IV Therapy

Objectives and Purpose of IV Therapy

• Overview of objectives set in the lesson plan.

• Importance of fluid and electrolyte balance in IV therapy.

• Uses of IV therapy:

  • Fluid maintenance.

  • Administration of medications.

  • Allows for quick restoration of fluid and electrolyte balance.

  • Medications can include antibiotics, which can be given continuously or intermittently.

  • Administration of blood.

  • Nutritional support (Total Parenteral Nutrition, TPN).

Types of IV Administration

• IV therapy can deliver:

  • Continuous: Constant flow over time.

  • Intermittent: Stops and starts (e.g. antibiotics given every 24 hours).

  • IV Push: Directly pushed into the vein for immediate effect.

• Benefits of IV push:

  • Immediate response compared to oral medications that take longer to act.

Considerations Before Starting an IV

1. Order Verification

   • Ensure the nursing order matches the Medication Administration Record (MAR).

   • Ensure the order is appropriate for the patient.

2. Patient History and Physical

   • Assess past medical history such as surgeries (e.g. mastectomy).

   • Importance of checking history for any potential complications based on previous medical procedures.

3. Lab Data

   • Monitor relevant laboratory values (e.g. CBC, CMP, clotting factors).

   • Be cautious of low platelet counts as they can lead to bleeding complications.

4. Allergies

   • Check for allergies to medications, fluids, or latex products.

5. Compatibility of Treatments

   • Assess compatibility between fluids, nutrients, and medications.

IV Access Devices

• Types of IV access devices include:

  • Steel Winged Butterfly Needle for temporary access and specimen collection.

  • Over-the-Needle Catheter: Continuous fluid delivery into the vein.

• Gauge Information:

  • Gauge System: Smaller numbers represent larger needles (e.g. 18 Gauge = larger needle for trauma).

  • 18 Gauge: Rapid blood and fluid administration (trauma).

  • 20 Gauge: Common for general care and fluid maintenance.

  • 24/22 Gauge: Used for neonates and pediatrics.

Supplies Needed for IV Therapy

• Essential supplies:

  • IV catheters.

  • IV fluid bags.

  • Alcohol wipes for site cleaning.

  • Extension sets for connection to the IV catheter.

Seven Rights of Medication Administration

• Right Patient

• Right Drug

• Right Dose

• Right Route

• Right Time

• Right Documentation

• Right Indication

Patient Education and Communication

• Explain the purpose of IV therapy to the patient (e.g., quicker pain relief).

• Describe the procedure and address patient concerns honestly.

• Techniques to minimize anxiety, such as distraction or options during the visit.

Procedure for Starting an IV

• Tourniquet Application:

  • Position the tourniquet 4-6 inches above the insertion site.

  • Ensure the distal pulse is present to avoid occlusion.

• Site Selection Considerations:

  • Avoid the dominant hand, painful areas, and areas with previous venipunctures or mastectomy.

  • Signs of site selection include:

  • Palpation: Feel for the vein.

• Insertion Technique:

  • Insert catheter at a 10-30 degree angle, bevel up. Ensure you see blood return in the chamber before advancing the catheter.

  • Once in, occlude the vein above insertion to prevent bleeding.

Administering Medications via IV

• Administering IV Push Medications:

  • Verify the medication against orders.

  • Assess for any potential allergies or incompatibilities.

  • Clean the port of the IV line before administration.

  • Follow a consistent procedure of flushing, administering the medication, and follow-up flushing based on the rate of administration.

• Incompatibility Procedures:

  • If a medication is incompatible, stop the IV fluids and flush with a saline solution to clear the line.

  • Follow protocols for monitoring patient status and side effects.

Monitoring IV Sites

• Regular assessments needed, with frequency based on usage:

  • Every 4 hours for saline locks.

  • Every 1-2 hours if IV fluids are running.

• Look for signs of complications such as:

  • Infection: Redness, swelling, warmth, or discharge.

  • Infiltration: Swelling, coolness to touch, IV fluids leaking.

  • Phlebitis: Red streak, pain, and warmth.

Infusion Complications

• Fluid Overload:

  • Watch for symptoms such as weight gain, edema, and respiratory distress (crackles in lungs).

• Air Embolism:

  • Clamp the IV, place patient in left lateral Trendelenburg position, and administer oxygen.

  • Monitor vital signs closely.

• Infection:

  • Remove any infected IV sites, document, and notify the physician.

Total Parenteral Nutrition (TPN)

• Indicated for patients without functioning GI tract.

• Contains nutrients including carbohydrates, proteins, and fats—administered via a central line.

• Monitor blood sugars closely due to potential elevated levels from dextrose.

• Follow strict aseptic technique during administration.

• Discontinue TPN gradually to prevent hypoglycemia.

Central Venous Access Devices (CVADs)

• Different types: non-tunneled, PICC lines, implanted ports.

• Advantages include:

  • Reduced need for repeated venipunctures.

  • Long-term access for medications that are irritating to veins.

• Infections associated with CVADs can lead to serious complications; monitoring and proper technique are critical.

Documentation and Follow-Up

• Thorough documentation includes details of the IV insertion, medications administered, patient response, and any complications.

• This ensures quality of care and accountability in patient management, especially in the clinical setting.