IV Therapy Study Guide

Review Hand-outs, Homework Assignments, and Contracts

• Review hand-outs and homework assignments.
• Distribution of Skill Competency Sheets.
• Sign contracts required for IV therapy training.
• Review State Board of Nursing By-Laws by Micheal Coats RN, BSN, CMSRN, VA-BC.

Recommended Reading

• Use PowerPoints accompanied by instructor’s notes as core course materials.

IV Therapy Objectives

• Terminology: Define relevant IV therapy terms.
• Intravenous Access Devices: Discuss various types of intravenous (IV) access devices.
• IV Solutions: Differentiate among isotonic, hypotonic, and hypertonic IV solutions and their clinical uses.
• Medication Administration: Identify principles for medication administration and dosage calculations concerning IV administration.
• IV Catheters: Compare and contrast types of IV catheters: peripheral IV catheters, midline catheters, and central line catheters.
• IV Administration Techniques: Describe techniques related to IV maintenance using saline locks, IV bags, infusion pumps, and secondary piggyback sets.
• Baseline Assessment: Discuss baseline assessment for IV therapy, including proper IV maintenance and implanted vascular access devices.
• Complications: Identify signs, symptoms, and treatment for complications associated with IV therapy.
• Scope of Practice: Define the scope of practice for practical nurses as it relates to IV therapy according to the Missouri Nursing Practice Act.
• Blood Transfusion Principles: Discuss principles surrounding blood transfusions.

IV Therapy Regulations and Practice

• Exceptions: In emergencies, an LPN-IV certified may administer IV push via the closest port to the insertion site.
  

State Board of Nursing Regulations

• Permitted Actions:
    - Calculate flow rates.
    - Initiate Peripheral IVs (PIVs) smaller than 3 inches.
    - Administer fluids, TPN, or PPN.
    - Change PIV sets and maintain locked lines.
    - Administer pre-mixed medications.
    - Perform IV pushes with documented employer verification in emergencies.
• Prohibited Actions:
    - Administer anti-neoplastic (chemotherapy) medications.
    - Initiate blood products and access ports.
    - Add medication to intravenous fluids.
    - Remove midline or central catheters.
    - Perform IV pushes on neonates, including thrombolytic therapy, sedation, and anesthesia.

Basic Principles of IV Therapy

• Injection Definition: Injection of a solution into the vein is an effective method for
    - Rapidly administering large volumes of fluid.
    - Quickly absorbing medications.
• Physician Orders: Requires a written order detailing date, time, type of solution, medication, dosage, rate, and frequency.

Advantages of IV Therapy

• Direct Administration: Medications can be injected directly into the vein using a syringe.
• Flexible Administration: Medications can be administered intermittently or through continuous infusion.
• Patient Comfort: More comfortable than intramuscular (IM) or subcutaneous routes.
• Quick Response: Faster patient response to medications.

Disadvantages of IV Therapy

• Requires extended time for administration.
• Necessary for skilled healthcare providers to manage and administer IV therapy.
• Reduces patient mobility.
• Higher risk of infection at the administrative site.
• Potential for severe adverse drug reactions.

Venipuncture Considerations

• Contraindications: Avoid sites showing signs of inflammation, infiltration, thrombosis, or on limbs post-lymph node removal (i.e., mastectomy).
• Initial Catheter Placement: Start at the most distal site to enable proximal site utilization if venipuncture needs to change.

Venipuncture Procedure Overview

• Use a sharp rigid stylet to puncture the vein.
• General Purposes of Venipuncture:
    - Collect blood specimens.
    - Start IV fluid infusions.
    - Instill medications.
    - Inject tracers for diagnostic examinations.
• Utilize intermittent infusion when medications are needed only at specific times, emergencies, or to minimize discomfort.
• Continuous infusion of fluids may occur over a 24-hour period.

Practice Flow Rates and IV Sizes

Important IV Sizes and Flow Rates

• IV Catheter Sizes: 14G, 16G, 18G, 20G, 22G, 24G.
    - Flow rates in ml/min vary based on IV gauge:
      - 14G: 240 ml/min
      - 16G: 180 ml/min
      - 18G: 90 ml/min
      - 20G: 60 ml/min
      - 22G: 36 ml/min
      - 24G: 20 ml/min
• Usage Guidelines:
    - Blood transfusions generally require at least an 18G for effective flow rates.
    - Select size based on the type of fluids being administered.

Procedure Checklist for IV Insertion

• Equipment Needed:
    - 22G catheter, tourniquet, alcohol swab, 2 clean 2x2 gauzes, occlusive dressing, medical tape, extension tubing, flush syringe, towel, clean gloves, anatomical model, infusion pump, primary and secondary administration tubing, primary solution bag.

Steps for Inserting PIV

IV Insertion Procedure

1. Wash hands.
2. Apply tourniquet; assess for potential venipuncture site.
3. Release tourniquet.
4. Open necessary packages and prime tubing.
5. Place a barrier under the proposed site.
6. Put on clean gloves and reapply tourniquet.
7. Clean the site with antiseptic agent from distal to proximal.
8. Allow the site to air dry.
9. Inspect the catheter for defects.
10. Use non-dominant hand to hold skin taut.
11. Inform the client prior to puncture.
12. Insert needle at a 5-15 degree angle.
13. Check for blood return; confirm placement.
14. Release the tourniquet.
15. Remove needle while applying pressure near the catheter tip.
16. Connect extension tubing and flush catheter.
17. Stabilize the catheter with an occlusive dressing.

IV Push Medications

• Technique: Administer via the port closest to the patient.
• SASH Protocol: Saline flush, administer medication, saline flush, heparin flush if applicable.
• Rate of Administration: Varies based on the medication, generally over 1-5 minutes.
• Calculations:
    - Desired/Dose x Supply = Volume to Administer.

Complications of IV Therapy

• Infiltration: Fluid leaks into surrounding tissues if the catheter is not in the vein.
• Phlebitis: Inflammation of a vein; can lead to thrombophlebitis which can cause blood clots.
• Local Infection: Assess for redness, swelling, and discharge.
• Fluid Overload: Monitor for symptoms of excess fluids, such as crackles in the lungs.
• Septicemia: Pathogens invade from local infections into the bloodstream.
• Circulatory Overload: Signs include engorged neck veins, dyspnea, reduced urine output, and edema.

Blood Transfusions Guidelines

• Definition: IV administration of blood products for various therapeutic purposes (e.g., increase blood volume post-surgery, treat anemia).
• Patient Assessment: Prior to transfusion, review history of transfusions and current reasons for transfusion.
• Informed Consent: Ensure consent is obtained.
• Pre-transfusion Assessment: Record baseline vital signs.
• Verification: Double-check blood type compatibility and patient identity before administering blood products.

Blood Component Therapy

• Products: Whole blood or various components (e.g., RBCs, plasma, platelets).
• Compatibility Verification: Match patient blood type against donor blood type.
• Administration Guidelines: Use appropriate catheter size (18G or 20G), and initiate transfusion slowly while monitoring for reactions.

Conclusion on Safe IV Practices

• Home IV Therapy: Involves maintaining sterile techniques at home for ongoing needs.
• Monitoring and Documentation: Monitor for possible complications and maintain accurate documentation on IV therapy.
• Patient-Centric Care: Emphasize education on IV therapy, signs of complications, and adherence to safety guidelines to ensure a successful treatment outcome.