IVP with saline lock

SAS

1. insert syringe of saline
2. unlock clamp (before or afer insertion)
3. aspirate to check of blood if your protocol requries it
4. push saline
5. give med
6. flush with saline
7. lock clamp before removal of syringe
8. SALINE, ADMINISTER MED, SALINE

SASH

IVP with picc line

1. insert syringe of saline
2. unlock clamp
3. push saline gently to determine if line is patent
4. if patent, give medication
5. flush with saline
6. flush with heparin
7. Lock clamp before each removal of syringe
8. SALINE, ADMINISTER MED, SALINE, HEPARIN

1. select port
2. scrub hub for 15 sec
3. insert needleless syringe into port
4. inject med at appropriate rate, occlude IV line by pinching tubing above port if nescessary
5. release pinched tubing as necessary for med to flow into patient
6. repeat as necessary until entire med is infused
7. dispose of syringe

1. to supply maintenance fluid and electrolyte requirement
2. to provide replacement or corrective fluid
3. to provide nutrients when a client is unable to absorb them from GI tract
4. to provide a route for giving medications

IV therapy

supply maintence fluid and electrolytes requirements

this maintains requirements refer to the amount of fluid and electrolytes that the body needs to function properly under normal conditions

• client who is NPO
• post-op client who is unable to take enough fluid orally

IV therapy

provide replacement or corrective fliud

fluid is needed when the client has had abnormal fluid lossses

situations like:

• diarrhea
• loss of gastric fluid and electrolytes from vomiting
• hypovolemia secondary to acute blood loss or burn

IV therapy

provide nutrient when client is unable to absorb them

IV therapy

provide a route for giving meds

hypotonic, 10 and 50% are hypertonic

maintain water balance and correct imbalance. supplies calories as carbohydrates

provide "free" water

electrolyte free solutions may cause peripheral circulatory collapse and anuria in patients with sodium deficiency, may aggravate hypokalemia

dont administer with blood

Hypotonic (.45%), isotonic(.9%), hypertonic (3%)

indications: fluid replacement, dehydration, sodium depletion, low salt syndrom

Percautions: use sodium solution with caution in edematous patients with heart, renal or hepatic disease

administer 3% or 5% slowly.

Hypotonic (5% dextrose and .45% NaCl)

Isotonic (5% doxtrose and .9% NaCl)

Indication: fluid replacement, few calories, dehydration, sodium depletion

precautions: Check serum electrolytes: Na, Cl, K, dextrose 5% spares muscles breakdown in NPO status

Lactated Ringers injection

Isotonic

Indications: replacement of surgical and GI loss, dehydration, sodium depletion, acidosis, diarrhea and burns

Precautions: Trauma fluid

These solutions are used to increase the volume of blood following severe loss, hemorrhage or burns, common blood volume expanders are:

1. dextran

2. plasmanate

3. Human serum albumin

when this happens people show:

decrease urinary output, acute weight loss, lack of tears, poor skin turgor, sunken eyes, increase pulse

when people experience this they are:

increased urine output, acute weight gain, tears present, possible edema, full fontanel, pulmonary edema, increase pulse, decreased bp

1. amount of fluid to be infused over a period of time is calculated

2. the order for intravenous fluid intake is written for number of liters per 24 hours or rate in mL per hour

Frequent nursing observation of IV

1. patency of intravenous: every hour the entire iv set up needs to be checked.

2. Client tolerance of intravenous- note any changes in vitals, discomfort or pain at site, output, note any abnormal daily weight gains.

