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ASSISTING IN IVF

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Objectives:
After four (4) hours of classroom lecture, discussion and demonstration,
the level 1 students will be able to:
1. define the following terms:
1.1 angiocatheter 1.11 isotonic solution
1.2 antecubital spaces 1.12 ischemia
1.3 blood transfusion 1.13 intravenous infusion
1.4 colloid solution 1.14 infiltration
1.5 donor 1.15 patency
1.6 edema 1.16 phlebitis
1.7 embolus 1.17 intracatheter
1.8 hemolysis 1.18 recipient
1.9 hypertonic solution 1.19 venipuncture
1.10 hypotonic solution
2. give the importance of intravenous infusion
3. enumerate the purpose of intravenous infusion
4. explain the different scientific principles involved
during intravenous infusion
5. discuss the types of solution according to:
5.1 tonicity
5.2 purpose
6. give the importance of intravenous infusion
7. enumerate the purpose of intravenous infusion
8. explain the different complications of
intravenous fluid therapy with regards to insertion
and administration of fluids, the nursing
interventions to prevent or manage these
complications and the techniques in checking
intravenous site patency.
9. identify the different venipuncture site
10. discuss the nursing responsibilities before,
during, and after IVF infusion
11. calculate the following:
11.1 drop factor
11.2 flow rate
11.3 number of hours to consume
11.4 volume infused (number of milliliter/hour)
11.5 conversion of milliliter/hour to drops/minute
11.6 conversion of drops/minute to milliliter/hour
12. Demonstrate the beginning skills in assisting IVF
infusion
12.1 assisting in intravenous infusion
12.2 discontinuing intravenous infusion
DEFINITION OF TERMS

Angiocatheter
– hollow, flexible tube inserted into the blood
vessels to withdraw instill fluids.
Antecubital spaces
– the anterior space of your elbow.
Blood transfusion
- administration of blood products into
venous circulation
Colloid solution
- is a solution in which the material is evenly
suspended in liquid. Colloid solutions have large
molecular weight, so they can stay in blood for a
long time. They can also maintain plasma
osmotic pressure effectively, expand blood.
Donor
- someone who supplies living tissues to be
used be another body( recipient).Such as in
blood transfusion, semen for insemination,
or transplantation
Edema
– accumulation of fluid in interstitial spaces
of tissues.it is most apparent in areas where
pressure is low.
Embolus
- an abnormal mass, usually a blood clot that
has detached from its origin which travels and
lodges in blood vessels and obstructs it.
Hemolysis
– the destruction of red blood cells.
Hypertonic solution
- solution having a greater osmotic pressure
than that of cells or body fluids; a solution that
draws water out of cells, thus inducing
plasmolysis.
Hypotonic solution
- solution having osmotic pressure less than of
cells or body fluids; a solution that will cause
water to enter cells, thus including swelling and
possibly lysis.
Isotonic solution
- one that has the same osmolarity as body
fluids.
Ischemia
- this refers to inadequate blood supply, or
circulation to local area due to blockage of
blood vessels to the area.
Intravenous Infusion
- a method for delivering medicines or
substances to the body through a catheter
or needle.
Infiltration
- a pathological accumulation in tissue or
cells of substances not normal to them or
in amounts of excess of the normal
Patency
- line is one that is correctly placed, allowing
the treatment to flow directly into the
patient's vein
Phlebitis
- means inflammation of a blood vessel.
Occurs quite commonly after insertion of
intravenous catheter.
Intracatheter
- A plastic tube, usually attached to the
puncturing needle, inserted into a blood
vessel for infusion, injection, or
pressure monitoring.
Recipient
– one who receives the intravenous therapy.
Venipuncture
- this is the process of obtaining intravenous
process for the purpose of intravenous
therapy or for blood sampling
Importance of IVF:
 Effective and fast-acting way to
administer fluid or medication treatment
in an emergency situation.
 Helps administer blood or blood
products. The donated blood from
another individual can be used in
surgery, to treat medical conditions
such as shock or trauma, or to treat a
failure in the production of red blood
cells.
Importance of IVF:
 Restores circulating volumes, improves
the ability to carry oxygen and replaces
blood components that are deficient in
the body.
 Delivers nutrients and nutritional
supplements to patients who cannot
take it orally.
 Replaces the fluid loss of the patient.
Purpose of the IVF:

• It is prescribe when a patient’s condition is


so severe that it cannot be treated
effectively by oral medications.
• Used for fluid replacement (such as
correcting dehydration)
• To correct electrolyte imbalances
• To deliver medications
Purpose of the IVF:
• For blood transfusions
• To maintain homeostasis when internal
intake is insufficient
• To replace any additional losses
Principles Involved in IVF:
Microbiology
• While administering intravenous fluid to
the client, the equipment used should be
sterile to prevent any possible infection.
The nurse perform medical hand washing
before the procedure to reduce transfer of
microorganism.
Chemistry
• Is utilized in intravenous fluid in the
medications. Its structure and function
effects of the medication on the client.
Anatomy and Physiology
• Knowledge of anatomy and physiology will
help the nurse locate where and how to
properly administer medicine to the client.
Safety and Security
• The needles that are not used should be
away from the patient. Proper disposal of
the needles for safety purposes.

