Principles of IV Therapy
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Why do we use IV therapy?
- Restore and maintain fluid and electrolyte balance.
- Provide IV meds and blood products.
- Provide parenteral nutrition.
What is the dwell time for peripheral IV catheters (unless complication arises)?
up to 96 hrs.
How many mL can peripheral veins accomodate? How much glucose concentration?
- up to 200mL/hr
- glucose concentrations up to 12%
What are common IV sites? What's the one IV site exeption?
Feet- for peds, nonambulatory pts *last resort*
What are the different methods of delivery of IV?
- Continous infusion
- Intermittent infusion
- Direct Injection
This infusion is administered at a carefully regulated amount of fluid over a prolonged period of time.
This infusion has a solution that is given at certain intervals. (ex. IV antiobiotic every 8 hrs)
This is an IV "PUSH" delivery of a single dose (bolus) of a drug or solution.
When programming the pump what do most pumps ask for?
TVBI "Total Volume to Be Infused" and the rate per hour
Who orders IV solutions?
The health care provider
How are IV solutions classfified?
What are the different kinds of solutions based on osmolarity?
List the key ingredients in IV solutions.
- Dextrose and Water
How much is serum usually?
This IV solution has osmolarity that is equal to serum.
This IV solution stays in the intravascular space, expands the intravascular volume, replaces ECF fluid lossses.
This IV solution is a good choice for hypovolemia and treating Na loss.
Examples of isotonic solution are:
- 0.9% saline
- Lactated Ringers
This IV solution has an osmolarity that's lower than the serum.
In this IV solution it shifts fluid out of the intravascular compartment to hydrate cells and tissue compartments.
What are examples of hypotonic solutions?
How many calories a day does an adult on bedrest need?
This IV solution has an osmolarity that's higher than the serum.
This IV solution draws fluid into the intravascular compartment from the cells and interstitial spaces
This IV solution expands intravascular volume so used in post-op pts. to stabilize BP, regulate urine output, decrease risk of edema
What are some examples of hypertonic solutions?
5% Dextrose in 0.45% saline
What do we check for with an IV order?
- rate of infusion
- any additives: Potassium Chloride, MVI (Multivitamin)
What can never be pushed in an IV, but you can dilute in an IV bag? Why?
Potassium chloride because of the heart
Dextrose 5%, 0.5% Normal Saline
How is the IV packaged?
What kind of technique do we use to handle IV equipment?
What must we do when we use IV equipment?
Maintain a "closed system", no air, no pathogens, think of the IV as an extension of your pt's circulatory system.
What does a basic IV setup include?
- Venous access device
- Bag or bottle of solution
- Administration set (IV tubing)
What are the venous access devices called?
This gauge size is used for major surgery, trauma
This gauge size is used for blood, blood components
This gauge size is suitable for most electrolyte/dextrose solutions
This gauge size is used for neonates, children, and some elders.
Why is the gauge size for blood so big?
So we don't destroy RBCs
What kind of volume amounts does the IV solution come?
What are the different kinds of containers that IV solution comes in?
What should we do when an IV solution comes as a glass bottle?
- Requires vented tubing to run
- Comes in 1000, 500 mL volumes
- *Rarely see these
What are the two ends of the IV tubing known as?
- male adaptor end
- Both have covers to maintain sterility of the set
What are all the parts to the administration set or IV tubing?
- male adaptor end
- drip chamber
- injection ports
This part of the IV tubing maintains prime and set rate
This part of the IV adjusts the flow rate
This part of the IV tubing is where you add meds or additional tubings.
What will an IV package state on it?
- Tubing type (primary/secondary set)
- Drop Factor
- Vented or not
Primary set has a...
longer IV and it regulates the drip
Secondary set is...
shorter because its for piggy back
What do we do before connecting IV pt to tubing?
What is considered a slow flow rate?
List the factors affecting flow rate.
- Ordered rate is "slow"
- Tubing drop factor
- Height of fluid container
- IV site location: flexion points at wrist (ex. antecubital site = a "positional" IV)
- Position of extremity
- Kinked tubing
60 drops/mL is a...
15 drops/mL is a...
Macro (most common)
Needle is drip chamber means...
No needle in drip chamber means...
Larger drops and goes faster
List the steps to setting up infusion.
- Verify MD order
- Wash hands
- Gather appropriate solution and equipment
- Prepare solution
- Prepare tubing
- Set up infusion (attach tubing to bag) using aseptic technique
List the steps in preparing the solution.
- VERIFY the solution against the MD order
- INSPECT it for expiration date, leaks, signs of contamination
- LABEL it: pt name, date & time, rate per hour, initials and title
How high should the IV bag be placed on the pole?
30" above the IV site
What are the steps to priming the tubing?
- Squeeze drip chamber so fills half full
- Remove distal adaptor end cover, keeping ends sterile
- Open roller clamp slowly
- Adjust flow rate so that fluid fills tubing and expels all air...still keeping distal end of tubing sterile
- Invert tubing at injection ports prn
- Recap distal adaptor end once all air bubbles are expelled
List the steps to starting the infusion.
- Identify the pt, explain procedure
- Don gloves and assess IV site
- Flush access device and reassess site
- Attach adaptor end (clave adaptor) of tubing securely to access device
- Open roller clamp and adjust to ordered rate
- Reassess in 5 min
What do we document with IV?
- Date and time IV hung
- Solution type, any additives (added to IV)
- Ordered rate
- IV site location and assessment data
When do we monitor infusions?
Baseline and at least every 2 hrs after
What do we teach our pt about the IV?
- Leaking, pain?
- Keep site dry
- Don't touch
- Use other arm for talking on phone etc.
When assessing the infusion we remember SDTSDT:
- Solution: ordered? date hung? amount left?
- Drip chamber: half full? rate correct?
- Tubing: dated? kinked? dependent loops?
- Site: skin color, temp, any edema, leaking, pain?
- Dressing: is it dry? intact?
- Talk to pt: pain? other probs?
Why do we make sure drip chamber is half full?
Prevents too many pockets of air
When is the arm board used now?
Only for peds
How do we estimate the volume infused?
Measure amt of solution hanging (amt "up") and subtract from amt hanging when you came on shift.
What must we remember to do to estimate the volume infused?
- Bag: Grasp bag with both thumbs about an inch above the fluid level and pull taut
- Bottle: Measure at meniscus of fluid level
How do we prevent IV site infection?
- Peripheral IV sites restarted and rotated every 72-96hrs or sooner if pain, tenderness or leaking occur
- IV solutions replaced Q24h
- Tubings changed every 72-96hrs (check agency policy)
- Replace site dsg whenever loose, soiled, or damp
When there's no pump what do we do to make sure the right bag is running?
The bag you want to run should be higher than the other bag.
Where do labels on the IV bag?
On the back
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