PRINCIPLE AND CARE OF PATIENTS WITH INTRAVENOUS THERAPY MATRON ROZAILA BINTI ZAINON @ MD ALI PPUITM SG BULOH
OBJECTIVE • AS A GUIDELINE FOR NURSES IN PROVIDING SAFE AND QUALITY NURSING CARE TO PATIENTS WITH INTRAVENOUS INFUSION THERAPY. • PROMOTE THE APPLICATION OF PRINCIPLES UNDERLYING THE ADMINISTRATION OF IV THERAPY
• INTRAVENOUS THERAPY IS A DELIVERY METHOD FOR FLUIDS AND MEDICATION THROUGH THE VEINS. • THE FLUIDS, BLOOD, MEDICATIONS AND NUTRIENTS (BASED ON THE PHYSICIANS WRITTEN PRESCRIPTION ) IS DELIVERED VIA IV INFUSION OR INJECTION INTO THE VEIN, WHICH ALLOW THE THERAPY TO ABSORBED QUICKLY THROUGH BLOODSTREAM.
TYPES OF IV THERAPY
ISOTONIC. -ISOTONIC IV FLUIDS - HAVE THE SAME CONCENTRATION OF SOLUTES AS BLOOD PLASMA -ARE USED TO INCREASE FLUID VOLUME DUE TO BLOOD LOSS, SURGERY, OR DEHYDRATION . -THERE ARE MANY DIFFERENT TYPES OF COMMON ISOTONIC FLUIDS, SUCH AS: 1. NORMAL SALINE (0.9% NACL, NS) 2. 5% DEXTROSE IN WATER (D5W) 3. LACTATED RINGER’S SOLUTION (LR)
HYPOTONIC. •HYPOTONIC IV FLUIDS -HAVE LESSER CONCENTRATION OF SOLUTES THAN PLASMA. -ARE DESIGNED TO BRING FLUID FROM THE BLOODSTREAM INTO THE CELLS AND TISSUES TO HELP IN BODY WASTE EXCRETION. IN OTHER WORDS, THEY ARE COMMONLY USED TO HELP PATIENTS AVOID DEHYDRATION. -THERE ARE MANY COMMON TYPES OF HYPOTONIC FLUID, SUCH AS: – 0.45% NORMAL SALINE (HALF NORMAL SALINE) – 0.225% NORMAL SALINE (QUARTER NORMAL SALINE) – 2.5% DEXTROSE
HYPERTONIC. •HYPERTONIC IV FLUIDS -HAVE GREATER CONCENTRATION OF SOLUTES THAN PLASMA. -TO SHIFT FLUIDS INTO THE BLOODSTREAM TO DILUTE ELECTROLYTES. -MUST BE MONITORED CLOSELY BECAUSE THEY COULD LEAD TO AN OVERLOAD IN FLUID. •TYPES OF COMMON HYPERTONIC FLUIDS INCLUDE: 1.SALINE SOLUTIONS: >0.9% A. 3% NACL B. 5% NACL 2.DEXTROSE SOLUTIONS >=10% A. D10W B. D20W C. D50W 3.MANNITOL
INDICATION OF IV THERAPY •MAINTAIN HYDRATION / CORRECT DEHYDRATION IN PATIENTS UNABLE TO TOLERATE SUFFICIENT VOLUMES OF ORAL FLUIDS MEDICATIONS.
•ADMINISTRATION OF DRUG. •PARENTERAL NUTRITION/ NUTRITIONAL SUPPORT cont..
cont.. •TRANSFUSION OF BLOOD OR BLOOD COMPONENTS .
CONTRAINDICATION IN PERIPHERAL IV THERAPY •WHEN PERIPHERAL ACCESS IS IN INJURED , INFECTED OR BURN. Some irritant solution can cause blister and tissue necrosis Complication in medicine
CONTRAINDICATION IN IV FLUIDS THERAPY •CIRCULATORY OVERLOAD / PULMONARY EDEMA
•AGE < 1 YEAR ( 22 , 23 GAUGE) 1-8 YEARS ( 18 , 20 , 22 GAUGE) >8 YEARS ( 16, 18, 20 GAUGE) ONE OF THE IMPORTANT THINGS TO KNOW WHEN STARTING AN IV IS THE PROPER NEEDLE SIZE TO USE. IV NEEDLES ARE SIZED BY GAUGES AND THE SMALLER THE GAUGE NUMBER, THE BIGGER THE NEEDLE WILL BE.
DIFFERENT SIZE OF CANNULA GAUGE CLINICAL APPLICATION CANNULA
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DOCUMENTATION OF IV INSERTION Example : Branula inserted at right hand antecubital with 20 gauze under aseptic technique . Flushing with 5 cc Normal Saline with good flow. Secure site of branula with transparent dressing. Dressing dry and intact.
