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
Why would you hang a piggyback solution higher than the larger bag of fluids?
Gravity helps it flow better
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
What condition should the nurse monitor if a patient is receiving TPN?
Hyperglycemia
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
What type of tubing is used with blood administration?
Y tubing
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
What action should the nurse take to help maintain patency of the IV cannula
Perform a regularly scheduled flush
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
The nurse notes coolness of the skin at the IV site and a slow infusion rate. What should the nurse do?
Stop the infusion
sensible loss vs. insensible loss
Sensible loss- water loss that can be measured
Insensible loss- we cannot measure. occurs in lungs and skin
What type of solution is used when flushing the IV after confirming patency?
0.9% normal saline
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
An example of an isotonic solution is
0.9% sodium chloride (NS)