. Check the sterility and integrity of the IV solution, IV set and other devices/materials. 8. Place IV label on IVF bottle duly signed by RN who prepared it (patient’s name, MR#, room #, type of solution, time and date). 9. Open IV administration set aseptically following the infection control measures. 10. Close the roller clamp and spike the infusate container aseptically. 11. Fill the drip chamber to at least half and prime it with IV fluid aseptically.
12. Expel air bubbles if any and put back the cover to the distal end of the IV set (get ready for IV insertion. 1. B. Inserting IV Cannula 1. Choose site for IV. 2. Apply tourniquet 5 to 12 cm (2 -6 inches) above injection site depending on condition of patient. 3. Check for radial pulse below tourniquet. Prepare site with effective topical antiseptic according to hospital policy or cotton balls with alcohol in circular motion and allow 30 seconds to dry (no touch technique).
4. Using the appropriate cannula, pierce skin with the correct technique. 5. Upon backflow visualization, continue inserting the catheter into the vein. 6. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance the catheter until the hub is 1 mm to the puncture site. 7. Slip a sterile gauze under the hub. Release the tourniquet, remove the stylet while applying digital pressure over the catheter with one finger about 1 -2 inches from the tip of the inserted catheter.
8. Anchor the needle firmly in place with the use of: a. Transparent tape/dressing directly on the puncture site. b. Tape (using any anchoring style) 9. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter. 10. Open the clamp and regulate the flow rate. Reassure patient. 11. Tape a small loop of IV tubing for additional anchoring. Apply splint if needed.
12. Calibrate the IVF bottle and regulate flow of infusion according to prescribed duration. 13. Label on IV tape near the IV site to indicate the date of insertion, date of dressing and countersign. 14. Label with plaster on the IV tubing to indicate the date when to change the IV tubing. 15. Observe patient and repot any untoward effect.
16. Document in the patient’s chart: > Date/time of insertion > Site of insertion > Size of cannula > Patient’s reaction/ response to therapy 17. Discard sharps and waste according to Infection Control.
Complications of Intravenous Therapy • • • Infection Phlebitis Infiltration Fluid overload Electrolyte Imbalance Embolism
SUMMARY Ø IV cannulation is a technique that permits insertion of a needle or catheter into the vein. Ø Cannula catheter must be change every 72 hours. Ø Change of cannula dressing every 72 hours Ø Always start cannulation on the distal branches before using the proximal veins. Ø Select the appropriate vein and catheter before you cannulate.
REFERENCES > King Abdullah Hospital P&P. > Potter & Perry, Fundamental of Nursing, 6 th edition, 2005. > Williams & Wilkins, Lippincott Manual of Nursing Practice, 8 th edition. > Kozir, Erb, Berman & Snyder, Fundamentals of Nursing, 7 th edition, 2004. > MOH orientation program for saudi staff.
THANK YOU
- Slides: 29