IV THERAPY TRAINING

[Audio] Good day! Welcome to Intravenous Therapy Training. The aim of this thrainig is for you to be able to know the nursing guidelines in IV therapy, determine the different types of IV fluids and how it works in our body. Also this is to review the basic parts, types of IV cannula and IV set, Identify the different IV complications, signs, symptoms, nursing interventions and accurately calculate IV fluid rates..

[Audio] The following slides will talk about the Nursing Guidelines in IV therapy specifically nursing care and management in IV administration.

[Audio] Let us start with the review of the policies and procedures on IV administration and cannulation with reference to internal policies and procedures number eight and modhs nursing policies and procedures pages ninety three to ninety six..

[Audio] As part of the patient's rights, it is our responsibility to always inform the patient about the procedure and to obtain verbal consent from them..

[Audio] It is important also to involve the patient in their care and the way to do this, is to educate them or significant others about the purpose of the procedure, the precautions to take such as contraindicated IV sites and expected outcome of the procedure. All education provided to the patient must be documented in nurse's notes or nursing process and nursing care plan as necessary..

[Audio] Inserting IV cannula serves an important role in patient's treatment. It is a vehicle used to sustain patients who are unable to take fluids orally. IV fluids replaces water, electrolytes, nutrients more rapidly than oral medications. Furthermore, IV therapy increases fluid volume and access to vascular system in case of dehydration. Lastly, IV cannulation serves as a vehicle for drug medications and blood components..

[Audio] How do we select the right vein for IV cannula insertion? The priority consideration is for patient's Comfort and Safety. Use veins on the non-dominant hand to provide comfort and to avoid frequent dislodgement of IV catheter resulting to multiple reinsertion. Next is to choose the suitable IV site. Avoid using veins that are located on areas of flexion. Do not use the limb for or after surgery like Arteriovenous fistula . Third, select the appropriate Vein according to its condition. Do not use varicose, tortuous and hard veins. Previous insertion site should not be reuse for cannulation. Fourth, choose a vein depending on the Purpose and Duration of therapy. For Blood Transfusion, Parenteral Nutrition, chemotherapy and other vesicant solutions, use large and palpable veins. Lastly, select a vein according to patient's age and condition..

[Audio] The human body has at least thirty four main veins and many more smaller veins that are connected to capillaries, but not all of them can be used for IV insertion. The ideal veins that can be used are the metacarpal, basilic and cephalic veins. In some conditions like children two years old and below, renal patient's with A-V-F or reserved vein for A-V-F creation, and for patients with compromised upper limb circulation in case of mastectomy, we can use the lower limb..

[Audio] Shown in the slide are the recommended IV sites for insertion which are digital dorsal vein, dorsal metacarpal vein, dorsal venous network, cephalic vein and basilic vein..

[Audio] After identifying the ideal veins for insertion, you have also to consider these important points in order to avoid complications and maintain asepsis. There are some deep veins that lie beside arteries and nerves. Thus, You must be careful in identifying a vein from an artery because arteries cannot carry the solution into the heart and the patient might bleed profusely if you hit it. In addition to that, punctured nerves can cause paralysis. So, in choosing IV site, it is least priority to select the lower limbs since it can easily cause phlebitis or varicosities. In difficult Intravenous access, you can choose small veins for insertion but only for short term use. Remember also that the normal circulatory time is fifteen seconds which is the time it takes for the oxygen to circulate back to the heart and then up to the brain. Furthermore, it is easier to identify a vein and an artery from its characteristics. Arteries are deeper, larger and thicker while veins are usually superficial that makes it more palpable. A suitable vein should feel round, firm, elastic and engorged and not hardened, bumpy or flat. For easy access, distend the vein and make it more visible by applying tourniquet about eight to fifteen centimeter above the insertion site..

[Audio] In selecting a vein, use the non dominant hand or arm following the priority of choice In order to avoid frequent dislodgement of IV cannula. First, use the metacarpal vein. Second choice willl be the basilic, cephalic and the medial veins of lower arm. The third choice will be the veins in antecubital area or upper arm. Remember also that infections such as phlebitis and systemic infection can be from intravenous device. To prevent this complications from happening, observe the five moments of hand hygiene in IV therapy, use proper personal protective equipment and disinfectant during IV cannulation. Equipment used for IV therapy such as infusion pump and IV set especially continuous IV drips should be maintained as a closed system..

