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INTRAVENOUS THERAPY

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Chapter 25 INTRAVENOUS THERAPY Carol Chamley and Michelle Wilson Introduction This presentation outlines the principles of caring for a patient receiving intravenous ... – PowerPoint PPT presentation

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Title: INTRAVENOUS THERAPY


1
INTRAVENOUS THERAPY
Chapter 25
Carol Chamley and Michelle Wilson
2
Introduction
  • This presentation outlines the principles of
    caring for a patient receiving intravenous fluid
    therapy.
  • Part 1 - Historical Background to Intravenous
    Therapy
  • Part 2 - Definition and Scope of Intravenous
    Therapy
  • Part 3 - Physiology Fluid Compartments, Movement
    of Body Fluids and Acid Base Balance and pH
    Values
  • Part 4 - Classification of Solutions
  • Part 5 - Methods of Cannulation and Fluid
    Delivery
  • Part 6 - Principles of Caring for the Patient
  • Part 7 - Complications of Intravenous Therapy
  • Part 8 Reflective Practice

3
  • PART 1 Historical Background to Intravenous
    Therapy

4
Historical Background
  • Historically, methods for gaining vascular access
    have been recorded for approximately four
    centuries.
  • A major landmark came with the discovery of the
    circulation of blood and the unfolding of
    anatomical structures within the human body.
    This discovery was made by William Harvey
    (pictured).

5
  • The idea of circulation probably existed before
    its discovery in 1628, but it is considered the
    greatest medical finding due to its enormous
    effect upon knowledge and clinical practice.
    Harveys theory has remained untouched and
    unchanged for centuries.

6
  • Medical experimentation and discovery were quite
    limited during the 18th century, with greater
    progress being made during the 19th century when
    knowledge and science sped up the understanding
    of human physiology.
  • In 1831 it was reported that cholera victims,
    who lost vast amounts of salts and water, could
    have their health restored with injections of
    water directly into the bloodstream (Dudrick
    2006).

7
  • Historical events have therefore facilitated a
    complex and potentially hazardous therapeutic
    modality to evolve into a commonly applied
    practice (Dudrick 2006).
  • The field of intravenous therapy has been
    subject to change over time, with increasing
    numbers of nurses taking on high profile
    technological aspects of patient care.
  • The previously medicalised task of cannulation
    has been welcomed by nurses who are keen to
    embrace the concept of holistic care.

8
  • PART 2 Definition and Scope of Intravenous
    Therapy

9
Definition and Scope
  • Intravenous fluid therapy is an integral part of
    care for many patients.
  • The word intravenous literally means within a
    vein.

10
  • Intravenous therapy, also referred to as IV
    therapy, constitutes the administration of
    liquid substances directly into a vein and the
    general circulation through venepuncture (Mosby
    1998).
  • The intravenous route is a fast and efficient
    method to administer fluids and medication, which
    can be given continuously or intermittently.

11
  • Currently the scope of IV therapy and the
    evolving range of solutions is immense.
  • Infusion therapy may range from mere measures
    to hydrate a patient to more complex
    administration during resuscitation, and the
    administration of medication including toxic
    cancer drugs.

12
  • The infusion of sterile fluids may be
  • Sterile solutions
  • Medication
  • Blood or blood products

13
  • According to Brooker (2007) and Martin (2003)
    intravenous fluid therapy may be used to
  • Replace fluids and replace imbalances.
  • Maintain fluid, electrolyte and acid-base
    balance.
  • Administer blood and blood products.
  • Administer medication.
  • Provide parenteral nutrition.
  • Monitor cardiac function.
  • Refer to the RCN (2003) Standards for Intravenous
    Therapy (www.rcn.org).

14
  • PART 3 Physiology Fluid Compartments, Movement
    of Body Fluids and Acid Base Balance and pH
    Values

15
Physiology
  • Water is the major constituent of the human
    body, and body tissue fluids play an important
    role in maintaining equilibrium in the body.
  • This equilibrium is known as homeostasis.

16
Fluid Compartments
  • Functionally, total body water can be divided
    into two major compartments
  • Extracellular fluid (ECF)
  • Approximately 80 of extracellular fluid is
    interstitial, which occupies the microscopic
    spaces between cells. Approximately 20 of
    extracellular fluid is plasma, which is the
    liquid portion of blood
  • Intracellular fluid (ICF).
  • This is also known as cytosol and is the fluid
    within cells.

17
Distribution of body fluids
40 body weight (24l)
Volume (litres)
16 body weight (9.6l)
4 body weight (2.4l)
Extracellular Fluid (ECF)
18
  • Within the body it is essential that substances
    move around.
  • Substances will move from areas of high
    concentration to low concentration and a
    concentration gradient will exist between the
    two.
  • No energy is required for these physiological
    movements as they are described as passive.
  • Movement is facilitated through processes of
    osmosis or diffusion.

19
  • OSMOSIS
  • Osmosis is the movement of water, which goes down
    the concentration gradient, across a
    semipermeable membrane when equilibrium cannot be
    achieved by diffusion of solute molecules.

20
  • DIFFUSION
  • Diffusion refers to the movement of a chemical
    substance from an area of high concentration to
    an area of low concentration.
  • This process mainly occurs in gases, liquids and
    solutions.

High concentration
Low concentration
21
Acid-base Balance and pH Values
  • Body fluids have pH values that must be
    maintained within relatively narrow limits for
    normal cell activities.
  • A pH value of 7 and below indicates an acid
    solution.
  • A pH value of 7 and above indicates an alkaline
    solution.

22
Acid-base Balance
Bicarbonate 20 parts/carbonic acid 1 part
6.80
7.35
7.45
7.80
pH level
23
pH Values of Body Fluids
24
  • PART 4 Classification of Solutions

25
Classification of Solutions
  • There are three main types of fluid which
    include
  • Isotonic fluids.
  • Hypotonic fluids.
  • Hypertonic fluids.

26
  • Intravenous fluids are divided into
  • Crystalloids - a clear aqueous solution of
    mineral salts and other watersoluble molecules,
    for example 5 Dextrose Solution.
  • Colloids - contain large insoluble particles
    which are referred to as solutes, for example
    blood, or blood products.

27
  • PART 5 Methods of Cannulation and Fluid Delivery

28
Methods of Cannulation and Fluid Delivery
  • There are a number of veins available for
    intravenous cannulation.
  • Intravenous cannulation is a clinical procedure
    which is carried out by the doctor, or nurses who
    have undergone special training to prepare them
    for this role.
  • Several factors will determine the choice of
    vein, including
  • Suitability of the vein for the job required
  • Accessibility of alternative sites
  • Duration of catheter use
  • Success rate
  • Complication rate
  • Urgency of cannulation

29
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30
  • Cannulation is the insertion of a cannula into a
    blood vessel, using a small flexible tube that is
    sometimes guided by a pointed instrument known as
    a trocar.
  • There are a variety of cannulae available for
    use.
  • Choice will very much depend upon the purpose and
    urgency of the situation.

31
From www.hku.hk
32
  • Intravenous fluid is normally administered via
    bags or bottles of fluid.
  • The fluid is delivered through a sterile,
    single-use administration set also known as a
    giving set.
  • See the printed text for more information.

33
  • The method of fluid delivery will depend upon the
    patients condition and the urgency of the
    situation.
  • Commonly, access is achieved through
  • Needle and syringe
  • Peripheral Intravenous lines
  • Central Intravenous lines
  • Peripherally Inserted Central Catheter (PICC)
  • Syringe Pumps
  • Central Venous Lines
  • Implantable Ports
  • Epidural Pump
  • Ambulatory Pump
  • Subcutaneous Infusion (Hyperdermolysis)
  • Intraosseous Infusion

34
  • The potential use of intraosseous (IO) infusions
    for adults was first explored some 80 years ago
    (Deboer et al 2005).
  • Until recently the procedure was the preserve of
    paediatrics, being utilized as a medical rescue
    technique.
  • It is now recognised as a valuable adjunct to
    adult and paediatric care.
  • It is an effective, reliable and relatively
    simple procedure to gain vascular access and
    administer fluids and medication in emergency
    care.

35
  • Recent technological advances ensure that
    intraosseous devices are safe and reliable.
  • Bone marrow functions as a non-collapsable vein,
    and access can potentially be gained successfully
    within one minute (Deboer et al 2005).
  • Potential complications associated with
    intraosseous infusion include
  • Osteomylitis
  • Micro-fat-emboli
  • Infiltration and subsequent Compartment
    Syndrome
  • Inhibition of bone growth

36
  • PART 6 Principles of Caring for the Patient

37
Principles of Caring for the Patient
  • Intravenous therapy is a relatively common
    clinical procedure, however nurses need to be
    knowledgeable about the following
  • Related anatomy, physiology and pharmacology
  • Procedure and method of delivery
  • Infection control and universal precautions
  • Safe drug/fluid calculations
  • Types of fluids to be used
  • Maintaining accurate fluid balance charts
  • Duty of care and accountability (NMC
    2004)(www.nmc-uk.org)
  • Monitoring for incompatibilities,
    contraindications, side effects and complications
  • Maintenance of accurate patient records including
    fluid balance charts (NMC 2002)
  • Trust policy and procedures and mechanisms for
    reporting errors

38
  • The overriding principles of care for the
    patient are to ensure the comfort, safety and
    dignity of the patient.
  • Ideally the non-dominant arm is used to site the
    infusion.
  • Practitioners must also be sensitive to cultural
    issues, for example Muslims use the left hand for
    personal cleaning and the right hand for feeding
    (Brooker 2007).

39
  • Intravenous infusion bags/bottles are changed
    using aseptic technique.
  • All intravenous fluids are prescribed by the
    doctor, but it is the responsibility of the
    registered nurse to ensure that the correct fluid
    is administered to the correct patient.

40
  • PART 7 Complications of Intravenous Therapy

41
Complications of Intravenous Therapy
  • Possible complications include
  • Infection
  • Anaphylaxis
  • Speedshock
  • Phlebitis
  • Infiltration
  • Extravasation

42
  • PART 8 Reflective Practice

43
Reflective Practice
  • Reflective practice is a critical element of
    health care practice.
  • Reflection encourages us to examine and think
    about what we do. Furthermore, it is a process
    which facilitates better understanding of a
    situation and questions how we might, or might
    not, do things differently next time.

44
Description what happened?
Action plan if it arose again, what would you do?
Feelings what were you thinking and feeling?
Reflective Cycle
Evaluation what was good and bad about the
experience?
Conclusion what else could you have done?
Analysis what sense can you make of the
situation?
45
  • There are many models available for structured
    reflection, for example Gibbs (1988) model,
    which is a reflective cycle beginning with the
    description and finishing with an action plan for
    future practice.

46
  • Q. Reflect upon a situation when nursing a
    patient with intravenous therapy and, utilizing a
    model of structured reflection, work through the
    situation from description to the formulation of
    an action plan.
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