Brenda McLoud BSN, RN, CGRN

Learning ObjectivesDescribe the Nurse’s role in IV therapy

careExplain IV supplies, type of vascular

access devices, and administration of IV therapy

GI nurse’s role in IV therapyAssessmentPlanningImplementationEvaluation.

Competencies in IV Therapy for the GI NurseKnowledge of Vascular Access Devices (VAD)

usedSkill in performing procedure competently &

safelySkill in inspecting insertion siteAbility to problem solveKnowledge to monitor patient’s condition &

report changesProper documentation and record-keeping

skills

Basic Principles of Fluid & Electrolytes

Water is 60% of the average adult’s total body weight

In infants, body water represents about 80% of total body weight

Solutions – liquids (solvents) containing dissolved substances (solutes) – are classified according to their concentration or tonicity and includeIsotonic SolutionsHypotonic SolutionsHypertonic Solutions

Body fluids are isotonic solutions

Basic Principles of Fluid & Electrolytes

Body water is contained in two major body compartmentsIntracellular fluid (ICF)Extracellular fluid (ECF)

Fluid balance is maintained when water intake equals water output

Solutes are substances dissolved in a solution

Basic Principles of Fluid & Electrolytes

Solutes are classified asNonelectrolytesElectrolytes

Cations Na, K, Ca, Mg, H

Anions Cl, P, HCO3

Electrolytes perform four essential functionsPromote neuromuscular irritabilityMaintain body fluid osmolalityRegulate acid-base balanceRegulate distribution of body fluids among body

fluid compartments

Fluid & Electrolyte imbalancesImbalances may result from

Vomiting, diarrhea, suction, draining wounds, intestinal obstructions, draining fistulas, hemorrhage, infections, fever or prolonged use of enemas &

Infants are more vulnerable because of their higher proportion of body fluid, immature kidneys, increased heat production & rapid growth

Excessive loss of body water can lead to dehydration

Administration of Fluids & Electrolytes

All IV solutions are considered medicationsRequires a Dr.’s orderTypes of Solutions

Isotonic Solutions 0.9% NS or LR

Hypotonic Solutions 0.45% NaCl

Hypertonic Solutions 3% NaCl or 10%Dextrose

Risks for the GI NursePrimary risks due to needlesticks

InjuryDisease transmission

SpillsSplashes

Because universal precautions require use of gloves when dealing with blood and body fluids, development of latex allergies pose a concern for health care workers and patients

Latex allergiesIndividuals who develop burning or tingling

around mouth after blowing up latex balloonsKnown allergy to

BananasAvocadosPotatoesTomatoesPoinsettiasHistory of contact dermatitis History of asthma History of eczema

Vascular Access Devices (VAD)Steel winged infusion set (butterfly winged

device)Peripheral short IV cathetersPeripheral long or midline cathetersPeripherally inserted central catheters

(PICC)Nontunneled central venous catheters

(CVC’s)Tunneled central venous cathetersTotally implanted devices or ports

IV Insertion sitesPreferred sites

Dorsum of handUpper arm

Avoid Extremities withLymphedema, postop swelling, recent trauma,

dialysis shunt, hematoma, axillary lymph node dissection, local infection or cellulitis, phlebitis or open wounds

Best to begin with distal veins and proceed proximally towards the body

Cannulation of lower extremities should be avoided in adults

ComplicationsInfiltration/extravasationHematomaPhlebitisPyrogenic reactionsAir embolismCatheter embolismPulmonary edemaSpeed shock/overloadNerve injury

IV Medication AdministrationTechniques & routes of administration

Appropriateness of the prescribed therapyPatient’s age and conditionAny medication allergiesDose, route and rate of the medication ordered

MedicationsIndicationsActionsSide effectsAppropriate nursing interventions with adverse

reactions

Indications for IV meds in GIModerate sedation/analgesiaControl of variceal hemorrhageTreatment of opioid-induced respiratory

depressionTreatment of benzodiazepine-induced

respiratory depressionTreatment of cardiac dysrhythmiasReducing peristalsis or intestinal spasmsTreatment for increased risk of infection

Blood & Blood ComponentsWhole bloodPacked red blood cellsLeukocyte-poor bloodPlateletsFresh frozen plasma (FFP)CryoprecipitatesFactor VIIIFactor IXHuman albuminAutologous transfusion

Adverse ReactionsCirculatory overloadAllergic reactionsHemolytic reactionsHepatitis B, hepatitis C and human immune

deficiency virusesOther transfusion-related infectious agentsCitrate toxicity

When Adverse Reaction OccursStop the transfusionKeep vein open with normal salineAsses vital signsNotify Dr.Notify blood bankSend all transfusion containers &

administration sets to blood bankTreat patient symptomatically & supportivelyPatient EducationDocumentation

ReviewSalts that dissociate in solution into positive

and negative ions are called:A. AnionsB. CationsC. ElectrolytesD. Colloids

ReviewDrugs should never be added to blood

transfusions because:A. They are incompatible.B. It complicates determination of the source

of any adverse reaction.C. Drugs can cause clotting.D. The rate of infusion is too slow.

ReviewThe following may indicate a higher risk for

latex allergy except,A. History of asthma.B. Use of powder-free gloves.C. Allergy to bananasD. History of multiple surgical procedures.

ReviewHemolytic reactions to blood transfusions

usually occur :A. ImmediatelyB. Within the first 5 to 15 minutes of the

transfusion.C. Within 24 hours.D. As long as 6 months after the transfusion.