CARE OF PATIENTS WITH INTRAVENOUS THERAPY Intravenous Therapy the administration / introduction of fluids directly into the veinPurposes

s / Rationale / Goals:a. Maintain & replace body stores of water, electrolytes, vitamins, proteins, fate & calorieswhen patient or client cannot maintain an adequate intake by mouthb. Restore acid-base balancec. Restore volume of blood componentsd. Provide avenue for the administration of medicatione. Provide nutrition while resting the GI TractEquipment Needed:a. IV Fluid in bottle or plastic containerb. Tubingc. Needle / Catheter in different sizes (gauge 14 25) or winged, butterfly needled. IV Pole / IV Infusion Pumpe. Others dressing (transparent gauze); tape / plaster; splint / armboardAdvantages:a. used when patient cannot take oral medicationb. permits accurate dosec. acts instantly absorbed quickly by the bodyDisadvantages:a. Carries risk like bleeding, infiltration, infection, and allergic reactionsb. Limits patient activitiesc. Costly costs more than any other drug Intracellular 55% of total body fluid2. Extracellular 45% of total body fluida. Interstitial Fluidsb. CSF Cerebro Spinal Fluidc. PlasmaKinds of IV Solutions: Adult contain 60% of fluids in the bodyFunctions of Fluid:1.

1. Isotonic solution has the same osmolarity as serum and other body fluids, hence, itstays where it is infused (intravascular space). It expands thiscompartment without pulling the fluid from other compartments(intracellular & interstitial). Example: LR, NSS (0.9 NS). Indication:Blood loss or hypovolemia2. Hypertonic solution osmolarity is higher than the serum. When infused, it initiallyincreases osmolarity causing the fluid to be pulled from the interstitial& intracellular compartments into the blood vessel (intravascularspace). Example: D50.5NS, D5LR, D5NS. Indication: Regulate urineoutput; stabilize blood pressure; reduce risk of edema; Post-opPatients3. Hypotonic solution osmolarity is lower than the serum. When infused, fluid shifts out of the blood vessels (intravascular space) into the cells while reducingthe fluid in circulatory system. Example: D0.45NS; 0.33NS; Dextrose2.5% in Water. Indications: Dehydration; DKA; HHNK Osmolarity no. of particles in a Liter of Water Osmolality no. of particles per Kg. of Water Crystalloid clear IV fluid - Hypotonic- Hypertonic- Isotonic Colloid Murky / Black IV FluidParts of IV Tubing:a. Piercing spikeb. Drop orificec. Drip chamberd. Roller clampe. Y-injection site / port direct injection to the blood vesself. Luer-Lock site Volume Control Set patients at risk with circulatory overload (e.g. infants)- controls the volume of solution that goes through / the amount of medication yougive to the patient

Location:Adult- Use Peripheral, Superficial veins- Metacarpal veins dorsal aspect of hand- Cephalic veins in line with thumb- Basilic veins ulnar side- Median Cubita vein vein that crosses in the cubital region- Great Saphenous vein- Dorsal venous network- Frontal- Superficial temporal- OccipitalChildrenGreat Saphenous vein- Dorsal venous networkInfant- Frontal- Superficial Temporal- OccipitalFactors Affecting Rate of Flow1. Pressure gradient the difference between two levels in a fluid system2. Friction the interaction between fluid molecules & surfaces of inner wall of tubing3. Diameter & Length of tubing, gauge of cannula4. Height of infusion container ideal height is 36 or 3 ft. from insertion site5. Size of opening through which fluid leaves receptacle

6. Characteristic of fluida. Viscosityb. Temperature refrigerated fluids may cause diminished flow & venous spasmIntervention: Administer fluid at room temperature7. Vein trauma, clots, plugging of veins, venous spasma. Vasoconstriction result from anxiety; cold IV fluids; sever vein irritation fromirritating drugs or fluids8. Flow control clamp derangementa. Some clamps may slip & loosen resulting in rapid or runaway infusionb. Plastic tubing may distort causing creep or cold flowc. Marked stretching of tubing may cause distortion of tubing & render clampineffective (may occur when patient turns over & pull on the short tubing).9. Manipulation of the clamp by the patient or significant others April 23, 2005 How To Terminate IV Therapy: 1. Check the doctors order for IV termination2. Wash hands3. Prepare the equipment needed- plaster- cotton balls (3 wet, 3 dry)- bandage scissors- waste receptacle4. Explain procedure to the client5. Clamp the IV line6. Put on gloves as necessary7. Lift the tape from skin to expose the insertion site using wet cotton balls8. Apply dry cotton ball directly over the insertion site. Using the other hand, quicklyremove the device and tape from the skin9. Maintain direct pressure on the IV site for 1 to 2 minutes10.

Put plaster over the insertion site, hold limb upright for 5 minutes11. Instruct patient to restrict activity for about 10 minutes and leave the site with a plasterin place for at least 8 hours as necessary