INTRAVENOUS FLUID THERAPYY

- involves the administration of water, nutrients (e.g. dextrose, protein, fats, & vit.), electrolytes,
blood products & medications.
- used for fluid replacement or fluid maintenance to treat disorders like dehydration,
malnutrition, and electrolyte imbalance

IV catherers/cannula

Types:

 Insyte
 Venflon
 Neoflon (for pediatric px)

Winged Steel Needle Set (Butterfly)

Advantages:

 Easiest device to insert

 Ideal for non-irritating IV push drugs

Needle Selection

Recommended Gauges:

1. Gauge 16-18 – Trauma

2. Gauge 18-20 – Infusion of hypertonic solutions; blood administration
3. Gauge 22- 24 – Pediatric patients
4. Gauge 22 – Patients with fragile veins

IV parts:

 Roller clamp
 Bag spike
 Needle end
 Auxillary clap
 Drip chamber
 Injection part/ Y port

Complications

Local:

 INFILTRATION
- Results when the infusion cannula becomes dislodged from the vein and fluids are infused into
the surrounding tissues

S/S:

- Increasing edema at the site of the infusion

- Discomfort, burning, pain at site
 - Feeling of tightness
- Decreased skin temp
- Blanching at site
- Absent backflow of blood
- Slower flow rate

Interventions:

 Lower IV bottle
 Kink tubing near insertion site. If there’s blackflow = patent

Nursing considerations:

 Check infusion site

 Discontinue if symptoms occur
 Restart infusion at different site
 Limit the movement of the extremity with IV
 Don’t obscure above the site with tape

 EXTRAVASATION
- Occurs when fluids seep out from the lumen of a vessel into the surrounding tissue

Causes:

- Damage to the posterior wall of vein

- Occlusion of the vein proximal to the injection site

Examples of Vesicants:

- Phenergan - Calcium gluconate

- Dilantin - Dopamine
- High concentration of KCl - Sodium bicarbonate

S/S:

- Swelling
- Discomfort
- Burning
- Tightness
- Coolness in the adjacent skin
- Slow flow rate

Nursing Interventions

 Immediately stop infusion and remove device

 Elevate the affected limb
 Apply cold compress to decrease edema and pain
 Apply moist heat to facilitate the absorption of fluid at grossly infiltrate sites

 THROMBOSIS
 - Injury to the endothelial cells of the vein wall, allowing platelets to adhere and thrombus to
form

S/S:

- Painful, reddened, and swollen vein

- Sluggish or stopped IV flow

Nursing Interventions

 Remove the device; restart the infusion in the opposite limb if possible
 Apply warm soaks
 Watch for IV therapy-related infection
 Notify the physician

 THROMBOPHELIBTIS
- Presence of clot plus inflammation of the vein

S/S:

- Localized pain
- Redness
- Warmth
- Swelling at insertion site
- Immobility of extremity
- Sluggish flow rate
- Malaise
- Leukocytosis

Treatment

- Discontinue IV
- Apply cold compress first (to decrease flow of blood and increase platelet aggregation;
- Followed by warmth compress
- Elevate extremity
- Restart IV in opposite extremity

 PHLEBITIS
- Inflammation of the vein in which endothelial cells of venous wall becomes irritated

Causes

- Mechanical trauma from needle or cath.

- Chemical trauma from solution
- Bacteria

S/S:

- Local, acute tenderness

 - Redness
- Warmth
- Slight edema of vein above the insertion sit
- Sluggish infusion

Nursing considerations

- Discontinue infusion immediately

- Apply warm, moist compresses to the affected site
- Avoid further us of the vein
- Restart infusion in another vein

Systemic:

 Embolism (pulmonary embolism, air embolism, catheter embolism)

 HEMATOMA
- Blood leaks into tissues surrounding IV insertion site
- Manifested as ecchymosis and immediate swelling at site

Treatment

- Remove IV
- Apply light pressure with a sterile, dry dressing
- Apply ice for 24hrs
- Elevate extremity
- Restart in other extremity

 SYSTEMIC INFECTION
- Successful transmission or encounter of hosts with potentially pathogenic organism
- Major hazard – septicemia
- Caused by: S. aureus, Klebsiella, Serratia, P. Aeruginosa

S/S:

- Fever, chills & malaise

- Usually with no visible signs of infection at site

Causes

- Failure to maintain aseptic technique during insertion or site care

- Severe phlebitis which can set up ideal conditions for organisms’ growth
- Poor taping
- Prolonged indwelling time of device
- Immunocompromised patient
Nursing Interventions:

 Notify the doctor

 Adm. medications as prescribed
 Culture the site and the device
 Monitor the px’s vital signs

Preventions:

 Use aseptic technique

 Secure all connections
 Change IV solutions at recommended times

 SPEEDSHOCK
- Body’s reaction
 Circulatory overload
 Allergic reaction

-5cc of air that can be introduced to the px can be fatal

FACTORS AFFECTNG THE FLOW:

- Position of the forearm

- Position and patency of tubing
- Height of infusing bottle
- Possible infiltration & fluid leakage, vein trauma, clots, plugging of veins, venous spasm,
vasoconstriction
- Characteristics of fluid: viscosity, temperature

Intravenous fluid trouble shooting:

- Tapping
- Curling
- Aspiration of air using syringe

Common Procedural Problems:

- Fluctuating flow rate

- Sluggish IV
- Tubing disconnection
- Blood back up on tubing
- IV-line obstruction
- Leaks d/t inappropriate device
- Air bubbles
Identify a suitable vein:

Signs of good vein

- Bouncy
- Soft
- Above previous sites
- Refills when depressed
- Visible
- Has a large lumen
- Well supported
- Straight
- Easily palpable

Vein dilation

Technique

- Tourniquet
- BF cuff
- Gravity
- Fist clenching
- Tapping vein
- Warm compress
- Multiple tourniquets

Prevention of IV site infection:

- Wash hands
- Use sterile technique
- Change IV solution q 24 hrs