L1 IV therapy Flashcards Preview

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Flashcards in L1 IV therapy Deck (34):
1

what r some reasons for IV cannulation

• Administration of medications • Fluid and electrolyte replacement • Caloric replacement (TPN) • Administration of blood products • Supplement fluid for patients who are unable to swallow adequate volumes • Access line in an emergency

2

what r some indication for IV therapy

• Patients who are fasting for surgery • Dysphagic patients • Rapid fluid administration • Patients who GIT is impaired • Patients who require blood/blood products • Patients requiring treatment that would be destroyed by gastric secretions or not absorbed by GIT

3

Fluid infusion routes

Subcutaneous • Intravenous • Epidural • Intraosseous

4

Subcutaneous infusions

• allows continuous supply of arange of drugs bypassing the gut and associated problems with swallowing and malabsorption • can provide more stable plasma levels of drugs and better symptom control as peaks and troughs of intermittent drug administration are avoided • generally involves a small,portable or relatively portable battery operated pump that delivers medications at an accurately controlled rate provides versatility offering a convenient, accessible alternative for continuous administration of medications; • can be used for ambulant patients with most devices able to be worn relatively unobtrusively, not interfering with patients wanting to continue with their normal daily activities; • can provide continued management of symptoms removing the need for frequent interventions like repeated oral medications or injections at end of life.

5

Indications for commencement of a subcutaneous infusion

• inability to swallow due to dysphagia from physical obstruction/ tumour in the mouth, throat or oesophagus; • persistent nausea and vomiting; • severe weakness; • unconsciousness; • bowel obstruction.

6

Subcutaneous infusions‐ Contraindications

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7

what is Epidural infusion.

Anepiduralisalocal(regional)anaestheticdelivered through a catheter (small tube) into a vacant space outside the spinal cord called the epidural space. The anaesthetic agents that are infused through the small catheter block spinal nerve roots in the epidural space and the sympathetic nerve fibres adjacent to them. Epidural anaesthesia can block most of the pain of labour and birth for vaginal and surgical deliveries. Epidural analgesia is also used after caesarean sections to help control postoperative pain.

8

what is intraosseous 

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9

what is piggyback

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10

gravity infusion set

- micro

- macro

- in drops per minutes DPM

11

pumps infusion set

– High flow

– Low flow
– In mLs/hour

12

intravenous therapy

• Central (CVC)
• Peripheral (PVC)
• Peripherally inserted central line (PICC)

• Continuous
• intermittent

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13

Intravenous fluid orders

• Must comply with the requirements for a legal prescription

• Always written on a separate intravenous order chart

Must be checked by 1 RN and another nurse

Charting to policy guidelines

14

5 rights of IV therapy

Right fluid
• Right volume • Right patient • Right time
• Right rate

15

Factor influencing the flow rate

• Height of solution above cannula
• Regulator or clamps on the IV line
• Position of the extremity and cannula in vein

• Size of cannula
• Patency of tubing/cannula
• Size and condition of vein
• Possible infiltration or leakage
• Viscosity of fluid being infused

16

Infection control on IV therapy

• Inspect insertion sites each shift for signs of infection

Ensure a close system for infusion

Injection sites cleaned or not left open

Change line according to hospital policy

• Intravenous infusions must not hang for greater 24hours

17

safety on IV therapy

• All details of the prescription and calculations are checked by 2 nurses

• Student have all medications supervised by an RN not just injections

• Check the compatibility of medications with the infusing solution

• Check compatibility of solutions if more than 1 infusing

• Never add medications to blood products

• Accurate labelling of additives and records of administration of medications and fluids is essential

18

Nursing responsibilities on IV therapy

• Patient ID and verify the prescription/order

• Check the infusion fluid and container for any contamination, faults

• Check 5 rights with another nurse( 2 if you are a student)

• Check IV device/system is patent

• Inspect insertion site and record and report any abnormalities

• Control the rate of flow as prescribed

• Monitor the condition of the patient and record and report any changes

• Maintain records

19

complication peripheral IV

INFILTRATION– Swelling, Coolness, Pain/discomfort, Pallor, Absense of blood return

INFECTION

Local

–phlebitis

– Pain

– Warmth
– Redness at site – Vein‐ “cord like”

• Systemic

– Fever

– Chills
– malaise

EXTRAVASATION

SEPSIS

FLUID OVERLOAD: increase BP, dyspnoea, rales, neck vein distension

 

20

what is a central line

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21

insertion site for central line 

• Subclavian vein

• Internal or external jugular
• Anticubital fossa, Bacillic or Cephalic

• Femoral vein

22

indication for insertion central line

• Administration of fluid

• Monitoring hydrational status

• Monitoring cardiac status

• Monitoring the effects of cardioactive drugs.i.e. Inotropes, vasodilators

Administration of potent/hazardous medications

Parental nutrition

Haemodialysis

23

complications for inserting central lines

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24

complication of central lines

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25

nursing responsibilities on central lines

• Observations
– Local, systemic i.e. BSL for TPN – CVP

• Dressings
• Line changes
• Securing central line

• Fluid compatibility
• Removal techniques

• Heparin locking

26

types of central venous catheters

• PICC lines

• Central lines
• Hickman's (tunneled catheters)

• Ports
• Vascaths for Haemodyalisis

27

Identifying target tissue/ route of administration

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28

Bags with additives

Bags (and bottles) only require user‐applied labels when a medicine is added in the clinical/ward area

Bags with additives

> Label IMMEDIATELY an injectable medicine is added

> The ‘diluent’ should be identified on the label if the base fluid contained is not easily identifiable from the original manufacturers label (see label placement).

29

syringes bolus or infusion

Label all injectable medicines drawn up in syringes that leave the hand of the operator IMMEDIATELY.

> Prepare and label multiple syringes sequentially in independent operations.

30

insertion of catherter/cannular choice

- use the most distal site in the non-dominant arm

- avoid:

site with infections, areas interfere with activities of daily living, avoid site distal to previous venepuncture site, avoid fragile dorsal vein in order adults

31

common IV site on inner arm

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32

common IV site on the dorsal surface of hand

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33

common IV sites on dorsal surface of foot (used only for children)

high risk of phlebitis in adult

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34