IV therapy....easily to practice

Intravenous Therapy



IV THERAPY
I n d i c a t i o n s


Establish or maintain a fluid or electrolyte
balance

Administer continuous or intermittent
medication

Administer bolus medication

Administer fluid to keep vein open
(KVO)
Administer blood or blood
components
Administer intravenous
anesthetics
Maintain or correct a patient's
nutritional state
Administer diagnostic reagents
Monitor hemodynamic functions

Steel Needles



Example: Butterfly Catheter

They are named after the wing-like plastic tabs at the base of the needle. They are used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples (although not routinely, since the small diameter may damage blood cells). These are small gauge needles ( i.e. 23 gauge )


Over the Needle Catheters

Example: Peripheral IV catheter.



This is the kind of catheter you will primarily be using

To deliver large amounts of fluid, select a large vein & use a 14 or 16-gauge catheter.
To administer medications, an 18 or 20-gauge catheter in a smaller vein will do.


veins of hand



Three Main Types of Fluids: Isotonic fluids

Examples: Lactated Ringer's ( LR )
Normal Saline ( NS ) or 0.9% Saline in Water

Hypotonic fluids

Example: D5NS.45 (5% Dextrose in 1/2 Normal Saline

Hypertonic fluids

Examples: 9.0% NS,
Blood products
Albumin



Preparation: It is important to gather all the necessary supplies before you begin. You will need






Absorbent disposable sheet

1 alcohol prep pad

1 Betadine swab

Tourniquet

IV catheter

IV tubing

Bag of IV fluid

four pieces of tape (preferably paper tape or easy to remove tape which has been precut to approximately 4 inches (10cm) in length and taped conveniently to the table or stretcher
.
Disposable gloves

Gauze (several pieces of 4x4 or 2x2)

It is important to point out that starting an IV is an ART - form which is learned with experience accumulated after performing many IVs. Some patients are easy but many are difficult.


Prepare the IV fluid Administration set




Inspect the fluid bag to be certain it contains the desired fluid, the fluid is clear, the bag is not leaking, and the bag is not expired


Select either a Mini/ Micro or Macro drip administration set and uncoil the tubing.
Do Not let the ends of the tubing become contaminated.


Close the flow regulator (roll the wheel away from the end you will attach to the fluid bag).
Remove the protective covering from the port of the fluid bag and the protective covering from the spike of the administration set.

Insert the spike of the administration set into the port of the fluid bag with a quick twist.
Do this carefully.

Be especially CAREFUL NOT
puncture yourself

Hold the fluid bag higher than the drip chamber of the administration set. Squeeze the drip chamber once or twice to start the flow. Fill the drip chamber to the marker line (approximately one-third full). If you overfill the chamber, lower the bag below the level of the drip chamber and squeeze some fluid back into the fluid bag.


Open the flow regulator and allow the fluid to flush ALL the AIR from the tubing. Let it run into a trash can or even the (now empty) wrapper the fluid bag came in. You may need to loosen or remove the cap at the end of the tubing to get the fluid to flow although most sets now allow flow without removal.


Take care not to let the TIP of the administration set become contaminated.
Turn off the flow and place the sterile cap back on the end of the administration set (if you've had to remove it). Place this end nearby so you can reach it when you are ready to connect it to the IV catheter in the patient's vein.

Perform the Venipuncture


Be sure you have Introduced Yourself to your Patient and Explained the Procedure.

Apply a Tourniquet high on the upper arm.



It should be tight enough to visibly indent
the skin, but not cause the patient discomfort.

Have the patient make a FIST several times
in order to maximize venous engorgement.

Lower the arm to increase vein engorgement.


If you cannot easily see a suitable vein, you can sometimes feel them by palpating the arm using your fingers (not your thumb) The vein will feel like an elastic tube that "gives" under pressure.


Select the APPROPRIATE vein


Wear disposable GLOVES


Clean the entry site carefully with the alcohol prep pad



Allow it to dry.
Use a circular motion starting with the entry site and extending outward about 2 inches.
(Using alcohol after betadine will negate the effect of the betadine)

Note:

Some facilities may require an alcohol prep without Betadine.