[Audio] In reference to the policy stated in I-P-P Number NUR 023 entitled IV Cannulation , only the registered nurse who are certified in IV therapy management shall initiate and discontinue peripheral lines to ensure safe and correct technique in initiation and discontinuation of IV line..

[Audio] Infections can be acquired thru devices like IV catheter where microorganisms can travel through the blood circulation. In order to prevent this, infection prevention measures should be applied such as review of device days. To do this, place a label on the IV site dressing with the following information, date and time, the size of cannula and the initial and employee number of the person who changed the IV dressing. The recommended time of changing the IV site dressing is at least once every twenty four hours unless it is soiled or loosened..

[Audio] Ideally, only one IV access must be inserted to the patient to avoid pain and infection but in some cases that are life threatening, a second IV access is needed. For difficult intravenous access, the physician can insert central line catheter or Port-a-cath. All IV therapy procedures including IV medications must be documented in medication administration record and in the nurse's notes. To prevent IV complications and to ensure that the IV catheter is patent and intact, hourly observation for patient's response to therapy in adult patients and every half an hour in children must be done..

[Audio] Line reconciliation is important in prevention of infection. It means that the IV tubings must be checked and reviewed to determine if the patient still needs the line. If IV cannula is no longer needed, it must be removed as soon as possible. For suspected infection, blood culture can be done to determine the type microorganism that caused the infection and appropriate antibiotics to be given. Another important point is during difficult cannulation especially on children. In case like this, inform the doctor and get assistance for insertion. All procedures done regarding IV therapy must be documented..

[Audio] The next topic is about the types of IV fluids, IV cannula and IV set. This slide will discuss about the types of IV fluids and how it works. Water is essential to every cell in our bodies. In fact, our bodies are made up of about sixty percent of water. If you don't have enough water it can lead to a serious condition like severe dehydration. But the good thing is, it can be treated by administration of IV fluids. Different conditions require specific type of IV fluids where we are going to discuss on the next slides..

[Audio] The main objectives of these slides is for you to understand the different types of IV fluids, to know the priority nursing considerations for each type of IV fluid, to determine which type is appropriate according to patient's condition and to review the basic parts of IV cannula, sizes and the types and parts of IV set..

[Audio] Before discussing the types of IV fluids we have to understand first the different fluid compartments. Fluids are distributed in different areas of our body. It is placed inside the cell which is called the intracellular fluids, inside the blood vessels referred to as intravascular fluids and the interstitial fluids which are located in between the cells and the blood vessels. The doctor will determine which type of IV fluid to prescibe to the patient according to the type of IV fluid lost and any associated electrolyte or acid base abnormalities..

[Audio] The two major types of IV fluids are the colloids and crystalloids..

[Audio] Colloid solutions contain large molecule that can pass through the semi permeable membrane but not as easily as the crystalloids. Some examples of colloid fluids are albumin twenty five percent, five percent and ten percent dextran. In this training, we will focus on the crystalloid fluids. These are made up of small solutes that can pass through the semi-permeable membrane. The three types of crystalloid solutions are isotonic, hypotonic and hypertonic solutions which we are going to discuss in details on the next slides..

[Audio] Hypotonic solutions contain more concentration of water than solute. For better understanding, Solute is a substance that is dissolved in a solution such as salt. So, when we give hypotonic solution the body's cell will take up the water and it will become swell. Hypotonic solution also has lower osmolality or basically less concentrated because the water dilutes the solute. The examples of hypotonic solutions are one half normal saline or zero point forty five percent sodium chloride, one third normal saline or zero point thirty three percent sodium chloride and one fourth normal saline or zero point two two five percent sodium chloride. Two point five and five percent dextrose in water are considered hypotonic solutions once it enters the cell. In which condition is hypotonic solution used for? Mainly the function of this solution is to treat cellular dehydration. It is done by adding intracellular fluid. Also, hypotonic solution lowers down sodium level in case of hypernatremia by diluting the sodium with water. In case of diabetic ketoacidosis, blood sugar level and blood acidity are reduced by diluting the glucose with water thus, maintaining acid-base balance..

