IV Fluid Therapy Lecture and Demo PFN: SOMPSD03slides.jsomtc.org/SOMPSD03/SOMPSD03.pdf · JSOMTC,...
Transcript of IV Fluid Therapy Lecture and Demo PFN: SOMPSD03slides.jsomtc.org/SOMPSD03/SOMPSD03.pdf · JSOMTC,...
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Slide 1JSOMTC, SWMG(A)
IV Fluid Therapy Lecture and DemoPFN: SOMPSD03
Hours: 2.0
Instructor:
Slide 2JSOMTC, SWMG(A)
Terminal Learning Objective
Action: Communicate knowledge of IV fluid therapy
Condition: Given a lecture and demonstration in a classroom environment
Standard: Received a minimum score of 75% on the written exam IAW course standards
Slide 3JSOMTC, SWMG(A)
References
Fluids and Electrolytes Made Incredibly Easy, 5th edition, 2011
The ICU Book, 3rd edition, 2007
AACN Essentials of Critical Care Nursing, 2006
Infusion Nursing an Evidence Based Approach, 3rd edition, 2010
PHTLS Manual, Military 7th edition, 2011
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Reason
Hemorrhagic shock is a leading cause of death on the battlefield
Infusion of intravenous fluids and blood products will help sustain the casualty until surgical intervention occurs
IV cannulation enables providers to administer a variety of life saving drugs for both clinical and trauma scenarios
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Agenda
Identify the physiology, indications, and contraindications of IV fluids
Identify the indications and considerations for a peripheral IV
Identify the peripheral IV sites
Identify the characteristics of common IV equipment
Slide 6JSOMTC, SWMG(A)
Agenda
Identify the steps for initiating and discontinuing a peripheral IV
Identify the complications of IV fluid therapy
Demonstrate initiating and discontinuing a Peripheral IV
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Identify the physiology, indications, and contraindications of IV fluids
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IV Fluids
IV fluid bags are good for 24 hours after being spiked, IV sites/lines are good for 72 hours
Crystalloids
Inexpensive, common, non‐infectious
Lack O2 carrying/coagulation capability, and have short IV half‐life
Colloids
Greater osmotic pull
Potential reactions and storage issues
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Crystalloids Solutes capable of crystallization are easily mixed and dissolved in a solution
May be electrolytes or non‐electrolytes, such as dextrose
Contain small molecules that flow easily across semi‐permeable membranes, allowing for transfer from bloodstream into cells and body tissues
May increase fluid volume in both interstitial and intravascular spaces
Useful in replenishment or dilution in the treatment of fluid and electrolyte disturbances
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Crystalloids
Distinguished by their relative tonicity (before infusion) in relation to plasma
Tonicity refers to concentration of dissolved molecules held within solution
Isotonic, Hypotonic, and Hypertonic
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Isotonic Crystalloids
Dissolved particles concentration similar to plasma
Osmotic pressure constant both inside and outside cells
Fluid shift does not occur. Cells neither shrink nor swell
Distributed between intravascular and interstitial spaces, thus increasing intravascular volume
0.9% sodium chloride, lactated Ringer's, Plasmalyte, D5W
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0.9% Sodium Chloride
Contains only water, sodium (154 mEq/L), and chloride (154 mEq/L)
Often called "normal saline (NS)" because percentage of NS dissolved in solution is similar to concentrations of sodium and chloride in intravascular space
Because water goes where sodium goes, 0.9% sodium chloride increases fluid volume in extracellular spaces
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0.9% Sodium Chloride Indications
Hyponatremia and hypercalcemia
Rhabdomyolysis
Medication and blood administration
Used as a vehicle for many parenteral drugs to replenish electrolytes for maintenance of deficits of extracellular fluid
Contraindications
Shock
• Large volumes of normal saline leads to hyperchloremic acidosis
Cardiac or renal disease
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Lactated Ringer's
Electrolyte content is most closely related to body's blood serum and plasma
