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8/3/2019 IVT Procedure I
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INTRAVENOUS
THERAPY
Dale Brian T.Gaviola,WOCN
PROCEDURE I
SETTING UP / CHANGING / DISCONTINUING
I.V. INFUSION
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Indications
1. Establish or maintain a fluid or electrolyte balance.
2. Administer continuous or intermittentmedication.
3. Administer bolus medication.
4. Administer fluid to keep vein open
(KVO).
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5. Administer blood or blood
components.
6. Administer intravenous anesthetics.
7. Maintain or correct a patient's
nutritional state.
8. Administer diagnostic reagents.
9. Monitor hemodynamic functions.
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IV Devices
Types of IV needles
and catheters:
STEEL NEEDLES
Example: Butterfly catheter. They are named after the wing-like plastic
tabs at the base of the needle. They are used to deliver small
quantities of medicines, to deliver fluids via the scalp veins in
infants, and sometimes to draw blood samples (although not
routinely, since the small diameter may damage blood cells). These
are small gauge needles (i.e. 23 gauge).
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OVER THE NEEDLE CATHETERS
Example: peripheral IV catheter. This is the kind of catheter you will
primarily be using.
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INSIDE THE NEEDLE
CATHETERS
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Example: midline andextended dwell catheters
This is a typical
catheter over the
needle arrangement
This is an inside
the needlecatheter
arrangement
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AND NOW, A WORD ABOUT GAUGES:
Catheters (and needles) are sized by their diameter,
which is called the gauge. The smaller the diameter,
the larger the gauge. Therefore, a 22-gauge catheter
is smaller than a 14-gauge catheter. Obviously, the
greater the diameter, the more fluid can be delivered.
To deliver large amounts of fluid, you should select alarge vein and use a 14 or 16-gauge catheter. To
administer medications, an 18 or 20-gauge catheter
in a smaller vein will do.
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16G 18G 20G 22G 24G 24G**
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3 MAIN TYPES OF IV FLUIDS
ISOTONIC FLUIDS
HYPOTONIC FLUIDS
HYPERTONIC FLUIDS
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ISOTONIC FLUIDS
CLOSE TO OSMOLARITY AS SERUM. STAY INSIDE
INTRAVASCULAR COMPARTMENT THUS EXPANDING IT
CONTAINS APPROXIMATELY EQUAL NUMBER OF
MOLECULES AS SERUM SO FLUID STAYS WITHININTRAVASCULAR SPACE
CAN BE HELPFUL IN HYPOTENSIVE AND HYPOVOLEMIC
PTS.
CAN BE HARMFUL. RISK OF FLUID OVERLOADING ESP
IN PTS WITH CHF AND HPN
EX. LR, NS
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HYPOTONIC FLUIDS
HAVE LESS OSMOLARITY THAN SERUM
DILUTES SERUM WHICH DECREASES SERUMOSMOLARITY
CAN BE HELPFUL WHEN CELLS ARE DEHYDRATEDSUCH AS A DIALYSIS PT. ON DIURETIC THERAPY
MAY ALSO BE USED FOR HYPERGYCEMIC PTS.LIKE DIABETIC KETOACIDOSIS
CAN BE DANGEROUS TO USE BECAUSE OF THE
SUDDEN FLUID SHIFT FROM THE INTRAVASCULARSPACE TO THE CELLS WHICH CAN LEAD TOCARDIOVASCULAR COLLAPSE AND INCREASEDICP
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CONTAIN LOWER NUMBER OF MOLECULES THAN
SERUM SO THE FLUID SHIFTS FROM THE IV SPACE
TO THE INTERSTITIAL SPACE
THIS DECREASES THE INTERSTITIAL SPACEOSMOLARITY WHICH THEN CAUSES THE FLUID TO
MOVE INTO THE CELLS
EX. D5 NS .45
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HYPERTONIC FLUIDS HAVE A HIGHER OSMOLARITY THAN SERUM PULLS FLUID AND ELECTROLYTES FROM THE
INTRACELLULAR AND INTERSTITIAL
COMPARTMENTS IMTO THE INTRAVASCULAR
COMPARTMENT CAN HELP STABILIZE BLOOD PRESSURE,
INCREASE URINE OUTPUT, AND REDUCE EDEMA
CARE MUST BE TAKEN WITH THEIR USE
DANGEROUS IN THE SETTING OF CELLDEHYDRATION
EX. 9.0% NS, BLOOD PRODUCTS,
ALBUMIN
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CONTAIN A HIGHER NUMBER OF MOLECULES
THAN THE SERUM SO THE FLUIDS SHIFT FROM
THE INTERSTITIAL SPACE TO THE
INTRAVASCULAR SPACE
THIS DECREASES THE INTERSTITIAL SPACE
OSMOLARITY THAT THEN CAUSES FLUID TO LEAK
OUT OF THE CELLS
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Procedure I
A. Setting up IV infusion
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1. Verify doctor¶s order and make IV
label.