    1. change the IV tubing every 72 hours or according to hospital policy

2. prevernt air contamination with glass bottls by changing the bottles every 24 hours

3. be caertain that all conncections are secure to avodi their coming apart and becoming contaminated

4. IV site care

5. scrub the hub

6. hand hygiene before handling IV equipment

1. amount and type of fluid
2. important with children, critically ill, elderly
3. also provides safety check

this refers to the accumulation of IV fluid in the extra vascular tissue "leaks"

occurs when needle becomes dislodged fromthe vein and the fluid infuses into tissue instead of the bloodstream. to large a volume of fluid is forced into a small vein

sign of this include:

pian at the site, swelling at the site or swelling in the dependent part of extremity, blanching or paleness at the site, skin cool to touch over site, IV flow may slow or stop

nursing actions for this include:

1. to prevent, protect IV- taping IV securely, limiting movement
2. Assessment- the goal of assessment is to detect an infliltration early stages when signs are subtle, observe IV site carefully and frequently
3. check for blood return

when this occurs you should:

• stop IV immediately
• remove venipuncture device
• use of warm packs to cause vasodilation to increase absorption of fluid
• keep extremity elevated and immobilized
• notify someone to restart IV
• check extravasation policy

reason for this would be:

• catheter punctures wein wall
• difficult IV start
• catheter migrates out of vein due to movement of catheter by pt or staff
• high pressure injection
• chemical irritation

treatment:

•  once you know it is no longer in the vein
• or once it is causing tissue trauma
• it needs to be removed
• warm packs to area
• elevate
• restart IV in another site

what to look for when on shift

• what is hanging
• what rate is running at?
• are the connections secure?
• is the tubing patent
• is fluid running correct?

• type of fluid hanging
• rate of fluid
• site inspection
• document when a new IV bag is hung
• chart amount of med given for IV meds not volume

• start at the top of the set up and wrok toward the patient
• IV pump battery/settings
• pump set correctly
• clamps open/no air/no tubing problem
• IV site patency
• height of fluid if gravity set up

this is inflammation of the vein, can develop any time during IV therapy, potassium is irritating to veins

due to: side of IV catheter, medication, rate of infusion

Signs and symptoms of this:

edema, puffy, warm to the touch, redness at site of IV , possibly red along the vein the IV catheter, hardness along the path of vein, observe and palpate site to assess.

observation of site- change IV site, change IV tubing, do site care

Dilute medication appropriately, use smallest size catheter possible, Ice area to decrease inflammation followed by hot packs in a few hours, continue observations

signs and symptoms of this;

• Localized: inflammation, warm to touch, purulent drainage
• entire blood stream: febrile, N/V, change in VS decrease bp tachycardia, site changes red, swelling, tender, abscess

preventions;

• aeseptic technique with all IV starts, changing IV, accessing the IV line
• change IV tubing per routine
• check sterility of any solution hung or pushed through IV

signs and symptoms are;

increased pulse, respiration and bp, pulmonary edema, peripheral edema, acute weight gain, increase urinary output, circulatory collapse

nursing prevention;

never have more than 2 hours worth of fluid in the soluset at one time, check IV frequently, monitor urine output, monitor vital signs, observe for edema, ausculate lungs for rales

signs and symptoms or this;

cyanosis, weakness, weak, rapid pulse, hypotension, unconsciousness

nursing actions;

Make sure all connections from the needle to bottle fit snugly, infuse fluid completely through the tubing before attaching the needle, observe carefully for air bubbles, notify physician immediately

1. Head

2. Heart

3. superior vana cava where CVC distal tip is to be located, could be a little closer to the heart but you do not want it to enter the Right atrium

depending you could;

infuse medication that irritate veins, infuse blood, infuse hypertonic solutino, blood draws, may have one tow or three or four lumens

complications include;

pneumothorax (collapse lung)- they would have trouble breathing

infection, catheter occulusion- clot, kink

air embolism, catheter displacement, venous thrombosis, catheter cracking

Nursing care is essential to the sucess of CVC therapy through:

knowledge of administration of meds, nutrition therapy, chemo, blood through this route

Knowledge of care maintenance of catheter to pervent and decrease risk of complications

A larger part of the catheter that is designed to prevent the microbes from traveling any further up the catheter.

it looks like a tiny balloon under the skin but it is not something that has air injected into it like a foley catheter.