Term
| Indications for IV Therapy |
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Definition
Fluid Volume Replacement and Maintenance
Electrolyte Imbalance Correction
Medication Administration
Nutritional Support
Blood Administration |
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Term
| Causes of fluid volume deficit (FVD) |
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Definition
vomiting
diarrhea
fistula drainage
GI suctioning
fever
third space fluid shifting
diuretics
hemorrhage
anorexia or inability for oral intake
dehydration secondary to a tx that is already in place |
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Term
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Definition
administration route for emergency access
administration route for unconscious pts
administration route for NPO patient
route to counteract adverse medication reactions
quicker and faster absorption
ability to maintain serum levels
less discomfort |
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Term
| disadvantages of IV therapy |
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Definition
invasive
potential for fluid volume excess
painful insertion and/or site
immediate effect from medications
rapidly occurring allergic reaction potential
break in sin integrity/potential for infection
potential for speed shock (hypovolemic shock when meds pushed too fast) |
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Term
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Definition
a measure of the number of dissolved particles per unit of water in serum
maintains ICF/ECF concentration |
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Term
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Definition
270-300
body fluids are isosmotic to each other |
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Term
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Definition
fluid moves OUT of cells
cells shrink |
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Term
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Definition
fluid move IN to cells
cells swell or burst |
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Term
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Definition
osmolality resembles plasma
osmotic pressure: ICF = ECF
fluid remains intravascular (stay where it is administered) |
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Term
| uses for isotonic IV solutions |
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Definition
expand intravascular volume
treat hypotension
treat hypvolemia |
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Term
| different isotonic IV solutions |
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Definition
0.9% (Normal Saline)
Lactated Ringers
D5W (Dextrose 5% in water) |
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Term
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Definition
Hypovolemia
Medication diluent
Only solution compatible with blood products
Hyponatremia |
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Term
| nursing implications for 0.9% NS |
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Definition
Assess for fluid volume excess/circulatory overload
Check serum electrolyte levels |
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Term
| indications for lactated ringers (LR) |
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Definition
Rehydration (water and electrolytes)
Fluid Replacement d/t diarrhea or burns
Treat Acidosis |
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Term
| nursing implications for LR |
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Definition
I&O
Risk for hyperkalemia if given with K+ supplement
DO NOT administer in cases of alkalosis (once inside body, converts lactate to bicarb) |
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Term
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Definition
rehydration
fluid maintenance |
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Term
| nursing implications for D5W |
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Definition
increase urine output
DO NOT use on pts with CHF, FVE or ICP
ISOtonic in bag only, when infused becomes HYPOtonic b/c dextrose is metabolized quickly, solution is able to freely infuse from compartment to compartment |
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Term
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Definition
higher osmolarity than plasma
pulls fluid from cells into the blood vessels (circulatory system)
can cause RBCs to shrink |
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Term
| examples of HYPERtonic IV solutions |
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Definition
D5.45NaCl (MOST COMMON)
D5.9NaCl
D5 in LR |
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Term
| Indications for HYPERtonic IV solutions |
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Definition
post-op patients
dehydrated patients |
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Term
| HYPERtonic GLUCOSE solutions |
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Definition
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Term
| indications for HYPERtonic GLUCOSE solutions |
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Definition
provide calories
treat severe hypoglycemia
usually given through a primary line as IV push |
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Term
| nursing implications for HYPERtonic GLUCOSE solutions |
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Definition
CVAD for solutions greater than 10% dextrose
assess for hyperglycemia
assess for sepsis |
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Term
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Definition
lower osmolarity than plasma
fluid moves from blood vessels into cells and interstitial spaces (can make cells burst)
may deplete fluid in the circulatory system
examples:
0.45% Sodium Chloride
0.33% Sodium Chloride |
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Term
| indications for HYPOtonic solutions |
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Definition
treat cellular dehydration d/t diuretics
diabetic ketoacidosis
rehydration and fluid maintenance
(not used very often as these are rare conditions) |
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Term
| terms used to fully document IV therapy |
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Definition
amount
solution
additive (usually electrolytes or vitamins)
rate
tonicity
eg. 1000mL D5.45NS c 20meqKCL at rate of 125mL/hr hypertonic |
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Term
| patient teaching points for IV therapy |
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Definition
explain procedure
length of IV therapy
rationale for IV therapy
benefits to the patient
describe any discomfort, immobility and inconvenience expected (pt will feel solution in veins - temp and speed)
S/S to be reported |
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Term
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Definition
swelling
burning
redness
pain
itching
blood in tubing
leaking
extremity cool to touch |
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Term
| What to verify before starting IV therapy |
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Definition
date and time
prescribed solution with or without additives
Vol to be Infused (VTBI)
rate of administration (mls/hr or total volume/# of hrs)
physician signature
math formula for infusion |
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Term
| equipment needed for IV therapy |
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Definition
container
tubing (primary, secondary, Y tubing)
IV poles/hangers
IV pump
take, dressings (transparent) and labels
gloves
IV start kit |
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Term
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Definition
the fluid is infusing at a constant rate over a 24/7 period until d/c
infused with a pump or by gravity
always going to be the long line with access ports for secondary/piggyback |
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Term
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Definition
IV piggyback line or rider
short tubing
used for additives |
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Term
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Definition
for pump: ml divided by hours
no pump: amount to be infused times the gtt factor of the tubing being used divided by time for infusion in minutes = gtt/min |
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Term
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Definition
| 60 gtt/min (read box for info) |
