Indications of Venipuncture

and IV Infusion Therapy

When no other route of administration is available. Pt. cannot take in oral substances
To restores & maintains fluid & electrolyte balances
To provides medication & chemotherapeutic agents
To transfuse blood & blood products
To delivers parenteral nutrients & nutritional supplements
When administration of continuous or intermittent medication is required
When administration of bolus medication
Indications for Venipuncture & IV Infusion Therapy
When administration of intravenous anesthetics is required for the surgical pt.
or the administration of diagnostic reagents! radiopaque dyes used for radiographic
images
or monitoring & maintaining hemodynamic functions "homeostasis#
$enefits & %ses for IV Therapy
$enefits! allo&s for more accurate dosing' it(s a fast method of delivery &hich &orks immediately
)rug administration
* Provides rapid & effective administration of medications
+,ntibiotics' thrombolytics' cardiovascular drugs' anticonvulsive drugs'
histamine- receptor antagonist' antineoplastic' analgegics
- Immediate & accurate administration of medication
* ,llo&s for IVP' a direct single dose
* or the use of long-term continuous infusion "short-term during hospital stay#
* PP. "peripheral parenteral nutrition# &hen limited nutritional therapy rather
than total pareteral nutrition is needed.
Total parenteral nutrition "TP.# * given through a central line
- Provides essential nutrients to blood organs & cells by IV route
- TP. is usually customi/ed for ea. Pt. in order to meet their energy & nutrient
0equirements
- 1ontains proteins' carbohydrates' fats' vitamins' traces of elements and &ater.
- TP. should only be used &hen the gut is unable to absorb nutrients.
- 1an be used indefinitely' ho&ever' TP. may cause liver damage.
- "PP.# peripheral parenteral nutrition * is a limited nutritional therapy2 it!
o contains fe&er non-protein calories' lo&er amino acid concentration than
TP.
o may be used for appro3. 4 &ks.
$lood administration
- restores & maintains adequiate circulatory volumes
- maintains homeostasis - prevents cardiogenic shock
- increases the blood(s o3ygen-carrying capacity
IV )elivery 5ethods
$y peripheral veins - usually the distal arms & hands
6o&er e3tremities are avoided' may be used in children
* Primary 6ines
* 7econdary 6ines "IVP$#
* Intravenous Push "IVP#
* 8eparin 6ock lush "86#' 7aline 6ock
* Intravenous Pump %se
1annulas - 1annula selection
Cannula size Clinical Application____________________________
9:' 9;' 9< ga. - trauma' suregery' blood transfusion
=> ga. - continuous or intermittent infusion' also blood adm.
== ga. - use in children and elderly' or for general use "?I lab#
=: ga. - ragile veins' children
IV )elivery 5ethods
1entral line veins - a fle3ible catheter inserted into large central vein
* Inserted by by a physician in the ! @ugular vein2 7ubclavian vein2 or emoral vein
Procedure performed by a 5) * requires a consent
PI11 lines & 5idline 1atheters
PI11 * "Peripherally inserted central catheters# * performed by a trained nurse. The tip of the
catheter reaches the subclavian and terminates at the superior vena cava. Post 3-ray required for
determining placement.
5idline catheters - are long catheters "A 4 inches in length#. they are peripherally inserted &ith the
tip located at the level &ith the a3illa' and distal to the shoulder.
Peripheral IV VS. 1entral 6ines
In for short periods of time 1an be left in for longer periods of time
0elatively easy to put in 0equired skilled person for placement "5)#
Is accomplished by nursing staff PI11 line "0. &ith special training#
6ess complications 5ay infuse chemotherapy
7ome drugs & fluids may be irritable to vein 5ay infuse parenteral nutrition formulae
)o not infuse fluids &ith a p8 B C or AD 5ay e3ceed 9>E de3trose and CE protein
1annot give anything A C>>mFsmG6
)elivery Pumps
NO Free Flow
7afety mechanism that prevents free flo&
If not sure ho& to operate' ask!!!!
,l&ays keep alarms on.
Venipunture 7ites
0H5H5$H0!
C 0ights of 5edication ,dministration
0ight drug
0ight dose
0ight clientGpatient
0ight route
0ight time
Starting an I.V.
