Parenteral Therapy

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Parenteral Therapy

• NURS 124

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Reasons for parenteral or IV therapy

• Provide or replace fluids and electrolytes
• Provide nutrients
• Administer medications

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TYPES OF IV SOLUTIONS

• Categorized according to how their osmolality
  compares with plasmas osmolality
• Isotonic
• Hypotonic
• Hypertonic

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ISOTONIC FLUIDS

• Have a total osmolality close to plasma (ECF)
• Do not cause RBC to shrink or swell
• Types
• - D5W 5 Dextrose and water
• - When not to use

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Types cont.

• Normal Saline 0.9 sodium chloride

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Types cont.

• Lactated Ringers

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HYPOTONIC FLUIDS

• Have a total osmolality less than plasma
• Used to provide free H2O or treat hypernatremia
• Excessive amounts can lead to intravascular fluid
  depletion
• Types
• 0.45 Normal Saline
• D2 1/2 W

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HYPERTONIC FLUIDS

• Have a total osmolality greater than serum
• Types
• - D10W
• - D50W
• - 3 sodium chloride

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Other Substances given IV

• Protein solution-
• Fats-
• Plasma Expanders-
• Blood Products-
• Medications-

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Nursing Management

• Follow institutions policies
• Always verify order and patient identity
• Use needleless IV delivery system
• Use an infusion device
• Know how to regulate an IV manually

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Nursing Mgmt. cont.

• KVO rate
• Assess site for
• Know correct fluid, rate and expiration
  times
• - Fluids changed every ___ hours
• - Tubing changed every ___ hours
• - IV site changed every ___ hours

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Nursing Mgmt. cont.

• Flush vascular devices used intermittently

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Removal of a peripheral IV

• Verify order and patient
• Turn off all IV fluids and clamp tubing if needed
• Remove dressing and tape
• Apply firm pressure to site
• Possible complications

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IV Therapy predisposes the patient to both
systemic and local complications.The local ones
occur more often but the systemic ones are more
serious.
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Systemic Complications of IV Therapy

• Fluid Overload-
• S S
• Nsg. Interventions
• Prevention
• Complications

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Systemic Complications cont

• Air Embolism-
• S S
• Nsg. Interventions
• Prevention
• Complications

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Systemic Complications cont

• Septicemia and pyrogenic (febrile) reaction-
• S S
• Treatment
• Prevention

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Local Complications of IV Therapy

• Infiltration-
• S S
• Nsg. Interventions
• Prevention

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Local Complications cont

• Phlebitis-
• S S
• Nsg. Interventions
• Prevention

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Local Complications cont.

• Thrombophlebitis-
• S S
• Treatment

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Local Complications cont.

• Hematoma-
• - Causes
• S S
• Nsg. Interventions
• Whos at risk for hematomas?

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Local Complications cont.

• Clotting or obstruction
• S S
• Nsg. Interventions

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DOCUMENTATION

• IV Fluid and rate
• Catheter size and location
• IV site condition
• Amount infused on I O sheet
• Reason for extended access if not changed
• Pt Education-
• - Notify nurse if
• - Explanation of I O

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Administration of IV Medication

• Double check with 2 qualified nurses
• Check compatibility
• Check expiration date
• Confirm 5 rights
• Clean Y site port or adapter with alcohol

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Administration of IV meds cont.

• For adapter, perform SAS
• For mini bags
• - Connect bag to 2nd tubing, prime or back
  prime current 2nd tubing sufficiently
• Or, connect primed primary tubing to adapter or Y
  site
• Secure connections
• Administer med over required amount of time

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Administration of of IV Meds cont.

• Document drug and patient response
• Never give unlabeled med prepared by another
  person.
• If an error occurs
• Accept professional responsibility
• Assess and carefully monitor the patient
• Notify MD ASAP
• Document the error as required by hosp. policy
• Modify personal practice to avoid future errors

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• QUESTIONS????????