INTRAVENOUS INFUSIONS

INTRAVENOUS INFUSIONS

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An introduction of a large amount of fluid into body via veins is called as intravenous infusion

Intravenous infusion is puncturing vein with sterile cannula/needle into a vein to supply the body with fluids electrolyte, nutrients and medication

Purpose

• To supply fluids and electrolytes
• To restore fluid volume due to dehydration, hemorrhage, vomiting, diarrhea, etc
• To meet patient’s basic requirements, e.g. calories, vitamins, etc
• To maintain homeostatic balance
• To treat in emergency conditions some medications are given intravenously
• To prevent and treat shock and collapse

Indication

• To save the patients in life-threatening situations, e.g. extensive burns
• To introduce a drug into the circulation for diagnosis purpose, e.g. IVP (intravenous pyelogram)
• To supply fluids and nutrients to the patients who are unable to digest or absorb a diet administered mouth or through the nasal tube
• To dilute toxins in case of toxemia or septicemia
• When blood or blood products are to be given, e.g. anemia, hemorrhage

Solutions Used

• Isotonic solutions: sodium chloride 0.9% commonly used
• Hypotonic solutions or buffer substances sodium/potassium, calcium chlorides and lactic acid
• Nutrient solutions dextrose 5, 10, 25, 50%
• Alkalinizing and acidifying solutions
• Blood volume expanders: plasma substitute and contains large molecular substances, e.g. dextran, lomodex, hemocoele, etc

Factors Affecting Fluid Movement

• Diffusion molecules move from a solution of higher concentration to solution of lower concentration. Increase in the temperature increases the rate of diffusion
• Osmosis: the diffusion water molecules through a permeable membrane from an area  of lesser solute concentration
• Hydrostatic pressure: it is the pressure exerted by a fluid within a closed system. Counter balancing the osmotic pressure of the plasma, which attract fluid into the vascular system
• Dialysis: the diffusion of molecules of soluble constituents through a permeable membrane is known as dialysis
• Filtration: it may be defined as the passage of fluids and dissolved substances across membranes because of differences in mechanical pressure on two sides of the membrane
• Selective permeability of membranes: in body, the capillary and the cell membranes are described as selective permeable

Factors that Favors Absorption

• Warmth: application of heat over the site of injection or the use of warm solution
• Massaging: massaging the part gently increases the local supply and increase absorption
• Diffusibility and solubility of the drug

Venipuncture Site

The selection of site depends upon following facts:

• The condition of veins
• The characteristics of tissues over the vein
• Purpose and durations of infusions
• The type and amount of IV fluids ordered
• The diagnosis and general condition of the patient

The commonly used veins are:

• Basilic and cephalic veins (forearm)
• Median cubital, cephalic and basilica veins (antecubital fossa)
• Radial vein (radial area)
• Dorsal metacarpal veins (the hand)
• Veins in the foot
• Femoral and saphenous veins (thigh)
• Veins in the scalp (for infants)

Complications of IV Infusion

• Circulatory overload: the intravascular compartment contains more fluid than the normal. Circulatory overload results in cardiac failure and pulmonary edema
• Infiltration: it is the escape of fluid into the subcutaneous tissues due to dislodgement of needle
• Hematoma formation: the walls of blood vessels may be damaged due to careless introduction of the needle into the body
• Thrombophlebitis: it is caused by mechanical trauma to the vein or the chemical irritation of some substances introduced into the veins such as potassium chloride
• Pyrogenic reactions: it is characterized by temperature elevation, chills, headache, nausea, vomiting and circulatory collapse in severe cases
• Air embolism: the vascular collapse occurs due to occlusion of the vessel by embolism. The signs of pulmonary embolism are dyspnea, cyanosis, low blood pressure, shock and collapse, tachycardia and unconsciousness
• Infection at the needle site: contamination occurs during insertion or left exposed for a long period
• Serum hepatitis: infectious hepatitis has been attributed to improperly disinfected syringes and needles
• Allergic reaction: this may due to certain drugs administered along with the IV fluids

Fluid Rate Calculation

Flow rate = total volume infused in ml (multiply) drops/ml //total time of the infusion in minutes

Total volume infused = 200 ml in 24 hours

Drops per ml = 15

Total time in minutes = 24 (multiply) 60 = 1440 minutes

Flow rate = 2000 (multiply) 15 /144 = 16.6 drops

General Instructions

• Follow strict aseptic technique throughout the procedure
• Administer IV fluids only with a clearly written prescription
• Maintain the specified rate of flow to prevent circulatory overload
• Constant and continuous observation for any unfavorable symptoms
• Observe the rights during administration
• Check the expiry date before opening the bottles
• If fluids are discolored, cloudy in appearance that should not be used for infusion
• Do not use any site that is tender, red, edematous and inflamed
• Never allow the bottle to get empty completely to prevent the entry of air into the tissues
• Keep the patient warm and comfortable with blankets if necessary
• Immobilize the joints with splints when the needle is placed near a joint
• Frequent observation of the vital signs throughout the procedure will help to detect many complications
• Allow the patient to void before the IV infusion is started

Observation Needed Throughout the Procedure

• Flow rate and potency of IV tubing
• Dislodgement of needle
• Signs of circulatory over load
• Urinary output
• Needle site
• Fluid level in the bottle
• Vital signs at frequent intervals

Preliminary Assessment

Check

• Patients name, age, bed number and diagnosis
• Purpose of infusion
• Doctors order
• Level of consciousness
• General conditions
• Abilities and limitation
• Need for additional restraints
• Articles available
• Previous experience

Equipment

A tray containing

• Sterile IV solution
• Sterile IV infusion set
• Sterile needle of choice (butterfly or cannula)
• Sterile syringe (2 or 5 ml)
• Sterile transfer forceps in a jar
• Sterile cotton swabs and gauze pieces
• Surgical spirit
• Kidney tray and paper bag
• Bowl with water
• Tourniquet
• Adhesive tape and scissors
• Specimen bottles
• Mackintosh and towel
• IV pole
• Restrainer (Splint with roller bandages)

Preparation of the Patient and Environment

• Explain the procedure
• Sent the visitors outside
• Provide privacy
• Allow the patient to empty the bladder
• Check the vital signs
• Adjust the height of the bed
• Arrange the articles at the bedside
• Place the patient in comfortable and relaxed position
• Provide adequate light in the room

Procedure

• Hand wash
• Prepare the IV solution; insert the drip set, and the air vent into the bottle openings
• Hand the bottle on the IV pole about 18 to 24 inches high
• The patient is placed in supine or sitting position with head titled back
• Draw the lower lid and ask the patient to look up
• Instill the ordered number of drops in the center of the lower lid 2 cm above the eyes
• After instillation, ask the patient to close the eye and move eye balls from side so that medications will spread all over the sac
• Wipe of excess medication

After Care

• Dry lids with dry cotton swabs
• Make the patient comfortable
• Remove articles from bed side
• Hand wash
• Record the procedure in the nurse’s record

Patient Education

• If the patient is on self-medication, give him clear instructions and make sure that he is clear of it
• Ask the patient to consult the doctor regularly
• Do not massage the eyeball after instillation of medications

Complications

Improper dressing and procedure may lead to further serious infection