9. ,ssembles equipment
IV. $ag' IV tubing' IV start kit' tape' op-stie dressing' IV cathlon needle' syringe' gloves
IV pump' medication' 5edication administration record "5,0#2
=. Positions clients and adIusts lighting
H3plain to the patient' make them feel comfortable' present self-confident
4. Washes hands and applies gloves
,llo& pt to see you &ash hands
:. Prepares equipment
clean bedside table' use aseptic technique - uses body fluid precautions
C. 7elects and prepares venipuncture site
HTF8 s&absGpadsJ>E' apply in a circular motion =-4 inch diameter' moving from the
center to&ards the outside. ,llo& area to dry. .o fanning' blotting' or blo&ingK
THEN
,pply povidone-iodine "betadine s&ab# L also in a circular motion. 1enter to out&ards.
,llo& to dry for 4> seconds
Caution! If patient is allergic to Iodine then use alcohol s&ab &ith friction until final
application is visually clean. )ry for 4> seconds
;. ,pplies tourniquet - do not tie a knot' tourniquet must be easily removed.
7. Hnters skin &ith needle either ne3t to or directly over vein
1ephalic vein
1ephalic vein
1ephalic vein
,ccessory cephalic vein
5edian cubital vein
5edian vein
5edian cubital
vein
)orsal
metacarpals
)orsal digital vein
)orsal venous net&ork
$asilic vein
Meep the bevel of the needle up. Hnter at a 9>-4> degree angle
<. Fbserves for NpopO and flashback of blood2 advance the needle a little bit more "= cm#
separate the cathlon and needle stylate
D. 1arefully advances needle "cathlon# - the stylate further separates from the cathlon as it is
advanced.
9>. 0eleases tourniquet
,pply pressure over the vein' above the venipucture to prevent blood leaking before removing
stylate. 0emove the stylate and attach the IV tubing
99. Fpens clamp on I.V. tubing
If giving an IVP medication or heplock flush' be sure to push fluid slo&ly
9=. Fbserves for s&elling at I.V. site
94. ,pplies appropriate dressing * chevron or 8 method
9:. Tapes the needle and tubing - use opsite dressing
9C. 7ets flo& rate
9;. 6abels I.V. site
9J. )ocuments
9<. 7tates the difference bet&een catheter and heparin lock set-up
)iscontinue I.V.
Practice standard precautions.
1lamp tubing * stop fluid infusion.
?ently peel the tape back
Withdra& catheter. Place gau/e over site and gently slide the plastic catheter out of the
patientPs arm.
%se direct pressure for a =-4 minutes to control any bleeding.
Place a band aide over the site
Documentation
)ate
Time
7ite description
,ttempts
?auge
Types of IV Solutions
IV solutions are based on the patient(s medical history and diagnosis' the type of fluid volume deficit
being treated "overload or dehydration#. The IV solution is also selected on the type of electrolyte
content and osmolarity "tonicity#
Isotonic * a solution &ith the same osmalility as body fluids' such as plasma.
* total electrolyte content appro3. 49> mFsmG6
8ypertonic * is a solution &ith greater concentration of solutes than body plasma
* total electrolyte content A 4JC mFsmG6
IV fluids or 86
.ame of solution
0ate of flo&
Patient toleration
1omplications
8ypotonic * is a solution &ith lo&er concentration of solutes than body plasma
* total electrolyte content B =C> mFsmG6
Colloids - 1olloid osmotic pressure "or oncotic pressure# L is the osmotic "pulling# force of albumin
"proteins# in capillary reabsorption. It dra&s &ater into the vascular space. These &ould be hypotonic
solutions like! ,lbumin "a component of blood#2 )e3tran2 8etastarch
Crystalloids - electrolyte solutions that move freely bet&een the Intravascular and Interstitial spaces.
These are isotonic solutions like! )CW and .ormal 7aline >.DE
IV solutions can be used to correct fluid imbalances. They are usually dependent upon the solution(s
osmolarity "concentration# as compared to the serum osmolarity.
Fsmolarity concentrations of solutions are e3pressed in msm!" "milliosmol per liter of
solution#
.ormal serum is appro3imately * 4>> mFsmG6' and it is the same osmolarity as other body
fluids
, B lo& serum osmolarity suggests fluid overload
, A high serum osmolarity suggests hemoconcentration ' dehydration
.FTH ! .ormal serum L 4>> mFsmG62 it(s the same osmolarity as other body fluids
Isotonic
Fsmolarity "tonicity# of the solution is the same solute concentration as serum and other body
fluids
Infusing solution doesn(t alter concentration of serum2 therefore' osmosis doesn(t occur.