130 mEq/L Sodium
109 mEq/L Chloride
4 mEq/L Potassium ‐ 3 mEq/L Calcium
28 mEq/L Lactate
Indications
Shock/Burns ‐ Alkalization helps attenuates metabolic acidosis
Dehydration
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Lactated Ringer's
Contraindications
Rhabdomyolysis
• Due to K+ content of solution
Conditions decreasing lactate metabolism and excretion
• Liver failure prevents lactate conversion into bicarbonate
• Kidney failure: Hyperkalemia risk
• PH >7.5 due to alkalinization
Not given w/blood products
• C++ can increase hypercoagulable state which results in emboli
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Plasmalyte‐148
Electrolyte content is similar to LR, with many of the same indications
140 mEq/L Sodium
98 mEq/L Chloride
27 mEq/L Acetate
23 mEq/L Gluconate
5 mEq/L Potassium
1.5 mEq/L Magnesium
Indications
Same as LR plus……
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Plasmalyte‐148
Uses acetate and gluconate as buffers. May be used in liver failure pts w/caution
Approved for use in use with blood product transfusion
No calcium/citrate interaction
Contraindications
Rhabdomyolysis/ PH >7.5
Kidney failure: Hyperkalemia and Hypermagnesemia risk
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D5W (Dextrose in Water)
D5W's initial tonicity comparable to intravascular fluid (isotonic). Dextrose is metabolized leaving no osmotically active particles (hypotonic)
Indications:
Moderate nutrition
Hypernatremia/Isotonic dehydration
Dilute concentrated drugs for IV infusion
Contraindications:
Shock, TBI, stroke, hyperglycemia, transfusions, corn allergy, renal failure
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Hypotonic Crystalloids
Compared with intracellular fluid, hypotonic solutions have lower concentration, or tonicity, of solutes (electrolytes)
Lowers serum osmolality within vascular space, causing fluid to shift from intravascular space to both intracellular and interstitial spaces
Solutions will hydrate cells, although their use may deplete fluid within circulatory system
0.45% NaCl, 0.33% NaCl, 0.2% NaCl, 2.5% dextrose in water
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Hypotonic Crystalloids
Indications
Intracellular dehydration conditions
•Only after the initial resuscitation of DKA is complete
A SOCM will not initially use a hypotonic solution for resuscitation
Contraindications
Trauma ‐ Shock, burns
Hypotension
Increased ICP
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Hypertonic Crystalloids
Hypertonic solutions have higher sodium and chloride concentrations
Solute concentration > ICS. Water drawn out of ICS, temporarily increasing fluid volume in the IVS
3% NaCl, 5% NaCl
Vasoregulatory, immunologic, and neurochemical effects can attenuate post injury complications
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Indications
Increased ICP/Cerebral edema
•Osmolarity almost identical to Mannitol w/o risks of diuresis, and subsequent hypovolemia
• Less chance of rebound in ICP
Hyponatremia
Contraindications:
Pulmonary edema
Hypertension
Hypertonic Crystalloids
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Hypertonic Crystalloids
Complications
Central Pontine Myelinolysis
• Rapid transition from hyponatremia to hypernatremia
•Manifested clinically as lethargy and quadriplegia/paresis
Hypernatremia
Hypervolemia
Pulmonary edema
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Colloids
Unlike crystalloids, colloids contain molecules too large to pass through semipermeable membranes, such as capillary walls
Remain in intravascular compartment
Expand intravascular volume by drawing fluid from interstitial spaces into intravascular compartment
• Known as volume expanders or plasma expanders
Same effect as hypertonic crystalloids of increasing intravascular volume, but have longer duration of action and require administration of less total volume
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Colloids
Blood products (SOCM fluid of choice for hemorrhagic shock)
Packed RBCs (PRBC)• Store at 33‐43 degrees F
• 2 units given w/FFP at a 1:1 ratio
Plasma (FFP)• Shelf life once thawed: 3 days at 33‐43 degrees F, 30 min room temperature
• Supplied as AB or A, RH factor is not a concern
Platelets (PLTS)
