Complications of IV therapy
Inflammation of the veins that includes edema, throbbing, burning and warmth to the touch. A red line can be visible up the arm and palpable cord is present
Phlebitis?
Discontinue infusion, elevate the extremity, apply warm compress for 3-4 minutes, restart infusion in a different vein, obtain a specimen for culture at site
Treatment for phlebitis
For fluids, medication and blood products.
location :hand, wrist, forearms, AC
Peripheral IV
This is the most accurate indicator of fluid balance
Daily weight
Made in red bone marrow. It transports oxygen from the lungs to tissues of the body
Why would we use: surgery, anemia, blood loss, cancer, blood disorder
Packed red blood cells (PRBC)
usually occurs when a client gets a blood transfusion. Think TACO (transfusion associated circulatory overload) Symptoms include distended neck veins, increased BP, SOB, crackles and edema.
Circulatory overload
Stop the infusion, raise the head of the bed, measure vital signs and o2 sats, adjust rate after correcting fluid overload, administer diuretics.
Treatment for circulatory overload
For patients that require frequent and or long-term IV therapy. Enters the body at AV and ends in the superior vena cava (SVC)
Central line IV
This property makes Dextrose 5% in water unique
It is isotonic in the bag but hypotonic in the body
Promote clotting blood.
given to people with decreased levels of platelet production due to cancer growth or because of destruction of bone marrow from cancer therapy
Given when count is BELOW 20,000
Platelets
IV solution or medication leaks into the sub q tissue. Infiltration is NON vesicant while extravasation IS vesicant that can damage tissues.
Infiltration/extravasation
Stop the infusion, elevate the extremity, encourage ROM, apply warm or cold compress, restart the infusion proximal to site or at a different site
Treatment for infiltration/extravasation
Stops near the armpit
Midline IV
Age related changes in the cardiovascular system may leave them less able to manage alteration in fluid balance
Age related renal system make an older client more prone to hypervolemia
Decreases renin-angiotensin system due to aging
Older adults prescribes diuretics and SRIs can result in electrolyte imbalances
Fluid changes in elderly population
Fresh frozen plasma
Maintains BP and volume. Contains albumin.
Given to clients who have trauma, major burn, or shock
Can be stored 1 year frozen
Obstruction of vessel by air caused by placement of CVAD, disconnection between IV catheter and IV tubing, IV bag running dry or infusion of air into tubing.
Air embolism
Hypervolemia vs. Hypovolemia
Hypervolemia: TOO MUCH FLUID:
Tachypnea, decreased BUN/Creatinine/osmolarity, crackles, decreased electrolytes. Risks include heart failure, renal failure, SIADH
Hypovolemia TOO LITTLE FLUID:
Dry mucous membranes, increased electrolytes
Acute hemolytic reaction vs non hemolytic febrile reaction
Acute Hemolytic Reaction: Hypotension, fever, tachycardia, chills, back pains, REMEMBER hematuria
Non- hemolytic febrile reaction: Fever, vomiting REMEMBER anxiety and headaches
sensible loss vs. insensible loss
Sensible loss- water loss that can be measured
Insensible loss- we cannot measure. occurs in lungs and skin
Preparing for blood administration
MUST check with another nurse that it is blood for the correct patient.
Stay with patient for the first 15 minutes to watch for reactions.
Must be infused over 4 hours
obtain vitals before administering blood
use NORMAL SALINE only
start infusion slow but at a rate greater than 2 mL
During the first 15 mins get set of vitals and monitor
if no reactions occur after 15 mins, increase rate to prescribed rate
check vitals every hour after
Abrupt onset of difficulty breathing, cough, wheezing, low BP, tachycardia, chest and shoulder pain
Symptoms of Air embolism
Symptoms of dehydration
hypotension, tachycardia, high electrolytes, tenting of skin, thirst, decreased urine output
Fluid volume deficit vs fluid volume excess
Deficit: Dehydration, Decreased urination, low BP, tachycardia, urine specific gravity is high and concentrated, elevated electrolyte levels.
Treated with IV fluids or PO fluids
Fluid volume excess: SIADH "soaked in ADH", renal failure
Edema, swelling, fluid retention, HTN, tachycardia, skin will leak fluid, increased weight, cough
Treated with diuretics (Lasix, furosemide). Raise the head of the bed, give oxygen
Tonicity and solution of isotonic, hypotonic, and hypertonic
Isotonic- same osmolality of blood. STAYS in vascular system. INCREASES bp
NS 0.9%, LR, D5W
Hypotonic: less molecules and solutes than blood. Moves out of vasculature and Moves INTO the tissue. HYPOtinic causes HYPOtension. NEVER use with cerebral edema.
1/4 NS (0.225%, 1/2 NS 0.45% D2.5W
Hypertonic: more molecules and solutes than blood. Moves from tissue into vasculature. INCREASE bp MORE than isotonic solution. USED for cerebral edema
3% or 5% NS, D5 1/2 NS, D10W
anything less than 0.9% is HYPOtonic. Anything more than 0.9% is HYPERtonic
Derived from plasma with solvent detergent and heated to kill viruses
Cryoprecipitate