FORMULA
FLOW RATE (MLS / HOUR) WHEN USING ELECTRONIC INFUSION CONTROLLERS, THE FLOW RATE NEEDS TO BE SET. THE RATE IS THE VOLUME IN ML DIVIDED BY THE DURATION IN HOURS (MLS PER HOUR). THIS CALCULATION CAN BE EXPRESSED AS A FORMULA FLOW RATE = VOLUME (ML) / TIME (HOURS) FORMULA
REGIME 2 PINTS NORMAL SALINE + 2 PINTS DEXTROSE 5% OVER 24 HOURS = 24 4 = 6 HOURS Normal Saline 0800 - 1400 Dextrose 5% 1400 – 2000 Normal Saline 2000 - 0200 Dextrose 5% 0200 - 0800
COMPLICATIONS OF IV THERAPY Classified according to their location -Local complication : at or near the insertions site or as a results of mechanical -Systemic complication : occur within the vascular system , remote from the site. Can be serious and life threatening
https://youtu.be/vE99rZ7JT3Q
CARE OF PATIENTS WITH IV THERAPY PRE - INTRAVENOUS THERAPY DURING INTRAVENOUS THERAPY POST INTRAVENOUS THERAPY
PRE-INTRAVENOUS THERAPY 1. REVIEW PHYSICIAN’S ORDER THE NURSE MUST ADHERE TO THE FOLLOWING PRINCIPLES OF GIVING INTRAVENOUS (IV) MEDICATION:- •RIGHT PATIENT •RIGHT DRUG : TYPE OF SOLUTION TO BE INFUSED •RIGHT DOSAGE : EXACT AMOUNT TO BE ADDED TO A COMPATIBLE SOLUTION EITHER HOURLY OR 24-HOUR VOLUME •RIGHT ROUTE •RIGHT TIME : DURATION OF INFUSION OR THE TIME OVER WHICH THE INFUSION IS TO BE COMPLETED •RIGHT DILUTION •RIGHT DOCUMENTATION •PHYSICIAN’S SIGNATURE
cont.. 2. HAND HYGIENE 3. PREPARE THE EQUIPMENT 4. PATIENT ASSESSMENT AND PSYCHOLOGICAL PREPARATION -INTRODUCE SELF AND VERIFY THE CLIENT’S IDENTITY. -PROVIDE PRIVACY -EXPLAIN THE PROCEDURE TO THE CLIENT. A VENIPUNCTURE CAN CAUSE DISCOMFORT FOR A FEW SECONDS, BUT THERE SHOULD BE NO DISCOMFORTS WHILE THE SOLUTION IS FLOWING. -EVALUATE THE PATIENT PREPAREDNESS FOR IV PROCEDURE BY TALKING WITH PATIENT BEFORE ASSESSING VEINS 5. SITE SELECTION AND VEIN DILATION
TYPE OF TUBING
TYPE OF TUBING
TYPE OF TUBING
2. IV THERAPY SITE -OBSERVE DAN INSPECT OF THE INSERTION SITE FOR ANY SIGN & SYMPTOMS OF PHLEBITIS. -CHANGE TRANSPARENT DRESSING WHEN IV THERAPY SITE WET, SOIL & STAIN -CLEAN THE SITE WITH TOPICAL ANTISEPTIC SWAB. -LOOP THE TUBING AND SECURE IT WITH TAPE. LOOPING AND SECURING THE TUBING PREVENT THE WEIGHT OF THE TUBING OR ANY MOVEMENT FROM PULLING ON THE NEEDLE OR CATHETER. -FLUSH THE LINE EVERY SHIFT OR WHEN NECESSARY -REMOVE THE IV LINE IF NOT USE FOR 48 HOURS -REMOVE THE IV LINE IF THERE IS SIGN OF REDNESS OR WARM -ENSURE APPROPRIATE INFUSION FLOW. CARE OF PATIENTS WITH IV THERAPY
3.LABELING -INSERTION SITE •THE VENIPUNCTURE SITE SHOULD BE LABELED: •DATE AND TIME •TYPE AND LENGTH OF CATHETER •NURSE’S INITIALS -ADMINISTRATION SET •LABEL ACCORDING TO AGENCY POLICY: LABEL SHOULD HAVE DATE ON WHICH ADMINISTRATION SET MUST BE CHANGED cont..
CARE OF PATIENT POST INTRAVENOUS THERAPY 1.PATIENT EDUCATION •PATIENT MUST RECEIVE INFORMATION ON ALL ASPECTS OF THEIR CARE. AFTER CATHETER IS STABILIZED, DRESSING IS APPLIED, AND LABELING COMPLETE. •INFORM REGARDING ANY LIMITATIONS OF MOVEMENT OR MOBILITY •INSTRUCT TO CALL FOR ASSISTANCE IF VENIPUNCTURE SITE BECOMES TENDER OR SORE OR IF REDNESS OR SWELLING DEVELOPS •ADVISE THAT SITE WILL BE CHECKED EVERY SHIFT BY THE NURSE
2. DOCUMENTATION •DOCUMENT THE RELEVANT DATA, INCLUDING ASSESSMENTS. •RECORD THE START OF THE INFUSION ON THE PATIENT’S CHART. •INCLUDE THE DATE AND TIME OF THE VENIPUNCTURE •THE GAUGE AND LENGTH OF THE DEVICE •SPECIFIC NAME AND LOCATION OF THE ACCESSED VEIN •AMOUNT OF SOLUTION USED, INCLUDING ANY ADDITIVES •FLOW RATE •TYPE, LENGTH AND GAUGE OF THE NEEDLE OR CATHETER •VENIPUNCTURE SITE, HOW MANY ATTEMPTS WERE MADE AND LOCATION OF EACH ATTEMPT •SIGNATURE OF NURSE cont..
I.USE STRICT ASEPTIC TECHNIQUE WHEN INITIATING , CHANGING BAG, CHANGING TUBING II.DIRECT ACCESS TO CIRCULATORY SYSTEM III.EXAMINE SOLUTION FOR TYPE , AMOUNT, EXPIRATION DATE , CHARACTER OF SOLUTION AND INTEGRITY OF CONTAINER IV.IV SOLUTION SHOULD BE AT ROOM TEMPERATURE V.TYPE OF SOLUTION ORDERED BY PHYSICIAN VI.ALWAYS CLOSE CLAMP WHEN CHANGING BAG, PATIENT GOWN EQUIPMENT VII.ALWAYS CLOSED CLAMP WHEN REMOVING FROM PUMP FOR ANY REASON VIII.ALWAYS CHECK TUBING AT LEAST 4 HOURLY IX.NEVER PLAY ‘CATCH UP’ IF BEHIND SCHEDULE TAKE HOME MESSAGE
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