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Intravenous Therapy

Intravenous Therapy. Brenda McLoud BSN, RN, CGRN. Learning Objectives. Describe the Nurse’s role in IV therapy care Explain IV supplies, type of vascular access devices, and administration of IV therapy. GI nurse’s role in IV therapy. Assessment Planning Implementation Evaluation.

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Intravenous Therapy

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  1. Intravenous Therapy Brenda McLoud BSN, RN, CGRN

  2. Learning Objectives • Describe the Nurse’s role in IV therapy care • Explain IV supplies, type of vascular access devices, and administration of IV therapy

  3. GI nurse’s role in IV therapy • Assessment • Planning • Implementation • Evaluation.

  4. Competencies in IV Therapy for the GI Nurse • Knowledge of Vascular Access Devices (VAD) used • Skill in performing procedure competently & safely • Skill in inspecting insertion site • Ability to problem solve • Knowledge to monitor patient’s condition & report changes • Proper documentation and record-keeping skills

  5. Basic Principles of Fluid & Electrolytes • Water is 60% of the average adult’s total body weight • In infants, body water represents about 80% of total body weight • Solutions – liquids (solvents) containing dissolved substances (solutes) – are classified according to their concentration or tonicity and include • Isotonic Solutions • Hypotonic Solutions • Hypertonic Solutions • Body fluids are isotonic solutions

  6. Basic Principles of Fluid & Electrolytes • Body water is contained in two major body compartments • Intracellular fluid (ICF) • Extracellular fluid (ECF) • Fluid balance is maintained when water intake equals water output • Solutes are substances dissolved in a solution

  7. Basic Principles of Fluid & Electrolytes • Solutes are classified as • Nonelectrolytes • Electrolytes • Cations • Na, K, Ca, Mg, H • Anions • Cl, P, HCO3 • Electrolytes perform four essential functions • Promote neuromuscular irritability • Maintain body fluid osmolality • Regulate acid-base balance • Regulate distribution of body fluids among body fluid compartments

  8. Fluid & Electrolyte imbalances • Imbalances may result from • Vomiting, diarrhea, suction, draining wounds, intestinal obstructions, draining fistulas, hemorrhage, infections, fever or prolonged use of enemas & • Infants are more vulnerable because of their higher proportion of body fluid, immature kidneys, increased heat production & rapid growth • Excessive loss of body water can lead to dehydration

  9. Administration of Fluids & Electrolytes • All IV solutions are considered medications • Requires a Dr.’s order • Types of Solutions • Isotonic Solutions • 0.9% NS or LR • Hypotonic Solutions • 0.45% NaCl • Hypertonic Solutions • 3% NaCl or 10%Dextrose

  10. Risks for the GI Nurse • Primary risks due to needlesticks • Injury • Disease transmission • Spills • Splashes • Because universal precautions require use of gloves when dealing with blood and body fluids, development of latex allergies pose a concern for health care workers and patients

  11. Latex allergies • Individuals who develop burning or tingling around mouth after blowing up latex balloons • Known allergy to • Bananas • Avocados • Potatoes • Tomatoes • Poinsettias • History of contact dermatitis • History of asthma • History of eczema

  12. Vascular Access Devices (VAD) • Steel winged infusion set (butterfly winged device) • Peripheral short IV catheters • Peripheral long or midline catheters • Peripherally inserted central catheters (PICC) • Nontunneled central venous catheters (CVC’s) • Tunneled central venous catheters • Totally implanted devices or ports

  13. IV Insertion sites • Preferred sites • Dorsum of hand • Upper arm • Avoid Extremities with • Lymphedema, postop swelling, recent trauma, dialysis shunt, hematoma, axillary lymph node dissection, local infection or cellulitis, phlebitis or open wounds • Best to begin with distal veins and proceed proximally towards the body • Cannulation of lower extremities should be avoided in adults

  14. Complications • Infiltration/extravasation • Hematoma • Phlebitis • Pyrogenic reactions • Air embolism • Catheter embolism • Pulmonary edema • Speed shock/overload • Nerve injury

  15. IV Medication Administration • Techniques & routes of administration • Appropriateness of the prescribed therapy • Patient’s age and condition • Any medication allergies • Dose, route and rate of the medication ordered • Medications • Indications • Actions • Side effects • Appropriate nursing interventions with adverse reactions

  16. Indications for IV meds in GI • Moderate sedation/analgesia • Control of variceal hemorrhage • Treatment of opioid-induced respiratory depression • Treatment of benzodiazepine-induced respiratory depression • Treatment of cardiac dysrhythmias • Reducing peristalsis or intestinal spasms • Treatment for increased risk of infection

  17. Blood & Blood Components • Whole blood • Packed red blood cells • Leukocyte-poor blood • Platelets • Fresh frozen plasma (FFP) • Cryoprecipitates • Factor VIII • Factor IX • Human albumin • Autologous transfusion

  18. Adverse Reactions • Circulatory overload • Allergic reactions • Hemolytic reactions • Hepatitis B, hepatitis C and human immune deficiency viruses • Other transfusion-related infectious agents • Citrate toxicity

  19. When Adverse Reaction Occurs • Stop the transfusion • Keep vein open with normal saline • Asses vital signs • Notify Dr. • Notify blood bank • Send all transfusion containers & administration sets to blood bank • Treat patient symptomatically & supportively • Patient Education • Documentation

  20. Review • Salts that dissociate in solution into positive and negative ions are called: • A. Anions • B. Cations • C. Electrolytes • D. Colloids

  21. Review • Drugs should never be added to blood transfusions because: • A. They are incompatible. • B. It complicates determination of the source of any adverse reaction. • C. Drugs can cause clotting. • D. The rate of infusion is too slow.

  22. Review • The following may indicate a higher risk for latex allergy except, • A. History of asthma. • B. Use of powder-free gloves. • C. Allergy to bananas • D. History of multiple surgical procedures.

  23. Review • Hemolytic reactions to blood transfusions usually occur : • A. Immediately • B. Within the first 5 to 15 minutes of the transfusion. • C. Within 24 hours. • D. As long as 6 months after the transfusion.

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