IV THERAPY

Lecture / Demonstration

IV THERAPY
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals. It is commonly referred to as a drip because many systems of administration employ a drip chamber, which prevents air from entering the blood stream (air embolism), and allows an estimation of flow rate.

Intravenous therapy may be used to correct electrolyte imbalances, to deliver medications, for blood transfusion or as fluid replacement to correct, for example, dehydration. Intravenous therapy can also be used for chemotherapy (The treatment for any kind of cancer.) Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body.

IV INSERTION PROCEDURE
I. A. Setting Up 1. Verify written prescription and make IV label. 2. Observe the 10 Rs when preparing and administering IVF. 3. Explain the procedure to reassure patient and or significant other, secure consent if necessary. 4. Assess patients vein; choose appropriate site, location, size/ condition. 5. Do hand hygiene before and after. 6. Prepare necessary materials (IV tray with IV solution administration set, IV cannula, cotton balls soaked in alcohol) with cover. 7. Check the sterility and integrity of the IV solution set and other devices.

8.

9.

10.

11.

Place IV label on IVF bottle duly signed by the RN who prepared it. Open IV admnistration set aseptically and close the roller clamp and spike the infusate container aseptically. Fill drip chamber to at least half and prime it with IV fluid aseptically. Expel air bubbles if any and put back the cover to te distal end of the IV set. (get ready for IV insertion).

I. B. Inserting the IV Cannula using the Dummy Arm 1. Verify the written prescription for IV therapy; check prepared IVF and other things needed. 2. Explain the procedure to reassure patient and SO. 3. Do hand hygiene before and after the procedure 4. Choose site for IV 5. Apply tourniquet 5-12cm (2-6 inches) above insertion site depneding on the condition of the patient. 6. Check for radial pulse below the tourniquet

7.

8.

9.

10.

11.

Using the appropriate IV cannula, pierce skin with the correct technique. Upon backflow visualization, continue inserting the catheter into the vein. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance the catheter until the hub is 1mm to the puncture site. Slip a sterilize gauze under the hub. Release the tourniquet; remove the stylet wile applying digital pressure over the catheter with one finger about 1-2 inches from the tip of the inserted catheter. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter.

12.

13.

14.

15. 16. 17.

18.

Open the clamp and regulate the flow rate. Reassure patient. Anchor needle firmly in place with the use of plaster (using appropriate anchoring style) Tape a small loop of IV tubing for additional anchoring. Apply splin, if needed. Calibrate the IVF bottle and regulate flow of infusion. Observe patient and report any untoward effect. Document in the patients chart and endorse to the incoming shift. Discard sharps and waste according to health care management.

I. C. Changing an IV Solution 1. Verify the doctors prescription in doctors order sheet. Countercheck IV label, IV card, type, amount, additive (if any) and duration of infusion. 2. Obseve 10Rs. 3. Explain procedure to the patient and SO and assess site for redness, swelling, etc. 4. Change IV tubing and cannula if 48-72 hours has lapsed after IV insertion. 5. Prepare necessary materials and place them on an IV tray. 6. Check sterility and integrity of IV solution.

7.

8.
9.

10.

11. 12.

13.

14.

Place IV label on IV bottle Wash hands before the procedure Calibrate new IV bottle according to duration of infusion as per prescription. Open and connect the iv tubing into the solution bottle Close the roller clamp Regulate the flow rate according the prescribed infusion rate. Expel air bubbles, if evident. Discard all waste materials according to health care management. Document and endorse.

I. D. Discontinuing an IV Infusion 1. Verify the doctors order including IV medications. 2. Observe 10Rs. 3. Assess and infor the patient of the discontinuation of IV infusion, 4. Prepare necessary materials 5. Wash hands before procedure. 6. Close the roller clamp of the IV administration set. 7. Maoisten adhesive tapes around the IV catheter with cotton ball iwht alcohol; remove plaster gently.

8.

9.

10.

Without applying pressure remove the needle or IV catheter with then immediately apply pressure over the venipuncture site using a dry cotton ball and secure it with a tape.. Discard all waste materials including the IV cannula according to health care management. Document time of discontinuance, status of insertion site and integrity of IV catheter and endorse accordingly.

MANAGING COMPLICATIONS OF INTRAVENOUS

THERAPY

1. Infiltration
Definition:

The escape of fluid into the subcutaneous tissue. Dislodged needle Penetrated vessel wall. Swelling, pallor, coldness or pain around the infusion site Significant decrease in flowrate. Check the infusion site often for symptoms. Discontinue the infusion Restart the infusion at a different site. Limit the movement of the extremity with the IV

Causes:

Signs and Symptoms:

Nursing Considerations:

2. Phlebitis
Definition:

An inflammation of a vein.

Causes:
Mechanical trauma from needle or catheter. Chemical trauma from solution. Septic (due to contamination)

Signs and Symptoms:

Local, acute tenderness Redness Warmth Slight edema of the vein above the instertion site

Nursing Considerations:
Discontinue the infusion immediately. Apply warm, moist compresses to the affected site. Avoid further use of the vein. Restart the infusion in another vein.

3. Thrombus
Definition:

A blood clot Tissue trauma from needle or catheter

Causes:

Signs and Symptoms:

Local, acute tenderness Redness Warmth Slight edema of the vein above the instertion site IV fluid flow may cease if clot obstructs needle.

Nursing Considerations:
Stop the infusion immediately. Apply warm compresses as ordered by the physician. Restart the IV at another site Do not rub or massage the affected area.

4. Speed Shock
Definition:

The bodys reaction to a substance that is injected into the circulatory system too rapidly. Too rapid a rate of fluid infusion into circulation. Pounding headache Fainting Rapid pulse rate Chills Backpain Dyspnea If symptoms develop discontinue the infusion immediately. Report symptoms of speed shock to the physician asap Monitor vital signs if symptoms develop. Use the proper IV tubing. Use microset on all pediatric clients Carefully monitor the rate of fluid flow. Check the rate frequntly for accuracy.

Causes:

Signs and Symptoms:

Nursing Considerations:

5. Fluid Overload
Definition:

The condition caused when too large a volume of fluid infuses into the circulatory system. Too large a volume of fluid infused into circulation.

Causes:

Signs & Symptoms:

Engorged neck veins Increased blood pressure Difficulty in breathing (dyspnea)

Nursing Considerations:
If symptoms develop, slow the rate of infusion. Notify the physician immediately. Monitor vital signs. Carefully monitor the rate of fluid flow. Check the rate frequently for accuracy.

6. Embolus
Definition:

Is any detached, traveling intravascular mass (solid, liquid, or gaseous) carried by circulation, which is capable of clogging arterial capillary beds (create an arterial occlusion) at a site distant from its point of origin.

Causes:
Thrombus dislodges and circulates in the blood. Air enters the vein through the infusion line.

Signs and Symptoms:

Dependent on whether the embolism causes an obstruction or infarction in the circulatory system.

Nursing Considerations:
Check the site regularly to identify signs of phlebitis. Do not allow air to enter the infusion line. Treat phlebitis with the utmost caution. Report any sudden pain or breathing difficulty immediately.

7. Infection
Definition:

An invasion of pathogenic organisms into the body.

Causes:
Nonsterile technique used in starting the infusion. Improper care of infusion site. Contaminated IV solution.

Signs and Symptoms:

Fever Malaise Pain, swelling, inflammation or discharge at IV insertion site.

Nursing Considerations:
Use scrupulous aseptic technique when starting an infusion. Cahnge the dressing over the site regularly. Change IV tubing every 24 hours if agency policy permits. Always wash hands before working with the IV.