Isotonic solutions stay &here they are infused' inside blood vessel
IntravascularGH1 volume e3panders
H3amples! )CW' >.DE.7 ' 6.0. ' Hlectrolytes are considered isotonic
Isotonic 7olutions! H3amples & 1onsiderations
>.DE .7 5onitor for 18 & 8T.
=.CE)e3tG.:C.7 0ingers 7olution
)CW ) =.CE G Q 60
)CG >.99E .7 .o )CW &ithA I1P
Plasmalyte )on(t give 60 in liver disease. %nable to metaboli/e lactate
6actated 0ingers .o 60 if p8AJ.C2 converts 6actate 81F4
8ypotonic
Fsmolarity "tonicity# of the solution is B than serum osmolarity. It has a lo&er solute
concentration.
luids shift out of intravascular fluid into the interstitial & intracellular fluid2 because fluid is
pulled to&ards the area of higher osmolarity. In this case' the intracellular fluid has higher osmolaritiy.
8ydrates cells' reduces circulatory fluid.
The purpose for hypotonic sol. is to replace cellular fluids2 or treat hypernatremia or
other hyperosmolar conditions'
Isotonic solutions! half strength .7 "Q ..7#' >.44E .a1l2 )=.CW

Too much &ill deplete intravascular fluids' decrease $P' cause cellular edema and cell
damage. "rupture#
8ypertonic
Fsmolarity "tonicity# of the solution is A than the serum osmolarity. 7olute concentration is
higher than the solute concentration of serum as &ell as the e3tracellular fluid
luids shift out of the intracellular & interstitial fluid into the intravascular fluid
- This effect is temporary since de3trose is metaboli/ed quickly
5ay be ordered in post-op pts to reduce edema' stabili/e $P and regulate urine output
#see $andout%
H3amples of
8ypertonic 7olution!
)C Q .72 )C>W )C60 5annitol
)C .72 )9>.7 Q ..7 )=.CW
)C >.=E .7 )9>W >.44E.a1l )9> Q .7
1onsiderations
5ay cause cells to shrink2 and may cause damage to endothelial cells
If used in increased intracranial pressure "I1P#' it &ill dra& fluids out of cells
and lo&er the I1P.
8ypotonic solutions may be necessary for children since their daily turnover of &ater e3ceeds that of
adults. 1hildren are subIect to rapid fluid shifts. 5ost common pediatric maintenance solutions!
)CE or )9>E
.7 >.==E' .7 >.4E
,nything less "or less than >.=E of sodium chloride# may cause cerebral edema.
Ruick ?uide to IV 7olutions!
, solution is isotonic if its osmolarity falls &ithin "or near# the normal range of serum of =:> * 4:> mFsmG6. ,
hypotonic solution has a lo&er osmolarity! a hypertonic solution has a higher osmolarity. This chart lists common
e3amples of the tree types of IV solutions and provides key considerations for administering them.
Solution E&amples Nursing considerations
Isotonic
6actated
0inger(s
0inger(s
.ormal saline
)e3trose CE in
&ater ")CW#
$ecause isotonic solutions e3pand the intravascular
compartment' closely monitor the patient for signs of fluid overload'
especially if he has hypertension of heart failure.
$ecause the liver converts lactate to bicarbonate' don(t give
lactated 0inger(s solution if the patient(s blood p8 e3ceeds J.C
,void giving )CW to a patient at risk for increased
intracranial pressure "I1P# because it acts like a hypotonic solution.
CE ,lbumin
8etastarch
.ormosol
",lthough usually considered isotonic' )CW is actually isotonic only
in the container. ,fter administration' de3trose is quickly metaboli/ed'
leaving only &ater * a hypotonic fluid.#
8ypotonic
8alf-normal
saline >.:CE..7.
>.44E sodium
chloride
)e3trose =.CE
in &ater
,dminister cautiously. 8ypotonic solutions cause a fluid shift
from blood vessels into cells. This shift could cause cardiovascular
collapse from intravascular fluid depletion and increased I1P from
fluid shift into brain cells.
. )on(t give hypotonic solutions to patients at risk for
increased I1P from stroke' head trauma or neurosurgery.
)on(t give hypotonic solutions to patients at risk for third-
space fluid shifts "abnormal fluid shirts into the interstitial
compartment or a body cavity# * for e3ample! patients suffering from
burns' trauma or lo& serum protein levels from malnutrition or liver
disease.