Whole blood (WB)• Equivalent of FFP, PBRC and PLTS in a 1:1:1 ratio
• 24 hours shelf life or refrigerated for 21‐42 days
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Colloids
Albumin
5% solution ‐ 25% solution
One of the most commonly utilized colloid solutions
Used to maintain a normotensive state, or even a hypervolemic state in neuro trauma (Triple H therapy)
Dextrans ‐ LMWD (Dextran 40) and HMWD (Dextran 70)
Reduces erythrocyte aggregation, Factor VIII‐Ag (Von Willebrand), platelet adhesiveness, and can inhibit a‐2 anti‐plasimin
Interferes with blood cross matching/labs. Anaphylactoid risks
Hydroxyethylstarches ‐ Hespan and Hextend
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Hydroxyethylstarches
Hypertonic synthetic colloids used for volume expansion
Hespan
• 6% hetastarch in normal saline
Hextend
• 6% hetastarch in Lactated Ringer’s
Effects can last 24 hours
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Current Events Regarding HextendA1
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Hydroxyethylstarches
Black Box Warning
Do not use in critically ill adult patients including those with sepsis, and those admitted to the ICU
Avoid use in patients with pre‐existing renal dysfunction, or in open heart surgery w/cardiopulmonary bypass due to excess bleeding
Discontinue use at the first sign of renal injury, or coagulopathies
Need for renal replacement therapy has been reported up to 90 days after administration; monitor renal function for at least 90 days in all patients
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Hextend
SOCM’s fluid of choice for treating hemorrhagic shock if blood products are unavailable
Powerful volume expander that remains in IVS longer than crystalloids, requiring less fluid needs to be carried
Indications
Shock
Contraindications
Hypertension (CHF)
Heat casualties (volume expansion does not equal hydration)
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A1 LTC Riesberg want this slide to remain in power point.Author, 6/5/2017
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Slide 31JSOMTC, SWMG(A)
Hextend versus Lactated Ringer’s
Why use Hextend instead of much less expensive Lactated Ringer’s?
1000 ml of LR (2.4 lbs) will yield expansion of circulating blood volume of only 200 ml one hour after fluid is given
The other 800 ml of LR has left circulation after an hour and entered other fluid spaces in body
500 ml of Hextend (1.3 lbs) will yield expansion of intravascular volume of 600 to 800 ml
This intravascular expansion is still present 8 hours later
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Identify the indications and considerations for a peripheral IV
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Peripheral IV Indications
Patient requiring infusion of:
Medications
Fluids
• Volume replacement/expansion for hemorrhagic shock
• Correction of acid/base, and electrolyte disturbances
Blood product admin/labs
Nutritional supplements
• GI dysfunction, obstruction, perforation, coma, absence
• Relieve organ workload
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Slide 34JSOMTC, SWMG(A)
Peripheral IV Considerations
Cannulation site criteria
Most distal site on extremity
Upper extremities preferred
Straight veins/free of valves
Veins not prone to rolling
Site selection troubleshooting
Pumping fist (open and close)
Gravity dependent position
Tapping/stroking site
Applying heat to the site
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Peripheral IV Considerations
Sites to avoid:
Veins near joints (if so, splint the joint)
Locations with penetrating injuries
Lower extremities when abdominal trauma may have compromised the vena cava or portal circulation
Sites distal to previous insertion sites
Infiltrated/bruised areas
Burned areas may be used if no other sites are available
Slide 36JSOMTC, SWMG(A)
Peripheral IV Considerations
Choosing right diameter (or gauge) needle or catheter is important for ensuring adequate flow and patient comfort
The higher the gauge, the smaller the diameter of the needle
Small gauge catheters (14G, 16G, or 18G) w/a shorter length offer less resistance, and should be used for rapid fluid infusions
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Peripheral IV Considerations
Tactical considerations (not all casualties need IVs!)
