Initiating Peripheral IV Infusion

Slide Addendum

Slide 3

Isotonic

  • Normal saline
  • Lactated ringers (no metabolic alkalosis or liver disease)
  • Concentration of ECF = ICF

Hypotonic

  • ½ Normal Saline (0.45%)
  • For patients that may be overhydrated
  • Pulls water into the cells and rehydrates the cells

Hypertonic

  • 3% Normal Saline
  • For patients with severe dehydration
  • Be cautious of fluid overload
  • Pulls water from the cells into the vascular space to maintain circulating blood volume

**Whatever is going on with the patient will indicate the type of fluid to be used**

Slide 4

  • Don’t be overly concerned with these names
  • Per Janie, likely charting will involve (R or L) wrist, forearm, hand, etc.

Slide 5

  • Use the most distal spot possible
  • Start looking in the hand or wrist prior to the antecubital space, because you can move up the arm as needed for additional sticks
  • Consider the medication that must be given when choosing a spot
  • Vesicants require a larger vein to decrease irritation
  • Avoid antecubital sticks on mastectomy patients

Slide 6

  • Non-tunneled central lines should have at least two lumens
  • Tunneled central lines are for long-term use (ex. chemo patients)
  • We do not access implanted ports

Tunneled / Non-Tunneled
  • Dacron Cuff
  • Inserted into the Sup. Vena Cava
  • Dressing for the 1st 24 hours
  • Low rate of infection
  • Only Hickman, Broviac, and Groshong catheters are tunneled
  • Groshong’s do not require heparin
/
  • No cuff
  • Internal Jugular Vein, Subclavian Vein, or Femoral Vein
  • Require sterile dressings
  • High rate of infection

Slide 8

  • Always check IV fluid during the morning assessment
  • Is it running at the correct rate?
  • Is it the correct fluid?
  • Is the tubing labeled?
  • How does the IV site look?

Slide 9

  • When selecting a site, consider:
  • Previous sticks to that area
  • Vesicants or other medication to be infused
  • How long will the IV need to stay?
  • How old is the patient?
  • Is the patient small and frail or large and robust?
  • Which hand is dominant?
  • Will it interfere with ADL’s?

Slide 11

  • Medications may dictate the need for a larger catheter (ex. lipids, blood)
  • The larger the #, the smaller the gauge
  • Ex. A #16 catheter is much larger than a #22 catheter

Slide 17

  • Consider holding the skin more taut with elderly patients

Slide 19

  • Remember to chart safety and IV checks every two hours

Slide 22

  • Always wash your hands to prevent contamination
  • Hematogenous spread involves contamination spreading through the blood, such as contaminated IV fluid
  • Change IV’s every three days to prevent hub colonization

Slide 23

  • Be cautious of septicemia, especially with an immuno-compromised patient
  • Notify the doctor ASAP

Infiltration / Phlebitis
  • Caused by displaced cannula or enlarged puncture wound
  • Swollen & Cool
  • Discontinue the infusion before doing anything else
  • Apply warm, moist heat & elevation
  • Document!
/
  • Caused by movement of the cannula within the vein or veins irritated by medication (esp. vesicants)
  • Red & Hot
  • Discontinue the infusion before doing anything else
  • Document!

Slide 28

  • Armboards are a rare method of immobilization now

Slide 29

  • Extravasation involves the loss of blood flow and sloughing off of skin
  • Caused by vasoconstriction of vesicant drugs infiltrating the subcutaneous skin
  • May result in necrosis

Slide 33

  • With extravasation, stop the infusion!
  • Call the doctor
  • Pull the hospital policy for further direction and possible antidote medication
  • Warm compresses for 20 minutes, every 4 hours
  • Document!!

Slide 37

  • With an air embolism, the air enters the right atrium
  • Respiratory distress is immediate
  • Remember to always prime IV tubing

Slide 38

  • Turn the patient on their left side with their head down- this allows for the air embolism to rise up and stay in the right atrium, without going into the lungs
  • This will be an ICU stay

Slide 41

  • Do not catch a patient up on IV fluid- instead, document why there was an interruption, and then run the fluid at the ordered rate

Slide 46

  • New protocol for IV phenergan
  • Give at the port FARTHEST from the patient
  • For all medications, flush the IV over the same amount of time the initial drug was given

Slide 47

  • We cannot administer blood or blood products (including albumin) as students
  • Albumin requires consent just as all other blood products

Slide 49

  • There is always a risk of infection with blood administration
  • Cormorbidities to consider include renal and heart failure patients

Slide 52

  • Hemolytic reactions are immediate
  • Febrile reactions take longer to appear
  • Typically, reactions happen to those that get frequent transfusions
  • If there is a reaction, STOP the infusion, get new tubing & saline, assess the patient, call the doctor, notify the blood bank, send the blood container and tubing to the blood bank, and DOCUMENT!

Slide 53

  • TRALI is related to a hemolytic reaction and causes pulmonary edema

Slide 55

  • Erythropoietin (Procrit Injections)
  • Thrombopoietin replaces clotting factors