8ypertonic
)e3trose CE
in half-normal saline
)e3trose CE
normal saline
)e3trose CE
lactated 0inger(s
4E sodium
chloride
=CE ,lbumin
J.CE sodium
chloride
$ecause hypertonic solutions greatly e3pand the intravascular
compartment' administer them by IV pump and closely monitor the
patient for circulatory overload
8ypertonic solutions pull fluids from the intracellular
compartment2 so don(t give them to a patient &ith a condition that
causes cellular dehydration * for e3ample' diabetic ketoacidosis.
)on(t give hypertonic solutions to a patient &ith impaired
heart or kidney function * his system can(t handle the e3tra fluid.
6ippincott Williams & Wilkins. I.V. Therpay made Incredibly Hasy.
Patient ,ssessment
1heck patient(s status before starting fluid replacement.
What is their ageS ,re they having surgeryS What is the condition of the veinsS
This may determine the si/e of needle you &ill use.
,nticipate changes in fluid balance that can occur during IV therapy - check lab.
values.
'luid deficits 'luid e&cess
Wt. 6oss
Increased' thready pulse rate
)iminished $GP' "orthostatic hypotension#
)ecreased central venous pressure 1VP
7unken eyes' dry conIunctivas' decreased tearing
Poor skin turgor "not reliable in elderly patients#
Wt. ?ain
Hlevated blood pressure
$ounding pulse that isn(t easily obliterated
@ugular vein distention
Increased respiratory rate
)yspnea
Pale' cool skin
Poor capillary refill "A = seconds#
6ack of moisture in groin and a3illae
Thirst
)ecreased salivation
)ry mouth'
)ry' cracked lips
urro&s in tongue
)ifficulty forming &ords "patient needs to moisten
mouth first#
1hanges in mental status
Weakness
)iminished urine output
Increased hematocrit
Increased serum electrolyte levels
Increased blood urea nitrogen "$%.# levels
Increased serum osmolarity
5oist crackles or rhonchi on auscultation
Hdema of dependent body parts!
"sacral edema in patients on bed rest#
"edema of feet and ankles in ambulatory pts.#
?enerali/ed edema
Puffy eyelids
Periorbital edema
7lo& emptying of hand veins &hen the arm is
raised
)ecreased hematocrit
)ecreased serum electrolyte levels
)ecreased $%. levels
0educed serum osmolarity
)o they have a fluid deficits of fluid e3cessS
0I7M7 and 1omplications rGt IV therapy
H)H5, L an imbalance bet&een e3tracellular and intracellular fluidG compartments2
an imbalance in osmolarity "concentration# or osmotic pressure "pulling#.
$leeding * hematoma' separation of IV tubing
$lood vessel damage
Infiltration "IV sol. leaks into surrounding tissues#
1atheter dislodgement "e3travasation# - e3travasation from vesicant drugs
Fcclusion * bent catheter' IV flo& interrupted' line clamped' ailure to flush
device' blood back-up
Phlebitis' - tenderness' redness caused by friction from catheter' hypertonic sol. c
high p8. 1an damages the blood vessel.
may occur &ith prolonged ind&elling IVs' immunocompromised pts' poor
taping.
7crupulous aseptic tech. required &hen handling IVs at anytime.
thrombosis - painful' reddened' s&ollen vein. IV flo& sluggish or stopped.
1auses
inIury to endothelia cells of vein &all' platelets adhere & can form a thrombus
thrombophlebitis * severe discomfort' reddened' s&ollen & hardened vein.
1aused
by thrombosis and inflammation. 0emove IV' restart' &arm soaks' report 5)
Infection * redness T site' inflammation' &arm to touch' drainage. 7epsis *
fever'
chills' general malaise. ailure to maintain aseptic technique.
1irculatory overdose "rapid infusion# * 7U neck vein distention or engorgement'
respiratory distress' inc $P' lung crackles. 0aise 8F$' slo& infusion' F='
,dverse or allergic reactions * stop infusion' notify 5). fGu protocol for adverse drug
reaction
7U! itching' uticaria "rash#' bronchospasm' &hee/ing' edema' anaphylactic reaction "occurs
&ithin minutes to up to 9 hour of e3posure#.
,naphylactic shock L flushing' chills' an3iety' agitation' generali/ed itching' palpitations'
throbbing in ears' &hee/ing' coughing' sei/ures' cardiac arrest.
7TFP infusions & s&itch to ..7.' maintain open air&ay' 5)' adm' antihistamine steroid or
anti-inflammatory agents' cortisone' epinephrine'.antipyretic as ordered. 5onitor pt carefully.