[Audio] Five percent dextrose in water is considered as isotonic solution while it is still in the solution bag because the concentration of water and the solute is equal. Once it is administered to the patient, the cell will take up the glucose and retains the water, making it a hypotonic solution. With all types of IV fluids and IV medications, there are special precautions that we need to consider before giving it to the patient. Five percent dextrose in water should not be given to patients with increased intracranial pressure. The high concentration of water adds more pressure to the brain and makes the swelling worse. It should not be given also to diabetic patients because of its glucose content..

[Audio] When giving hypotonic solution you should consider this things to avoid complications. This type of IV fluid adds pressure to the brain from high concentration of water so it should not be given to patients with increase intra-cranial pressure like bleeding in the brain, a tumor, stroke, aneurysm and high blood pressure. During administration of hypotonic solution, watch out for risk of cerebral edema, extracellular hypovolemia and hypotention. Adminiter the solution slowly to prevent intracellular fluid overload. Hypotonic solutions can cause blood hemolysis so it should not be given along with blood products. Be cautious in giving hypotonic solution to patients with burns, liver disease and trauma as this can increase fluid volume outside the intravascular space..

[Audio] The other type of crystalloid is the Hypertonic solution. It contains lower concentration of water than solute. The water moves out from the cell making it shrink. The examples of this type of solutions are three percent normal saline, five percent normal saline, five percent dextrose in half normal saline, five percent dextrose in lactated ringers, fifty percent dextrose in water and ten percent dextrose in water. Hypertonic solution is given in order to reduce intracranial pressure by moving out water from the intracellular space. In addition to that, if blood has low sodium level or hyponatremia the patient needs to receive high level of solute which is sodium that is present in hypertonic solution..

[Audio] To monitor for any complications such as hypervolemia, you need to check first the baseline vital signs for comparison. Since water is drawn out from intracellular to extracellular compartment, there is a greater risk of hypervolemia. For patient's who has low cardiac output or kidney problem where there is water retention, it is important to prevent further water overload on the extracellular compartment caused by hypertonic solution. This type of Intravenous fluid has high concentration of solute that can increase the blood sugar level so, complete blood sugar monitoring should be done..

[Audio] Isotonic solution has an equal concentration of water and solute. Examples of this solution are zero point nine percent normal saline and lactated ringers solution. Do not give lactated ringers solution to patients with kidney problem because it can not excrete potassium and giving this intravenous fluid increases more the potassium level. Lactated ringers solution also contains lactate which cannot be metabolized by the patient with liver impairment. Isotonic solution is used to replace fluid inside the blood vessels or intravascular space. In case of dehydration from diarrhea or vomiting, blood loss from trauma or surgery and burn, the water inside the blood vessels shift to extracellular compartment. In order to replace this lost fluid, give isotonic solution..

[Audio] In giving all types of intravenous fluids, always check the baseline vital signs. Watch out for signs of fluid volume overload on the intravascular space and continued hypovolemia on the extracellular space. If there is presence of edema, elevate the patient's legs to facilitate venous return. Involve the patient in the care by educating them and their families to report signs of fluid overload. Hypervolemia is a serious complication so closely monitor the patient especially those with heart failure..

[Audio] Understanding other types of solutions like vesicant plays an important role in preventing Intravenous therapy complications. Vesicant solutions are solutions that can cause severe tissue injury or extravasation. This solutions are thick that it can lead to blistering, tissue ischemia and necrosis. We have to be familiar with this solutions or medications that are vesicant and how to use it properly including dilution and duration of infusion in order to avoid such complication. Some examples of vesicant solutions are dilantin, antibiotics, vasopressors, electrolytes, chemotherapy, total parenteral nutrition and blood products. Vesicant solutions must be administered more than one hour, sholud follow the protocol for standard dilution and administered via mini bag or IV bolus via side port of a free-flowing IV infusion..

