Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 13: Intravenous Therapy

2. Introduction • IV Therapy • Parenteral administration of fluids, additives; Requires continual assessment • State nurse practice acts determine LPN role in IV therapy • All RNs may administer IV therapy

3. Question Is the following statement true or false? The extent of an LPN’s practice with IV therapy is determined by education level and nurse practice act rules.

4. Answer True. The licensing state Nurse Practice Act and an LPN/VN’s personal certification determine their involvement in IV therapy administration.

5. Indications for IV Therapy • Maintain, restore fluid balance • Oral intake inadequate, impossible • Maintain, restore electrolytes • Administer nutrients; Medications • Specifically designated meds • Route with most rapid effect • Replace blood, blood products

6. Types of Solutions • Types of IV Solutions • Crystalloid: Water and uniformly dissolved crystals • Colloid: Water and molecules of suspended substances • Crystalloid Solutions (Table 13-1, pg 129) • Isotonic, hypotonic, and hypertonic solutions • Influences osmotic distribution of body fluid

7. Types of Solutions • Crystalloid Solutions (Cont’d) • Isotonic Solutions • Same concentration of dissolved substance as plasma • Maintains fluid balance when NPO • Hypotonic Solutions • Fewer dissolved substances than plasma • Rehydrates fluid-deficit clients • Temporarily increases blood pressure

8. Question Is the following statement true or false? Hypotonic IV solutions increase blood pressure permanently.

9. Answer False. Hypotonic IV solutions may increase blood pressure temporarily.

10. Types of Solutions • Crystalloid Solutions (Cont’d) • Hypertonic Solutions • More concentrated than plasma • Infrequent use • Uses: Reduces cerebral edema; Expands circulatory volume rapidly; Parenteral nutrition

11. Types of Solutions • Crystalloid Solutions (Cont’d) • Hypertonic Solutions (Cont’d) • Total parenteral nutrition (TPN) • Complete nutrition; Instilled into central circulation only • Lipid emulsion: Stabilized mixture of two insoluble liquids • Provides essential fatty acids, additional calories

12. Types of Solutions • Colloid Solutions (Table 13-2, pg 130) • Replace circulating blood volume; Blood; Blood products; Plasma expanders • Blood • Whole blood: Blood cells, plasma, preservative, anticoagulant • Use: Restores fluid, blood cells

13. Types of Solutions • Colloid Solutions (Cont’d) • Packed cells: Plasma removed • Use: Cellular replacements when additional fluid contraindicated • Inadequate oral fluid intake • Risk for CHF • Laboratory test before administration

14. Types of Solutions • Colloid Solutions (Cont’d) • Blood Products • Use: Clients needing specific blood substances • Plasma Expanders • Nonblood solutions • Use: Hypovolemic shock

15. Administering Intravenous Therapy • Common equipment: Solution; IV tubing; IV pole; Infusion device • Equipment preparation; Infusion technique • IV Solution preparation • Intentionally reduce infection potential • IV Tubing choice • Four options

16. Administering Intravenous Therapy Fig 13-4, pg 131

17. Administering Intravenous Therapy • Instillation of IV Solutions • Methods: Gravity; Electronic infusion device • Rate of infusion • Drops per minute; Milliliters per hour Figure 13-5 (Left) vented tubing and (right) unvented tubing

18. Administering Intravenous Therapy • Gravity Infusion • Flow rate influences: Solution elevation; Roller clamp adjustment; Pressure infusion sleeve • Electronic Infusion Devices: Programmed • Infusion pumps • Volumetric controllers

19. Administering Intravenous Therapy • Preparing Client for Venipuncture • Client education; Answer questions • Site selection • Piercing a peripheral vein: Various devices; Differing gauge or diameter • Greater gauge number = smaller diameter; Diameter: Smaller than vein

20. Question Is the following statement true or false? The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter.

21. Answer True. The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter. Conversely, the lesser the gauge number, the larger the catheter’s diameter.

22. Administering Intravenous Therapy Figure 13-9, pg 134 Examples of venipuncture devices. (A) Butterfly needle. (B) Over-the-needle catheter

23. Administering Intravenous Therapy Figure 13-8, pg 134 Venipuncture sites

24. Administering Intravenous Therapy • Venipuncture Sites • Peripheral venous sites; Central veins • Vein selection factors • Peripheral Venous Sites • Most common: Superficial veins of arm, hand • Infants: Scalp veins; Avoid feet • Midline catheter: Peripherally inserted venous access device

25. Administering Intravenous Therapy • Venipuncture Sites (Cont’d) • Peripheral Venous Sites (Cont’d) • Midclavicular catheter • Peripherally inserted • Extends from superficial to proximal axillary veins • Current controversy: Thrombosis

26. Administering Intravenous Therapy • Venipuncture Sites (Cont’d) • Central Venous Sites (Fig 13-11, pg 135) • Delivers solution: Vena cava • Physician inserts into jugular; subclavian vein • Trained nurses: Insert PICC • Post insertion procedures: Chest radiograph for placement confirmation • REVIEW: Stop, Think and Respond, 13-2, pg 135

27. Administering Intravenous Therapy • Equipment Replacement • Reduce infection potential • Solutions • Upon completion; q24h • IV tubing • Per policy; per solution • Venipuncture devices

28. Administering Intravenous Therapy • Site Care • Venipuncture site: Frequent inspection; Document appearance • Dressing change • Per agency’s infection control policy • REVIEW: Nursing Process for Client requiring IV Therapy, pg 137 - 139

29. Potential Complications of IV Therapy • Potential Complications (Table 13-3 pg 137) • Risk for infection; Phlebitis; Thrombus formation • Air bolus • Site infiltration; REVIEW Pharmacy, pg 135 • Circulatory overload; REVIEW Gerontologic, pg 136

30. Discontinuing Intravenous Therapy • IV Infusions • Infusion complete • Medication lock: Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only • REVIEW:Nursing Guidelines 13-1, pg 137 - 139 Figure 13-14, pg138 Attaching a lock device with extension tubing to the IV catheter hub

31. Special Considerations for IV Therapy • TPN • REVIEW: Box 13-2, pg 139 Candidates for TPN • REVIEW: Nursing Guidelines 13-2, pg 140

32. Potential Complications of IV Therapy • Potential Complications: Blood transfusions • Same as crystalloid solutions • Reactions: usually occur within the first 5 – 15 minutes • REVIEW: Pharmacy, pg 140 • REVIEW: Table 13-5 pg 142

33. Potential Complications of IV Therapy • Potential Complications: Blood Transfusions (Cont’d) • Incompatibility reaction: Life threatening • Delayed reactions: Immune response • Nonimmune complications: Septic; Symptoms - shaking chills and a fever • Hypocalcemia: Citrate in donor blood • Blood-borne infections: Hepatitis A, B, and C; HIV; MFE

34. Chapter End