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IV THERAPYPART 2
Catherine Luksic BSN, RN
METHODS OF IV INFUSION
Primary infusion“maintenance infusion”“continuous infusion”
Via gravity Via electronic pump
Secondary infusion“piggyback” “IVPB”
Usually via electronic pump
EQUIPMENT: IV TUBING
Primary IV administration setGravity infusionElectronic pump infusion
Secondary IV administration set“piggyback tubing”
Blood administration Y set Extension tubing Intermittent infusion lock
HL or SL
METHODS OF IV INFUSION Gravity Drip
Manually set, regulated w/ roller clampSimplest methodCount drops manuallyMacrodrip tubing - drop factor determined by
manufacturer Can range from 10-20 gtts/mL (common
10gtts/mL) standard primary tubing for rapid infusions
Microdrip tubing - 60gtts/mL Used for peds, elderly, slower rates
GRAVITY INFUSION
Advantages:EasyDoes not require power source or
pumpCan set-up quickly
Disadvantages:Not greatly accurateNo free-flow preventionRoom for error
CALCULATING A GRAVITY IV RATE
Volume ordered to be infused1000 ml or 1000 cc
Drop factor of tubing being used
Rate of infusion as per order100 ml /hr (or 100 cc/hr)
**refer to IV calculations worksheets
RATE OF IV INFUSION
Check physician orders ! Gravity drip or electronic pump ? cc/hr = ml/hr KVO (10-20 ml/hr) TKO Check IV site & IV rate at least every
hour
PRIMING Refer to procedure Maintain sterility Remember to close the roller clamp 1st
** ?? Invert all Y-sites and tap to remove
air
Demonstration Practice
FACTORS THAT WILL AFFECT FLOW RATE
Height of bag36 inches above heart
Position of roller clamp is it open or closed ?
Patency of tubingCheck for kinks
SLOWED INFUSION RATE Check rate - has it been
changed? Check tubing - is it kinked? Check clamp(s) - are they open? Check site -
is cath or vein being compressed?ANY abnormality? Look for sign of infiltration
ELECTRONIC CONTROL DEVICES
Purpose – improve accuracy of delivery.
Requires power source
Deliver a preset fluid rate over a specified period Uses constant force
Always use pump w/ TPN, central lines, titrated medications, blood products
ELECTRONIC PUMP ALARMS(COMMON)
Occlusion Air-in line Infusion complete Power
ELECTRONIC IV PUMPS
SINGLE CHANNEL
MULTI-CHANNEL
PCA (Patient controlled analgesia)
AMBULATORY IV PUMPS Home care use
NURSING PROCESS
ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
ASSESSMENT
FIRST STEP, AS ALWAYS chronic conditions use of long-term medications
(anticoagulants) previous IV experiences/problems allergies (especially latex & antimicrobial
agents) hand dominance Skin *Cultural considerations, communication
barriers, level of understanding
ASSESSMENT
Physical examNeurological status – AAO, ability to understand and cooperate
Cardiovascular status – color, pulses, edema, appearance of veins
Skin – bruising, rashes, lesions
NURSING DIAGNOSIS Examples:
Risk for injury related to (lack of knowledge regarding equipment)
Knowledge deficit related to (new IV insertion) AEB (pt verbalization …)
Impaired physical mobility related to placement of peripheral IV AEB…
Anxiety related to (initiation of IV therapy) AEB...
Alteration in comfort: Pain
PLANNING
Patient outcomes and goals - what do you (and the patient!) expect.Ex: Pt. will remain free of S/S of
complications related to IV therapy More specific – Pt. will remain free of
signs of phlebitis
IMPLEMENTATION
Nursing Care:Check site HOURLY for complications - redness, pain,
edema, infiltration Instruct pt. to call nurse immediately: pain, bleeding, other concerns. Instruct pt. to call nurse if pump alarm sounds.Maintain correct infusion rate as ordered.Secure IV (to prevent accidental dislodging of
catheter during movement).Change tubing according to hospital policy (usually q 72 hr.)Change IV site according to hospital policy (usually q 72 hrs.)
IMPLEMENTATION
Nursing Care:2011 Infusion Nurse Society
(recommendations)Do not change IV tubing more frequently
than q 96 hrs.If IVPB tubing is detached from
continuous tubing, change q 24 hrs.
EVALUATION
How will you know if the goal/outcome has been achieved?AssessmentPatient recordLab valuesCommunication