Not required for minor wounds
IV fluids and supplies are limited
IVs take time and distract from other treatments
May unnecessarily disrupt tactical flow
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Identify the peripheral IV sites
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Peripheral Veins
Upper extremities
Dorsal aspect of hand
Radial and ulnar veins
Antecubital (AC) vein
Median cephalic and median basilic veins
Lower extremities
Dorsal aspect of foot
Medial malleolus region
Long saphenous vein
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Slide 40JSOMTC, SWMG(A)
Peripheral Veins
Head/Scalp veins Used primarily on infants
External jugular vein Used in emergent situations
Procedure largely same as for other peripheral sites• Place patient supine (preferably in Trendelenburg)
• Increases blood flow to vein
• Aids in visualization of site
• Pressure may be put on portal system if not contraindicated
• Potential air entrainment
Slide 41JSOMTC, SWMG(A)
Alternate Infusion Methods
Hypodermoclysis: Subcutaneous infusion of fluids
Patients unable to take adequate fluids orally or when it's difficult/impractical inserting an IV
Moderately dehydrated adult patients
Animals
Rectoclysis‐ Proctoclysis: Fluids and nutrients
Intraosseuos: Same as IV (use with pressure infuser)
Endotracheal Tube: ACLS Medications (Navel/Lean)
Dosage 2‐2.5 times
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Identify the Characteristics of Common IV Equipment
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Slide 43JSOMTC, SWMG(A)
IV Catheters
Hollow needle (Butterfly)
• Used for peds or other patients w/tiny‐delicate veins
• No Teflon tube, needle left in vein, and must be secured
• Some hollow have wings for guidance and securing
Over the needle catheter (Angiocath)
• Over the needle catheter comprises a semi‐flexible catheter enclosing a sharp metal stylet (needle) that is hollow and beveled at distal end
•Most common ‐ Quick and easy to use
•More comfortable for patient
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Over the Needle Catheter
Components Needle
• Permits easy puncturing
• Blood flows from needle to flashback chamber
Teflon catheter • Slides over needle into punctured vein
Flashback chamber • Visualize blood after needle has punctured vein
• Allows you to confirm initial placement in vein
Hub • Located at back of catheter
• Connects to IV tubing, or saline lock
Slide 45JSOMTC, SWMG(A)
Catheter Flow Characteristics
The flow of fluids through an IV catheter can be described by Poiseuille’s Law.
It states that the flow (Q) of fluid is related to a number of factors: the viscosity (n) of the fluid, the pressure gradient across the tubing (P), and the length (L) and the diameter (r) of the tubing.
The smaller the gauge the larger the diameter
Doubling the diameter of a catheter increases the flow rate by 16 fold.
Shorter/larger catheter = Faster fluid flow rate
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Catheter Flow Characteristics
Increasing viscosity decreases flow through a catheter
Warming viscous fluids (blood products) prior to administration increases flow rate
Increasing pressure further maximizes flow rate.
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Catheter Diameter and Length
Catheters come in different lengths and gauges
22 to 26 gauge ‐ Pediatrics
18 to 20 gauge ‐ TKO lines, non‐acute fluid resuscitation
14‐16 gauge ‐ Rapid fluid replacement, blood products
Which catheters would you use on adult trauma patients?
14‐16 gauge
What catheters would you use for med admin?
18‐20 gauge
Slide 48JSOMTC, SWMG(A)
Catheter Diameter and Length
18 gauge 1 ¼ inch is the catheter of choice for a trauma patient in a tactical environment
Ease of cannulation (higher success rate)
Rapid administration of crystalloids and colloids
14G 1 ¼”
16G 2”
18G 1¼”
20G 1 ¼”
22G 1 ¼”
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Slide 49JSOMTC, SWMG(A)
IV Administration Set
Clear plastic tubing for detection of air bubbles
One end connects to catheter
Other end connects to IV fluid or bag
Drip chambers are either Micro or Macro meaning that X # of drops = 1 ml
