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    Chapter 27 (Perry & Potter)

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    sultan
    The document provides information on intravenous (IV) fluid administration including: 1. The purposes of IV therapy include replacing fluids, correcting nutritional imbalances, and providing medication. Nurses are responsible for regulating IV infusions, maintaining equipment, identifying and addressing problems, and discontinuing infusions. 2. IV solutions are categorized as isotonic, hypotonic, or hypertonic depending on electrolyte values and fluid balance. Nurses must understand the rationale for and type of IV fluid ordered. 3. Nursing responsibilities for IV therapy include assessing the patient, verifying orders, preparing supplies, calculating drip rates, administering fluids, monitoring the infusion, and documenting care provided. Precise setup and regulation of

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    Chapter 27 (Perry & Potter)

    Uploaded by

    sultan
    161 views41 pages
    The document provides information on intravenous (IV) fluid administration including: 1. The purposes of IV therapy include replacing fluids, correcting nutritional imbalances, and providing medication. Nurses are responsible for regulating IV infusions, maintaining equipment, identifying and addressing problems, and discontinuing infusions. 2. IV solutions are categorized as isotonic, hypotonic, or hypertonic depending on electrolyte values and fluid balance. Nurses must understand the rationale for and type of IV fluid ordered. 3. Nursing responsibilities for IV therapy include assessing the patient, verifying orders, preparing supplies, calculating drip rates, administering fluids, monitoring the infusion, and documenting care provided. Precise setup and regulation of

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    The document provides information on intravenous (IV) fluid administration including: 1. The purposes of IV therapy include replacing fluids, correcting nutritional imbalances, and providing medication. Nurses are responsible for regulating IV infusions, maintaining equipment, identifying and addressing problems, and discontinuing infusions. 2. IV solutions are categorized as isotonic, hypotonic, or hypertonic depending on electrolyte values and fluid balance. Nurses must understand the rationale for and type of IV fluid ordered. 3. Nursing responsibilities for IV therapy include assessing the patient, verifying orders, preparing supplies, calculating drip rates, administering fluids, monitoring the infusion, and documenting care provided. Precise setup and regulation of

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    161 views41 pages

    Chapter 27 (Perry & Potter)

    Uploaded by

    sultan
    The document provides information on intravenous (IV) fluid administration including: 1. The purposes of IV therapy include replacing fluids, correcting nutritional imbalances, and providing medication. Nurses are responsible for regulating IV infusions, maintaining equipment, identifying and addressing problems, and discontinuing infusions. 2. IV solutions are categorized as isotonic, hypotonic, or hypertonic depending on electrolyte values and fluid balance. Nurses must understand the rationale for and type of IV fluid ordered. 3. Nursing responsibilities for IV therapy include assessing the patient, verifying orders, preparing supplies, calculating drip rates, administering fluids, monitoring the infusion, and documenting care provided. Precise setup and regulation of

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    of 41

    Chapter 27 (Perry & Potter)

    IV Priming
    Why do clients need an IV?
    Replacing fluids
    Correct or prevent nutritional imbalances
    Provide IV medication therapy

    Nursing Responsibilities
    1.

    Know the correct solution & equipment needed & how


    to initiate the infusion

    2.

    Regulate the infusion (with or without a pump)

    3.

    Care for an maintain the system

    4.

    Indentify and correct problems

    5.

    Discontinue the infusion

    Categories of IV solutions
    1.
    2.
    3.

    Isotonic
    Hypotonic
    Hypertonic

    Determined by serum electrolyte values and


    fluid volume balance

    RN must understand the rationale for IV fluid administration


    and the type of solution ordered

    Establish IV Access
    IV catheter can remain in place for 96 hrs (check hospital

    policy, most are 72 hours), IV solution replaced every 24 hours

    Palpate insertion site daily and prior to initiating infusion


    Inspect site if client c/o pain at site or developed S&S of

    infection

    Change transparent dressing if becomes damp, soiled, loose


    Clean injection port with antiseptic before accessing system

    Supplies
    Administration set (IV lines)
    Correct IV solution
    Antiseptic swabs
    Tape
    IV pole, rolling or ceiling mounted
    Hospital gown with snaps
    1-3 ml normal saline, 3 ml syringe (or larger)pre-

    filled n/s syringes may be available, to flush IV


    catheter prior to initiating infusion

    Nursing Diagnosis
    Risk for imbalanced fluid volume
    Deficient fluid volume
    Excess fluid volume
    Risk for infection

    Assessment
    Review physicians order (type, amount and/or rate)
    6 medication rights (medication, dose, client, route, time,

    documentation)
    Physical assessment pertaining to IV fluid administration
    Understand rationale and purpose of IV fluid, potential

    incompatibilities, and potential side effects

    Implementation
    Change gown
    Prepare tubing and solution
    Check solution (6 rights)
    Color
    Clarity
    Expiration date
    Leaks

