1 IV Fluids Nursing B23 2 Objectives 3 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 4 Isotonic Isotonic fluids = same osmolality as plasma Fluids remain primarily in the extracellular fluid (ECF) Used to increase extracellular volume 5 Isotonic Fluids Normal Saline (NS, 0.9% NaCl) Ringer s solution Lactated Ringer s (LR) 6 Hypotonic Hypotonic solution - lower osmolality than plasma Water is pulled from blood vessel into the cells 7 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) 8 Hypertonic Hypertonic fluids - higher osmolality than normal plasma Water is pulled from the cells into the vessels 9 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 10 Effect on Cell 11 Fluid Replacement Products Crystalloids Isotonic solutions Hypotonic solutions Hypertonic solutions Colloids proteins or starch, do not cross the capillary semipermeable membrane Blood products TPN. 12 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. 13 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 14 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 15 Peripheral line 16 Veins to access 17 Triple Lumen Catheter 18 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 19 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 20 Hickman Catheter (also known as Broviac or Groshong) Surgically implanted Long term use Chemo Long term IV therapy Transfusions TPN Surgical removal needed 21 Port-a-cath (PAC) 22 Port-a-cath PAC in pocket under skin with phalange into large vein 23 Port-a-cath Variety of different styles Most common single port Heparin flushes Huber needle to access Needle changed weekly Sterile dressing 24 Accessing a port-a-cath Clean site with Chloraprep Sterile gloves Push down to anchor port Sterile dressing 25 Central Line dressing Frequency Per hospital policy When dressing detaches When dressing is soiled Equipment
Sterile gloves Mask Chloraprep Biopatch Transparent dressing tape 26 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 27 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 28 Infiltration Accumulation of fluid in tissue surrounding IV Catheter site. Usually caused by penetration of vein wall by catheter itself. 29 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 30 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 31 Phlebitis
Signs and Symptoms: Sluggish flow rate Swelling around infusion site Patient complaint of pain or discomfort at site Redness and warmth along vein 32 Thrombophlebitis Presence of a blood clot and vein inflammation Treatment is same as infiltration and phlebitis 33 Infection Infection Bacteria in blood stream via IV therapy Asepsis should be maintained at insertion, during clinical use and at removal of the device. 34 Circulatory Overload Cause: infusion of fluids at rate greater than patient can tolerate Symptoms: SOB, cough, engorged neck veins, moist BS, and edema Treatment? 35 Air Embolism Causes of air embolism include: Failure to remove air from IV tubing Allowing solution bags to run dry Disconnecting IV tubing 36 Air Embolism Immediate action for suspected air embolism: Patient on left side with feet elevated Administer O2 Notify physician immediately 37 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