,ir embolism. - 7U respiratory distress' unequal breath sounds' &eak pulse' inc. 1VP' confusion
or loss of conciousness. 1ause! air in vascular system - caused! empty solution container * the ne3t
container &ill push air do&n the line. Tubing disconnects from venous access or IV bag.
)1 IV' place pt in trendelenberg of left side. ?ive F=' .otify 5). ,l&ays purge IV lines' air-
detection devices on pumps2 secure all connections.
)rug & IV incompatibility
1ellulitis * infection
Vein irritation or pain at IV site
7evered or fractured catheter * caused by reinsertion of needle into catheter. The fractured
foreign catheter fragment may act as an emboli. If portion of catheter entered bloodstream' place a
tourni(uet a)o*e t$e IV site to prevent progression. .otify 5) & radiology.
Ne*er reinsert needle
Venous spasm - caused by severe vein irritation' rapid adm. of cold fluids or blood. ,pply
&arm
soak' slo& rate of fluid.
Damage to a ner*e+ tendon+ or ligament - causes e3treme pain "electric shock &hen
the nerve is contracted#' numbness' or muscle contraction. )elayed effects may include paralysis'
numbness & deformity. 1aused by improper VP or improperly securing "splinting# the IV arm to an
arm board. 6ike taping too tight.
If pain or damage occurs' stop procedure & remove IV. ,void repeatedly penetrating tissue.
)on(t encircle arm &ith tape2 don(t apply e3cessive pressure &hen taping2
Physiological Interrelated 7ystemic 0isks
luid overload
* Cardio*ascular system * inc. $P' 80' e3erts the heart.
* 0.,trium releases hormone * ,trial natruiretic peptide ",.P# in response to
elevated $P * it inhibitsGblocks the rennin-angotensin mechanism & aldosteron
secretion * in order to decrease $P by allo&ing .aV and &ater to flo& out of the
body in urine. - produces salty urine.
* Ner*ous system * Pituitary gland secretes hormones that stimulate the kidneys to release fluid
* ,1T8 "adenocorticotropic hormone# stimulates adrenal corte3 to release corticosteriod
hormones' like glucocorticoid and mineralocorticoids.
* 5inerolocorticoids helps regulate electrolyte concentrations in e3tracellular fluids
"particularly MV' .aV#. ,ldosterone is a mineralocorticoid.
- ,ldosterone reduces the secretion of .aV' through kidney tubules reabsorption' helps to
regulate $icarbonate and chloride' other electrolytes
* ,enal system * 0enin-angiotensin mechanism &hich influences blood volume & $P by
releases rennin that acts on angiotensinogen "plama globuline made in the liver#. It converts it to
angiotensin I' &hich then converts that into angiotensin II. "by ,1H * antiotensin converting enyme#.
,l this to help stableli/e $P and e3tracellular fluid volumes.
This is associated &ith capillary endothelium in various body tissues "particularly lungs#
* -ituitary gland secretes .DH "vesopressin#' in response to increased osmolarity of blood or
decreased blood volume. 7timulates kidney tubule to reabsorb &ater.
* ,espiratory system * can easily become congested and dev. Pulmonary edema' and also
develop blood gasses imbalance.
1omplication of 1V lines
Pneumothora3 - usually discovered during 1U0
* 1hest pain
* )yspnea "7F$#
* 1yanosis - because of the diminished o3ygen
* )ecreased or absent lung sounds on the affected side
* Thoracotomy & chest tube
- ,1T L ,cute respiratory distress' Chest &all motion asymmetrical' Tracheal shifting
.utritional assessment
5edical 8U. ,llergies & intolerance to foods. 8T' Wt' ideal body &t' body frame' $5I. 7kin turgor'
bruising' muscle &asting' ill-fitting denture & denture caries' dry mouth' darkening of mouth lining'
infections or irritations in and around the mouth. .eck s&elling' lo& albumin levels . )ietary intake.
/eta)olic complication-
5onitor $7 levels - 8yperglycemia "infuse insulin#
8yperosmolar hyperglycemic non-ketotoc syndrome - stop de3trose' rehydrate
8ypokalemia - 8ypomanesemia - 8ypophosphatemia - hypocalcemi/ - metabolic acidosis
6iver dysfunction * decrease carbs & IV lipids. 1onsider cyclic infusion rather than continuous
8yperkalemia * decrease potassium
actors ,ffecting )esired lo& 0ate
1hange in cannula position- bent cannula can occlude flo&2 also level of IV bag
"ht of liquid#
Patency of the cannula. * diameter of aannula and tubing2 thrombus formation
&ill impede flo&
,lso' the longer the tubing' the slo&er the flo&. Viscosity of solution
Venous spasm.
