Intravenous Therapy

1. Intravenous Therapy Brenda McLoud BSN, RN, CGRN

2. Learning Objectives • Describe the Nurse’s role in IV therapy care • Explain IV supplies, type of vascular access devices, and administration of IV therapy

3. GI nurse’s role in IV therapy • Assessment • Planning • Implementation • Evaluation.

4. Competencies in IV Therapy for the GI Nurse • Knowledge of Vascular Access Devices (VAD) used • Skill in performing procedure competently & safely • Skill in inspecting insertion site • Ability to problem solve • Knowledge to monitor patient’s condition & report changes • Proper documentation and record-keeping skills

5. Basic Principles of Fluid & Electrolytes • Water is 60% of the average adult’s total body weight • In infants, body water represents about 80% of total body weight • Solutions – liquids (solvents) containing dissolved substances (solutes) – are classified according to their concentration or tonicity and include • Isotonic Solutions • Hypotonic Solutions • Hypertonic Solutions • Body fluids are isotonic solutions

6. Basic Principles of Fluid & Electrolytes • Body water is contained in two major body compartments • Intracellular fluid (ICF) • Extracellular fluid (ECF) • Fluid balance is maintained when water intake equals water output • Solutes are substances dissolved in a solution

7. Basic Principles of Fluid & Electrolytes • Solutes are classified as • Nonelectrolytes • Electrolytes • Cations • Na, K, Ca, Mg, H • Anions • Cl, P, HCO3 • Electrolytes perform four essential functions • Promote neuromuscular irritability • Maintain body fluid osmolality • Regulate acid-base balance • Regulate distribution of body fluids among body fluid compartments

8. Fluid & Electrolyte imbalances • Imbalances may result from • Vomiting, diarrhea, suction, draining wounds, intestinal obstructions, draining fistulas, hemorrhage, infections, fever or prolonged use of enemas & • Infants are more vulnerable because of their higher proportion of body fluid, immature kidneys, increased heat production & rapid growth • Excessive loss of body water can lead to dehydration

9. Administration of Fluids & Electrolytes • All IV solutions are considered medications • Requires a Dr.’s order • Types of Solutions • Isotonic Solutions • 0.9% NS or LR • Hypotonic Solutions • 0.45% NaCl • Hypertonic Solutions • 3% NaCl or 10%Dextrose

10. Risks for the GI Nurse • Primary risks due to needlesticks • Injury • Disease transmission • Spills • Splashes • Because universal precautions require use of gloves when dealing with blood and body fluids, development of latex allergies pose a concern for health care workers and patients

11. Latex allergies • Individuals who develop burning or tingling around mouth after blowing up latex balloons • Known allergy to • Bananas • Avocados • Potatoes • Tomatoes • Poinsettias • History of contact dermatitis • History of asthma • History of eczema

12. Vascular Access Devices (VAD) • Steel winged infusion set (butterfly winged device) • Peripheral short IV catheters • Peripheral long or midline catheters • Peripherally inserted central catheters (PICC) • Nontunneled central venous catheters (CVC’s) • Tunneled central venous catheters • Totally implanted devices or ports

13. IV Insertion sites • Preferred sites • Dorsum of hand • Upper arm • Avoid Extremities with • Lymphedema, postop swelling, recent trauma, dialysis shunt, hematoma, axillary lymph node dissection, local infection or cellulitis, phlebitis or open wounds • Best to begin with distal veins and proceed proximally towards the body • Cannulation of lower extremities should be avoided in adults

14. Complications • Infiltration/extravasation • Hematoma • Phlebitis • Pyrogenic reactions • Air embolism • Catheter embolism • Pulmonary edema • Speed shock/overload • Nerve injury

15. IV Medication Administration • Techniques & routes of administration • Appropriateness of the prescribed therapy • Patient’s age and condition • Any medication allergies • Dose, route and rate of the medication ordered • Medications • Indications • Actions • Side effects • Appropriate nursing interventions with adverse reactions

16. Indications for IV meds in GI • Moderate sedation/analgesia • Control of variceal hemorrhage • Treatment of opioid-induced respiratory depression • Treatment of benzodiazepine-induced respiratory depression • Treatment of cardiac dysrhythmias • Reducing peristalsis or intestinal spasms • Treatment for increased risk of infection

17. Blood & Blood Components • Whole blood • Packed red blood cells • Leukocyte-poor blood • Platelets • Fresh frozen plasma (FFP) • Cryoprecipitates • Factor VIII • Factor IX • Human albumin • Autologous transfusion

18. Adverse Reactions • Circulatory overload • Allergic reactions • Hemolytic reactions • Hepatitis B, hepatitis C and human immune deficiency viruses • Other transfusion-related infectious agents • Citrate toxicity

19. When Adverse Reaction Occurs • Stop the transfusion • Keep vein open with normal saline • Asses vital signs • Notify Dr. • Notify blood bank • Send all transfusion containers & administration sets to blood bank • Treat patient symptomatically & supportively • Patient Education • Documentation

20. Review • Salts that dissociate in solution into positive and negative ions are called: • A. Anions • B. Cations • C. Electrolytes • D. Colloids

21. Review • Drugs should never be added to blood transfusions because: • A. They are incompatible. • B. It complicates determination of the source of any adverse reaction. • C. Drugs can cause clotting. • D. The rate of infusion is too slow.

22. Review • The following may indicate a higher risk for latex allergy except, • A. History of asthma. • B. Use of powder-free gloves. • C. Allergy to bananas • D. History of multiple surgical procedures.

23. Review • Hemolytic reactions to blood transfusions usually occur : • A. Immediately • B. Within the first 5 to 15 minutes of the transfusion. • C. Within 24 hours. • D. As long as 6 months after the transfusion.