INTRAVENOUS THERAPY.pptx

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1. INTRAVENOUS THERAPY PREPARATION AND ADMINISTRATION GIDEON MAXWELL AMOAH BSc. PUBLIC HEALTH (EDUCATION) DIP. EDUCATION, DIP. (NURSING), RGN

2. Intravenous simply is defined as ‘within a Vein’. Intravenous therapy therefore the administration of an infusion of liquid substances directly into a vein. It provides a speedy and effective method of delivering medication, fluids, parenteral nutrition and blood products. It can be intermittent or continuous

3. Steps to take before carrying out an IV Therapy Educate patient on the procedure, purpose, possible discomfort and potential risks. Gather all necessary equipment Assess veins for size, straightness and ease of access.

4. Uses of IV Therapy To correct electrolyte imbalance To deliver medications For blood transfusions As replacement therapy in cases of dehydration

5. Common Vein sites Back of the hand Arm Foot Scalp Femoral jugular

6. Nursing assessment/ observation to be made during intravenous therapy Monitor the patient closely for any acute weight gain or loss Keep an accurate record of all intake and output Assess for any signs of oedema Auscultate the lung sounds (crackles may be heard for fluid volume overload) Notify the doctor if urine output is less than 30mls within 2hours Examine the site for swelling, dislodgement of cannula, extravasation (infiltration) of leakages.

7. Nursing assessment/ observation to be made during intravenous therapy cont. Observe for any discomfort Observe the drip chamber and ensure that it is not empty Observe the flow rate frequently Observe for signs of over- infusion such as dyspnoea, cough and enlargement of cervical veins. (What will you do if you observe these?)

8. Commonly used intravenous solutions Hypertonic solution 5% dextrose in R/L 5% Dextrose in N/S 5% Dextrose in 0.45% N/S Have higher osmotic pressure, thus pulls or draws fluid out of the cell into the extracellular space thereby increasing intravascular volume.

9. Commonly used intravenous solutions Hypotonic solution 0.45% N/S 0.33% N/S Pushes fluid from the vascular space into the cells because they have lower osmotic pressure.

10. Commonly used intravenous solutions Isotonic solution Ringers Lactate 5% Dextrose in water Normal saline (0.9% NaCl ) Have same osmotic pressure as that found in cells hence fluid moves equally between all compartments.

11. Commonly used intravenous solutions Other solutions include: 5:4:1 commonly used for Cholera patients Badoe’s solution

12. Calculating the flow rate of an infusion Flow rate = volume of solution( mls ) x drop factor duration of infusion( mins ) (try some questions in scenarios)

13. Types of Cannulas used for intravenous therapy

14. Parts of a Cannula

15. The 10 Rights of Drug Administration Right medication Right client Right dose Right time Right route Right client education Right documentation Right to refuse Right assessment Right evaluation

16. Types of Intravenous Fluids Crystalloids They are aqueous solutions of mineral salts or water soluble molecules commonly used for rehydration and electrolyte replacement. Eg . N/S, R/L, Dextrose Saline

17. Types of Intravenous Fluids cont. Colloids They are large insoluble molecules are used to replace lost blood, maintain healthy blood pressure and volume expansion. Eg . Haemacel , Dextran, hetastarch , Blood etc.

18. Complications/ Risks of IV Therapy Infection Phlebitis Infiltration/ extravasation Fluid overload Electrolyte imbalance Embolism Hypothermia Shock Nerve damage

19. ASSIGNMENT Preparing trolley and setting up Intravenous Infusion

20. GIDEON MAXWELL AMOAH BSc. PUBLIC HEALTH (EDUCATION) DIP. EDUCATION, DIP. (NURSING), RGN

21. ADMINISTERING BLOOD TRANSFUSION

22. BLOOD TRANSFUSION Is the intravenous administration of whole or component of blood into direct circulation to restore blood volume, increase haemoglobin levels or combat shock The transfer of blood or blood products from one person (donor) into another person’s blood stream (recipient).

23. BLOOD TRANSFUSION Autologous blood transfusion? Heterogeneous (donor) blood transfusion?

24. Indications of blood transfusion To increase blood volume after surgery, haemorrhage or trauma To provide clotting factors ( in plasma) for patients with DIC, haemophilia etc. To increase the number of RBC’s in clients with anaemia

25. Indications of blood transfusion cont. To provide platelets to patients with low platelet count, especially those on chemotherapy To replace lost plasma proteins in severe burns

26. DISCUSS BLOOD GROUPINGS AND WHO CAN DONATE TO WHO (A, B, AB, O) Rhesus + , - Universal donor and recipient

27. Forms of blood transfused include: Platelets Fresh frozen plasma Whole blood Packed cells

28. Nurses responsibilities for safe blood transfusion

29. Nurses responsibilities for safe blood transfusion Explain procedure and obtain informed consent Never order a blood to be transfused to patient Two nurses are required to crosscheck blood for the right patient, correct blood type, expiry date. (they must both sign their names in the nurses notes) Check patency of IV line Check patient’s vital sign and observe any anomalies.

30. Nurses responsibilities for safe blood transfusion Administer pre medication if prescribed Offer bed pan or urinal bowl before commencement of blood transfusion.

31. Nurses responsibilities during blood transfusion Check vital signs 15minutes after the commencement of transfusion, after 30 minutes, then hourly till transfusion is completed. Monitor the flow rate Observe for signs of transfusion reaction such as urticaria rash, elevated temperature, shivering etc . (what will the nurse the nurse when he/she observes this?)

32. Nurses responsibilities during blood transfusion Observe for signs of circulatory overload Monitor urine output and report any abnormalities.

33. Nurses responsibilities After blood transfusion Clip the roller clamp off and flush the intravenous line with N/S. Make patient comfortable in bed Discard trolley and used transfusion set appropriately. Document procedure (what does the nurse write?) Monitor vital signs one hour after completion to detect delayed transfusion reactions.

34. Complications of blood transfusion Infection usually with fever Embolism Circulatory overload Hyperthermia Coagulopathy Urticaria rash Pulmonary oedema characterised by dyspnoea Hepatitis B HIV Shock