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IV Administration Set
MICRO ‐ Small bore drip chamber
Used on medical and pediatric emergencies
Easy to titrate
Avoids fluid overload
MACRO ‐ Large bore drip chamber
Used on trauma patients
Allows for rapid fluid replacement/boluses
Slide 51JSOMTC, SWMG(A)
IV Accessories
IV Pressure Infuser Bag
Used in field for rapid fluid replacement
Also used when IV pole is not available
Required for I/O fluid administration
Saline Lock (PRN adapter or med port)
Used when IV medication or fluid bolus is required, but not a continuous infusion
Flushed every hour to keep open
Conserves IV fluid and supplies
Do not put needle in needless port
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Identify the Steps for Initiating and Discontinuing a Peripheral IV
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Both techniques will be taught during your SOCM course training
You will be expected to be proficient at both
If you can perform a Ranger IV, you will be able to perform a traditional IV
During lecture, Ranger IV specific steps and equipment will be in orange font
Traditional IV versus Ranger IV
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Traditional IV versus Ranger IV
Traditional IV
Used in hospitals, and ambulances
Quicker to initiate
Less equipment required
With multiple casualties it could equal more equipment
Faster flow rate
Ranger IV
Tactical option for IV fluid therapy
Designed by Rangers
Also referred to as a “Ruggedized IV”
More versatile than traditional IV
More resistant to accidental or deliberate DC
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Slide 55JSOMTC, SWMG(A)
IV Equipment IV fluid
IV catheter
IV administration set
Tape and OpSite
2x2s
Alcohol/betadine swabs
Constriction band
Gloves and eye protection
10 ml syringe
18G needles
Saline lock
Slide 56JSOMTC, SWMG(A)
Prepare Equipment
Select and inspect IV fluid
Color, clarity and expiration date
Select and inspect admin set
Connect administration set to IV bag
Clamp line
Fill drip chamber
Flush tubing
Apply 18G needle
Pre‐fill 10 ml syringe with 5 ml of IV fluid
Leave 18G needle attached
Tear tape
Open saline lock packets
Open alcohol, betadine swab and OpSite
Take BSI precautions
Gloves
Eye protection
Slide 57JSOMTC, SWMG(A)
Select Site
Apply constriction band
Used to halt venous return not arterial flow as in tourniquets
Best to use a quick release
Palpate vein
Clean site with alcohol and betadine
Select and inspect catheter
Catheter moves freely over needle
Use free hand to pull skin taut stabilizing vein
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Slide 58JSOMTC, SWMG(A)
Cannulate Vein
Approach vein at 20 to 30 degrees
From side of vein or over vein insuring needle bevel is up
Once you see “flash” or feel a “pop” reduce your angle and ease catheter and needle approximately ¼ inch
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Cannulate Vein and Connect IV Tubing
Advance catheter over needle
Maintain manual control of hub until IV is secured by tape strips
Occlude vein proximally to staunch flow
Withdraw needle while stabilizing catheter , and immediately place directly into Sharps container
W/the traditional IV, connect IV tubing to catheter hub, then check IV patency
Slide 60JSOMTC, SWMG(A)
Verify IV Flow
Release constricting band
Start flow
Check patency
Drop the bag
Pinch and prime
Proximal occlusion
Apply OpSite
Adjust flow rate as appropriate
Double up/S‐fold tubing and tape down
Splint extremity if site is on joint
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Slide 61JSOMTC, SWMG(A)
Document
Label IV site
Date
Time
Catheter gauge and length
Document the procedure
Same info as above
Fluid type and amount
MIST Report (MOI, injuries sustained, S/S, treatments provided
Combat Casualty card
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Ranger IV Saline Lock
For the Ranger IV, connect a saline lock instead of the direct IV line
Cleanse lock or port w/alcohol
Verify Saline Lock Patency
Attach syringe and aspirate blood
Flush saline lock with 1‐3 ml of fluid
Secure Saline Lock
