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What is IV?
fluids directly going into the the venous bloodstream. Large amounts of fluids can be administered at one time. Usually less irritation. Most rapid of all parenteral routes because it bypasses all barriers to drug absorption. Established peripheral or central IV line.
All sets of IV tubing have....
insertion spike, a drip chamber, plastic tubing with a rate control clmap, a rubber injection portal a needle adapter and a protective cap over the needle adapter. The sets are availalbe with a variety of additoanl attachments(volume and size of drip chamber, piggyback portals, filters, style of control clamp.
Macrodrip chambers provide....
- 10, 15 or 20 drops/ml whereas micropdrip chambers deliver 60 drops/ml of solution. Microdrip admin sets are used when a small vol of fluid is being adminitered. used with neonatal and ped populations.
- The IV container must be 24-36 inches above the IV site so that the pressure of the infusion solution in the tube is greater than the resistance(back pressure) from the vein allowing the infusion to flow into the vein.
What is non-volumetric IV controllers?
montor only the gravity infusion rate by counting the drops that drip through the chamber. They protect the pat by sounding an alarm if the clamp slips and results in an inadvertent gravity free flow.
Pumps - volumetric IV controllers are actually pumps that apply external pressure to the admins set tubing to squeeze the solution through the tubing at a specific rate. ml/min or m./hr. Volumetric control devices can be programmed for a specific volume over time and are much more acccurate than the nonvolumetric controllers.
Disadvantages are the cost of the equipment and training of personnel, cost of maintenance.
Syringe pumps hold a prefilled syringe and apply positive pressure to the plunger, delivering a specific volume of med over a set time. Usually used with small volumes.
Examples are: those that conintually infuse insulin into subcut tissue of pat with diabetes mellitus. or pat controlled analgesia(PCA) pumps.
IV access devices are often subdivided into 4 groups
- 1.Peripheral devices - for short term use
- 2.Midline catheters- are for 2-4 wks inserted into intermideated sized veins and advanced into larger vessels.
- 3.central devices- are inserted into intermidated-sized vessels and advanced into central veins for maximal mixing with large volumes of blood.
- 4.implantable venous infusion ports- are placed into central veins for long term therapy.
What are butterfly or scalp needles, winged needles?
are short sharp-tipped needles originally designed for venipuncture of small veins in infants and for geriatric use. These needles are available in sizes ranging from 17-29 gauge and are designed to minimize tissue injury during insertion. Patency of the needle is maintained by use of a heparin or saline flush routine.
What are over the needle catheters?
known as short peripheral venous catheters. Are recommened for routine peripheral infusion theapy. Neeles are stainless steal and coated with teflon like plastic catheter. After the needle penetrates the vein in the hand or forearm the catheter is advanced int the vein and the metal needle is removed, leaving the plastic catheter in place. IV administration is then attached for a few days. Blood samples should not be drawn from peripheral catheters. Check for symptoms of phlebitis, infiltration and infection.
In the needle catheters what do they use?
a large -bore needle for venipuncture. A 4-6 inch sterile smaller gauge plastic catheter is then advanced through the needle into the vein. The needle is withdrawn and the skin forms a seal around the plastic catheter. IV ami is attached directly to the plastic catheter. Seldom used today for peripheral IV becuase of the risk of shearing the through the needle cather.
What are Central Assess devices used for?
Used for chomotherapy or when hypertonic solutions such as total parenteral nutrion are to be infused. The most commonly used for central venous catheters are the subclavian and jugular veins.
Where are peripherally inserted central venous catheters(PICCs)?
They are inserted into the superior vena cava or just outside the right atrium by way of the cephalic or basilar veins of the antecubital space, providing an alternative to subclavian or jugualr vein catheterizations PICCS are available in 14-28 gauge with various lengths therby making them availalbe to peds use. The catheter itself can have an open tip or valved(Groshong) tip and comes with a single or double lumen. The PICC line has the advantage of ease of insertion because the procedure can be performed at the bedside by a qualifeied nurse. Cost less. require less rotation. Can remain in place 1-3 mos, but can last for 1 yr or longer if cared for properly. When not in use the the IV is disconnected and the catheter is flushed and capped. The line should be flushed with a saline-heparin sol after every use.
