Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128

Chapter 13: Intravenous Therapy By: P.K. Williams, RN VH-71 Seats 14 0 liters


38 Words to Know 02/370 Pg 128 38 Words to Know 02/370 Pg 128

• ABO System Blood products Central venous sites

• Colloid solutions Crystalloid solutions Drop factors

• Drop size Emulsion Infusion pump

• Electronic infusion device In-line filter

• Hypotonic solutions Intravenous(IV) therapy

• Isotonic solution Macrodrip tubing Midclavicular catheter

• Midline catheter Packed cells Peripheral venous sites

• k


38 Words to Know 03/37 Pg 128 38 Words to Know 03/37 Pg 128

• Phlebitis Plasma expanders Secondary tubing

• Pressure infusion sleeve

• Primary tubing Total parenteral nutrition Universal donor

• Universal recipient Unvented tubing

• Volumetric controller Whole blood

• Y-administration tubing Microdrop tubing

• Medication loc

• Salvaged blood

• Total parenteral nutrition


Learning Objectives 04/37 Pg 128 Learning Objectives 04/37 Pg 128

• On completion of this chapter, you will be able to:

• Explain common indications for intravenous (IV) therapy.

• Differentiate between crystalloid and colloid solutions and give examples of each.

• Describe the difference between isotonic, hypotonic, and hypertonic solutions.

• Explain the difference between whole blood, packed cells, blood products, and plasma expanders.

• Describe nursing responsibilities for preparing intravenous solutions, selecting tubing, and selecting an infusion technique.

• Identify nursing responsibilities when preparing the client for IV therapy


Learning Objectives 05/37 Pg 128 Learning Objectives 05/37 Pg 128

• Describe nursing actions involved in performing a venipuncture, including sites and devices commonly used.

• Explain the equipment that must be replaced during IV therapy.

• List complications of IV therapy and signs and symptoms for which the nurse monitors.

• Explain how the nurse discontinues IV therapy.

• Discuss the purpose of a medication lock.

• Describe the nursing process for the client requiring IV therapy.

• Discuss the purpose of total parenteral nutrition, and name one solution often administered concurrently


Introduction 06/37 Pg 128 Introduction 06/37 Pg 128

• IV Therapy

– Parenteral administration of fluids, additives; Requires continual assessment

– State nurse practice acts determine LPN role in IV therapy

– All RNs may administer IV therapy


Question 07/37 Pg 128 Question 07/37 Pg 128

Is the following statement true or false?

The extent of an LPN’s practice with IV therapy is determined by education level and nurse practice act rules.


Answer 08/37 Pg 128 Answer 08/37 Pg 128

True.

The licensing state Nurse Practice Act and an LPN/VN’s personal certification determine their involvement in IV therapy administration.


Indications for IV Therapy 09/37 Pg 128 Indications for IV Therapy 09/37 Pg 128

• Maintain, restore fluid balance

– Oral intake inadequate, impossible

• Maintain, restore electrolytes

• Administer nutrients; Medications

– Specifically designated meds

– Route with most rapid effect

• Replace blood, blood products


Types of Solutions 10/37 Pg 129 Types of Solutions 10/37 Pg 129 • Types of IV Solutions

– Crystalloid: Water and uniformly dissolved crystals

– Colloid: Water and molecules of suspended substances

• Crystalloid Solutions

– Isotonic, hypotonic, and hypertonic solutions

– Influences osmotic distribution of body fluid


Types of Solutions 11/37 Pg 130 Types of Solutions 11/37 Pg 130

Figure: 13-1 Crystalloid solution

Figure: 13-2Osmotic distribution of fluid


Types of Solutions 12/37 Pg 128 Types of Solutions 12/37 Pg 128 • Crystalloid Solutions (Cont’d)

– Isotonic Solutions

• Same concentration of dissolved substance as plasma

• Maintains fluid balance when NPO

– Hypotonic Solutions

•Fewer dissolved substances than plasma

•Rehydrates fluid-deficit clients

•Temporarily increases blood pressure




Hypotonic IV solutions increase blood pressure permanently.



False.

Hypotonic IV solutions may increase blood pressure temporarily.



• Crystalloid Solutions (Cont’d)

– Hypertonic Solutions

•More concentrated than plasma

•Infrequent use

•Uses: Reduces cerebral edema; Expands circulatory volume rapidly; Parenteral nutrition



• Crystalloid Solutions (Cont’d)

– Hypertonic Solutions (Cont’d)

•Total parenteral nutrition (TPN)

•Complete nutrition; Instilled into central circulation only

•Lipid emulsion: Stabilized mixture of two insoluble liquids

•Provides essential fatty acids, additional calories


Types of Solutions 17/37 Pg 130Types of Solutions 17/37 Pg 130

• Colloid Solutions

– Replace circulating blood volume; Blood; Blood products; Plasma expanders

– Blood

•Whole blood: Blood cells, plasma, preservative, anticoagulant

•Use: Restores fluid, blood cells


Types of Solutions 18/37 Pg 130 Types of Solutions 18/37 Pg 130 • Colloid Solutions (Cont’d)

– Packed cells: Plasma removed

•Use: Cellular replacements when additional fluid contraindicated

•Inadequate oral fluid intake

•Risk for CHF

•Laboratory test before administration



• Colloid Solutions (Cont’d)– Blood Products

• Use: Clients needing specific blood substances

– Plasma Expanders

• Nonblood solutions

• Use: Hypovolemic shock

• Dextran

• Hespan


Administering Intravenous Therapy 20/37 Pg 133 Administering Intravenous Therapy 20/37 Pg 133 • Common equipment: Solution; IV tubing;

IV pole; Infusion device

• Equipment preparation; Infusion technique

– IV Solution preparation

•Intentionally reduce infection potential

– IV Tubing choice

•Four options


Administering Intravenous Therapy 21/37 Pg 131 Administering Intravenous Therapy 21/37 Pg 131



• Instillation of IV Solutions

– Methods: Gravity; Electronic infusion device

•Rate of infusion

•Drops per minute; Milliliters per hour

Figure 13-5(Left) vented tubing and(right) unvented tubing



– Gravity Infusion

•Flow rate influences: Solution elevation; Roller clamp adjustment; Pressure infusion sleeve

•Electronic Infusion Devices: Programmed

•Infusion pumps

•Volumetric controllers



• Preparing Client for Venipuncture

– Client education; Answer questions

– Site selection

– Piercing a peripheral vein: Various devices; Differing gauge or diameter

•Greater gauge number = smaller diameter; Diameter: Smaller than vein




The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter.



True.

The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter. Conversely, the lesser the gauge number, the larger the catheter’s diameter.


Administering Intravenous Therapy*** 27/37 Pg 134 Administering Intravenous Therapy*** 27/37 Pg 134

Figure 13-9 Examples of venipuncture devices. (A) Butterfly needle. (B) Over-the-needle catheter



Figure 13-8Venipuncture sites



• Venipuncture Sites***

– Peripheral venous sites; Central veins

– Vein selection factors

•Peripheral Venous Sites

•Most common: Superficial veins of arm, hand

•Infants: Scalp veins; Avoid feet

•Midline catheter: Peripherally inserted venous access device



• Venipuncture Sites (Cont’d)

– Peripheral Venous Sites (Cont’d)

•Midclavicular catheter

•Peripherally inserted

•Extends from superficial to proximal axillary veins

•Current controversy: Thrombosis



• Venipuncture Sites (Cont’d)

– Central Venous Sites

•Delivers solution: Vena cava

•Physician inserts into jugular; subclavian vein

•Trained nurses: Insert PICC

•Post insertion procedures: Chest radiograph for placement confirmation



• Equipment Replacement

– Reduce infection potential

– Solutions

•Upon completion; q24h

– IV tubing

•Per policy; per solution

– Venipuncture devices



• Site Care

– Venipuncture site: Frequent inspection; Document appearance

– Dressing change

•Per agency’s infection control policy


Potential Complications of IV Therapy 34/37 Pg 135 Potential Complications of IV Therapy 34/37 Pg 135 • Potential Complications***

– Risk for infection; Phlebitis; Thrombus formation

– Air bolus; Site infiltration

– Circulatory overload

• Potential Complications: Blood transfusions

– Same as crystalloid solutions

– Reactions: Nonautologous donor cells; Additives; Preservatives


Potential Complications of IV Therapy 33/37 Pg 135 Potential Complications of IV Therapy 33/37 Pg 135

• Potential Complications: Blood Transfusions (Cont’d)

– Incompatibility reaction: Life threatening***

– Delayed reactions: Immune response

– Nonimmune complications: Septic; Symptoms - shaking chills and a fever

– Hypocalcemia: Citrate in donor blood

– Blood-borne infections: Hepatitis A, B, and C; HIV; MFE


Discontinuing Intravenous Therapy 36/37 Pg 137 Discontinuing Intravenous Therapy 36/37 Pg 137 • IV Infusions

– Infusion complete

– Medication lock: Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only Figure 13-14

Attaching a lock device with extension tubing to the IV

catheter hub


End of Presentation NOW ENCLEX

By: P.K. Williams, RN 37/37 [$400 mil] [email protected]

Date post:	04-Jan-2016
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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128

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