____________________________________________________________ Chapter 18 Intravenous Therapy 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Slide 22
Infusion Control Devices
• Electronic infusion control devices maintain an infusion rate set by the nurse
• The most commonly used types also have alarms that sound when the fluid bag is empty,
when there is air in the line, or when there is resistance to infusion
• Variety of infusion control devices
Slide 23
• You must know how to dilute the medication and the correct rate of infusion
Intravenous Infusion of Medications
• Agency policies dictate what medications nurse may give by piggyback or by direct
injection through cannula into the vein (intravenous push)
• Many states do not permit LVN/LPNs to give medications by intravenous push
6
Slide 24
Changing Venous Access Devices and Administration Sets
• Short peripheral cannulas and the tubing are usually changed every 48-72 hours
• If complications occur with 72-hour intervals, the interval should be limited to 48 hours
• Administration sets for continuous peripheral and central infusions changed every 72
hours
• PICC lines should be changed every 6 weeks
Changing Venous Access Devices and Administration Sets (cont.)
Slide 26
Termination of Intravenous Therapy
• Put on gloves
• Stop the flow of fluid
• Loosen or remove the tape and dressing
• Gently press a dry gauze pad over the site
Termination of Intravenous Therapy (cont.)
• Elevate the extremity and apply pressure to the puncture site with a sterile gauze pad for
2 or 3 minutes
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LESSON 18.1
5
Precautions
• Always be aware of the risk of exposure to blood-borne pathogens
• Most serious: human immunodeficiency virus and hepatitis B virus
TALKING POINTS:
• Every nurse should be familiar with the agency needle puncture and body fluid exposure
guidelines.
Slide 29
Precautions (cont.)
• Accidental needlesticks
• Most policies require blood specimens to be drawn from the nurse and the patient to
test for blood-borne infections
Slide 30
Complications of Intravenous Therapy
• Tissue trauma
• Infiltration
• Inflammation
Slide 31
The Older Patient and Intravenous Therapy
• Anchor vein with the thumb of your nondominant hand to hold it in place during
venipuncture
• When performing venipuncture, you may be able to distend the vessel by simply pressing
the vein
TALKING POINTS:
• If a tourniquet is needed, protect fragile skin by wrapping a washcloth under the tourniquet
or by using a blood pressure cuff inflated just above the patient’s diastolic pressure.
• What can be applied to the skin to protect it from adhesives?
• Monitoring for excess fluid volume especially important; older people have less efficient
cardiac and renal function
The Older Patient and Intravenous Therapy (cont.)
• If patient confused or restless, protect infusion site and tubing with a commercial
securement device or conceal the site under long sleeves
____________________________________________________________ Chapter 18 Intravenous Therapy 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Assessment
• Determine the prescribed rate of flow, and assess the actual flow rate
• Inspect the infusion site for edema, pallor or redness, bleeding, and drainage
TALKING POINTS:
• If blood flows into the tubing when the fluid container is lowered, can the infusion be
infiltrated?
Slide 34
Assessment (cont.)
• Take patient’s vital signs and compare the readings with previous findings to detect
increased pulse and blood pressure
• Measure and record the fluid intake and output, and auscultate the patient’s lungs for
crackles
Slide 35
Risk for Injury
• Trauma
• The insertion of a cannula is traumatic to the skin and underlying tissues
• Tape may irritate or tear skin
Slide 36
Risk for Injury (cont.)
• Infiltration
• Can be caused by leakage where cannula enters vein or by puncture of a second site
in the vein by the cannula
• Patient may report pain or burning
TALKING POINTS:
• Infiltration is the collection of infused fluid in tissue surrounding the cannula.
7
Slide 37
Risk for Injury (cont.)
• Vesicant: drugs that are especially toxic to subcutaneous tissue
• Common vesicants
• Vasopressors
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LESSON 18.1
5
Risk for Infection
• Contamination of the site by the intravenous fluid or by the tubing used to deliver the fluid
• Infected site red and warm; purulent drainage
TALKING POINTS:
• Phlebitis may be due to irritation by the cannula or by medications.
• What symptoms may suggest phlebitis?
Slide 39
Excess Fluid Volume
• Blood volume may increase excessively when fluid is delivered directly into the
bloodstream
• Happens when large volumes of fluid are infused, especially in patients with impaired
renal or cardiac function
Slide 40
• Make sure all connections in infusion set are secure
Decreased Cardiac Output
• Bleeding may occur if the cannula is moved excessively after insertion
• More serious bleeding is possible if the tubing becomes disconnected from the cannula,
allowing blood to flow freely from the vein
TALKING POINTS:
• What measures should be taken if a large amount of blood is lost from the IV site?
Ineffective Tissue Perfusion
• Risks of emboli from blood clots, air, broken catheters
• Blood clot can develop in IV needles or catheters
TALKING POINTS:
• An embolus can have serious and even life–threatening effects if it lodges and obstructs
blood flow in a critical blood vessel.
• The risk of air embolism with peripheral lines has been greatly reduced by the use of
____________________________________________________________ Chapter 18 Intravenous Therapy 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Slide 42
Self-Care Deficit
• Provide assistance as needed with eating, dressing, toileting, and hygiene
• Dressing may be easier if patient provided with a gown or shirt that unfastens at the
shoulder
Slide 43
Question 1
• Which of the following is a true statement about intravenous therapy?
A. Fluids can be classified by tonicity, a measure of the concentration of electrolytes in
the fluid.
B. Intravenous administration of drugs may be ordered when a delayed drug effect is
needed.
C. Fluids that contain water and electrolytes are referred to as colloids.
D. Fluids containing blood and blood components are called crystalloids.
Slide 44
Question 2
• Which of the following is a true statement about intravenous therapy catheters and veins?
A. The larger the gauge, the larger the inside diameter of the intravenous cannula.
B. Central lines are inserted into the left or right ventricle, jugular or femoral veins, or
into the superior vena cava.
C. Peripheral veins are located in the extremities and are used for long-term therapy.
D. Examples of central venous tunneled catheters are the Hickman, Broviac, Groshong,
Hickman-Broviac, Raaf, and the implanted venous access ports.
TALKING POINTS:
18 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the various indications and uses for
intravenous therapy.
• Discuss the variety of substances that may
be administered through intravenous routes.
• As a class, have students call out the names
2
DISCUSS
• Discuss the kinds of fluids that are used in
intravenous therapy. Why is tonicity of the
fluid important? What is normal saline?
• Discuss the conditions under which a
hypotonic solution might be ordered for
intravenous therapy.
• Discuss when a hypertonic solution might be
ordered.
• Divide the class into small groups. Present
the following scenarios and ask each group
to identify the correct type of fluid that would
be used and why.
____________________________________________________________ Chapter 18 Intravenous Therapy 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
3
DISCUSS
• Discuss the various venous access devices
available and the circumstances for which
they are particularly useful.
• Discuss the advantages and disadvantages
of various venous access devices in terms of
cleaning, restriction of movement for the
patient, suitability for long-term use, rate of
infusion, etc.
4
DISCUSS
• Discuss what to do if an infusion is running
too fast.
• Discuss the basic steps involved in
calculating the infusion rate.
• Divide students into small groups. Using the
formula provided in the example on p. 302,
have each group calculate the infusion rate
for the following physician’s orders:
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LESSON 18.1
5
DISCUSS
• Discuss the precautions that must be taken
to protect the nurse when performing
intravenous therapy.
• Discuss key points in the care of elderly
patients receiving intravenous therapy.
• Divide the class into small groups and have
students list the signs and symptoms and
nursing implications for the following
complications of intravenous therapy:
• Tissue trauma
____________________________________________________________ Chapter 18 Intravenous Therapy 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
6
DISCUSS
• Discuss and list the basic equipment that will
be needed to start an infusion of intravenous
fluids.
• Discuss measures that may be taken to
reduce discomfort during venipuncture and
cannula placement.
• Discuss how to document the infusion
correctly.
• Discuss at what intervals continuous
infusions, PICC lines, ports, and the tubing
that is used to administer blood or blood
• Discuss the risk of embolism and its
consequences.
• Discuss ways to avoid air embolism when
using a central line.
• Divide the class into small groups and have
students identify nursing responsibilities
associated with the administration of
intravenous therapies through the following
methods:
22 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
7
DISCUSS
• Divide the class into small groups and have
students identify several nursing
interventions for a patient receiving
intravenous therapy with the nursing
Critical Thinking Question
Why are central veins used for some patients receiving intravenous therapy? Who inserts
central catheters?
Discussion Guidelines: Central veins are large vessels located near the heart and are used when
Instructor Notes/Student Feedback
____________________________________________________________ Chapter 18 Intravenous Therapy 23
Introduction to Medical-Surgical Nursing, 6th ed.
18
Assessments for
Intravenous Therapy
CHAPTER OBJECTIVES
Lesson 18.1:
2. Describe the types of fluids used for intravenous fluid therapy.
4. Given the prescribed hourly flow rate, calculate the correct drop rate for an intravenous fluid.
6. Explain the nursing responsibilities when a patient is receiving intravenous therapy.
7. Identify intravenous medications that require dilution because they are vesicants or irritants.
Assessments by Lesson & Objective
Lesson 18.1
1
Study Guide
• Part IIC: 2 (p. 106)
Evolve Student Resources
• NCLEX Review: 5
2
Study Guide
• Part IA: 1-6 (p. 105)
Evolve Instructor Resources
• Test Bank: 7, 8
Evolve Instructor Resources
4
Study Guide
• Part IIC: 4, 5, 14 (pp. 106-107)
• Part IIID: 6, 11 (p. 108)
Evolve Instructor Resources
• Test Bank: 6, 10, 20
Evolve Student Resources
24 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
5
Study Guide
• Part IA: 7-14 (p. 106)
• Part IIC: 1, 3, 6-12, 15-17 (pp. 106-107)
• Part IIID: 1-5, 8 (pp. 107-108)
Evolve Instructor Resources
• Test Bank: 1-3, 9, 11, 14, 16-18
Evolve Student Resources
Evolve Instructor Resources
• Test Bank: 4, 5, 13, 15, 20-29
Evolve Student Resources
• NCLEX Review: 1, 3, 4, 6, 7
• Prioritization: 1, 3, 4
7
Evolve Instructor Resources
• Test Bank: 19
Evolve Student Resources
• Prioritization: 2
Instructor’s Notes/Student Feedback