Where are tunneled central venous catheters administered?
are placed with a local anesthesia. Through an incision the terminal tip of the catheter is inserted into the subclavian vein and advanced to the superior vena cava. The proximal end of the catheter is tunneled about 6 inches away from under the skin on the chest, exiting near a nipple. Which anchors the catheter and forms a seal around the catheter as the skin heals helping to keep the tunnel sterile.
There types of tunneled central venous catheters are:
- Hickman: larger in diameter than the broviac catheter but contains 2-or 3 lumens
- Broviac single lumen catheter with a larger exteranal diameter and a standard end hole.
- Groshong catheters. contains 1-3 lumens each with a rounded valved tip. opens inward for blood sampling and outward for infusion but reamins closed when not in use. when closed it seals the fluid inside the catheter and prevents it from coming into contact with the patient's blood.Must be flushed with a saline-heparin solution after every med administration or at least once daily if not in use.
What is an implantable infusion port?
- are used when long-term therapy is required and the central vein is required for adm IV fluids, med, total parenteral nutrition(TPN) chemo and blood products. Similar to the tunneled devices, except that the proximal end of the single or double lumen catheter is attached to a single or double lumen asccess port implanted and sutured into a subtaneous pocket in the chest arm or upper arm.
- The double ports are designed to allow for adm of 2 iv solution, 2 iv med or one of each simult. One port can be also be reserved for drawing blood samples. 90 degree angle huber needle is used to penetrate the skin and the septum of the implanted device to minimize damage to the self-sealing septum. Use the smallest gauge nocoring needles. Port can withstand up to 2000 punctures, the arm port life is 1000 punctures. Can remain in longer than 1 yr. Need to x-ray to verify the location of the device and to check for presence of pneumothrox with cathers tunelled into the chest.
Types of Intravenous Solutions, what are they?
- IV solutions consist of Water(the solvent), sodium chloride, dexrtose and potassium chloride. The solutes that disolve in water and dissocaite into ion particles are called electrolytes because these ions give water the ability to conduct electricity. Total parenteral solutions contain all electrolytes, plus carbs(usually dexrtrose), aminio acids and fatty acids to sustain life. Water is distributed into 3 compart.
- intravascular compartment arteries, veins and capillaries.
- intracellular compartment: spaces between the cells, outside the vascular compartment.
- extracellular compart is composed of the intravascular and interstitial compartments and contains about 1/3 of the total body water and the intracellural compart contains about 2/3 of the total body water.
- Spontaneous movement of water across the intravascular compt capillary membranes to the interstitial spaces and across the cell membranes and back to the intravscular capillary space is called osmosis. The water moves from an area of high concentration of water(low electrolytes concentration) to an area of low water concentration(high electrolyte concentration)
Solutions that have fewer dissolved particles than the blood are known as being.....
hypotonic and thus have a higher concentration of dissolved particles are considered to be hypertonic solutions. A .9% solution of Sodium chloride also know as normal saline is an isotonic solution. 308 mosm/l
Isotonic Solutions(.9% sodium chloride) are...
lactate ringers(LR) are ideal replacement fluids for the patient with an intravascular fluid deficit. This is used for hypovolemic, hypertensive patients to increase vascular volume to support b/p, patients must be monitored for fluid overload(pulmonary edema) especially if have congetive heart failure.
Isotonic solution- dextrose 5 % with .5% sodium chloride d5/0.2NS is a standard solution for aminainting hydration and electolyes(potassium chloride) administering continuous infusion IV med and to keep open(TKO)
D5/0.2 NS solutions even though initially isotonic should not be used to maintain vascular volume in a pat who is hypovolemic and hypotensive. Hypotonic solution have lower osmolaity than the serum. Contains fewer eletrolytes and more free water, so the water is rapidly pulled from the vascular comparment into the interstitial and intracellualr fluid compart.
Antibiotics are administered thorugh...
tandem setup, piggyback(IVPB) or IV rider.
The rate of flow equation is:
- ml of solution x no of drops/ml =drops/min
- hr of admin 60 min/her