2. Observe ten (10) Rs when preparing
and administering IVF
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10 GOLDEN RULES on drug
administration Obtain a complete drug history
Identify if the client has any drug allergies
Know potential drug effects, drug-drug interactions and compatibilities.
Teach your client about the drug he is receiving
Administer the right drug
Administer the right drug to the right patient
Administer the right dose
Administer the right drug at the right route
Administer at the right time and frequency
Right documentation of each drug you administer
* to protect your patients and your license as a nurse, follow theseguidelines for avoiding medication errors.
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3. Explain procedure to the patient and/or
significant others , secure consent if
necessary.
4. Assess patient¶s vein; choose appropriate
vein ;location,size condition
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VEINS OF THE HANDDIGITAL
DORSALIS VEIN
DORSAL
METACARPAL VEINS
DORSAL VENOUS
NETWORK
CEPHALIC VEIN
BASILIC VEIN
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AVEINS OF THE FOREARM
CEPHALIC VEIN
MEDIAN CUBITAL VEIN
ACCESORY CEPHALIC
VEIN
BASILIC VEIN
CEPHALIC VEIN
MEDIANANTEBRACHIAL VEIN
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5. Wash hands and maintain asepsisthroughout the preparation during the
therapy .
6. Prepare the necessary materials for
procedure
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1. IV tray with solution
2. Administration set
3. IV cannula
4. Forceps soaked in antiseptic solution
5. Alcohol prep pads, cotton balls with alcohol6. Plaster
7. Tourniquet
8. Gloves
9. IV splint10. IV hook
11. 2x2 gauze or transparent dressing
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7. Check the sterility andintegrity of the IV solution ,IV set and other devices
8. Place IV label on IVF bottle
Patients name
Room number
Solution,
drug incorporation
Bottle sequenceDuration
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9. Open the seal aseptically of the solutionand disinfect rubber port with cotton ball
with alcohol.
10. Open administration set aseptically and
close the IV clamp
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11. Spike the infusate aseptically.
12. Fill drip chamber to at least half
and prime tubings.
13. Remove air bubbles any and pull
back the cover to the distal end of the
I.V. tubing.
( get ready for IV insertion)
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B. Changing an IV infusion
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14. Verify doctor¶s order ; countercheckthe ff:
a. IV label
b. IV Card
c. Infusate sequence
d. Type
e. Amount
f. Additives
g. Duration of infusion
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15. Observe ten (10) Rs.
16. Explain procedure to the patient andassess IV site for redness, swelling, pain ,etc.
17.Check date of IV insertion; re-site if 48-72hours has lapsed
18. Check date of changing IV tubings, changeif due for changing
(change IV tubings within 72 hours)
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19. Wash hands before and after the procedure
20. Prepare necessary materials
a. IV solution
b. IV label
c. Disinfectant
d. Kidney basin
e. IV tray
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21. Check sterility and integrity of IV
solution.
22. Place IV label on the IV bottle
23. Calibrate new IV bottle according to
duration of infusion.
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24. Open and disinfect rubber port of IV
solution to follow.
25. Close IV clamp or kink tubing and spike thecontainer aseptically
26. Regulate the flow rate based on duration of infusion . Remove air bubbles (if any)
27. Reasure patient and significant others.
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Nurse Alert !28. Discard all waste materials according to
MMDA Ordinance # 16
29. Document accordingly and endorse to
incoming shift,
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C. Discontinuing an I.V. Infusion
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30. Verify written doctor¶s order to
discontinue IV including IV medicines.
31. Observe ten (10) Rs
33. Assess and inform the patient of the
order and of any ordered medicines
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33. Prepare the necessary materials :
a. IV tray or injection tray
b. Cotton balls with alcoholc. Plaster
d. pick-up forceps in antiseptic solution
e. Kidney basin
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34. Wash hands before and after procedure
35. Close IV clamp of the tubing .
36. Moisten adhesive tapes around the IV
catheter with cotton ball with alcohol.
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37. Use pick-up forceps to get cotton ball
with alcohol and without applyingpressure , remove needle or IV catheter
then immediately apply pressure over veni
puncture site.
38. Inspect IV catheter for completeness
39. Place dressing over venipuncture site.
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40. Discard all waste materials including the
IV cannula according to MMDA Ordinance# 16
41. Reassure patient.
42. Document time of discontinuance, status
of insertion site and integrity of IV catheter and endorsee accordingly.
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NURSE ALERT !: Don·t forget to document your
actions!