1rying infants.
6ocal complications! Phlebitis' or thrombophlebitis.
$e sure to monitor the flo& for patency2 IV site' recheck calculations
-EDI.T,IC IV .D/INIST,.TIN
luid volume is based on child(s age' si/e and =: hr. needs
$efore starting an IV in children!
Parpare the parents and child for the stressful procedure
?ather all necessary equipment * to minimi/e interruptions
o Infusions pumps calibrated for pediatric use
o 7mall needle si/e! =:-== ga. IV site! foot' scalp vs. hand.
o %se IV tubing &ith a graded buretrol or solumet drip chamber ";> gttsGmin#
o %se of buffered lidocaine! H56,' or 65U: "lidocaine & prolocine#
o 1hild positioning * parental assistance vs. restraints
o 1heck for late3 sensitivity.
,nticipate changes in fluid balance that can occur during IV therapy * this is very
crucial before any serious complication develops.
,pply tourniquet over a &ashcloth to reduce pain or use a tourniquet belt' $GP
cuff.

%se an age appropriate approach
o )istracting activities' toy therapy' introduce to child that is coping &ell'
handling equip.' no use of restraints'
Fther Pediatric 1onsiderations
)ifficulty evaluating drug response * ho& do you assess ringing in the ear of a
child &ho doesn(t talkS
Vulnerable to overdose * infants may still have immature livers' or kidneys
Increase risk for fluid overload * kno& the minimum dilution for safe administration
of IV meds.
)ehydration poses a risk for to3ic accumulation
7ubIect to rapid fluid shifts
Intraosseous infusion * use in emergency trauma. , large-bore needle inserted into
the medulla cavity of a long bone "Tibial tuberosity' the distal 4
rd
of the femur in
ne&borns#
o Watch for oo/ing' s&elling at site and dependent areas' the tissue of the leg.
o 1omplication skin necrosis' fractures' osteomyelitis' cellulitis
Patient Teaching
,ssess patient(s previous e3perience
H3plain procedure
H3plain purpose of medication
6ength of time
Hase an3iety' allo& them to e3press feelings
8omecare instructions! care' hep-flush' hygiene & bathing' &hat to &atch for' 7U of
infection' phlebitis' &hen to report to 5)
)emonstrate of skill for administering medication "I5' via ?-tube#
)ocument teaching
I.V. T8H0,PW - Part X=
5aintaining peripheral IV therapy.
1alculating flo& rates
IV flo& rates * are measured in drops per minute
The number of drops required to deliver 9 ml.!
* &ill vary &ith the type of administration set used
* and its manufacturer "so check for the Ndrop factorO on the packet label#
There are = types of administration sets!
9. macrodrip "standard# - deliver 9>' 9C or => gttsGml
=. microdrip * delivers ;> gttsGml
,nother rate reminder is the!
0oller clamp - visual monitoring - 6abel infusion bag' check rate in mmGhr.
5any nurses check IV flo& rates q. time they(re in the patient(s room ,.) after ea. position change.
1heck Ivs frequently on 1ritical patients2 elderly2 &hen infusing caustic meds.
7ome solutions can damage tissue if infiltration occurs
Palpate gently around the IV area for infiltration2 ,sk the patient ho& it feels.
I the flo& rate decreases' check c 5) if the rate should be adIusted L especially if rate must must be
increased by A than 4>E
IV T01IN2
$asic set ,dd-a-line 5illi-si/e
- J>O-99>O "9J<-=JDcm# - longer - air vent * prevents
- %se for delivery of infusion - )elivery of secondary build-up of negative
through an intermittent intermittent infusions through pressure in the volume
infusion device. additional W-sites chamber' allo&ing sol. to
- W-site for secondary - ,fter secondary infusion is flo& out.
infusion in' the primary line resumes - 5icrodrip delivers ;>
gttsGml
-5acrodrip delivers 9>' 9C its regular infusion. - Volume control set!
$uretrol' 7oluset' Volutrol
=> gttsGml - $ackheck valve to prevent - %sed in ipediatrics
backflo& from secondary - )elivers precise amts of
solution fluidGmedication
Infection 1ontrol
"4
rd
leading cause of death in the %. 7.#
9. "ocal infection * infection penetrates the tissues at IV site2 it can spread
=. Systemic infection * it(s &hen the microorganism travels freely throughout the body
and affects otherGor all body systems
4. Sepsis * is &hen the pathological condition resulting from the spread of
microorganisms or to3ins throughout the circulatory system.
