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What are the indications for IV therapy? (7)
- Maintain fluid & electrolyte balance.
- Fluid Volume Replacement
- Medication Administration
- Transfusion of Blood & Blood Products
- Provide Nutritional Supplemention (TPN)
- Monitor Hemodynamic Functions
- Administer Diagnostic Reagents
Name the 2 types of IV Nutritional Supplementation:
- 1. Total Parenteral Nutrition (TPN) or Hyperalimentation
- 2. Peripheral Parenteral Nutrition (PPN)
Name two methods used for Hemodynamic Function Monitoring:
- 1. Swan Ganz Catheter
- 2. ART Line
Name 3 types of Diagnostic Reagents:
- 1. IVP Dye
- 2. CT Contrast
- 3. Nuclear Medicine Dye
What are 6 things you would assess to evaluate F&E status?
- 1. Daily weights
- 2. I&O
- 3. Lab Values
- 4. Skin Turgor
- 5. Mucous Membranes
- 6. LOC
What 6 lab values are important indicators of F&E status?
- 1. Hct
- 2. BUN
- 3. Creatinine
- 4. Serum CO2
- 5. Osmolality
- 6. Specific Gravity
What is Hematocrit (Hct)?
The # of RBC in 1 ml of whole blood. (% by volume of RBC in whole blood-WB)
What is the normal Hct level for women?
What is the normal Hct level for men?
Hct levels change how....
....with Fluid Overload & anemia?
- *Increases with dehydration.
- *Decreases with FVO & anemia.
What do BUN levels reflect?
Protein intake & renal excretory capacity.
What is the Normal values for BUN?
BUN levels do what.....
....with fluid overload?
- *Increases with dehydration
- *Decreases with FVO
What does Creatinine measure?
The glomerular filtration rate.
What is the normal Creatinine Values?
1. What do increased levels of creatinine indicate?
2. A 50% or > increase would indicate what?
1. Renal disease/dysfunction
2. Nephron damage
1. What does serum CO2 measure?
2. What is other way it is represented? (i.e. abbreviation)
1. Measures alkalinity or acidity of venous blood supply.
2. TCO2 (total carbon dioxide content)
Serum CO2 is regulated by what organ(s)?
What is the normal TCO2 or Serum CO2 values?
Serum CO2 increases with what?
TCO2 or Serum CO2 decreases with what?
What is osmolality?
# of particles in body water which exert osmolar pull
What is the normal osmolality values?
Osmolality increases with what condition?
Osmolality increases with what condition?
FVO: fluid overload
What does (urine) Specific Gravity measure?
The kidneys' ability to concentrate urine.
Normal Specific Gravity values
Specific Gravity increases with what condition?
Specific gravity decreases with what condition?
- Acute Renal Failure (ARF)
- When tubules lose the ability to concentrate urine.
Explain Isotonic Fluids & what they're helpful in treating:
- Isotonic fluids have a concentration equal to the concentration in the cells.
- They are helpful with hypovolemic/hypotensive pts.
Name 3 examples of isotonic fluid:
- LR- lactated ringers
- NS- normal saline
- D5W - Dextrose/water
Explain Hypotonic Fluid & what conditions its used for:
- Hypotonic fluids have solute concentrations lower than in the cells causing fluid to move into the cells to rehydrate.
- Useful in diabetic ketoacidosis. DKA
Explain why hypotonic fluids can be dangerous if used incorrectly:
Hypotonic fluids can cause a sudden shift from the intravascular space to the cells causing swelling & possible bursting of the cell.
Name 2 types of Hypotonic Fluids:
Explain hypertonic fluids & what they are used for:
- Hypertonic fluids have greater solute concentration than that of the cells, it pulls water out of the cells into the intravascular space.
- Can help stabilize Bp, increase urine output, and reduces cellular edema.
Name 4 examples of Hypertonic Fluids:
What are crystalloids?
- solutes which when placed in a solvent, homogeneously mix with it, dissove and cannot be distinguished from the resultant solution.
- They are able to diffuse through membranes. May be isotonic, hypotonic, or hypertonic.
What are colloids?
Glutinous substances whose particles cannot form a true solution because their molecules do not dissolve but remain uniformly suspended & distributed in fluid. They expand volume by raising colloid osmotic pressure.
Name the 4 types of solutions:
- Carbs in water
- Carbs in NaCl
- Electrolytes solutions
1. What do "carbs in water" solutions consist of?
2. What is another name for NaCl solutions?
- 1. Dextrose & water
- 2. Normal saline
Name 3 types of electrolytes solutions & their tonicity:
- 1. D5LR (5% dextrose in lactated ringers) Hypertonic
- 2. LR (lactated ringers) Isotonic
- 3. Ringers Solution, Isotonic
What are 4 types of special solutions?
What are important considerations when giving KCl via IV?
- *High risk
- *Never administer more than 10 mEq/hr
- *Irritating to veins, must be diluted
- *Check K & Cl levels before administration
- *NEVER give IVP!!!
What is the antidote for magnesium?