Sociology
• The nurse builds rapport with the client.
Psychology
• The nurse explains the procedure to help
reduce the client’s anxiety.

Mathematics
• Correct computation and conversation of
medicines when infused of IVF.
Types of Solutions:
TONICITY PURPOSE IVF USES
SOLUTIONS
Isotonic - It has the same Dextrose 5% in - Dextrose enters cell
osmolality (or Water rapidly, leaving free
tonicity) as water, which dilutes
serum and other extracellular fluid (ECF)
body fluids.
- Expands extracellular
Saline sol’n;
- It expands the fluid volume (ECV);
0.9% NaCl
intravascular does not enter cells.
compartment
Lactated - Contains Na+, K+,
without pulling
Ringer’s Ca^2+, Cl-, and lactate,
fluid from other
which liver metabolizes
compartments
to HCO3-
TONICITY PURPOSE IVF SOLUTION USES
Hypotonic - It has an osmolarity Quarter normal - Both solutions
lower than the saline; 0.225% expands ECV
serum osmolarity. NaCl (vascular and
interstitial) and
- It hydrates cells Half normal saline; rehydrates cells
while reducing fluid 0.45% NaCl
in the circulatory
system.
TONICITY PURPOSE IVF SOLUTION USES

Hypertonic - It has an Dextrose 10% in - Dextrose enters cells


osmolarity water rapidly, leaving free
higher than water, which dilutes
serum extracellular fluid (ECF)
osmolarity.
- Draws water from cells
Hypertonic
- It increases into ECF by osmosis
saline; 3% or 5%
osmolality
NaCl
rapidly and pull
water out of Dextrose 5%; - Dextrose enters cells
cells, causing Normal saline; rapidly, leaving 0.45%
them to 0.45% NaCl NaCl
shrivel. Dextrose 5%; - Dextrose enters cells
Normal Saline; rapidly, leaving 0.9%
0.9% NaCl NaCl
Dextrose 5% in - Dextrose enters cells
lactated Ringer’s rapidly, leaving lactated
Ringer’s
Additional Uses of IVF:
In addition to restoring and maintaining fluid
and electrolyte balance, I.V therapy is used for:

1. DRUG ADMINISTRATION
• The I.V route provides a rapid, effective way
of administering medications.
• Commonly infused drugs include antibiotics,
thrombolytics, histamine-receptor antagonist,
antineoplastic, and anticonvulsant drugs.
2. BLOOD ADMINISTRATION
• Blood products can be given through a
peripheral or central I.V line.
• Various blood products are given to restore
and maintain adequate circulatory volume,
prevent cardiogenic shock, increase the
blood’s oxygen-carrying capacity, and
maintain hemostasis
3. PARENTERAL NUTRITION
•Provides essential nutrients to the blood,
organs, and cells by the I.V route.

2 Kinds of Parenteral Nutrition:


1. Total Parenteral Nutrition
2. Peripheral Parenteral Nutrition
TOTAL PERIPHERAL
PARENTERAL NUTRITION PARENTERAL NUTRITION

- It is customized for each patient. - It is used in limited nutritional therapy.

- The ingredients in solutions - It contains fewer nonprotein calories


developed for TPN are designed to and lower amino acid concentrations
meet patient’s energy and nutrient than TPN and may also include lipid
requirements such as proteins, emulsions.
carbohydrates, fats, electrolyte,
vitamins, trace elements, and water.

- It should only be used when the gut - It can be used to support the
is unable to absorb nutrients. nutritional status of a patient who
doesn’t require a total nutrient support.

- Long term TPN can cause liver - The complications associated with
damage. PPN include risk of vein damage and
infiltration.
Factors Affecting IVF Insertion
as to its location of site.

1. Patient assessment
• A patient assessment is often multi-
factorial including the patient’s age,
diagnosis, other relevant co-morbidies,
life-style and preference.
2. Condition of the veins
• Veins should be avoided if they are:
thrombosed, inflamed, bruised, hard, near
bony prominences, near previous multiple
punctures, near sites of infection, near
sites of previous surgery, such as
mastectomy.
3. The purpose of the infusion
• What type of intravenous therapy or
treatment plan has been indicated for the
patient?
• Examples include: fluids for re hydration,
drug therapy, blood and blood products.
4. The duration of the therapy
• A peripheral cannula is indicated for short-
term use, if it is thought that the need for
intravenous therapy may be longer term,
an alternative device should be considered
and discussed with the patient.
5. The location of the cannula
• Preferred sites for the placement of a
cannula include: the metacarpal veins
found in the dorsum of the hand along with
the cephalic and basilic veins found in the
forearm.
Types of Intravenous System
Infusion
1. Large Volume Infusion
- can pump nutrient solutions large enough to
feed a patient. Uses computer controlled rollers
compressing a silicon rubber tube through
which the medicine flows.
2. Intermittent Intravenous Medication
- is an infusion of a volume of fluid/medication
over a set period of time at prescribed intervals
and then stopped until the next dose is
required.
a) Piggy Back
b) Tandem Infusion
A. Piggy Back
- is the administration of medication that is diluted
in a small volume of I.V. solution (e.g., 50–250ml
in a minibag) through an established primary
infusion line.
B. Tandem Infusion
- set up where the additive infusion is
connected to the primary line via secondary
port without a back check valve, more proximal
to the client.
3. Volume Control Infusion
- administration of IV in small amount of
compatible IV fluids. The fluid is within the
secondary fluid container separate from the
primary fluid bag. The container connects directly
to the primary fluid container line or to separate
tubing that inserts into the primary line.
a) Volume Control
b) Infusion Pump
c) Syringe Pump
A. Volume control
- small containers that are attached just below
the primary infusion bag or bottle (e.g.,
Buretrol)
B. Infusion Pump
- medical device used to deliver fluids into a
patient’s body in a controlled manner. It is
capable of delivering fluids in small or large
amounts and may be used to deliver nutrients
or medication.
C. Syringe Pump
- battery operated and allows medications to be
given in very small amounts of fluid within
controlled infusion times using standard
syringes.
4. IV Push Medication
- also known as IV “push” or “bolus” it is a rapid
injection of medication. A syringe is inserted
into the catheter to quickly send a one-time
dose of drug into your bloodstream. It could be
deliver through pump infusion or drip infusion.
Different Complications of IVF
Different Venipuncture Sites
Median Cubital Vein
• A superficial vein, most commonly used for
venipuncture, it lies over the cubital fossa and
serves as a an anastomosis between the
cephalic and basillic veins.
Cephalic vein
• Shown in both forearm and arm, it can be
followed proximally where it empties into the
axillary vein.
Basillic vein
• Shown in the forearm and arm, it divides
to join the brachial vein.
Dorsal metacarpal veins
• Least common; found in the middle of the
hand. Commonly used for intravenous
infusion. Viable alternative when
antecubital vein is inaccessible.
Nursing Responsibilities:

Before:
• Check doctor’s order and obtain the
medication.
• Gather equipment and supplies.
• Perform Medical Handwashing.
• Don Sterile Gloves.
Before:
• Check the medications
– Read the label using the 3 times check: Drug
name, Dose, Expiration date
– Compute for the patient’s dose.
– Draw the required amount of medication to the
syringe.
– Place label in the prepared syringe using the
sticker.
Before:
• Prepare waste receptacle
• Explain procedure to client and answer
any questions they may have
• Ask client if they have had any allergic
reactions to any previous medication.
During:
• Give injections
• Identify patients using at least 2 identifiers.
– Ensure the proper medicine is administered to the
correct site to prevent complications.
– Protect client’s privacy by only exposing the site
to be injected.
– Educate patients about their medications during
medication administration to reduce anxiety
During:
• Prepare injection site.
• Clean the skin at the injection site thoroughly
with an alcohol pad.
– Use a circular motion from the center of the
injection site outward.
– Keep the sterility of self and equipment
during the procedure
During:
• Reduce patient anxiety and encourage
cooperation by explaining the procedure as
you perform.
• Observe proper body mechanics when
administering the medicine to its site.
• Comfort
After:
• Dispose used needle and syringe
– Place the needle and syringe in the sharps
container (red).
• Observe the patient for unusual reactions.
Any medication can cause anaphylactic
reactions. Give appropriate information
regarding the medication to the patient.
After:
• Document the medication administered and if
there are any adverse effects.
• Reposition the patient for comfort.
• Ask the patient if there are anything else you
can do.
• Tell the patient when you expect to return to
check on any reaction and to notify you if
he/she experiences any problems.
Computation: