INTRAVENOUS INFUSIONS

INTRAVENOUS INFUSIONS

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

INTRAVENOUS INFUSIONS - Purpose, Instructions, Equipment, After Care, Procedure, Complications, After Care, Patient Education, Assessment
INTRAVENOUS INFUSIONS – Purpose, Instructions, Equipment, After Care, Procedure, Complications, After Care, Patient Education, Assessment

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