Vitamins may be added to IV solutions in what cases?
- Inadequate oral intake causing malnutrition or risk of.
- Vitamine deficiency r/t diet (chronic ETOH, anorexia, etc)
- Increased stress, surgery, burns.
Why are lipid solutions given?
To increase caloric intake, nutritional supplementation.
Name examples of methods used for Lipid solutions & availability:
- PPN-Peripheral IV
- TPN-Central Line
- Available in 10% or 20%
What should you remember about Lipid & TPN solutions?
Never add anything to them!!
TPN solutions should be stored how?
In the refridgerator.
What is a common medication added to TPN solution & why?
- Famotidine (Proton pump inhibitor)
- To reduce stomach acid in people who are NPO.
How long can one TPN bag infuse?
No longer than 24 hours.
How often should TPN tubing & filter be changed?
When TPN is initially started, how would the infusion rate be set?
How much would it be increased over time?
- Relatively low (50ml/hr) to avoid hyperglycemia.
- Increased by 25 ml/hr until order rate is reached.
Rapid infusion of TPN can cause what?
- hyperosmolar diuresis
- Seizures, coma, & death.
If TPN is stopped abruptly what could happen?
What NOT to do when administering TPN: (3)
- DO NOT....
- 1. play catch up, pitch it & start again
- 2. stop flow abruptly
- 3. interrupt line
What are 4 benefits of IV drug administration?
- 1. rapid absorption
- 2. immediate action
- 3. continuous administration
- 4. Immediate termination if allergic reaction occurs
What are IV meds usually mixed with and the normal infusion rates?
- Usually mixed with NS or D5W.
- Rate 50ml/30min or 100ml/hr
Name the 6 Blood Products available for IV administration:
- 1. PRBC's (packed RBC's)
- 2. FFP (fresh frozen plasma)
- 3. Platelets
- 4. Clotting factors 8 & 9
- 5. Albumin
- 6. WBC's
What is the purpose of PRBC's?
To increase the O2 carrying capacity of blood, restore circulating volume, to tx shock
PRBC's should be administered with what size needle?
- 19 ga or larger OR
- a needle in which you can "see" through the lumen
Blood products can only be given with what solution?
What are important assessments to be made/things to do with blood product administration? (5)
- 1. Draw a type & cross match prior
- 2. Monitor VS before, during, & after infusion
- 3. Stay with the pt at least 15 min following infusion to assess for s/s of reaction
- 4. Infuse over NO GREATER than 4 hrs.
- 5. Change tubing after q unit of blood given
Name the 4 types of IV devices:
- 1. Angiocaths
- 2. Winged "Butterfly" Catheters- portacath insertion
- 3. Midline catheter (MLC)
- 4. Central vascular devices (CVD)
Name the 5 types of Central Vascular Access Devices:
- 1. PICC- peripherally inserted central cath
- 2. Triple Lumen Central Line
- 3. Hickman (R atrial cath)
- 4. Groshong (R atrial cath)
- 5. Porta-cath- implanted venous access devices
What needle/cath size would be used for children & elderly?
What needle/cath size would be used for medical & post-op pts?
What needle/cath size would be used for surgical pts?
What needle/cath size would be used for trauma pts?
Name 5 ways to dilate veins:
- 1. gravity
- 2. milking
- 3. tapping
- 4. fist clenching
- 5. warm compress
What will you document when starting an iv? (9)
- Type/Gauge of needle
- # of attempts
- site(exact location)
- type of dressing applied
- pt's response
- special precautions (positional, armboard, pumps)
- fluid type, amount, & rate
- parenteral fluid sheet I&O
How long can a solution be hung?
No longer than 24 hrs.
What pt teaching would you include with IV administration?
- *Do not kink, compress, or lie on tubing
- *Avoid using arm
- *DO NOT adjust clamp or change bag level
- *When walking, call for help
- *Call when bag is low/empty, any wetness/blood, pain, burning, swelling, pump alarms
What assessments would you make with IV insertion?
- *Site: redness, blood, edema, drainage, leakage
- *Fluid level, pt tolerance, tubing patency q 1-2 hrs
- *Avoid Bp in IV arm, mastectomy side, CVA side
- *Check tubing for kinks, clamped
- *Avoid placing tubing in dominant hand
S/S of infiltration:
- Pain, blanching or coolness of skin around site,
- pallor, edema, tight skin, damp or wet dressing
- no blood return
- sluggish or no flow rate
What to do when there is infiltration?
- Stop infusion, remove cath, ice/warm compress if needed,
- restart iv, document everything done
S/S of Thrombophlebitis:
- sluggish flow rate, edema in limb, sore/hard/cordlike/ warm vein
- may look like red line above venipuncture site
- elavation in temp 1 degree or more above baseline
- throbbing limb pain
- mottling, cyanosis, pallor of limb
- diminished arterial pulses
Nursing considerations with thrombophlebitis:
- *DC infusion & remove cath
- *Apply warm wet compresses
- *Notify physician
- *Restart iv in another limb
- *document everything