Intravenous Therapy is

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Intravenous Therapy is

• Administration into the vein (IV)
• What can be given IV?

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Intravenous Therapy

• What will we be giving IV in Nursing 2?

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Intravenous Therapy

• What kind of IV are we not allowed to give in N
  002?

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Fluid Abbreviations

• Normal saline, 0.9NaCl ______
• ½ Normal saline, 0.45NaCl ______
• Dextrose 5 Water ______
• 3 Saline ______
• Ringers Lactate or Lactated Ringers ____

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There are many different ways to write normal
saline (NS)

• Normal Saline
• Saline Solution
• 0.9 Sodium Chloride
• 0.9 NaCl

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There are many different ways to write Half
Normal Saline

• Half Normal Saline
• ½ NS
• 0.45 Sodium Chloride
• 0.45 NaCl

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There are many different ways to write 5
Dextrose

• 5 Dextrose
• Dextrose 5 Water
• D5W

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Intravenous Therapy

• What kind of IV are we not allowed to give in N
  002?

• NO _____

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Equipment for IV Therapy

• 1)
• 2)
• 3)
• 4)
• 5)

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Administration Sets
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Common IV SolutionCombinations

• D5W 5 dextrose in water
• D5LR 5 dextrose in LR
• D 5 NS
• D 5 ½ NS

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D5

• What happens to D5 in W by itself or in
  combination with another solution when it enters
  the blood?

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OBJECTIVES OF IV THERAPY

• IV to maintain or replace fluids
• IV medications for
• Rapid effect
• NPO patients
• Altered drug absorption in GI tract (N/V)
• Therapeutic drug level or nutrition
• To keep a vein open for emergencies

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IVPB ?
Primary IV ?
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Piggy- Back
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(No Transcript)
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SELECTION OF EQUIPMENT

• Kinds of Infusion containers
• 1.
• 2.
• 3.

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SELECTION OF EQUIPMENT

• Kinds of Infusion administration sets
• Primary set macrodrip (10, 15, 20) or microdrip
  (60)
• Secondary set or piggyback set
• Volume-controlled sets

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Patient Preparation

• Explain the procedure
• Ask permission
• Approach with a confident, calm, caring attitude

Hi, Im going to start your IV fluids now, OK?
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Equipment for IV Therapy

• 1.
• 2.
• 3.
• 4.
• 5.

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The IV Order

• What information is required to complete an order
  for intravenous medication?
• 1.
• 2.
• 3.
• 4.
• 5. Volume and/or
• 6. Rate and/or
• 7. Duration
• 8.
• (Hint The first 4 are the same as for PO meds)

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Example 1

• 9/2/06, 1300, NS IV _at_ 125 ml/hr
• J. Depp, MD

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Order Example 2(Hours)

• 9/2/06, 1300, D5W 1 Liter
• over 4 hours. J. Smith, MD

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To calculate ml/hr

• Total ml ml/hr
• Total hours

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Order Example 3(Minutes)

• 9/2/06, 1300, NS 50 ml
• over 30 minutes. J. Smith, MD

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To calculate ml/hr for an order over minutes

• Total ml x 60 min/hr ml/hr
• Total min.
• Or use a ratio and cross multiply
• ml ordered X ml
• Min ordered 60 min

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IV Documentation

• 1.
• 2.
• 3.
• 4.
• 5.
• 6.
• 7.

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Documentation example

• 10/1/2007, 1740, 1 Liter NS infusing _at_ 75 ml//hr
  in right ac with 20 gauge IC. No signs of
  infiltration or inflammation. Dressing CDI.
  Client verbalizes understanding teaching
  regarding IV therapy and management. J.Walker, RN

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IV rates (How fast the IV fluid runs)

• What is Flow rate?
• What is Volume to be infused (VTBI)?
• What if you dont have a pump available?

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IV rates (How fast the IV fluid runs)

• What is Drip Rate?
• Why would a a drip rate be used?
• What is a Drop Factor?

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I.V. Therapy Vocabulary

• Drop Factor The number of drops it takes to
• make 1 ml come out of the tubing
• Primary Sets 10 drops 1 ml (Blood tubing)
• 15 drops 1 ml
• 20 drops 1 ml
• 60 drops 1 ml (Pediatric tubing)
• Secondary Sets (IV Piggyback tubing)

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Drips (gtts) per minute

• __V___ X C R
• T
• __V___ X C (drop factor) R
  (gtt/min)
• T (in min)

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IV Pumps

• What is rate (ml/hr)?
• What is volume (VTBI)?
• Does drip (gtt) rate get entered into pump?

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IVPB

• What is primary (IV)?
• What is secondary (IVPB)?
• What is IVPB?
• What is VTBI?

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Example IV Kefzol 0.5 g in 100 ml D5W over 30
min

• 100 ml X ml
• 30 min 60 min
• 30 X 6000
• 30 X 6000
• 30
• X 200 ml/hr

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How to figure IVPB

• When backflushing from primary bag to piggy back,
  about 5 ml enters piggy back from primary
  bagTHIS MUST BE INCLUDED WHEN FIGURING THE RATE

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How to figure IVPB

• VOLUME (VTBI) Add 5 ml to each volume
• RATE Add 5 ml to the rate for every portion of 1
  hour.

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IVPB IV Kefzol 0.5 g in 100 ml D5W over 30 min

• 105 ml X ml
• 30 min 60 min
• 30 X 6300
• 30 X 6300
• 30
• X 210 ml/hr

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IVPB IV Kefzol 0.5 g in 100 ml D5W over 20 min

• 105 ml X ml
• 20 min 60 min
• 20 X 6300
• 20 X 6300
• 20 20
• X 315 ml/hr

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• IV Kefzol 0.5 g
• in 100 ml over 20 min
• Divide the hour (60 min) by 20 min
• 2) ADD the 5 ml to each portion of hr.

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IV Kefzol 0.5 g in 100 ml D5W over 20 min
105
105
105
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How to figure IVPB

• Example 2 Give 100 ml Kefzol IVPB over 20
  minutes
• What is the rate per hour?
• What is the volume (VTBI)?

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IV Complications

• What is phlebitis?
• __________________________________
• Signs symptoms Interventions?
• 1.
• 2.
• 3.
• 4.

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IV Complications

• What is infiltration?
• ___________________________________
• Signs symptoms Interventions?
• 1.
• 2.
• 3.
• 4.

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IV Complications

• What is extravasation?
• ___________________________________
• Signs symptoms Interventions?
• 1.
• 2.
• 3.
• 4.

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IV Complications

• Local infection
• Signs symptoms Interventions?
• 1.
• 2.
• 3.
• 4.

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Fluid Overload

• What is circulatory overload?
• Signs and Symptoms Interventions?

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Drops (gttts) per minute using drop factor

• V (in ml)
• __________ x C R (gtts/min)
• T (in min)

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Patient Preparation

• Explain the procedure
• Ask permission
• Approach with a confident, calm, caring attitude

Hi, Im back and Im going to start your IV
fluids now, OK?
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Important

• Always double check the rate you put into the
  infusion pump
• Some infusion pumps BOUNCE and add an extra
  number
• So if you put in 20 ml/hr, just look at it to
  make sure it says 20 and not 220 or 200!

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Lifespan Considerations

• Who are at high risk
• for circulatory overload
• if IV fluids are accidentally infused too
  rapidly?

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Lifespan Considerations

• What device should you use
• to prevent too much fluid
• to be infused in children,
• especially those younger
• than 2 years of age?

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Lifespan Considerations

• Always use volume control administration sets to
  allow only a preset amount of fluid to be infused
  in children, especially those younger than 2
  years of age.
• Use IV solutions available in 250 500 ml
  containers to guard against such accidents.

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Lifespan Considerations

• Infants and Children
• For buretrol (VOLUME CONTROL SETS)
• Figure total number of hour(s) of volume ordered,
• Then ADD 10 ml of volume to put in set
• EXAMPLE If MD orders 50 ml of solution over 5
  hrs,
• AT what rate do you set the pump?
• At what volume (VTBI) do you set the pump?
• How much do you put in the volume control set?

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Collaboration and Delegation

• Flushing IV lines is not delegated to unlicensed
  personnel because breaks in aseptic technique
  could result in sepsis

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IV Abbreviations

• IVPB _____________________________
• VTBI ______________________
• CDI ____________________
• KVO ___________________
• TKO ___________________
• ac _______________________
• IC ______________________