    Open infusion set (maintaining sterility of each end)


    Place roller clamp 2-5 cm below drip chamber and move to

    OFF position
    Remove sheath over port on IV solution bag
    Remove tubing spike (DO NOT TOUCH)
    Insert spike into IV bag

    Priming:
    Compress drip chamber, fill 1/3 to
    Remove cap on end of tubing, KEEP and maintain sterility
    Slowing open roller clamp and prime tubing with fluid, return roller

    clamp to OFF position

    Inspect for air bubbles, tap tubing where bubbles are visible, and invert

    ports and tap to fill and remove air

    Replace cap from end of tubing


    Label tubing and bag with date and time

    Prepare n/s (1-3 ml) to flush intermittent infusion device (saline

    lock, PIID, clave) (p. 749 establish IV access, pictureA)

    Saline lock is attached to end of IV catheter which is then

    attached to the primary line

    Has a port or stopper (needleless)


    Must be irrigated q8-12 h, and before & after each drug infusion

    (hospital policy)

    Saline or heparinized saline (hospital policy)


    Sterile technique

    Regulating IV Flow Rate


    (Gravity)
    Flow rate established using pump (ml/hr) or gravity

    (gtt/min)

    If line patent and IV infusion initiated, flow rate must

    be established

    Educate client regarding positioning


    Inspect site often

    What is the drop factor: number of drops per ml (gtt/ml)

    IV tubing provides:
    Microdrip: 60 gtt/ml
    Macrodrip: Abbott: 15 gtt/ml
    Travenol: 10 gtt/ml
    McGaw: 15 gtt/ml

    Calculating drip rate:


    ml/hr x gtt/ml
    60 min

    drops/min

    If ml/hr unknown:
    ml/hr = total infusion (ml)
    hours of infusion

    Remember: if infusion is not exactly 1 hour


    (15 min, 30 min, 120 min, etc) you must calculate
    hourly rate.
    50 ml x ?
    15 min 60 min

    200 ml
    hr

    Example:

    Order: D5W @ 75 ml/hr


    Drop factor: 15 gtt/ml
    Calculate drip rate: ? gtt/min
    Answer: 75 ml/hr x 15 gtt/ml = 18.75 gtt/min
    60 minutes

    (18-19 gtt/min)

    Example:

    Order: Give 1 L Ringers Lactate over 4 hours


    Drop factor: 15 gtt/ml
    Calculate drip rate: ? gtt/min
    Answer:

    1000 ml x ?
    240 min 60 min

    250 ml
    hr

    250 ml/hr x 15 gtt/ml = 62.5 gtt/min


    60 minutes
    (62- 63 gtt/min)

    Establishing Drip Rate


    Count drops in drip chamber for 1 minute (with second

    hand), adjust roller clamp as needed (2-5 cm below drip


    chamber)
    If very fast or very slow, count for 30 sec (x 2) and adjust

    roller clamp. Count for 1 full minute once clamp is


    adjusted .

    Evaluation
    Monitor infusion at least q1h (note volume, rate)
    Assess for S&S of overhydration or dehydration,

    response, lab values


    Assess S&S of infiltration, inflammation, clot in catheter,

    kink or knot in tubing etc

    Recording and Reporting


    Rate of infusion, gtt/min, and ml/hr in nursing notes or IV

    fluid form
    Document any ordered changes in IV fluid rates
    Report rate, solution, volume remaining to the nurse

    assuming care of client at break or change of shift

    Practice Priming

    Chapter 21 (Perry & Potter)

    Piggyback (p. 737)


    A small IV bag connected to short tubing
    that is connected to the upper Y port of a
    primary infusion line. The small bag is set
    higher than the primary infusion bag. Upon
    completion of the secondary solution when
    the solution in the tubing falls below the
    primary drip chamber the primary solution
    begins again.

    IV Medication
    Secondary line (piggyback)
    Prepare medications: 6 rights and 3 checks
    Medical history & allergies
    Review medication indication

    Drugs prescribed 1 to 6 times per day, dissolved in

    small volumes of IV fluid


    Usual infusion time : 30 to 60 minutes
    Check compatibility of drug to solution

    When mixing powders for injections, remember:


    Check the type of fluid recommended to
    dissolve the powder
    The amount of fluid to add
    The strength of the solution made (mg/ml)
    Further dilution for infusion
    Infusion time

    The label of the vial


    Package insert inside the vial package
    Nursing Drug book
    Compendium of Pharmaceuticals and Specialties ( CPS)
    Parenteral drug manual

    Medication Calculation
    Example:
    Order: Drug 0.65 g QID IV
    Label directions : Add 2.5 ml water for injection. Provides

    approx volume of 3 ml (325mg/ml)