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Term
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Definition
10-20 gtt/min (read box for info)
commonly used for infants |
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Term
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Definition
24 hr = 42mL/hr
12 hr = 83mL/hr
10 hr = 100mL/hr
8 hr = 125mL/hr
6 hr = 167mL/hr |
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Term
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Definition
| date, time, patient's name, patient's MRN, what the solution is |
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Term
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Definition
start date/time of tubing
(tubing can only be used for max 72-96 hrs per facility P&P) |
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Term
| labeling for IV insertion site |
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Definition
| when it was started and by whom |
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Term
| checks for IV solution initiation |
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Definition
assess solution for clarity, particulats, leaks, expiration
assess for allergies
assess for compatibility (drugs with drugs, drugs with fluids, fluids with other fluids)
assess potential site |
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Term
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Definition
most common are KCL and Magnesium
DO NOT add to a hanging bag
know the P&P at your facility |
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Term
| MUST KNOW about K+ as an additive |
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Definition
MAX amount of K+ is 60meq/L or 10meq/hr
(if MD writes order for 20meq of K+, need to know it has to infuse of 2 hours)
NEVER give K+ IVP - can cause arrhythmia |
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Term
| important steps for maintaining IV infusions |
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Definition
monitor patient and IV site HOURLY
check solution and any additives
check for correct patient
initiation and completion times (based on VTBI)
assess entire pump system and site
assess lab work
NO IV BAG SHOULD HANG BEYOND 24 HOURS
DO NOT silence alarms no pump |
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Term
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Definition
assess HOURLY
transparent dressings, no tape
know dwell time (time IV catheter has been in vein)
change dressing per protocol
assess for allergies to latex, tape, iodine
secure tubing with tape
DO NOT tape over IV hub or ports
DO NOT encircle extremities with tape |
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Term
| documentation for IV therapy |
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Definition
IV infusion documentation (amount,solution ,additive, rate)
Labels (bag, tubing, and patient site)
method of infusion (pump/gravity)
patient response (only adverse)
verbal report |
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Term
| secondary/piggyback administration |
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Definition
Medications that are administered on an interval basis (q12h, q6h, once a day)
Medications are typically antibiotics, electrolytes or vasopressor
Check compatibility of medication with primary bag fluids
Pharmacy-prepared medication bag with label, including name of medication, date, time, rate of infusion, and patients name
Administered via IV pump or by gravity
The medication is “piggybacked” into the primary bag
Delivered usually in volumes ranging from 50-250mls. |
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Term
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Definition
Used to maintain venous access without continuous IV infusion
Access for IV Push (IVP) medications
Access for intermittent medication administration (e.g., antibiotics IVPB)
NEED TO FLUSH A SALINE LOCK EVERY 8 HOURS |
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Term
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Definition
Assess the site
Verify patency
Flush with 2-3ml 0.9%NS every 8-12 hours
Do not flush if resistance is met
Never use smaller than 3ml syringe for peripheral flush
Never use smaller than 10ml syringe for central lines |
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Term
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Definition
SALINE-ADDITIVE-SALINE
Flush saline lock with 2-3mL’s saline OR according to agency P&P!
(briefly aspirate before injecting saline to check patency, observe for blood return, then flush)
Administer medication
Flush again with 2-3mL of saline after medication administration complete to clear line |
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Term
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Definition
Confirm order
Gather supplies and gloves
Stop infusion
Prevent skin tears
Apply gauze over site
Pull cannula straight back
Apply pressure
Examine catheter and document |
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Term
| complications of IV therapy |
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Definition
phlebitis
circulatory overload
Extravasation
Infiltration
Occlusion |
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Term
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Definition
inflammation of the vein
commonly caused by:
vein trauma during insertion
prolonged dwell time
irritating medications
friction from catheter movement |
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Term
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Definition
redness, warmth or tenderness at sit and along vein (streak formation)
puffy area over vein
possible fever
palpable venous cord
(phlebitis can advance to thrombophlebitis - thrombi provide excellent medium for bacterial growth) |
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Term
| nursing care for phlebitis |
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Definition
STOP infusion, remove catheter
apply warm packs (although pt may prefer ice)
avoid further use of that vein
may need to dilute solution or slow rate as per pharmacy/physician order
perform venipuncture using larger vein for irritating solutions
document |
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Term
| common causes of occlusion of IV site |
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Definition
improper flushing (know your different catheter needs)
kinked tubing
IV flow interrupted (DO NOT let bags run dry)
blood backup in line
precipitation from incompatible drugs
when attempting to flush DO NOT FORCE if resistance met |
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Term
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Definition
IV fluid leaks into surrounding tissue
commonly caused by penetrated vein wall or dislodgement of catheter from poorly secured IV device
MOST COMMON COMPLICATION OF IV THERAPY
risk increases in the elderly b/c veins are thin and fragile |
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Term
| S/S of infiltration of IV site |
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Definition
swelling at and around IV site (may extend along entire limb)
tightness
cool skin
blanching; may appear translucent
discomfort, burning or pain
slowed IV rate |
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Term
| nursing care for infiltration of IV site |
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Definition
STOP infusion
remove catheter
elevate extremity
check pulse, cap refill, parethesia
perform venipuncture preferably in another extremity or above infiltrated site; restart infusion
document |
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Term
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Definition
Infiltration caused by vesicant (more toxic) drugs (such as antineoplastics, KCL*, phenytoin).
Can cause severe local tissue damage, infections, tissue necrosis, disfigurement, loss of function, even amputation.
Antidote must be administered according to agency P&P
Avoid using back of hand and wrist for infusion of vesicant drugs peripherally |
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Term
| S/S of circulatory overload |
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Definition
difficulty breathing
crackles
jugular vein distention
moist cough
tachycardia
irritability/confusion
PATIENTS MOST AT RISK: ELDERLY, CARDIAC DISEASE, RENAL DISEASE |
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Term
| nursing care for circulatory overload |
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Definition
raise HOB
slow infusion rate
notify physician
monitor VS
I&O
diuretics
check infusion pump
monitor labs |
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