Type and Indications of IV Therapy

1. Type and Indications of IV Therapy Done by : Salwa Maghrabi Teacher Assistant Nursing Department

2. Outline • Definition of IV therapy • Indication of IV therapy • Type of IV solution . • Isotonicsolution • Hypertonic solution • Hypotonic solution • Categories of intravenous solutions according to their purpose. • Nutrient solutions • Electrolyte solutions (Crystalloid) • Volume expanders (Colloid) • Parenteral Nutrition (PN)

3. cont’ • Clinical indications of parenteral nutrition. • IV Infusion Method . • Equipment of I.V. therapy. • Nursing role in managing patient receiving IV therapy • Nursing assessment . • Nursing diagnosis. • Implementation • Initiation phase • Maintenance phase • Discontinuing IV infusion . • Recoding and reporting . • Evaluation .

4. Objective • Define intravenous therapy . • List the indications of IV therapy . • Differentiate between the types of IV solutions. • Discuss the categories of IV solution according to their purpose . • List the IV infusion methods. • Discuss the nursing process for the patient who receiving IV therapy .

5. Definition of IV therapy It is an effective and efficient method of supplying fluid directly into intravenous fluid compartment producing rapid effect with availability of injecting large volume of fluid more than other method of administration.

6. Indication of IV therapy • Maintain or replace body store . • Restore acid abase balance • Restore the volume of blood component • Administer of medication • Provide Nutrition • Monitor CVP

7. Type of IV solution

8. Isotonicsolution • A solution that has the same salt concentration as the normal cells of the body and the blood. • Ex: 1- 0.9% NaCl . 2- Ringer Lactate . 3- Blood Component . 4- D5W.

9. Hypertonic solution: • A solution with a higher salts concentration than in normal cells of the body and the blood. • Ex: 1- D5W in normal Saline solution . 2-D5W in half normal Saline . 3- D10W.

10. Hypotonic solution • A solution with a lower salts concentration than in normal cells of the body and the blood. • EX: 1-0.45% NaCl . 2- 0.33% NaCl .

11. Categories of intravenous solutions according to their purpose: • Nutrient solutions. • Electrolyte solutions. • Volume expanders.

12. Nutrient solutions. • It contain some form of carbohydrate and water. • Water is supplied for fluid requirements and carbohydrate for calories and energy. • They are useful in preventing dehydration and ketosis but do not provide sufficient calories to promote wound healing, weight gain, or normal growth of children. • Common nutrient solutions are D5W and dextrose in half-strength saline.

13. Electrolyte solutions (Crystalloid) • fluids that consist of water and dissolved crystals, such as salts and sugar. • Used as maintenance fluids to correct body fluids and electrolyte deficit . • Commonly used solutions are: -Normal saline (0.9% sodium chloride solution). -Ringer’s solutions (which contain sodium, chloride, potassium, and calcium. -Lactated Ringer’s solutions (which contain sodium, chloride, potassium ,calcium and lactate) .

14. Volume expanders (Colloid) • Are used to increase the blood volume following severe loss of blood (haemorrhage) or loss of plasma ( severe burns). • Expanders present in dextran, plasma, and albumin.

15. Parenteral Nutrition (PN) • Parenteral nutrition is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes , vitamins, minerals, and fluids via the IV route to meet the metabolic functioning of the body.

16. Clinical indications of parenteral nutrition • Client cannot tolerate internal nutrition as in case of paralytic ileus, intestinal obstruction, persistent vomiting. • Client with hyper metabolic status as in case of burns and cancer. • Client at risk of malnutrition because of recent weight loss of > 10%, NPO for > 5 days, and preoperative for severely depleted clients.

17. IV Infusion Method

18. Equipment of I.V. therapy • I. Solution containers. II. I.V. administration sets.

19. Nursing assessment 1- assess the solution: 2- Reading the label on the solution. 3- Determine the compatibility of all fluid and additives. 4- observe I.V sets

20. Also, the nurse should assess the patient for : 1- Any allergies and arm placement preference. 2- Any planned surgeries. 3- Patient’s activities of daily living. 4- Type and duration of I.V therapy, amount, and rate.

21. Nursing diagnosis: • Anxiety (mild, moderate, severe) related to threat regarding therapy. • Fluid volume excess. • Fluid volume deficit. • Risk for infection. • Risk for sleep pattern disturbance. • Knowledge deficit related to I.V therapy.

22. Planning • Identify expected outcomes which focus on: • preventing complications from I.V therapy. • minimal discomfort to the patient. • restoration of normal fluid and electrolyte balance . • patient’s ability to verbalize complications.

23. Implementation • I. Implementation during initiation phase • A) Solution preparation: the nurse should be: • Label the I.V container. • Avoid the use of felt-tip pens or permanent markers on plastic bag. • Hang I.V bag or bottle .

24. B) Site preparation: 1- Cleanse infusion site. 2- Excessive hair at selected site should be clipped with scissor . 3- Cleanse I.V site with effective topical antiseptic. 4- Made Venipuncture at a 10 to 30 degree angle.

25. C) Regulating flow rate: • The nurse calculate the infusion rate by using the following formula :

26. II. Implementation during maintenance phase • A) Monitoring I.V infusion therapy: the nurse should : • inspect the tubing. • inspect the I.V set at routine intervals at least daily. • Monitor vital signs . • recount the flow rate after 5 and 15 minutes after initiation

27. B) Intermittent flushing of I.V lines • Peripheral intermittent are usually flushed with saline (2-3 ml 0.9% NS.) • C) Replacing equipments (I.V container, I.V set, I.V dressing): • I.V container should be changed when it is empty. • I.V set should be changed every 24 hours. • The site should be inspected and palpated for tenderness every shift or daily/cannula should be changed every 72hours and if needs. • I.V dressing should be changed daily and when needed

28. III. Implementation during phase of discontinuing an I.V infusion • The nurse never use scissors to remove the tape or dressing. • Apply pressure to the site for 2 to 3 minutes using a dry, sterile gauze pad. • Inspect the catheter for intactness. • The arm or hand may be flexed or extended several times.

29. Recording and reporting: • Type of fluid, amount, flow rate, and any drug added. • Insertion site. • Size and type of I.V catheter or needle. • The use of pump. • When infusion was begun and discontinuing. • Expected time to change I.V bag or bottle, tubing, cannula, and dressing.

30. Any side effect. • Type and amount of flush solution. • Intake and output every shift, daily weight. • Temperature every 4 hours. • Blood glucose monitoring every 6 hours, and rate of infusion.

31. Evaluation • Produce therapeutic response to medication, fluid and electrolyte balance. • Observe functioning and patency of I.V system. • Absence of complications.

32. reference • http://www.medterms.com/script/main/art.asp?articlekey=3870 • -Carol.T.taylor and carol lillis.R, (2001): Fundamentals of Nursing, 4th ed ,Lippincott, company,Pheladelphia ,pp:180-249.

33. Thank you for listening