- Infection is the process in &hich a host is invaded by microorganisms that gro&' reproduce and
cause inIury.
- -at$ogen L a substance or agent that is capable of producing disease
- Coloni3ation L is &hen the invading organisms do not result in a disease but reside in the host'
making the host a carrier &ithout causing adverse clinical signs or symptoms.
HU,5P6H!
The nurse starts an IV infusion on a patient "$ost#.
The nurse accidently touches the tip of the catheterGneedle contaminating it &ith
bacteria "agent#
The bacteria enters the blood "en*ironment# &hich becomes an ideal area atmosphere for it
to proliferate
Preventing Infections
0otate IV site2 standard is :< *J= hrs.
5aintain the peripheral IV in order to prevent infections
0outine care * to prevent complications
- observe IV site for signs of inflammation or infection'
- minimi/e IV manipulation
Wash hands & &ear gloves &hen handling VP site
1hanging the dressing q :< hrs.
Mno& facility(s protocolG policy
1hange transparent dressing &hen its integrity is compromised
1hang IV solution
)on(t allo& IV container to hang for more than =: hrs.
1heck for cracks' leaks or damage on ne& bags before hanging
1heck for discoloration' turbidity & particles
.ote date & time &hen solution &as mi3ed
1hanging administration set q J= hrs.
1hange if contaminated or according to facility(s policy
1hange &hen you start a ne& venous access devise during routine site rotation.
0otate IV site
7tandard routine is to change IV site q. :< *J= hrs' according to hospital policy
7ometimes limited vein access may prevent you from changing sites often
If that(s the case' notify 5) of the situation and discuss alternatives for long-term insertion
++ , complete change may be ordered if you detect signs of thrombophlebitis' cellulites' or
bacteremia related to IV therapy.
++ 1leanliness is the key! ,l&ays &ash hands before handling IVs
++ ,l&ays clean a W-site &hen accessing line or introducing a secondary infusion set.
7pecial 1onsiderations
Pediatric veins * may be difficult.
Veins are embedded in fat making them hard to isolate
Infants * have less subcutaneous fat' &hich makes the veins more prominent.
%se! viens of hands' feet' antecubital fossa' dorsum of the hand' scalp "bilateral superficial
temporal and the veins of the middle forehead
Hlderly * skin tissue is loose &hich makes it difficult to stabili/e veins.
Veins are more fragile because of decreased connective tissues
+ Perform VP quickly & s&iftly efficiently to avoid e3cessive bruising.
+ 7maller gauge needles' =: ga YO needle
+ 0emove the tourniquet promptly to prevent bleeding through the vein &all
Communication and t$e la4
Patient information must be communicated through verbal reports' medical record' &ritten
documentation required by the nurse(s employing institution
If it &as not reported and recorded' it &asn(t done
.urse is liable for communicating all patient data that may alter his &ell-being2 or hinder
progress.
1ourt rulings have endited nurses liable and negligent for failure to report and record
significant information.
@ust to revie& documentation!
o 7olution ordered
o Type of venous access used "length' gauge#
o Time' rate of infusion
o 7ite2 type of dressing2 condition of site2 unsuccessful attempts
o Pt(s physical and psychological response to procedure
o %se of electronic device
o Patient teaching associated &ith procedure and therapy2 pt(s understanding
Ne*er ignore it or try to conceal an error if it occurs
It must )e addressed so t$at correcti*e measures are taken to counteract t$e error.
The patient(s safety comes first
.otify physician
ill out appropriate forms "incident report' or medication error form# and documentation
ollo& protocols
Patient has the right to kno& about the error
+ 0emember! to make an error is human' to conceal or lie is dishonest and a
breach of duty o&ed to the patient
6egal Implications
6a&suits may result from
Wrongful medication administration
Incorrect route
Improper placement of an IV line
Hrrors in infusion pump use
ailure to monitor for adverse reactions' infiltration' dislodgement of IV equipment.
5edication Incompatibility
5ost IV drugs are compatible &ith common IV solutions
The more comple3 the solution' the greater the risk of incompatibility.
IV solutions containing divalent cations "calcium# have higher incident of
incompatibility
Incompatibility is also common among mi3tures containing!
Fther electrolytes
5annitol
$icarbonate
.utritional solutions "TP.s#

Incompati)ility falls into 5 categories6
9. physical incompatibility * commonly occurs &ith multiple additives
,E.D Court cases
p. 78 - 9IV T$erapy /ade Incredi)ly Easy:
Mno& your limits
Mno& the nurse practice acts' ederal regulations
acility(s policies
)ocument the condition of site2 the IV care provided2 dressing changes2
tubing & sol. changes2 pt teaching & evidence of understanding.
++ document that you are follo&ing up and monitoring the IV site & infusion therapy.
physical signs of incompatibility! precipitaion' ha/y or cloudy solution' dev. gas bubbles
lactated 0inger(s "has calcium in solution# increases precipitation &hen missed &ith another
drug.
.orepnephrine &ith degraded &hen added to sodium bicarbonate
=. chemical incompatibility * mi3tures of drugs alter the integrity and potency of active
ingredients rendering it less potent. actors influencing chemical incompatibility include!
drug concentrations
p8 of the solution
volume of solution used to mi3 medications
length of time that medications are in contact &ith each other. The long = or more drugs are
together' the more likely an incompatibility &ill occur ",mikacin & ,cyclovir A : hrs.#
temperature * the higher the temp. of an admi3ture' the greater the risk of incompatibility.
6ight * prolong e3posure to light can affect the stability of certain drugs ".itroprusside sodium2
amphotericin $#
4. therapeutic incompatibility * occurs &hen = or more drugs are administered concurrently
"Penicillin & 1hloramphenicol#. Penicillin should be given 9 hrs before chloramphenicol.
What should you put on the label &hen adding medication to IV solution' label!
Patient(s full name
0oom number
)ate
.ame & amt. of IV solution & drugs
Infusion rate
4 1hecks of 5edication ,dministration
=. 0ead the medication label as it is removed from the shelf' medication cart' dispensing system
or refrigerator.
4. 0ead the medication label &hen comparing it &ith the 5,0
:. 0ead the medication label once again before administering the drug to the patient
; -erform t$e 5 C$eck medication administration along 4it$ t$e < ,ig$ts.
Hliminates human errors.
P,0T 4
Parenteral nutrition
8yperalimentation! contains! 8ypertonic )e3trose' proteins' lipids'
electrolytes' vitamins'
&ater
TP. * used in ?I trauma &hen pt is unable to eat.
1ritical patients &ith unstable hemodynamics - in severe burns'
multiple trauma' anore3ia
nervosa
Poor tolerance to enteral feedings + )ebilitating illness
lasting A = &eeks
7erum albumin B 4.CgGdl + 1hronic vomiting or diarrhea
Inability to sustaine adequate &t. + 5alnutrition "1,' ?I dis2' HTF8#
0isk! catherter infection' hyperglycemia' hyperkalemia
,dded features! "any of the follo&ing to prevent metabolic deficiencies.#
C>E de3trose in &ater * provides calories for metabolism
,cetate * prevents metabolic acidosis
,mino acids * provide protein necessary for tissue repar
1alcium * promotes dev. of bone and teeth' aids in blood clotting
1hloride * regulates acid-base equilibrium' maintains osmotic pressure
olic acid * needed for deo3yribonucleic acid ").,# formation & gro&th & development
5agnesium * helps in the absorption of carbohydrate and protein
5icronutrients " /inc' manganese' cobalt# * to help &ould healing & 0$1 synthesis
Phosphate * minimi/es peripheral paresthesia "numbnessGtingling of e3tremities#
Potassium * for cellular activity & tissue synthesis
7odium * helps regulate &ater distribution & maintain normal fluid balance
Vitamin $ * helps in the final absorption of carbohydrates & proteins
Vitamin 1 * &ound healing' tissue repair
Vitamin ) * for bone metabolism2 helps maintain serum calcium levels
Vitamin M * helps prevent bleeding disorders
1omplications of TP. "read p. =<D#
7epsis related to serious catheter infections
5etabolic complications
++ TP. solutions should not hang for more than =: hours
++ TP. is a hypertonic solution of 9'<>> * =;>> mFsmoG6
.utritional 7upport
TP. * is used in ?I trauma &hen pt. is unable to eat.
* 1ritical patients &ith unstable hemodynamics ! such as severe burns' multiple trauma' anore3ia
nervosa
Poor tolerance to enteral feedings + )ebilitating illness lasting A = &eeks
7erum albumin B 4.CgGdl + 1hronic vomiting or diarrhea
Inability to sustaine adequate &t. + 5alnutrition "1,' ?I dis2' HTF8#