Human cells can exist only in a balanced environment. ◦ Cells are enclosed by a cell membrane. ...

Intravenous Cannulation and

Infusion

Human cells can exist only in a balanced environment.◦ Cells are enclosed by a cell membrane.

Small compounds can pass through easily. Larger charged compounds need assistance.

◦ Cell membrane is phospholipid bilayer. Allows selective permeability

Basic Cell Physiology

Total body water (TBW) is 60% of adult weight◦ Intracellular fluid (ICF):

45% ◦ Extracellular fluid: 15%

Interstitial fluid Intravascular fluid

Fluids are composed of solutions (solvent and solute).

Body Fluid Composition

Electrolytes◦ Carry charges◦ Reactive and dangerous if left to circulate

Water stabilizes electrolytes charges. ◦ Cation: positively charged◦ Anion: negatively charged


Electrolytes (cont’d)◦ Measured by milliequivalent (mEq)

1 mEq of a cation can react completely with 1 mEq of an anion.

◦ Singly charged: monovalent◦ Doubly charged: bivalent


Electrolytes (cont’d)◦ Sodium: regulates distribution of water◦ Potassium: major role in neuromuscular function

and conversion of glucose into glycogen Sodium-potassium pump helped by insulin and

epinephrine Hypokalemia: low serum levels Hyperkalemia: high serum levels


Electrolytes (cont’d)◦ Calcium: needed for bone growth

Hypocalcemia: low serum levels Hypercalcemia: high serum levels

◦ Magnesium metabolizes proteins and carbohydrates.


Electrolytes (cont’d)◦ Bicarbonate: determines metabolic acidosis and

alkalosis◦ Chloride: regulates the pH of the stomach◦ Phosphorus: important component in adenosine

triphosphate (ATP) ATP: the body’s energy source


A healthy body maintains a balance between intake and output of fluids and electrolytes. ◦ Homeostasis: internal environment’s resistance to

change◦ A healthy person loses approximately 2 to 2.5 L of

fluid daily.

Abnormal States of Fluid and Electrolyte Balance

Dehydration is an inadequate total systemic fluid volume.◦ Causes:

Diarrhea Vomiting Gastrointestinal drainage Infections Metabolic disorders


Overhydration occurs when the body’s systemic fluid volume increases.◦ Causes:

Unmonitored IVs Kidney failure Water intoxication in

endurance sports Prolonged

hypoventilation


© Medical-on-Line/Alamy Images

Each bag of IV solution is individually sterilized.◦ Altering IV concentration can

move water into or out of fluid compartment

IV Fluid Composition

IV solutions are categorized by their tonicity.◦ Isotonic: same concentration of sodium as cell◦ Hypertonic: greater concentration of sodium◦ Hypotonic: lower concentration of sodium

Types of IV Solutions

Oxygen-carrying solutions◦ Whole blood is the best replacement for lost

blood.◦ Synthetic blood substitutes are being researched.

Types of IV Solutions

Intravenous (IV) therapy involves cannulation of a vein with a catheter.◦ Keep the IV equipment sterile!

Techniques and Administration

Assembling your equipment◦ Gather and prepare in advance

Elastic tourniquet Cleaning wipe or solution Gauze Tape or adhesive bandage Appropriate size IV catheter IV administration set


Choosing an IV solution◦ Usually limited to

normal saline and LR solution

◦ IV solution bags must be used within 24 hours once opened.

◦ IV bags come in different fluid volumes.


Choosing an administration set◦ Must be used once

piercing spike is exposed◦ Number indicates

number of drops it takes for a milliliter of fluid to pass into the drip chamber Microdrip set: 60 gtt/mL Macrodrip set: 10 or 15

gtt/mL


© Jones & Bartlett Learning.

“Six rights” of medication administration◦ Right patient◦ Right drug◦ Right dose◦ Right route◦ Right time◦ Right documentation

Obtain order from Physician. Understand the physician's orders. Repeat any orders for verification. Ask the patient about medication allergies.

Procedure for Administering Medication

Verify the proper medication and prescription.◦ Read the drug label three times.

When it is in the original box When preparing the drug Before administering

Verify form, dose, and route of medication.


Check the expiration date and condition of the medication.

Confirm medication compatibility. Dispose of syringes and needles safely. Notify and advise the physician of any

changes in the patient condition.


Monitor the patient for adverse side effects. Document actions and patient’s response.

◦ Name of the drug◦ Dose of the drug◦ Time administered ◦ Route of administration◦ Name of person who administered the drug◦ Patient’s response to the medication


Standard precautions◦ Treat any bodily fluid as being potentially

infectious.◦ Handwashing is an effective way to prevent the

spread of disease. Handwashing alone will not prevent infection.

Standard Precautions and Contaminated Equipment Disposal

Disposal of contaminated equipment◦ After an IV catheter

or needle has penetrated a patient’s skin, it is contaminated.


Disposal of contaminated equipment◦ Immediately dispose of all

sharps in a sharps container.


Choosing an IV site◦ Avoid areas that contain

valves and bifurcations.◦ Locate vein that looks

straightest, firm, round, and springs when palpitated

◦ Limit IV access to distal areas of extremities.


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Choosing an IV site (cont’d)◦ Bulging veins can

roll from side to side. Pull skin over vein

taut with thumb of free hand.

Flex patient’s hand. Stabilize wrist.


Choosing an IV site (cont’d)◦ Consider the patient’s opinion.◦ Avoid extremity if it shows signs of:

Trauma Injury Infection

◦ Some protocols allow IV cannulation of leg veins.


Choosing an IV catheter◦ Over-the-needle: inserted over a hollow needle◦ Butterfly: hollow, stainless steel needle with two

plastic wings◦ Through-the-needle: inserted through a hollow

needle


Inserting the IV catheter◦ Keep the beveled side

up.◦ Maintain adequate

traction. ◦ Use a constricting

band above the site. Remove the band

while assembling IV equipment.


Courtesy of Rhonda Beck

Inserting the IV catheter (cont’d)◦ Prep site.◦ Apply lateral

traction, while holding catheter bevel side up.

◦ Insert at a 45-degree angle.

◦ Push through the skin until the vein is pierced.


Inserting the IV catheter (cont’d)◦ Drop angle to 15 degrees and advance catheter a

few centimeters.◦ Slide sheath off needle into vein.◦ Apply pressure to the vein. ◦ Remove needle.◦ Dispose needle in sharps container


Securing the line◦ Tape the area to

secure the catheter and tubing. Double back the

tubing to create a loop.

◦ Cover the site with sterile gauze and secure with tape.

See Skill Drill 11-2.


Changing an IV bag◦ Stop the flow by closing the roller clamp.◦ Prepare the new IV bag.◦ Remove the piercing spike, and insert it into the

port on the new bag.◦ Ensure the drip chamber is filled, and open the

roller clamp.


Discontinuing the IV line◦ Shut off the flow.◦ Peel tape back.◦ Stabilize the

catheter.◦ Do not remove IV

tubing from hub. ◦ Pull catheter and IV

line from patient’s vein.

◦ Apply pressure.


Saline locks◦ Maintain active IV

site without running fluids through vein

◦ Attached to end of IV catheter

◦ Filled with approximately 2 mL of saline

◦ Also called intermittent sites (INT)

Alternative IV Sites and Techniques

Catheters◦ The best gauges for

over-the-needle catheters are: 20-, 22-, 24-, 26-

◦ Butterfly catheters are ideal.

Pediatric IV Therapy Considerations


IV locations◦ Explain your actions to child and parent◦ Hand veins remain the location of choice. ◦ Technique for starting pediatric IV line:

Use penlight to illuminate veins through back of hand◦ Scalp vein cannulation can be difficult.

Pediatric IV Therapy Considerations

Checks to perform after IV administration:◦ Fluid◦ Administration set◦ Height of bag◦ Catheter type◦ Constricting band

Factors Affecting IV Flow Rates

Infiltration: escape of fluid into surrounding tissue◦ Causes area of edema◦ Causes include:

Catheter passes through vein and out other side Patient moves excessively Tape becomes lose or dislodged Catheter is inserted at too shallow an angle

Local IV Site Reactions and Complications

Infiltration (cont’d)◦ If infiltration occurs:

Discontinue the IV line. Reestablish IV line in the opposite extremity Apply direct pressure over the area. Do not wrap tape around extremity


Occlusion: blockage of vein or catheter◦ First sign: decreasing drip rate or blood in the IV

tubing◦ May develop due to:

Position of catheter within the vein Patient’s blood pressure overcoming the flow

◦ If occlusion does not dislodge: Discontinue. Reestablish IV in opposite extremity


Vein irritation◦ Often caused by too-rapid infusion rate◦ If redness at the IV site occurs:

Discontinue the IV line. Save the equipment for analysis. Reestablish the IV line in the other extremity with

new equipment.


Thrombophlebitis: inflammation of the vein◦ May be caused by lapses in aseptic technique◦ Pain and tenderness along the vein and redness

and edema at the venipuncture site◦ Appear several hours after IV therapy ◦ Stop the infusion and discontinue the IV at that

site.


Hematoma: accumulation of blood in the tissues surrounding an IV site◦ Often caused by:

Vein perforation Improper catheter removal

◦ Develops while inserting catheter: stop and apply direct pressure

◦ Develops after inserting catheter: evaluate the IV flow

◦ Develops as a result of discontinuing the IV: apply pressure



Nerve, tendon, or ligament damage◦ Results in sudden and severe shooting pain ◦ Remove catheter and select another IV site.

Arterial puncture◦ Bright red blood will spurt through the catheter.◦ Withdraw the catheter and apply direct pressure

for at least 5 minutes.


Allergic reactions◦ Anaphylaxis must be treated aggressively.◦ If an allergic reaction occurs:

Discontinue the line and remove the solution. Leave the catheter in place. Attach a saline lock. Notify medical control. Maintain an open airway; monitor vital signs. Retain the solution or medication for evaluation.

Systemic Complications

Circulatory overload◦ Problems may occur in patients with cardiac,

pulmonary, or renal dysfunction. ◦ To treat:

Slow the IV rate. Raise the patient’s head. Administer high-flow oxygen. Monitor vital signs and breathing adequacy.


Air embolus◦ Avoid by properly flushing an IV line and replace

empty IV bags with full ones◦ To treat:

Place patient on left side with head down. Administer 100% oxygen. Transport to closest facility Assist ventilations if needed.


Questions?

Human cells can exist only in a balanced environment. ◦ Cells are enclosed by a cell membrane. ...

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