IV Therapy Vema Sweitzer MN RN 1 Vascular

IV Therapy Vema Sweitzer, MN, RN 1

Vascular Access Devices (VADs) • Peripheral catheters: short term use (after surgery or a procedure) 2

Vascular Access Devices (VADs) • Central Catheters: long-term use (chemo therapy, PN) • More effective than peripheral catheters for administering large volumes of fluid, PN and medications 3

IV Therapy: Implanted Ports

Vascular Access Devices (VADs) • Central Catheters: long-term use (chemo therapy, PN) • PICC: Peripherally inserted central catheters 5

IV Therapy: Peripheral Sites Feet not recommended for adults

IV Therapy: Starting an IV • Review order • Get supplies • Explain to patient • Find best vein • Start distally • Perform venipuncture, secure, start fluids • Document • Dressing should be transparent

Complications of Intravenous Therapy

Circulatory overload • Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions to rapidly, failure to monitor the IV infusion or too rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal disease

Circulatory Overload

Circulatory Overload • NI/Treatment • Plan ahead if patient is to receive a lot of fluid • Stop the fluids and contact the HCP immediately for new orders. • Continue to monitor the patient and anticipate doctor’s orders: • Oxygen • Diuretics

Infiltration • Occurs with IV becomes dislodged or a vein ruptures and IV fluids enter subcutaneous tissue • Nursing Assessment:

Infiltration NI/Treatment Prevention • Remove the IV catheter • Apply warm soaks to aid in absorption (check hospital’s policy) • Elevate the limb • Notify the HCP if severe • Assess circulation • Restart the infusion in the other arm • Document the patient’s condition and your interventions • Check the IV site frequently • Don’t obscure area above site with tape • Teach the patient to report discomfort, pain swelling

Documentation Infiltration Scale

Extravasation • The inadvertent administration of a vesicant solution into surrounding tissue • Signs/symptoms

Extravasation NI/Treatment • Immediately stop the infusion and remove the device • Elevate the affected limb • Apply cold compress to decrease edema and pain • Apply moist heat to facilitate the absorption of fluid at grossly infiltrated site Prevention • Check the IV site frequently • Don’t obscure area above site with tape • Teach the patient to report discomfort, pain swelling • Drugs that can cause Necrosis • Calcium chloride • Calcium gluconate • Vancomycin • Cancer Chemotherapy drugs

Phlebitis • An inflammation of the vein in which the endothelia cells of the venous wall become irritated and cells roughen, allowing platelets to adhere and predispose the vein to inflammationinduced phlebitis • Causes • Injury during venipuncture • Prolonged use of the same IV site • Irritation/incompatible IV additives • Use of vein that is too small for the flow rate • Use of needle size too large for the vein size

Phlebitis Signs/symptoms: NI/Treatment • Upon assessment of phlebitis, remove the needle • Avoid multiple insertion attempts • Application of warm compress • Continuously monitor the patient’s vital signs

Documentation Phlebitis Scale

Local Infection • Caused by poor aseptic technique during catheter insertion • Signs/symptoms

Hematoma at the IV Site • Hematoma: formations resulting from the infiltration of blood into the tissues at the venipuncture site • Causes: nicking the vein during an unsuccessful venipuncture attempt, discontinuing the I. V. cannula or needle without pressure, applying a tourniquet too tightly above a previously attempted venipuncture site

Hematoma at the IV Site • Signs/symptoms: • Discoloration • Site swelling and discomfort • Prevention and treatment

Blood Seepage into the Extravascular Tissue • Causes • Coagulation defects • Inappropriate use of tourniquet • Unsuccessful insertion attempts • Little pressure upon removal of IV catheter