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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128. Chapter 13: Intravenous Therapy By: P.K. Williams, RN VH-71 Seats 14 0 liters. 38 Words to Know 02/370 Pg 128. ABO System Blood products Central venous sites

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128

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  1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128 Chapter 13: Intravenous Therapy By: P.K. Williams, RN VH-71 Seats 14 0 liters

  2. 38 Words to Know02/370 Pg 128 • ABO System Blood products Central venous sites • Colloid solutions Crystalloid solutions Drop factors • Drop size Emulsion Infusion pump • Electronic infusion device In-line filter • Hypotonic solutions Intravenous(IV) therapy • Isotonic solution Macrodrip tubing Midclavicular catheter • Midline catheter Packed cells Peripheral venous sites • k

  3. 38 Words to Know03/37 Pg 128 • Phlebitis Plasma expandersSecondary tubing • Pressure infusion sleeve • Primary tubing Total parenteral nutrition Universal donor • Universal recipient Unvented tubing • Volumetric controller Whole blood • Y-administration tubing Microdrop tubing • Medication loc • Salvaged blood • Total parenteral nutrition

  4. Learning Objectives 04/37 Pg 128 • On completion of this chapter, you will be able to: • Explain common indications for intravenous (IV) therapy. • Differentiate between crystalloid and colloid solutions and give examples of each. • Describe the difference between isotonic, hypotonic, and hypertonic solutions. • Explain the difference between whole blood, packed cells, blood products, and plasma expanders. • Describe nursing responsibilities for preparing intravenous solutions, selecting tubing, and selecting an infusion technique. • Identify nursing responsibilities when preparing the client for IV therapy

  5. Learning Objectives 05/37 Pg 128 • Describe nursing actions involved in performing a venipuncture, including sites and devices commonly used. • Explain the equipment that must be replaced during IV therapy. • List complications of IV therapy and signs and symptoms for which the nurse monitors. • Explain how the nurse discontinues IV therapy. • Discuss the purpose of a medication lock. • Describe the nursing process for the client requiring IV therapy. • Discuss the purpose of total parenteral nutrition, and name one solution often administered concurrently

  6. Introduction 06/37 Pg 128 • 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

  7. Question 07/37 Pg 128 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.

  8. Answer 08/37 Pg 128 True. The licensing state Nurse Practice Act and an LPN/VN’s personal certification determine their involvement in IV therapy administration.

  9. Indications for IV Therapy 09/37 Pg 128 • 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

  10. Types of Solutions 10/37 Pg 129 • Types of IV Solutions • Crystalloid: Water and uniformly dissolved crystals • Colloid: Water and molecules of suspended substances • Crystalloid Solutions • Isotonic, hypotonic, and hypertonic solutions • Influences osmotic distribution of body fluid

  11. Types of Solutions 11/37 Pg 130 Figure: 13-1 Crystalloid solution Figure: 13-2 Osmotic distribution of fluid

  12. Types of Solutions 12/37 Pg 128 • 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

  13. Question 13/37 Pg 130 Is the following statement true or false? Hypotonic IV solutions increase blood pressure permanently.

  14. Answer 14/37 Pg 130 False. Hypotonic IV solutions may increase blood pressure temporarily.

  15. Types of Solutions 15/37 Pg 130 • Crystalloid Solutions (Cont’d) • Hypertonic Solutions • More concentrated than plasma • Infrequent use • Uses: Reduces cerebral edema; Expands circulatory volume rapidly; Parenteral nutrition

  16. Types of Solutions 16/37 Pg 130 • 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

  17. Types of Solutions 17/37 Pg 130 • Colloid Solutions • Replace circulating blood volume; Blood; Blood products; Plasma expanders • Blood • Whole blood: Blood cells, plasma, preservative, anticoagulant • Use: Restores fluid, blood cells

  18. Types of Solutions 18/37 Pg 130 • 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

  19. Types of Solutions 19/37 Pg 130 • Colloid Solutions (Cont’d) • Blood Products • Use: Clients needing specific blood substances • Plasma Expanders • Nonblood solutions • Use: Hypovolemic shock • Dextran • Hespan

  20. Administering Intravenous Therapy20/37 Pg 133 • 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

  21. Administering Intravenous Therapy21/37 Pg 131

  22. Administering Intravenous Therapy 22/37 Pg 132 • 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

  23. Administering Intravenous Therapy23/37 Pg 132 • Gravity Infusion • Flow rate influences: Solution elevation; Roller clamp adjustment; Pressure infusion sleeve • Electronic Infusion Devices: Programmed • Infusion pumps • Volumetric controllers

  24. Administering Intravenous Therapy 24/37 Pg 133 • 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

  25. Question 08/37 Pg 134 Is the following statement true or false? The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter.

  26. Answer 26/37 Pg 134 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.

  27. Administering Intravenous Therapy***27/37 Pg 134 Figure 13-9 Examples of venipuncture devices. (A) Butterfly needle. (B) Over-the-needle catheter

  28. Administering Intravenous Therapy 28/37 Pg 134 Figure 13-8 Venipuncture sites

  29. Administering Intravenous Therapy 29/37 Pg 133 • 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

  30. Administering Intravenous Therapy 30/37 Pg 133 • Venipuncture Sites (Cont’d) • Peripheral Venous Sites (Cont’d) • Midclavicular catheter • Peripherally inserted • Extends from superficial to proximal axillary veins • Current controversy: Thrombosis

  31. Administering Intravenous Therapy 31/37 Pg 134 • Venipuncture Sites (Cont’d) • Central Venous Sites • Delivers solution: Vena cava • Physician inserts into jugular; subclavian vein • Trained nurses: Insert PICC • Post insertion procedures: Chest radiograph for placement confirmation

  32. Administering Intravenous Therapy 32/37 Pg 135 • Equipment Replacement • Reduce infection potential • Solutions • Upon completion; q24h • IV tubing • Per policy; per solution • Venipuncture devices

  33. Administering Intravenous Therapy 08/37 Pg 135 • Site Care • Venipuncture site: Frequent inspection; Document appearance • Dressing change • Per agency’s infection control policy

  34. Potential Complications of IV Therapy 34/37 Pg 135 • Potential Complications*** • Risk for infection; Phlebitis; Thrombus formation • Air bolus;Site infiltration • Circulatory overload • Potential Complications: Blood transfusions • Same as crystalloid solutions • Reactions: Nonautologous donor cells; Additives; Preservatives

  35. Potential Complications of IV Therapy 33/37 Pg 135 • 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

  36. Discontinuing Intravenous Therapy36/37 Pg 137 • IV Infusions • Infusion complete • Medication lock:Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only Figure 13-14 Attaching a lock device with extension tubing to the IV catheter hub

  37. End of Presentation NOW ENCLEX By: P.K. Williams, RN 37/37 [$400 mil] pkwilliams@DNI.edu

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