Wipe away any blood
Apply OpSite
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Connect IV Tubing to Saline Lock
Clean OpSite area over saline lock with alcohol
Insert needle through OpSite into saline lock until resistance is felt
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Slide 64JSOMTC, SWMG(A)
Discontinue an IV
Verify order and/or indication for discontinuation of IV
Explain procedure to patient
Shut off IV flow
While holding catheter with fingers and thumb, remove tape and OpSite
Place gauze over site
Withdraw catheter and apply pressure
Place catheter in appropriate container
Place gauze “wad” over first gauze
Secure gauze with tape or Coban
Document procedure
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Identify the Complications of IV Fluid Therapy
Slide 66JSOMTC, SWMG(A)
Complications of IV Fluid Therapy
Divided into two categories
Local
Hematoma
Infiltration
Infection
Phlebitis and thrombophlebitis
Extravasation
Arterial cannulation
Systemic
Circulatory (fluid) overload
Catheter related sepsis
Pyrogenic reaction
Catheter embolism
Air embolism
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Slide 67JSOMTC, SWMG(A)
Hematoma
Blood leaks from vessel into surrounding soft tissue
IV catheter penetrates both walls of vessel
Not applying pressure to site when catheter is removed
Signs and symptoms
Swelling at site, pain, and ecchymosis
This is not awesome
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Hematoma
Treatment
Remove catheter
Apply direct pressure to site
Reattempt at another site
Prevention
Utilize proper technique when initiating or discontinuing IV
Sub-Optimal
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Infiltration
IV fluid leaks from vein into surrounding tissue
IV catheter becomes dislodged from vein
Signs symptoms
Pain, swelling, coolness and leakage at insertion site
Sluggish or stopped IV fluid flow
Still not good
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Infiltration
Treatment
Stop infusion, elevate affected extremity, remove catheter, and restart infusion in another site
Apply warm packs initially to site, after 24 hours cold packs can be apply
Prevention
Avoid IV placement in joint areas
Properly secure catheter
Closely monitor insertion site
Nope
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Infection
Puncture for venous access disrupts integrity of skin, body's barrier to infection
Signs and symptoms
Drainage, pain, redness, swelling, and warmth at IV site
Hardness on palpation
Fever, chills, and elevated WBC count
Treatment
Remove catheter and monitor patient's vital signs
Swab site for culture and initiate anti‐microbial therapy
Slide 72JSOMTC, SWMG(A)
Infection
Prevention
Properly clean intended insertion site with antiseptic solution
Maintain sterile technique during catheter insertion and when performing IV site care
Rotate peripheral IV catheter sites every 72 hours
Try again NO!!
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Phlebitis and Thrombophlebitis
Both can result from poor insertion technique, use of solution or drug with inappropriate pH or osmolality, or IV catheter remaining in place too long
Phlebitis
Inflammation of vein
Mechanical, chemical, or bacterial
Thrombophlebitis
Irritation of vein with clot formationHeavy sigh…
Slide 74JSOMTC, SWMG(A)
Phlebitis and Thrombophlebitis
Signs and symptoms
Pain (more severe in thrombophlebitis), redness, swelling, or induration at site
Red line streaking along vein
Sluggish flow of infusion solution
Fever
Edema
Mild joint pain Come on!
Slide 75JSOMTC, SWMG(A)
Phlebitis and Thrombophlebitis
Treatment
Remove catheter
Apply warm soaks to site
Elevate extremity
Monitor patient's vital signs
Prevention
Choose large veins
Change IV catheter every 72 hours
For pity’s sake!
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Slide 76JSOMTC, SWMG(A)
Extravasation
Vesicant drug leaks into surrounding tissue at IV site
Can cause severe local tissue damage
Signs and symptoms
Pain and swelling at site
Delayed healing at site
Infection at site
Tissue necrosis and disfigurement
Loss of function/amputationREALLY!!!
