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IV Therapy

IV Therapy. Common Venipuncture Sites Dose Calculators Insertion of Peripheral IV Catheter Insertion of a Central Line Catheter Methods of IV Medication Administrations Six “Rights” for the administration of IV medications Classification of Fluid Replacement

shelley-whitney
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IV Therapy

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  1. IV Therapy Common Venipuncture Sites Dose Calculators Insertion of Peripheral IV Catheter Insertion of a Central Line Catheter Methods of IV Medication Administrations Six “Rights” for the administration of IV medications Classification of Fluid Replacement Common IV Solutions: Indications, Precautions, and Incompatibilities IV Delivery Methods – Advantages and Disadvantages Solution Compatibility Chart

  2. Common Venipuncture Sites • Cephalic Vein – thumb side • Basilic Vein - little finger side • Median Cubital vein – connects cephalic and basilic • Medial vein of forearm – center of the forearm • Radial vein – wrist area , thumb side • Superficial dorsal veins • Dorsal venous arch

  3. Sites of IV Insertions

  4. Dosage Calculators 1. Dose ordered/Dose on hand = Amount to administer 2. IV Dose Rate Calculation Dose Ordered/Solution Concentration = Volume/hour e.g. 50 mg/hr/2 mg/ml = 25 ml/hr 3. Calculation for gtts/minute # ml ordered/# hr x 60 min X # gtts/ml = # gtts/min e.g. D5W 1000 ml in 8 hours, drip factor of tubing is 15 gtts/ml. 1000 ml/8 hr x 60 minutes/hr x 15 gtts/ml = 31 gtts/min

  5. Generalizations you can Make • For 10 gtts /ml tubin g Rate = 1/6 (# ml/hr) e.g. For 125 ml/hr , 1/6 (125 ml/hr) = 21 gtts/min • For 15 gtts/ml tubing Rate = ¼ (#ml/hr) e.g. For 125 ml/hr , ¼ (125 ml/hr) = 31 gtts/min • For 20 gtts/ml tubing Rate = 1/3 ( #ml/hr) e.g. For 125 ml/hr, 1/3 (125 ml/hr) = 42 gtts/min • For 60 gtts/ml tubing , Rate = (#ml/hr) e.g. For 125 ml/hr, (125 ml/hr) = 125 gtts/min

  6. Tubing/Pumps • Usage - Primary - Secondary • Drip Factor - Macro 10, 15, 20 - Micro 60 • Infusion Ports - w/ backcheck valve - w/o backcheck valve • Extension Tubings • Filters • Flow Regulator(ml/hr) • Infusion pumps ( ml/hr)

  7. Types of Catheters • Peripheral - Winged ( butterfly), Heparin Lock, Over-the Needle angiocath • Central Catheters • Short term: - single lumen ( only one sol’n) - Multi lumen ( allows for more than one sol’n at a time without regard for compatibility. - CVP (Central Venous Pressure Cath) used only to measure C/V fluid status. • Long term; • Hickman (single lumen), Broviac (similar to Hickman) and Groshong (single or double lumen) catheters • Hickman/broviac (combined cath) • Long Line cath ( PICC)

  8. Things to Know ( Central Catheters) • Important to verify placement by X-rays. • Apply and maintain occlusive dressing (follow-protocol) • Change dressing, sol’n, tubings per protocol. • Instructing pt. to do valsalva maneuver when changing tubings, lessens a chance for air embolism. • Flush catheter(s): all ports need to be flushed, unless being used continuously. • Flushing solution: heparin solution (10 u – 1000u/ml) Saline Solution

  9. 6 Rights of IV Medication Administration • Right Patient • Right Dose • Right Route • Right Time • Right Attitude/Documentation. Advantages: • No absorption problems, drug go directly into pt. circulation, reaching therapeutic levels rapidly. • Accurate titration can be achieved by adjusting the concentration and administration rate. • Generally less discomfort. Disadvantages: • Incompatibility • IV soln containing divalent cations has a > incidence of incompatibility. • Loss of potency of drug can occur.- Binding, Alteration, Chemical change

  10. Common IV Problems • Infiltration • Phlebitis • Clot Formation • Infections • Prevention of Complications • Change Parenteral fluids, tubes per policy (48-72 hours) • Change peripheral and central sets q 48 hours ( hospitals now change central sets 72 hours). Check protocols. • Change dressing q 48 hours ( central lines are change dressing q weekly). • Label dressings • Rotate sites q 72 hours.

  11. Reconstituting Powder • IVs are generally prepared by the pharmacy - diluent - Asepsis - Mix thoroughly - label – date time, concentration, and the person who prepared the sol’n. • Adding drug to IV bottles/bags; - Consider the amount of the solution in the bag before adding the med. - Check the label of the container/solution ( mix-o-vial). • Hanging IV solution - Take out the sol’n out of refrigerator 1 hour before administration. - Check meds for meds expiration date/time. - Check for cloudiness, sediments, color change

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