IV Fluids Nursing B23 Objectives Discuss the purpose of IV Discuss nursing interventions in IV therapy Identify complications of IV therapy Differentiate between peripheral line, central line, and PICC line Explain the purpose of IV medication: IV push and IV piggyback Serum Osmolality Serum osmolality solute concentration of a solution Higher osmolality means greater pulling power for water Normal serum osmolality is 275 to 295 mosm/l Isotonic same osmolality as serum Hypotonic lower osmolality than serum Hypertonic higher osmolality than serum
Isotonic Isotonic fluids = same osmolality as plasma Fluids remain primarily in the extracellular fluid (ECF) Used to increase extracellular volume Isotonic Fluids Normal Saline (NS, 0.9% NaCl) Ringer s solution Lactated Ringer s (LR) Hypotonic Hypotonic solution - lower osmolality than plasma Water is pulled from blood vessel into the cells
Hypotonic Fluids 5% dextrose in water (D5W) 0.45% saline (1/2 NS) 0.33% saline (1/3 NS) 0.225 saline (1/4 NS) Hypertonic Hypertonic fluids - higher osmolality than normal plasma Water is pulled from the cells into the vessels Hypertonic Fluids D5NS Saline solutions > 0.9% Used infrequently Dextrose solutions > 5% Nursing implications: IV infusion pump Vital signs Neurologic assessment Respiratory assessment I & O Labs
Effect on Cell Fluid Replacement Products Crystalloids Isotonic solutions Hypotonic solutions Hypertonic solutions Colloids proteins or starch, do not cross the capillary semipermeable membrane Blood products TPN. Total Parenteral Nutrition TPN contains water, protein, carbohydrates, fats, vitamins, and trace elements Very strong hypertonic solution. Must be given through a central venous catheter to allow rapid mixing and dilution.
Nursing Interventions for TPN Check MD order daily Monitor infusion rate Daily weight I & O Sterile dressing changes Tubing changes Q 24 hrs Requires filter Blood glucose monitoring Vascular Access Devices Peripheral line Central line Triple or Double Lumen Subclavian Internal Jugular Femoral line Midline Access Device Peripherally Inserted Central Catheter (PICC) Hickman Broviac or Groshong Portacath Peripheral line
Veins to access Triple Lumen Catheter Placement: Subclavian vein (see left) Internal jugular vein Femoral vein Inserted by MD CXR done after insertion Reasons: TPN Long term IV therapy Central Venous Pressure (CVP) monitoring Triple Lumen Cath - cont Subclavian Easy to secure But can puncture lung Internal Jugular Difficult to secure Less chance of lung puncture Femoral Difficult to secure Greater chance of infection
Midline Access Device PICC Line Midline catheter 8 inches Up to 4 weeks No TPN PICC Long catheter ends in superior vena cava Can stay in for months Inserted by specially trained RN Hickman Catheter (also known as Broviac or Groshong) Surgically implanted Long term use Chemo Long term IV therapy Transfusions TPN Surgical removal needed Port-a-cath (PAC) Inserted surgically No external access Longterm use Chemo Crohns Valley fever
Port-a-cath PAC in pocket under skin with phalange into large vein Port-a-cath Variety of different styles Most common single port Heparin flushes Huber needle to access Needle changed weekly Sterile dressing Accessing a port-a-cath Clean site with Chloraprep Sterile gloves Push down to anchor port Sterile dressing
Central Line dressing Frequency Per hospital policy When dressing detaches When dressing is soiled Equipment Sterile gloves Mask Chloraprep Biopatch Transparent dressing tape Administering IV Meds IV Push through continuous infusion IV Ensure medication compatibility Don gloves Inspect site Select injection port closest to client Prepare injection site and cleanse Connect syringe to IV line Inject med slowly Remove gloves Dispose properly Administering IV Meds IV push through saline lock Obtain 10 ml syringe of Normal Saline Cleanse injection port with alcohol Insert NS syringe through injection port of IV lock Aspirate Flush with at least 2-3 ml s of normal saline Detach NS syringe and cover with sterile cap Swab injection port with alcohol again Inject med Swab site w alcohol Flush with NS again
Infiltration Accumulation of fluid in tissue surrounding IV Catheter site. Usually caused by penetration of vein wall by catheter itself. Nursing actions with IV infiltration Stop IV infusion immediately Remove IV Catheter Elevate extremity Apply ice to site if noticed within 30 min of infiltrate Apply warm compress if noticed after 30 or more minutes Document findings and actions Restart IV in an alternative location Preventive Measures to Avoid IV Infiltration: Securing catheter Stabilize extremity Avoid areas where flexion occurs Frequent assessment of IV site Keep flow rate at the prescribed rate Change IV site per hospital policy
Phlebitis Signs and Symptoms: Sluggish flow rate Swelling around infusion site Patient complaint of pain or discomfort at site Redness and warmth along vein Thrombophlebitis Presence of a blood clot and vein inflammation Treatment is same as infiltration and phlebitis Infection Infection Bacteria in blood stream via IV therapy Asepsis should be maintained at insertion, during clinical use and at removal of the device.
Circulatory Overload Cause: infusion of fluids at rate greater than patient can tolerate Symptoms: SOB, cough, engorged neck veins, moist BS, and edema Treatment? Air Embolism Causes of air embolism include: Failure to remove air from IV tubing Allowing solution bags to run dry Disconnecting IV tubing Signs and Symptoms of Air Embolism include: Abrupt drop in blood pressure Weak, rapid pulse Cyanosis Chest Pain Air Embolism Immediate action for suspected air embolism: Patient on left side with feet elevated Administer O2 Notify physician immediately Preventive Measures to avoid air embolism: Clear all air from tubing before attaching it to patient Change bag before it becomes empty Check to assure that all connections are secure
Extravasation Leakage of a vesicant IV solution or medication into extra-vascular tissue Signs and symptoms: same as infiltration Tissue sloughing appears in 1-4 weeks