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Isotonic Hypotonic Hypertonic

Where does water go? Water does not move Moves water into the Moves water out of
into or out of the cells to expand them body’s cells into the
body’s cells Hypernatremic blood stream to correct
Needs IV rehydration; fluid, electrolyte, &
no electrolyte acid-base imbalances
imbalance To expand the vascular
space
Risk for developing? Fluid overload (esp. Phlebitis: inflammation Infiltration:non-
Chart, pg 204 older adults) of a vein from irritation vesicant IV solution
leaks into the tissues
around the vein
Extravasation: Leaking
of vesicant IV solution
or medication into
extravascular tissue
Thrombosis: blood clot in the vein
Examples of solutions 0.9% saline (NS) 0.45% saline (1/2 NS) D10W
D5W D5 in 0.9% saline
D5 in 0.225% saline D5 in 0.45% saline
Ringers Lactate (LR) D5 in Ringer’s lactate
What is “speed Systemic reaction to the rapid infusion of a substance unfamiliar to the
shock”? patient’s circulatory system; the patient feels like they are allergic to the
medication
What is the standard 72-96 hrs
amount of time an IV
can remain in place?
Peripheral IV gauge Table 13-1, pg 190 The larger the number,
the smaller the gauge

Checklist for Blood Administration

Includes blood, platelets, fresh frozen plasma, clotting factors

 Positive patient ID requiring 2 patient identifiers by 2 qualified health care professionals

 Facility ID
 Blood bank # on blood matches patient’s blood bank wrist band
 Type of product being administered
 ABO group of patient and blood
 Expiration of product
 Must have at least a #22 gauge IV
 Change Blood IV tubing q4hrs

What is it and what’s Peripheral Nursing Complications

the procedure? or Central? Considerations
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Vascular Access Encompasses all Both Assess the

Device infusion catheters patient’s need
placed in a blood
vessel to deliver fluids
& medications
Peripheral IV  Placed into the Peripheral  Use smallest Infiltration
superficial veins of gauge Phlebitis
Use sterile the arms for IV possible for Extravasation
technique therapy prescribed Infection
 Use sterile skin therapy
prep and  If therapy >6
technique (pg 191 days,
Chart 13-1), use consider
clean gloves midline
catheter or
PICC
 Placement
(Chart 13-1,
pg 191)
 Flush with 3
mL saline
Midline Catheter  Inserted through Peripheral  Used for Phlebitis
the veins of the therapies Thrombosis
upper arms lasting 1-4 Extravasation
 The tip is located in weeks
the upper arm no  Infuse the
further than the same
axillary vein (pg solutions as
192) peripheral IV
 Strict sterile  Good for
technique for patients on
insertion & drsg anticoagulan
changes ts, steroid
therapy
 Do not use
vesicant
materials
 Do not draw
blood from
this line
 Flush with 5-
10 mL saline
Central Vascular  Placed in the Central  Confirm tip
Access Devices central circulation; placement
(CVAD) or Central superior vena with chest x-
Venous Catheter cava(SVC) near the ray before
(CVC) right atrium use
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 Flush 5-
10mL saline
and
prescribed
dose of
heparin
PICC  Peripherally Central  Single, Phlebitis
(Fig 13-6, pg 193) inserted central double, Thrombophlebi
catheter triple lumen tis, DVT,
 Inserted through a  Power PICC- Catheter
vein in the arm to contrast related blood
the SVC  Monitor CVP stream
 Sterile technique  Infusion of infections (CR-
for insertion all types of BSI)-Prevention
therapy Bundle pg 194
 Draw blood
 Flushing the
PICC (Action
Alert box pg
194)
 Remove
sutures; d/c
in short
segements
 Can remain
long term
Nontunneled CVC  Inserted by MD Central  Confirm Catheter
through the placement related blood
subclavian vein in by chest x- stream
the upper chest or ray infections (CR-
the internal jugular  Used for BSI)-
veins using sterile short term
technique  May have up
 The tip sits in the to 5 lumens
SVC  Remove
 Usually emergent sutures &
placement d/c in short
segements
Tunneled CVC  Portion of the Central  Single, Catheter
(Fig 13-8, pg 195) catheter in the double, related blood
subcutaneous triple lumen stream
tunnel, separating  Need for infections (CR-
from the point infusion BSI)-
where the catheter therapy is
enters the vein frequent
from where it exits and long
the skin term
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 Surgical procedure  Removal is a

for insertion and surgical
removal procedure
 Other Names-
Broviac, Hickman,
Leonard
Implanted port  Consist of a portal Central  Single or Drug Alert pg
(Fig 13-9-10, pg body(Subcutaneou double 196
195) s pocket surgically lumen
created), dense  No part of
septum over a the catheter
reservoir, and a is visible
catheter externally
 Inserted into a vein  Use power
and attached to injection,
the portal body noncoring
needle
(Huber
needle)
 Flush after
each use
and at least
qmonth
 Removal
requires
surgical
tecchnique
Needleless  Used to minimize healthcare workers exposure to contaminated
Connector needles.
 Fig 13-12, pg 198
On-Q  Used to deliver 
PainBuster(mecha intermittent or
nically regulated continuous pain
devices) Fig 13-13, medication
pg 199

Administration
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 Primary set- used to infuse primary IV fluid by gravity or pump

 Secondary/Piggyback set-attached to the primary set at a Y-injection site; used to deliver
intermittent medications.
 When no primary infusion is running, change the tubing every 24 hrs
 Monitor flow rate minimum q 1hr
 Change q72-96 hrs
 Documentation requirements – pg 203
 How to prevent Catheter related bloodstream infections – hand hygiene! Pg 204
 Flushing:
o Valved catheters and positive fluid displacement needleless devices
 S aline
 A dminister medication
 S aline
o CVC’s requiring heparin flush
 S aline
 A dminister medication
 S aline
 H eparin