What is IV therapy?

• intravenous- into the vein
• administration of substances (fluids) directly into the vein
• parenteral route

function of PN

• perform venipuncture, insert peripheral IV'S
• discontinue peripheral IV's
• administer IV fluids
• administer & maintain TPN, PPN, lipids
• may NOT administer (antineoplastic agents, blood products, titrated medications, IV push medications)

indications for IV therapy

• fluids & electrolytes
• medications
• nutrients
• blod products

advantages of IV therapy

1. Bioavailability is immediate (drug enters circulation immediately, permits access to site of action)
2. absorption into bloodstream is complete and reliable
3. large doses can be delivered at a continuous rate
4. no "first pass" effect in the liver (no biotransformation)

disadvantages of IV therapy

• adverse reactions may occur-can be life threatening
• if medication is administered to quickly, allergic reaction can occur
• increased risk of complications

blood vessels

• carry blood away from the heart
• branch off into smaller arteries and eventually into capillaries
• carry OXYGENATED blood

veins

• carry blood to the heart
• blood from the capillaries flow into veins
• carry UNOXYGENATED blood

blood vessel wall

Tunica intima

innermost layer, continuous with the endocardium

blood vessel wall

tunica media

middle layer- smooth muscle and elastic tissue

blood vessel wall

tunica adventicia (externa)

tough outer layer

arteries vs veins

arteries

• thick walls
• no valves
• pulsates
• bright red blood
• high pressure
• carry oxygenated blood

arteries vs veins

VEINS

• thin walls
• valves approximately every 3 inches
• no pulsation
• dark red blood
• lower pressure
• carry unoxygenated blood

what is used for iv therapy and recommended distal to proximal when starting?

veins

IV access: peripheral

located in peripheral veins of upper (and sometimes lower) extremities

-can be placed by nursing (LPN AND RN)

-smallers veins

-slower blood flow

-easy access

IV access: central

located in large vessels near heart- superior veins cava

• inserted via subclavian , internal jugular, femoral
• can only be placed by physicians or specially trained nurses/practitioners

central ALWAYS need x-ray verification before using ANY central line

-usually located in subclavian vein or internal jugular vein (IJ)

(T/F)

true

iv solution

solution containers- bottles

• not commonly used
• made for medications that cannot be in plastic
• easy to visualize the solution & see calibrations
• easier to break
• REQUIRES tubing with a vent (vent must be open to run from a bottle )

iv solution containers - plastic

• most common
• atmospheric pressure collapses bag and forces fluid out
• can be punctured
• ALWAYS inspect before use ( check for discoloration/sediment/cloudiness, expiration date, and compatibility if hanging with other medication)

type of solution

crystalloids

• most commonly used for hydration
• corrects fluid and electrolytes imbalances
• ex: saline solutions, dextrose solution, lactated ringers, plasmalyte

type of solutions

colloids

• volume expanders
• pull fluid into intravascular space
• can be used to treat low BP or shock
• ex: albumin (most common colloid, plasma protein, considered a blood product)

types of solutions

blood and blood products

• blood/blood products are used to restore blood volume or components of blood
• packed red blood cells (acute blood loss)
• fresh frozen plasma (replaces coagulation factors
• platelets (used to control bleeding
• whole blood (restores blood volume)

types of solution: transfusions reaction

hemolytic

dangerous, RBC's attacked by immune system- cells burst

• bleeding (urine)., chest pain, back pain, low BP, chills
• may be a delayed reaction, usually immediate

types of solution: transfusions reaction

Febrile

N/V, fever, chills, headache, chest pain

types of solution: transfusion reaction

allergic

itching, SOB, wheezing , possible rash

types of solution: transfusion reactions

anaphylaxis

Dangerous

• wheezing/stridor, SOB, low BP, cyanosis, anxiety

types of solution: transfusion reactions

circulatory overload

Low SP02, Tachycardia, high BP, dyspnea

Total parenteral nutriton (TPN)

