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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128. Chapter 13: Intravenous Therapy By: P.K. Williams, RN VH-71 Seats 14 0 liters. 38 Words to Know 02/370 Pg 128. ABO SystemBlood productsCentral venous sites - PowerPoint PPT Presentation
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/37 Pg 128
Chapter 13: Intravenous Therapy By: P.K. Williams, RN VH-71 Seats 14 0 liters
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
38 Words to Know 02/370 Pg 128 38 Words to Know 02/370 Pg 128
• ABO System Blood products Central venous sites
• Colloid solutions Crystalloid solutions Drop factors
• Drop size Emulsion Infusion pump
• Electronic infusion device In-line filter
• Hypotonic solutions Intravenous(IV) therapy
• Isotonic solution Macrodrip tubing Midclavicular catheter
• Midline catheter Packed cells Peripheral venous sites
• k
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38 Words to Know 03/37 Pg 128 38 Words to Know 03/37 Pg 128
• Phlebitis Plasma expanders Secondary tubing
• Pressure infusion sleeve
• Primary tubing Total parenteral nutrition Universal donor
• Universal recipient Unvented tubing
• Volumetric controller Whole blood
• Y-administration tubing Microdrop tubing
• Medication loc
• Salvaged blood
• Total parenteral nutrition
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives 04/37 Pg 128 Learning Objectives 04/37 Pg 128
• On completion of this chapter, you will be able to:
• Explain common indications for intravenous (IV) therapy.
• Differentiate between crystalloid and colloid solutions and give examples of each.
• Describe the difference between isotonic, hypotonic, and hypertonic solutions.
• Explain the difference between whole blood, packed cells, blood products, and plasma expanders.
• Describe nursing responsibilities for preparing intravenous solutions, selecting tubing, and selecting an infusion technique.
• Identify nursing responsibilities when preparing the client for IV therapy
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives 05/37 Pg 128 Learning Objectives 05/37 Pg 128
• Describe nursing actions involved in performing a venipuncture, including sites and devices commonly used.
• Explain the equipment that must be replaced during IV therapy.
• List complications of IV therapy and signs and symptoms for which the nurse monitors.
• Explain how the nurse discontinues IV therapy.
• Discuss the purpose of a medication lock.
• Describe the nursing process for the client requiring IV therapy.
• Discuss the purpose of total parenteral nutrition, and name one solution often administered concurrently
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Introduction 06/37 Pg 128 Introduction 06/37 Pg 128
• IV Therapy
– Parenteral administration of fluids, additives; Requires continual assessment
– State nurse practice acts determine LPN role in IV therapy
– All RNs may administer IV therapy
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Question 07/37 Pg 128 Question 07/37 Pg 128
Is the following statement true or false?
The extent of an LPN’s practice with IV therapy is determined by education level and nurse practice act rules.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer 08/37 Pg 128 Answer 08/37 Pg 128
True.
The licensing state Nurse Practice Act and an LPN/VN’s personal certification determine their involvement in IV therapy administration.
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Indications for IV Therapy 09/37 Pg 128 Indications for IV Therapy 09/37 Pg 128
• Maintain, restore fluid balance
– Oral intake inadequate, impossible
• Maintain, restore electrolytes
• Administer nutrients; Medications
– Specifically designated meds
– Route with most rapid effect
• Replace blood, blood products
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Solutions 10/37 Pg 129 Types of Solutions 10/37 Pg 129 • Types of IV Solutions
– Crystalloid: Water and uniformly dissolved crystals
– Colloid: Water and molecules of suspended substances
• Crystalloid Solutions
– Isotonic, hypotonic, and hypertonic solutions
– Influences osmotic distribution of body fluid
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Types of Solutions 11/37 Pg 130 Types of Solutions 11/37 Pg 130
Figure: 13-1 Crystalloid solution
Figure: 13-2Osmotic distribution of fluid
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Types of Solutions 12/37 Pg 128 Types of Solutions 12/37 Pg 128 • Crystalloid Solutions (Cont’d)
– Isotonic Solutions
• Same concentration of dissolved substance as plasma
• Maintains fluid balance when NPO
– Hypotonic Solutions
•Fewer dissolved substances than plasma
•Rehydrates fluid-deficit clients
•Temporarily increases blood pressure
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question 13/37 Pg 130 Question 13/37 Pg 130
Is the following statement true or false?
Hypotonic IV solutions increase blood pressure permanently.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer 14/37 Pg 130 Answer 14/37 Pg 130
False.
Hypotonic IV solutions may increase blood pressure temporarily.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Solutions 15/37 Pg 130 Types of Solutions 15/37 Pg 130
• Crystalloid Solutions (Cont’d)
– Hypertonic Solutions
•More concentrated than plasma
•Infrequent use
•Uses: Reduces cerebral edema; Expands circulatory volume rapidly; Parenteral nutrition
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Types of Solutions 16/37 Pg 130 Types of Solutions 16/37 Pg 130
• Crystalloid Solutions (Cont’d)
– Hypertonic Solutions (Cont’d)
•Total parenteral nutrition (TPN)
•Complete nutrition; Instilled into central circulation only
•Lipid emulsion: Stabilized mixture of two insoluble liquids
•Provides essential fatty acids, additional calories
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Solutions 17/37 Pg 130Types of Solutions 17/37 Pg 130
• Colloid Solutions
– Replace circulating blood volume; Blood; Blood products; Plasma expanders
– Blood
•Whole blood: Blood cells, plasma, preservative, anticoagulant
•Use: Restores fluid, blood cells
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Solutions 18/37 Pg 130 Types of Solutions 18/37 Pg 130 • Colloid Solutions (Cont’d)
– Packed cells: Plasma removed
•Use: Cellular replacements when additional fluid contraindicated
•Inadequate oral fluid intake
•Risk for CHF
•Laboratory test before administration
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Solutions 19/37 Pg 130 Types of Solutions 19/37 Pg 130
• Colloid Solutions (Cont’d)– Blood Products
• Use: Clients needing specific blood substances
– Plasma Expanders
• Nonblood solutions
• Use: Hypovolemic shock
• Dextran
• Hespan
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Administering Intravenous Therapy 20/37 Pg 133 Administering Intravenous Therapy 20/37 Pg 133 • Common equipment: Solution; IV tubing;
IV pole; Infusion device
• Equipment preparation; Infusion technique
– IV Solution preparation
•Intentionally reduce infection potential
– IV Tubing choice
•Four options
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Intravenous Therapy 21/37 Pg 131 Administering Intravenous Therapy 21/37 Pg 131
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Intravenous Therapy 22/37 Pg 132 Administering Intravenous Therapy 22/37 Pg 132
• Instillation of IV Solutions
– Methods: Gravity; Electronic infusion device
•Rate of infusion
•Drops per minute; Milliliters per hour
Figure 13-5(Left) vented tubing and(right) unvented tubing
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Intravenous Therapy 23/37 Pg 132 Administering Intravenous Therapy 23/37 Pg 132
– Gravity Infusion
•Flow rate influences: Solution elevation; Roller clamp adjustment; Pressure infusion sleeve
•Electronic Infusion Devices: Programmed
•Infusion pumps
•Volumetric controllers
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Administering Intravenous Therapy 24/37 Pg 133 Administering Intravenous Therapy 24/37 Pg 133
• Preparing Client for Venipuncture
– Client education; Answer questions
– Site selection
– Piercing a peripheral vein: Various devices; Differing gauge or diameter
•Greater gauge number = smaller diameter; Diameter: Smaller than vein
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Question 08/37 Pg 134 Question 08/37 Pg 134
Is the following statement true or false?
The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer 26/37 Pg 134 Answer 26/37 Pg 134
True.
The greater the gauge number of a venipuncture device, the smaller the catheter’s diameter. Conversely, the lesser the gauge number, the larger the catheter’s diameter.
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Administering Intravenous Therapy*** 27/37 Pg 134 Administering Intravenous Therapy*** 27/37 Pg 134
Figure 13-9 Examples of venipuncture devices. (A) Butterfly needle. (B) Over-the-needle catheter
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Administering Intravenous Therapy 28/37 Pg 134 Administering Intravenous Therapy 28/37 Pg 134
Figure 13-8Venipuncture sites
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Administering Intravenous Therapy 29/37 Pg 133 Administering Intravenous Therapy 29/37 Pg 133
• Venipuncture Sites***
– Peripheral venous sites; Central veins
– Vein selection factors
•Peripheral Venous Sites
•Most common: Superficial veins of arm, hand
•Infants: Scalp veins; Avoid feet
•Midline catheter: Peripherally inserted venous access device
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Administering Intravenous Therapy 30/37 Pg 133 Administering Intravenous Therapy 30/37 Pg 133
• Venipuncture Sites (Cont’d)
– Peripheral Venous Sites (Cont’d)
•Midclavicular catheter
•Peripherally inserted
•Extends from superficial to proximal axillary veins
•Current controversy: Thrombosis
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Administering Intravenous Therapy 31/37 Pg 134 Administering Intravenous Therapy 31/37 Pg 134
• Venipuncture Sites (Cont’d)
– Central Venous Sites
•Delivers solution: Vena cava
•Physician inserts into jugular; subclavian vein
•Trained nurses: Insert PICC
•Post insertion procedures: Chest radiograph for placement confirmation
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Administering Intravenous Therapy 32/37 Pg 135 Administering Intravenous Therapy 32/37 Pg 135
• Equipment Replacement
– Reduce infection potential
– Solutions
•Upon completion; q24h
– IV tubing
•Per policy; per solution
– Venipuncture devices
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Administering Intravenous Therapy 08/37 Pg 135 Administering Intravenous Therapy 08/37 Pg 135
• Site Care
– Venipuncture site: Frequent inspection; Document appearance
– Dressing change
•Per agency’s infection control policy
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Potential Complications of IV Therapy 34/37 Pg 135 Potential Complications of IV Therapy 34/37 Pg 135 • Potential Complications***
– Risk for infection; Phlebitis; Thrombus formation
– Air bolus; Site infiltration
– Circulatory overload
• Potential Complications: Blood transfusions
– Same as crystalloid solutions
– Reactions: Nonautologous donor cells; Additives; Preservatives
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Potential Complications of IV Therapy 33/37 Pg 135 Potential Complications of IV Therapy 33/37 Pg 135
• Potential Complications: Blood Transfusions (Cont’d)
– Incompatibility reaction: Life threatening***
– Delayed reactions: Immune response
– Nonimmune complications: Septic; Symptoms - shaking chills and a fever
– Hypocalcemia: Citrate in donor blood
– Blood-borne infections: Hepatitis A, B, and C; HIV; MFE
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Discontinuing Intravenous Therapy 36/37 Pg 137 Discontinuing Intravenous Therapy 36/37 Pg 137 • IV Infusions
– Infusion complete
– Medication lock: Venipuncture site capped, patency maintained; Client needs intermittent or emergency IV fluids only Figure 13-14
Attaching a lock device with extension tubing to the IV
catheter hub
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End of Presentation NOW ENCLEX
By: P.K. Williams, RN 37/37 [$400 mil] pkwilliams@DNI.edu
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