[Audio] During administration of a vesicant solution, do your purposeful hourly rounding with inspection of IV site and taking note of any complication such as infiltration to avoid a more severe complication like extravasation. For patient satisfaction and involvement, ask the patient to report any onset of pain and burning or discomfort in the IV site. As part of the purposeful hourly rounding, place the call bell within the patient reach. Any complication noted, immediately stop the infusion..

[Audio] Going back to basics, let us review the different parts of intravenous cannula and set used..

[Audio] Intravenous cannula is a thin, flexible tube designed to administer fluids or medications, blood products or nutrition directly into the patient's bloodstream. The luer lock plug secures the connection between the IV cannula and other medical devices or infusion system. Flashback chamber is a transparent reservoir that visually confirms successful vein entry by displaying a flashback of blood. The needle grip enhances the control and precision of the staff ensuring a smooth and accurate placement of cannula. The catheter hub and wings serves as anchors, providing stability during insertion and securing the cannula in place once successfully placed in the patient's vein. The valve regulates the flow of fluids preventing backflow and maintaining a controlled administration of medications or fluids. The injection port is a dedicated site for administering additional medications without disturbing the primary line. The catheter is a flexible tube that remains in the patient's vein facilitating smooth delivery of fluids or medications directly into the patient's bloodstream. The bushing reinforces the connection between the catheter and the hub preventing leaks. The needle serves as the initial puncturing point , creating an entry of the cannula into the patient's vein..

[Audio] IV cannulas come in different sizes, each catering to specific medical needs. The length of an IV cannula is denoted by the gauge, with lower gauge numbers indicating larger cannulas. Commonly used sizes include gauges fourteen, sixteen, seventeen, eighteen, twenty, twenty two, twenty four and twenty six. Larger gauges allow for a faster flow of fluids, making them suitable for situations where rapid fluid administration is required, such as in trauma cases. For easy identification, each size corresponds a color, red for gauge fourteen, gray for gauge sixteen, white for gauge seventeen, green for gauge eighteen, pink for gauge twenty, blue for gauge twenty two, yellow for gauge twenty four and purple for gauge twenty nine. In emergencies where rapid fluid resuscitation is paramount, a larger gauge IV cannula, such as gauge fourteen, is recommended. For routine hospital scenarios, where a balance of fluid delivery and patient comfort is essential, healthcare providers often opt for gauge eighteen or gauge twenty cannulas. In pediatric cases or with fragile patients, a smaller gauge IV cannula, such as gauge twenty two, may be chosen to minimize discomfort and the risk of complications..

[Audio] To ensure the safe and efficient administration of intravenous treatments, healthcare professionals rely on various IV set parts. These components, often taken for granted, play a significant role in the overall functionality and reliability of IV infusion systems. Before going into the specific parts of an IV set, it's important to understand the overall structure and purpose of these devices. An IV set is a disposable, sterile, and single-use system that connects the medication or fluid container to the patient's vascular access site. It is typically consists of various components such as IV tubing, drip chambers, filters, injection ports, connectors, flow regulators, and needles or catheters. IV tubing forms the primary pathway through which medications and fluids flow from the IV bag to the patient's bloodstream. Drip chambers are small, cylindrical chambers located between the IV tubing and the patient's access site. Their main function is to allow healthcare providers to visually monitor the flow rate of fluids and detect any air bubbles before they reach the patient. IV filters are crucial for removing particulate matter, air bubbles, and contaminants from IV fluids prior to patient administration. They effectively prevent the infusion of harmful particles, reducing the risk of complications like embolism or infection. injection ports and Y-sites are specialized components of an IV set that allow for the administration of additional medications or fluids without disrupting the primary infusion. Injection ports are small, self-sealing access points that healthcare professionals can use to introduce medications or draw blood samples. Y-sites connect two IV lines into a single line, allowing simultaneous administration of various fluids or medications. Connectors are integral parts of an IV set that facilitate the secure attachment of different components, such as tubing, filters, and injection ports. They ensure a tight seal and prevent leakage, reducing the risk of contamination and medication errors. Flow regulators are mechanisms that control the rate of fluid administration, allowing healthcare providers to precisely adjust the flow according to the patient's needs. Needles and catheters are essential components for gaining vascular access and delivering medications or fluids directly into the patient's bloodstream..

[Audio] There are two types of iv sets. A filtered IV set has a filter in the tubing that prevents any foreign matter from entering the bloodstream. This is important because it ensures that the patient receives only sterile solutions through their IV. Filtered IV sets are mainly used when there is a risk of infection or contamination..

[Audio] Gravity tubing is the most common type of IV set used in hospitals today. It consists of a plastic bag hung from a pole or hook, which holds it in place at a certain height above the patient's bed. The fluid is pushed through the tube and into the patient's bloodstream by gravity's force. Gravity tubing is used for delivering fluids and medications that do not need to be administered quickly because gravity will help move them from the bag down into the patient's vein at a slow but steady rate. Air Vent is a little blue hole in the side of the vented IV sets. The lid may be opened and closed by medical staff to let air in, displacing the fluid as it exits. A non-vented IV set does not include a removable air vent. This sort of intravenous set is required for use with flexible plastic containers. Before attaching a non-vented IV set to a patient, the tubing must be filled with IV fluid to eliminate the presence of air. As the IV bag empties, the tubing produces a vacuum, causing the bag to collapse..

[Audio] The main goal of nursing care is to aid in patient treatment and recovery. Delays in treatment, extended hospital stay and sentinel events can happen due to inadequate preventive measures, incorrect assessment, poor intervention and failure in patient monitoring. The following slides will discuss about the different IV therapy complications, presenting signs and symptoms, prevention and nursing interventions for each type of complications..

[Audio] The aim of these presentation is for you to identify the different IV therapy complications according to signs and symptoms thru assessment and to Know the prevention and nursing intervention for each type of complications.

[Audio] Local complications happens on the site of insertion. It includes infiltration, extravasation, thrombophlebitis, phlebitis and hematoma. The following slides will provide a brief overview of these local complications.

[Audio] This slide shows us a picture of an iv infiltration. Infiltration happens when the IV catheter is dislodged or out of the vein causing the infusate to leak on the surrounding tissues instead of going to the blood circulation. The leaked infusate causes swelling and pain as signs of injury or damage to the tissues. The patient will also feel a burning sensation, tightness and blanching due to inflammation. The skin on the insertion site is cool to touch and there is a decrease or stopped flow rate indicative of fluids or medications trapped into the tissues..

[Audio] Extravasation is the same as with infiltration where the IV catheter is out of the vein or dislodged. The difference of extravasation from infiltration is the type of solution infused. Extravasation is caused by vesicant solutions. The signs and symptoims of this complications are Blanching, Burning and Pain, Cool skin around the intravenous site, Swelling at or above the site , Blistering and or skin sloughing..

[Audio] Infiltration and extravasation can lead to more serious complications. These steps are guide to prevent this type of complications. Select proper IV site. Avoid areas of flexion or the dominant hand to keep the site intact especially for long term use. Unsuitable size of cannula can damage the vein resulting in infiltartion, so properly assess the vein and the type of infusion such as blood transfusion and select the appropriate size of the cannula. Make sure that IV dressing is not to tight and not too loose, just enough to cover and secure the IV site. For neonates and pediatrics who are frequently moving, see to it that the IV catheter is stable by placing immobilizing device. Make nurse's rounds purposefuly every hour to monitor the IV site for any sign of complications. Do accurate assessment starting with inspection. Inspect the IV site for presence of inflammation and also by doing pain screening. Always use an infusion pump for accurate rate of infusion and it helps also for signals of occlusions thru the alarm system. Miscalculations of IV fluid rate and medications can lead to damage of the vein which eventually leads to infiltration and extravasation..

[Audio] If you noted any sign and symptoms of infiltration and extravasation, immediately stop the infusion to prevent aggravation of the condition. Do not wait for a new device to be inserted before removing the IV cannula on the site with complication. Prolonging the device in placed can cause infection. Elevate the affected limb to pomote comfort and facilitate blood flow. Warm compress promotes vasodilation letting the medication or fluid distribution in other surrounding tissues and it also promotes blood circulation. Cold compress keeps the solution or medication in one region of tissue to spare other tissues from the infusate. Monitor the site as frequent as hourly. Inform the main responsible physician, do an incident report and document in nurse's notes and nursing care plan. Find another vein to insert a new line..

[Audio] Another local complication from intravenous therapy is thrombophlebitis. It is defined as inflammation of the vein due to blood clot. The clot hinders the infusate to pass through the blood circulation causing from recent use of IV line or after trauma of the vein. As manifestations, the IV site appears red, inflammed, tender, hard and warm. These are related to the damage of vein walls and trapped blood clot. The patient may complaint of pain from vein injury..

[Audio] Phlebitis is the inflammation of vein caused by infection. The patient may present signs and symptoms of infection such as pain, swelling, warm IV site and itching. Because the vein wall is damaged, the red line above the insertion site is evident. This is the unique characteristic of phlebitis. On skin palpation, you can feel changes in the texture of the surrounding skin. It becomes thick and hard..

[Audio] Before any complication can happen there are preventive measures that can be done. For phlebitis and thrombophlebitis it is important to monitor IV treatment like administration of antifibrinolytic drugs. To avoid the invation of infection, change the IV site at recommended time. That is after 96 hours or 4 days from insertion. Change IV dressing daily or if it is loosened, wet or unclean. Microorganisms that cause phlebitis can be prevented by hand hygiene, use of clean gloves and by using the approved antiseptic solution which is the seventy percent alcohol swab. Inserting on areas of flexion like the joints and wrists can easily dislodge the IV cannula that results to vein wall injury..

[Audio] Any sign of phlebitis and thrombophlebitis noted stop the infusion immediately to avoid further damage to the vein. Elevate the limb and apply warm compress to promote comfort and blood circulation. Do not use hot or moist compress that can burn the patient's skin. Perform venipuncture in different location and re-start the infusion. Inserting in previously used vein is more risky to develop blood clots..

[Audio] Another complication from IV therapy is hematoma. Due to vein wall damage from different causes the blood seeps out from the blood vessels to the surrounding tissues. The causes of hematoma are from inappropriate use of tourniquet. Apply the tourniquet for less than 1 minute and it should not be to tight. Do insertion in one vein only once. If there is no backflow from insertion, remove the IV catheter and do not puncture the vein multiple times. Some patients also has conditions like cogaulation defects making them more susceptable to bleeding or hematoma. Also, after removal of IV catheter, apply pressure on the site for 5 minutes to prevent this complication..

[Audio] Hematoma can be managed by frequently assessing the IV site. The initial response of an injury is pain and by pain screening you can easily identify early signs of complications. In addition to that, whenever you do IV insertion, make sure that you choose the good vein and take time to do it slowly and not in a hurry. When hematoma is noted, immediately remove the device and apply pressure on the insertion site for at least 5 minutes..

[Audio] A more severe complications that can happen from IV therapy is when it becomes systemic. It requires an extensive intervention, both medical and nursing in order to treat the patient. The following slides will discuss the different systemic complications of IV therapy, the signs and symptoms, prevention and nursing interventions. Systemic complications include embolism, systemic infection, speed-shock, circulatory overload and allergic reactions..

[Audio] A dangerous complication that can greatly harm the patient is embolism. An embolus is a particle, usually blood clot that moves about in the blood vessels which travels to the lungs and heart. Since it goes with the blood circulation, it can easily blocks the airways. The affected organs are the heart and lungs thus, the signs and symptoms are related to cardiovascular problem. The patient will experience shortness of breathing and chest pain because the air cannot pass through the airways caused by the blood clot that blocks it. Due to inadequate oxygenation, the brain will be deprived causing the patient to faint or even loose consciousness. Other symptoms that may occur are a cough that may include bloody or blood-streaked mucus, rapid or irregular heartbeat, lightheadedness or dizziness, excessive sweating, fever, leg pain or swelling, or both, usually in the back of the lower leg and cyanosis..