IV infusion of amino acids, vitamins, electrolytes, and minerals

• usually high dextrose concentration
• high dextrose concentration (>10%) can damage veins
• given via central line
• monitor blood sugar levels closely (every 4-6 hours)
• used when GI system cannot be used for feeding
• must be ran on pump-lan can administer

peripheral/partial parental nutrition (PPN)

• lower concentrations
• can be given via peripheral IV line
• patient is also getting nutrition from other sources

lipids

• IV infusion of fat/fatty acids
• essential fatty acid is linoleic acid which is needed for proper metabolism
• lipids are white
• can be administered with TPN/PPN- they are compatible to run together

Intracellular

• fluids inside the cells
• 2/3 of body water
• high concentrations of potassium (K+), phosphate and magnesium ions

extracellular

• fluids outside the cells
• compartments consist of interstitial and intravascular
• high concentration of sodium, chloride and bicarbonate ions
• 1/3 of body water

Iv solutions

Osmosis

movement through semi-permeable membrane (SPM) from an area of lower concentration to an area of higher concentration

• SPM is a barrier that will only allow some molecules to pass through; blocks others
• regulates fluid and electrolyte balance

Iv solutions

tonicity

the osmolarity or concentration of an IV solution

• the amount of solute in a fluid (ex)-dextrose, sodium, etc

Iv Solution:

isotonic fluids

• concentration is the same as blood
• no osmosis takes place/no fluid shifts
• no change in solute or water in the blood
• increases the amount of extracellular fluid (ECF)

uses for isotonic fluids

• replace fluid loss
• dehydration
• mixed with IVPB's

IV solutions:

hypertonic fluids

• fluid has a higher concentration/ osmolality than blood
• osmosis pulls fluids OUT of cells
• cells shrink
• fluid shifts from intracellular to extracellular spaces (to balance the concentration)

Normal saline

• 0.9% NS,NSS
• ISOTONIC-osmolality same as blood
• No calories
• standard IV flush solution
• standard solution for hydration

dextrose solutions

• contain dextrose and free water
• available in different concentrations
• cannot be administered with blood/blood products
• closely monitor diabetic patients

electrolyte solutions:

Lactated ringers

• isotonic solution
• crystalloid
• contains potassium, sodium, chloride, and calcium
• lactate is added as a buffer
• SHORT-TERM USE
• used for fluid loss, dehydration and electrolyte replacement

electrolyte solutions:

Plasmalyte

• isotonic solution
• crystalloid
• combination of: sodium chloride, sodium acetate, sodium gluconate, potassium chloride, and magnesium chloride
• monitor electrolytes (BMP)

IV solutions:

potassium chloride (KCL)

• can be continuous or intermittent
• continuous- maintenance infusion of a solution with potassium added
• intermittent-"K-rider" mini bag of potassium infused over 1-2 hours
• MUST be on an IV pump
• caustic to veins, monitor IV site often
• if infused too fast it can result in hyperkalemia which can lead to cardiac arrest

types of infusions: continuous

• not interrupted
• run at ordered rate
• large volume bag of solution administered continuously over time
• meant to maintain fluid and electrolyte balance

types of infusions :

intermittent- IVPB

• not continus
• intermittent infusion that us connected to the highest port of the continuous primary IV line
• be sure to check compatibility with primary infusion prior to hanging an IVPB medication
• IV piggy bank (ivpb)

Types of infusions: intermittent- IV push

• medications delivered within minutes
• pushed through saline lock manually- must flush the line with NSS before and after administering an IVP medication
• delivery is immediate
• must be administered by the RN, LPNS are not allowed to give IVP's -not in scope of practice

saline flushes

• LPN can perform saline flushes
• flush directly into the IV line
• flush saline locks at least every 8 hours or per facility policy to maintain patency of the IV line
• 3-10 mL of NSS

PICC

peripherally inserted central catheter

POC/PAC

port of Cath

TLC

triple lumen catheter

CVC

central venous catheter

HL

heparin lock

SL

saline lock

KCL

potassium chloride

CaGluc

calicum gluconate

Mgs04

magnesium sulfate