    Note : the manufacturer gives the strength of the solution
    Desire 0.65g
    Have: 325 mg/ml
    Stock : in every ml

    Desire: 0.65 g
    Have: 325 mg/ml
    Stock : in every ml

    Convert: 0.65g to mg
    1g = 1000 mg ( therefore answer should be bigger)
    1000mg = Three zeros
    Therefore move decimal point three spaces to the right
    0.65 g = 650 mg
    Desire X Stock

    = Amount

    Have
    650 mg
    325 mg

    1ml

    2mL

    Calculation of Drip Rate


    Example:
    Order: Flagyl 500mg/100 ml normal saline IV BID
    (administered over 1 hour)
    Drop factor: 15 gtt/ml
    Calculate drip rate: ? gtt/min
    Answer:

    100 ml x ?
    60 min
    60 min

    100 ml/hr x 15 gtt/ml = 25 gtt/min


    60 minutes

    100 ml
    hr

    When calculating IV rates, if the medication volume exceeds

    5 10 ml, add this into calculations

    Example:
    Amount: 100 ml NS plus 8 ml penicillin=108 ml
    Duration: Give over 30 minutes
    Calculate rate: ? ml/hr
    Answer:

    108 ml x ?
    = 216 ml
    30 min 60 min
    hr

    Lets Practice
    (vial containing a powder) p.706
    Reconstitution of medication
    Adding to secondary bag
    Attaching secondary line to primary line
    Regulating rate

    Follow 6 rights and 3 checks


    Wash hands
    Gather supplies
    Medication, secondary line,10 ml syringe, 18-22 gauge

    needle (filtered if indicated), alcohol swabs, dilutant (saline


    or sterile water), mini bag (medication bag), medication
    label, MAR

    Order
    Ampicillin 500 mg IV, q6h

    See vial for directions: to have 500 mg/ml add 5.6 ml dilutant
    IV drug manual indicates: add to 50 - 100 ml normal saline and
    infuse over 60 minutes
    How many ml of medication will you add to your minibag?
    What is the rate (ml/hr)?
    What is the drip rate with drop factor of 15 gtt/min?

    Answers: 50 ml X ?
    = 50 ml
    60 min 60 min
    hr

    gtt/min = 50 ml/hr X 15 gtt/min = 12.5 gtt/min


    60 min
    (12-13)

    100 ml X ?
    = 100 ml
    60 min 60 min
    hr

    gtt/min = 100 ml/hr X 15 gtt/min = 25 gtt/min


    60 min

    Preparation
    Remove cap covering medication and dilutant (6 rights, 3 checks),

    swab both rubber seals with alcohol swab and allow to dry

    Attach needle (or needleless device) to syringe, pull back on plunger

    drawing the equivalent amount of air (i.e. 5.6 ml) as solution and
    inject into solution (hold plunger firmly, vial on flat surface)

    Invert vial and allow pressure from the vial to fill syringe with

    solution (5.6 ml), pull back gently if required. Keep tip of needle in
    fluid. Place vial on flat surface to remove needle

    Inject dilutant into medication vial, remove needle and recap (scoop

    technique)

    Roll in palms (DO NOT SHAKE)


    Wait until medication is clear, swab medication bottle again,

    and withdrawal desired amount (follow same steps as


    withdrawing dilutant (inject equal volume of air (i.e.1 ml) as
    medication to be removed)
    Add medication to secondary bag, wipe port with alcohol
    swab, lay medication bag on flat surface, insert needle and
    inject. Discard needle (no need to recap)
    Mix medication turning gently end to end
    Complete medication label (apply to back of medication bag)
    Spike bag with secondary IV tubing, ensure clamp is CLOSED

    Clean port of main line and connect secondary tubing to

    medication bag, squeeze and fill drip chamber.


    Back prime: drop medication bag below level of primary
    drip chamber, open secondary line roller clamp, prime
    line, hang medication bag above primary fluid bag (use
    hook to lower main bag)
    Regulate flow by adjusting regulator clamp or using IV
    pump
    Observe for S&S of reaction
    Assess IV site frequently

    Order
    Ampicillin 500 mg IV, q6h

    See vial for directions: 500 mg/ml add 5.6 ml solution


    IV drug manual indicates: add to 50 - 100 ml normal saline
    and infuse over 60 minutes

    Answers: 50 ml X ?
    = 50 ml
    60 min 60 min
    hr

    gtt/min = 50 ml/hr X 15 gtt/min = 12.5 gtt/min


    60 min
    (12-13)

    100 ml X ?
    = 100 ml
    60 min 60 min
    hr

    gtt/min = 100 ml/hr X 15 gtt/min = 25 gtt/min


    60 min

    Next Lab
    Subcutaneous Injection & Insulin
    Chapter 21

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