Intravenous Therapy

Objectives
Define Intravenous Therapy Know the legal implications Identify the uses of Intravenous Therapy Identify the commonly used veins for venipuncture Enumerate the nursing responsibilities in intravenous therapy Know the complications of intravenous therapy and the nursing interventions in each complications.

Definition


the giving of liquid substances directly into a vein. It can vein. be intermittent or continuous; continuous administration is called an intravenous drip. drip. The word intravenous simply means "within a vein", vein", but is most commonly used to refer to IV therapy

Source: Wikipedia

Intravenous Therapy and Legal Implications

Philippine Nursing Act of 1991 Section 28 states that in the administration of intravenous injections, special training shall be required according to the protocol established. Nurses have to undertake a certified training course on intravenous therapy based on the Intravenous Standards of Practice developed by the Association of Nursing Service Administrators of the Philippines. *RA 9173 did not mentioned anymore the requirement or deleted the special training in intravenous injections. Nursing Service Administrators still require formal training in this aspect for the safety of the patient, and the protection of the nurse and of the agency/institution.

Uses of IV Therapy
   

Maintain and restoring fluid and electrolyte balance Administration of medications Transfusing of Blood Provision of nutrition

Source: Lippincott:Best Practices

*In selecting the best site for the venipuncture, keep in mind these VIP considerations: vein location consideration, and physical path along the extremity. I Infusion purpose and duration. P Patient degree of cooperation and compliance as well as his preference. V

Commonly Used Veins

Digital Veins run along the lateral and dorsal portions of the fingers.  Maybe used for short - term therapy  Maybe used when other means aren t available  Requires splinting fingers with a tongue blade, which decrease the patient s ability to use his hand.  Uncomfortable for the patient  Significant risk for infiltration

Metacarpal Veins located on the dorsum of the hand. It is formed by the union of the digital veins between the knuckles.  Natural splinting achieved by bones of the hand in an adult and large child.  Wrist movement decreased unless a short catheter is used.  Painful insertion because of the large number of nerve endings in the hands.

Dorsal Venous Network located on the dorsal portion of the arm.  Maybe difficult to access in elderly patient because of poor skin turgor.  Requires a stabilization device Median Antebrachial Vein arises from the palm and runs along the ulnar side of the forearm.  Hold winged needles well  High risk for infiltration

Accessory Cephalic Vein - runs along the radial bone as a continuation of the metacarpal veins of the thumb.  Large vein excellent for venipuncture  Readily accepts large gauge needle/catheters  Doesn t impair mobility  Discomfort during movement due to the location of the device at the bend of the wrist. Antecubital Veins located in the antecubital fossa  Large veins which facilitates drawing of blood  Commonly visible or palpable in children when their veins won t dilate.

Basilic Vein runs along the ulnar side of the forearm and upper arm  Straight, strong vein suitable for venipuncture  Painful insertion because of the penetration of the dermal layer of the skin, where nerve endings are located. Cephalic Vein runs along the radial side of the forearm and upper arm  Large vein excellent for large gauge needles  Decreased joint movement due to the proximity of the device to the elbow  Vein stabilization possibly difficult

     

Nursing Responsibilities in IV Therapy Verify the doctor s order.

Know the type, amount, indication of IV Therapy. Inform client and explain the purpose of IV therapy. Prime IV tubing to expel air. Practice strict asepsis. Clip the hair on the area of needle insertion if necessary. Clean the insertion site of IV needle from center to the periphery. Change IV site and tubing every 48 hours. Regulate IV every 15 -20 minutes. Observe for potential complications. complications.

  

Complications of IV Infusion
Infiltration needle/cannula is out of vein. Assessment: pain, swelling, skin is cold at the needle site, pallor of the site, and flow of IV decreases or stop. Nursing Intervention:  Change the IV site.  Apply warm compress.  Circulatory Overload This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. Assessment: headache, flushed skin, rapid pulse, increased BP, syncope, pulmonary edema, increase venous pressure, coughing, tachypnea, and shock.


Nursing Intervention:  Slow infusion to KVO  Place patient in high fowlers position Superficial Thrombophlebitis due to overuse of a vein, irritating solutions or drugs, clot formation, and large bore catheters. Assessment: Tenderness, pain along the course of vein, edema and redness at injection site, and arm feels warmer than the other arm. Nursing Intervention:  Change IV site  Use large vein for irritating fluids  Stabilize venipuncture at area of flexion.  Apply cold compress immediately to relieve pain and inflammation; later follow with warm compress to stimulate circulation and promote absorption. absorption.

Embolism - A blood clot or other solid mass, or an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel. Assessment : hypotension, cyanosis, loss of conciousness, respiratory distress, unequal breath sounds, and tachycardia Nursing Intervention:  Discontinue the infusion  Place patient on trendelenburg s position to allow air to enter the right atrium and disperse through the pulmonary artery.  Administer oxygen.  Notify the physician.

Hematoma Leakage of blood into tissue due to vein punctured through ventral wall at the time of venipuncture. Assessment:Bruising around the venipuncture site and tenderness at venipuncture site Nursing Intervention:  Remove the venipuncture device  Apply pressure and cold compress to the affected area  Reinsert IV using the appropriate size of venous access device.