NUR 220: Exam 3- Lecture 6: IV therapy + blood administration

True or False: IV solutions are a medication?

TRUE- even saline is considered a medication

Crystalloids

Fluids tonicity as compared to normal blood plasma

• Hypotonic

• Isotonic

• Hypertonic

Colloids

• Albumin

• Dextran

• Blood products

HYPOtonic solutions

LOW concentration of solutes compared to water

• Water shifts INTO the cell → cell gets really big like a HIPPO

• Treats: HYPERnatremia (high sodium) + severe dehydration

• Common solution: 0.45% Sodium Chloride (aka “half normal saline”)

What are risks with Hypotonic solutions?

Cells could expand too much and burst

• water intoxication (too much water in the cell/body)

• swelling of brain cells → increased ICP

Isotonic Solutions

Same tonicity as blood

• “I SO want to stay here!”

• Maintains equilibrium of water and solutes

• Common solutions: 0.9% Normal Saline (most common)

Prolonged use of 0.9% Normal Saline can cause what? What patients do you not want to use this with?

• HYPERnatremia (HIGH sodium)

• Do not use → HF, Edema, Hypernatremia

What solution most closely resembles blood plasma?

Lactated Ringers - Isotonic solution (do not use → renal or liver disease)

HYPERtonic Solutions

HIGHER concentration of solutes than water

• water moves OUT of the cell → Cell SHRINKS (looks like a skinny HYPER kid)

• Used for severe Hyponatremia (LOW sodium)

• (Use more in the ER)

What are the Risks with using a hypertonic solution?

• Cellular dehydration

• Fluid volume overload

In what case would you use Colloid solutions? (albumin, dextran, plasmanate)

When you need to establish equilibrium without large infusions of fluid

• Hypovolemic shock, burns, sepsis, trauma

Intravenous (IV) Access

Immediate access to bloodstream for:

• Meds, fluid, nutrition, blood

Peripheral Access (IV) vs. Central Venous Access device (Central Line)

• IV = short-term/intermittent use

• Central line = Long-term use

Peripheral IV (PIV) Sites

Adults = arms and hands

Infants = scalp and feet

• Start DISTAL in case the IV goes bad and you need to move up the arm

• AVOID wrists and elbows due to flexion

• DO NOT use extremity if injured → AV fistula, history of masectomy

PIV Catheter types

Winged infusion needle (butterfly needle)

• children + adults

• Short-term use

Midline catheter

• 3-8” long catheter

• For treatment up to 2 weeks

• Inserted by specially trained nurses

Central Venous Access Device (Central Line)

Line into major vein

• Insert by providers using STERILE technique (informed pt. consent needed)

Uses: Rapid infusion of large volumes, Rapid dilution of irritating solutions

• Requires regular assessment, flushing, and sterile dressing changes

Central Line (CVAD) Types

Peripherally inserted Central Line (PICC)

• Inserted by specially trained nurse

Implanted Port

• Common in oncology/hematology

• Continuous long-term use

CVAD/Central line care

Alcohol-impregnated caps

• decreases in CLABSI

• still manually disinfect before using line

Routinely check for patency and blood return

Keep line clamped when not in use

Discontinue only with a written order from provider

Caring for patient with IV access: Start of shift

• Verify correct solution + correct dose against the MAR

• Assess insertion site (redness, tenderness, swelling)

• Assess date on dressing + condition of dressing

• Check date on tubing

Caring for patient with IV access: Every hour

• Verify correct solution and correct dose

• Assess PIV insertion site (redness, tenderness, swelling)

What do you have to document with IV therapy?

• Start and stop times

• Volume infused

• Second RN verification for high risk meds! (heparin, insulin, PCA pain pumps)

What are the main IV complications that can occur?

• Infection

• Occlusion

• Phlebitis

• Infiltration

• Extravasation

Phlebitis (IV complication)

Inflammation due to poor insertion/moving of catheter

• tenderness, redness, swelling, pain, burning

• If suspected → stop fluids, notify provider, elevate extremity, apply warm compress

Occlusion (IV complication)

Infusion flow is SLOW + met with resistance when flushing

• Assess for kinks in tubing, arm position

• PIV → discontinue site + restart elsewhere

• CVAD → notify provider

Infiltration (IV complication)

Solution and/or nonvesicant med goes into surrounding tissue instead of vein

• Swelling, tenderness, coolness, blanching of skin

Prevention:

• Avoid wrists and elbows (places of flexion), assess insertion site frequently, always check patency before med admin

If suspected:

• STOP infusion immediately, remove PIV, asses for extravasation

Extravasation (IV complication)

SERIOUS

• Infusion of vesicant med into surround tissue (vesicant med = med that can blister and cause necrosis of tissue)

• Can lead to PERMANENT tissue or nerve damage

• Blisters are a LATE sign

Prevention: know common vesicants, infuse slowly, and use larger vein or CVAD

STOP infusion immediately, withdraw med from IV access, notify provider (for treatment/antidote)

• Use skin marker to track area of damage

• NEVER apply pressure to area

T or F: Crystalloids (hypo, iso, hyper) solutions restore fluids and electrolytes BUT cannot replace components of blood

TRUE → you need a blood transfusion for loss of blood (hemorrhage)

Blood Administration steps:

1. ASSESS

• Allergies, history of transfusion reaction

• Do not use blood product if clotted

• Vital signs

2. TWO REGISTERED NURSES confirm product info against patient information

• pt. name and DOB

• blood type

• blood product ID number

• expiration date

What is the most common reason for transfusion reaction?

inappropriate identification of product and patient prior to blood transfusion

Blood Transfusion process

Infuse slowly for first 15 minutes (look for a reaction in this time)

• MUST STAY at bedside for first 15 mins

• Monitor for flushing, fever/chills, dyspnea, SOB, itching, pain

• Second set of VS @ 15 minute mark

If no reaction…

• Increase infusion rate

• ALL product must be infused within 4 hours of leaving blood bank

Blood Transfusion Documentation:

• VS right before start, @ 15 minute mark, and at completion

• Date, start and end time of transfusion

• Blood type, component infused (RBC, platelets)

• Pt. tolerance + condition afterwards

• Document any adverse events/interventions

Allergic Reaction during Blood transfusion

Mild to Severe:

• mild = hives, itching, asthmatic wheezing

• severe = laryngeal swelling, dyspnea, tachypnea, chest pain

STOP TRANSFUSION + NOTIFY PROVIDER

Febrile Reaction during Blood transfusion

Reaction to WBC in donors blood

Can occur even AFTER transfusion complete

• Symptoms: chills, tachycardia, anxiety

STOP TRANSFUSION + NOTIFY PROVIDER

Hemolytic Reaction during blood transfusion

Destruction of RBC due to incompatibilities between pt. and donor

LIFE THREATENING

• Symptoms: fevers/chills, facial flushing, burning along vein, flank pain

STOP TRANSFUSION + NOTIFY PROVIDER

Blood transfusion reaction interventions

STOP TRANSFUSION + IMMEDIATELY NOTIFY PROVIDER

• remove tubing and infusion set (DONT THROW AWAY)

• Begin new infusion of 0.9% NS with new tubing at slow rate

• Closely monitor pt and VS

• Send blood and tubing back to blood bank!