To puncture the vein, hold the catheter in
your dominant hand



With the bevel up, enter the skin at about a 30 to 45 degree angle and in the direction of the vein. Use a quick, short, jabbing motion. After entering the skin, reduce the angle of the catheter until it is nearly parallel to the skin. If the vein appears to "roll" (move around freely under the skin), begin your venipuncture by apply counter tension against the skin just below the entry site using your nondominant hand. Many people use their thumb for this. Pull the skin distally toward the wrist in the opposite direction the needle will be advancing. Be carefully not to press too hard which will compress blood flow in the vein and cause the vein to collapse. Then pierce the skin and enter the vein as above.


Advance the catheter to enter the vein until blood is seen in the "flash chamber" of the catheter.



If you are unsuccessful in entering the vein and there is no flashback, then slowly withdraw the catheter, without pulling all the way out, and carefully watch for the flashback to occur.



If after several manipulations the vein is not entered TRY again in the other arm


After entering the vein, advance the plastic catheter (which is over the needle) on into the vein while leaving the needle stationary. The hub of the catheter should be all the way to the skin puncture site. The plastic catheter should slide forward easily.

DO NOT FORCE it ! ! !
Release the Tourniquet.

Apply gentle pressure over the vein just proximal to the entry site to prevent blood flow.



Remove the needle from within the plastic catheter.

NEVER reinsert the needle into the plastic catheter while it is in the patient's arm! Reinserting the needle can shear off the tip of the plastic catheter causing an EMBOLUS. Dispose of the needle in an appropriate SHARPS container. Remove the protective cap from the end of the administration set and connect it to the plastic catheter. Adjust the flow rate as desired.

Tape the catheter in place using the strips of tape and/or a clear dressing.



Label the IV SITE with the:
Date
Time
your Initials

Monitor the infusion for proper
flow into the vein
( in other words, watch for infiltration


Occasionally, you may
inadvertently enter an artery.

You'll recognize this because Bright RED blood is quickly seen in the IV tubing and the IV bag because of the high pressure that exists.

If this occurs, stop the fluid flow, remove the catheter, and put pressure on the site for at least 5 minutes.


It is sometimes helpful to draw blood after you have entered the vein and before you have connected the IV tubing and bag. You can easily withdraw blood into a 15 or 20 ml. syringe
and then inject it into blood vials. Be sure to fill the vials to at least three quarters full


To recall the order of the blood tubes, remember the pneumonic:
Red Blood Gives Life
for
RED, BLUE, GREEN,
LAVENDER
* Top Tubes.




Gently rock the tubes back and forth a few times to MIX the blood with the additives. There is NO need to rock the RED TOP tube, however, the blood in this tube will CLOT quickly because it contains NO additives

It should NOT be shaken because this will destroy the sample.


To Discontinue an IV

Remember to observe Universal Precautions. Start by clamping off the flow of fluids.
Then gently peel the tape back toward the IV site. As you get closer to the site and the catheter, stabilize the catheter and remove the rest of the tape from the patient's skin.
Then place a 4 x 4 gauze over the site and gently slide the plastic catheter out of the patient's arm. Use direct pressure for a few minutes to control any bleeding. Finally, place a band aid or plaster over the site.


How to correctly apply a warm, moist compress

Put a bath towel under hot water and wring it out. Then fold it in half (by width not length) and enclose the arm from fingertips to elbow in the towel. Now place the towel-wrapped arm into a plastic bag and seal the open end of the bag near the elbow. While the pack is working (using heat to cause venous dilation), you can be setting up your supplies and be ready to perform the


Venipuncture as soon as you remove the pack. It works wonders! Many professional, experienced IV Therapy nurses would not even consider performing a Venipuncture on patient with limited venous access without using a pack first.


To Calculate IV Flow Rates

Administration sets come in Two Basic Sizes:

Microdrip Sets :

Allow 60 drops ( gtt ) / ml. through a small needle into the drip chamber. Good for medication administration or Pediatric fluid delivery.


Macrodrip Sets :

Allow 10 to 15 drops / ml. into the drip chamber. Great for Rapid fluid delivery. Also used for routine fluid delivery & KVO..



F O R M U L A




(Volume in ml. ) X (drip set )
gtta/min = -------------------------------
( Time in minutes )





Doctor’s Order: Patient to receive 250 mL of Normal Saline Solution (NSS) over a 90 minute time period. You decide to use a Macro drip (10gtt. / mL) administration set. The Formula will now look like this :

ns 250 ml x 10
------------------
time 90


answer = 27.7 or 28 /min

my best wishes............Reeuoom