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Extravasation
Treatment
Remove catheter
Elevate extremity
Apply warm or cold packs depending on drug
Monitor site closely
Prevention
Use large, intact vein with good blood flow
Slide 78JSOMTC, SWMG(A)
Arterial Cannulation
IV catheter introduced into artery instead of vein
Signs and symptoms
Large amount of bright red, pulsating blood in flashback chamber of catheter
Blood will usually backflow into tubing if IV administration set is connected
• Due to arterial pressure
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Arterial Cannulation
Treatment
Remove catheter
Apply direct pressure for 10 minutes
Elevate extremity
Apply pressure dressing
Prevention
Avoid using IV sites near arteries
Slide 80JSOMTC, SWMG(A)
Circulatory (Fluid) Overload
Infusing excessive amounts of solutions too rapidly, especially in patient compromised by cardio, pulmonary or renal disease
Signs and symptoms
Increased BP and JVD
Increased respirations and shortness of breath
Crackles on auscultation and cough
Slide 81JSOMTC, SWMG(A)
Circulatory (Fluid) Overload
Treatment
Slow IV infusion rate and, monitor patient's vital signs, keep patient warm, elevate head of bed, and give supplemental oxygen
Prevention
Monitor IV infusion
Identify conditions which can be exacerbated by high volume infusions
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Catheter Related Sepsis
Improper technique in catheter insertion, infusion of contaminated solution, multiple line violation and manipulation, or skin colonization adjacent to catheter site
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Catheter Related Sepsis
Signs and symptoms
Temperature of > 38C or < 36C
Respiratory Rate of > 20 per minute
Heart Rate of > 90 bpm
WBC count > 12,000uL or < 4,000uL or 10% immature forms
Treatment
Remove catheter and administer antibiotic therapy
Prevention
Provide strict adherence to aseptic technique during line insertion, line manipulation and catheter care
Slide 84JSOMTC, SWMG(A)
Pyrogenic Reaction
Febrile phenomenon caused by infusion of pyrogenic organisms, toxins, or chemicals
Reaction can occur during or after infusion (as quickly as 30 seconds)
Signs and symptoms
Sudden rise in temperature (100‐106⁰F)
Nausea and vomiting
Tachycardia
Headache, backache, chills and malaise
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Slide 85JSOMTC, SWMG(A)
Pyrogenic Reaction
Treatment
Remove catheter
Administer antipyretic and antihistamine
Monitor patient’s vital signs
Prevention
Inspect IV solution and equipment for expiration dates and contamination
Ensure strict adherence to aseptic technique
Slide 86JSOMTC, SWMG(A)
Catheter Embolism
Piece of catheter breaks off and travels through vascular system to lungs
Signs and symptoms
Sharp sudden pain at IV site
Minimal blood return during IV patency check
Rough and uneven catheter noted on removal
Cyanosis, chest pain, tachycardia, and hypotension
Slide 87JSOMTC, SWMG(A)
Catheter Embolism
Treatment
Immediately place patient in left lateral decubitus w/the head down
Administer high flow oxygen
Evacuate for surgical removal of catheter tip
Prevention
Once you pull needle out of IV catheter, never re‐insert it
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Slide 88JSOMTC, SWMG(A)
Air Embolism
Large volume of air enters blood stream via IV administration set
Death may occur if large bubble of gas becomes lodged in heart stopping blood from flowing from right ventricle to lungs
20 ml of air may show symptoms and 70 to 150 ml of air can be fatal
Slide 89JSOMTC, SWMG(A)
Air Embolism
Signs and symptoms
Anxiety, dyspnea, tachypnea, chest pain, agitation or disorientation, shortness of breath, cyanosis, sudden loss of consciousness, and circulatory shock or sudden death
Treatment
Immediately place patient in left lateral decubitus w/the head down
Administer high flow oxygen
Prevention
Prime and monitor IV administration set
Slide 90JSOMTC, SWMG(A)
Demonstrate Initiating and discontinuing a peripheral IV
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Slide 91JSOMTC, SWMG(A)
Questions?
Slide 92JSOMTC, SWMG(A)
Agenda
Identify the physiology, indications, and contraindications of IV fluids
Identify the indications and considerations for a peripheral IV
Identify the peripheral IV sites
Identify the characteristics of common IV equipment
Slide 93JSOMTC, SWMG(A)
Agenda
Identify the steps for initiating and discontinuing a peripheral IV
Identify the complications of IV fluid therapy
Demonstrate initiating and discontinuing a Peripheral IV
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Reason
Hemorrhagic shock is a leading cause of death on the battlefield
Infusion of intravenous fluids and blood products will help sustain the casualty until surgical intervention occurs
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References
Fluids and Electrolytes Made Incredibly Easy, 5th edition, 2011
The ICU Book, 3rd edition, 2007
AACN Essentials of Critical Care Nursing, 2006
Infusion Nursing an Evidence Based Approach, 3rd edition, 2010
PHTLS Manual, Military 7th edition, 2011
Slide 96JSOMTC, SWMG(A)
Terminal Learning Objective
Action: Communicate knowledge of IV fluid therapy
Condition: Given a lecture and demonstration in a classroom environment
Standard: Received a minimum score of 75% on the written exam IAW course standards
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IV Fluid Therapy Lecture and DemoPFN: SOMPSD03
Hours: 2.0
Instructor: