IV Fluids

Nur 105 Adult Health

 Learning Objectives
• Identify sources of law.
• Define Legal Terms
• Describe the difference between
standards of practice and standards of
care.
 Sources of Law

Constitution Law

Statues Law

Administrative Law

Common Law
 Legal Terms
• Criminal

• Civil
– Tort
• Intentional/unintentional
• Negligent and Malpractice
Standards of Practice and Care
• Standards of Practice

• Standards of Care

• Breach of Duty

• I.V. Nurses’ Role as Expert Witness

 Factors to Reduce Risks
Risk Management
• Informed consent

• Unusual Occurrence Report (Incident

Report)

• Documentation
 Nursing Competency in
IV Therapy
• Competency Standards
– Accountability
– Communication
– Collaboration
– Autonomy
• Competency Model
– Cognitive, Psychomotor, Evaluation
 Occupational Risks
• Physical Hazards
– Needlestick injuries, abrasions and
contusions, chemical exposure, latex allergy

• Biologic Hazards
Summary
Infection Control Meaures

Nur 105 Adult Health

 Learning Objectives
• Describe the purpose and components of the
immune systems.
• Identify basic principles in infection control.
• Define the six chains of infection.
• Describe methods to break the chains of
infection.
• Describe the causes for infusion-related
infections.
• State measures to prevent and treat infections.
 Immune System
The Body System that protects
the body from invasion of
pathogens.
 The Immune Systems
Organs
• Primary
– Thymus and Bone Marrow

• Secondary
– Lymph Nodes, Liver, Lungs
– Spleen, Peyer’s patches, appendix and
Tonsils and adenoids
 Immune Systems
Defense Mechanisms
• Nonspecific Immune Responses
– Skin, mucous membranes, epiglottis,
respiratory tract, sphincters
– Tears, gastric acidity, vaginal secretions
– Lacrimation, intestinal peristalsis,urinary flow
 Immune Systems
Defense Mechanisms
• Specific Immune Responses
– Active acquired and Passive acquired
– Leukocytes
– B and T Lymphocytes
– Immunglobulins
– Phagocytic cells
– Complement system
 Immune Systems
Defense Mechanisms
• Impaired Host Resistence
– Primary immunodeficiency disorders

– Secondary immunodeficiency disorders

 Principles of Infection Control
(Epideminology)
• Colonization

• Dissemination

Nosocomial
Chains of Infection
 Break the Chains of Infection
• New Methods – microbiology and epideminology

• Survelience or Monitoring – Quality

Improvement Programs and Risk Management

• Pharmacology Treatment
– Stage 1
– Stage 2

• Emporiatrics
 IV Related Infections
Sources of Catheter-Related
• Skin Organisms
• Contamination of Catheter Hub
• Contaminated Infusate
• Contaminated Device (prior to insertion)
• Hematogenous

• Clinical Manifestations
– Cellulitis/Phlebitis – warmth, swelling, erythema, pain,
discharge (serosanguineous or purulent)
 IV Related Infections
Risk Factors
• Host
• Hematogenesis
• Provider
• Catheter
• Infusate Fluids
 Treatment of Infections
• Catheter – Antibiotics
• Infusate-Related
– Mechanism of contamination
– manufacturer
– during infusion
• Duration and frequent interruption or manipulation
of access devices (ports)
 Treatment of Infection
Prevention and Treatment
• Inspect All Infusates • CDC Precauations
– Before use check fluid for – Universal
leaks, expiration dates, color, – Transmission-Based
consistency • Airborne
• Preparation • Droplet
• Aseptic Techniques • Contact
• Periodic Replacement of • Hand Hygiene
Administration Set • Skin Antiseptics
• Monitor adjunct devices • Catheter site dressings
• Assess for infections • Sutures or sutureless
• Obtain cultures • Topical Antimicrobial
ointments
• Antimicrobial catheters/cuffs
• Anticoagulants and antibiotic
locks
Summary
Parenteral Solutions

Chapter 5
Purposes of IV Therapy
Maintenance

Replacement

Restoration
 Components of
Parenteral Solutions
• Water • Vitamins

• Glucose • Electrolytes

• Amino Acids • PH
 Osmolarity of
Parenteral Solutions
• Isotonic

• Hypotonic

• Hypertonic
 Types of
Parenteral Solutions
• Crystalloid • Colloid
– Dextrose – Dextran
– Sodium Chloride – Albumin
– Dextrose with Sodium – Mannitol
Chloride – Hetastarch
– Hydrating solutions
– Electrolytes Fluids
– Ringer’s/Lactated
Ringers
– Alkalizing/Acidifying
– Potassium Chloride
 Nursing Role
• Check MD order • Monitor IV Fluids
• Check IV fluid three every hour
times – 5 R’S – Check IV site
• Check IV fluid for • No “catch ups”
– Color, • Check compatibility
– Consistency, • Use aseptic technique
– Expiration date,
– Leaks
Summary
Parenteral Equipment
 Infusion Container
• Glass

• Plastic

• Use-Activated Containers
 Basic Administration Sets
• Single line or Y sets • Roller Clamp
• Spike/piercing pin • Injection ports
• Flange • Backcheck valve
• Drop orifice • Hub
• Drop chamber • Final filter
• Tubing • Primary/Secondary
 Administration Sets
• Primary Y

• Pump Specific Administration set

• Lipid Administration

• Nitroglycerin
 IV Accessory Devices
• Filters
– Different sizes (170 micorns to 0.22)
– Different locations( inline)
– Different types ( depth, membrane , blood
administration)
– Follow agency policy and procedures
• Extension tubing
• Adapters and Connectors (used at
injection site)
 Accessory Devices
• Stopcocks

• Needleless System
 Peripheral Infusion Devices
• Scalp vein needles (butterfly); short
therapy
• Over-the-Needle Catheter – most
commonly used; 14-22 gauge
– Thin wall, flashback chamber, wings, color
coding for sizes
• Dual Lumen
• Through –the-Needle Catheter
• Midline Catheter
 Infusion Regulation Devices
• Mechanical Gravity Devices
– Dial – A- Flow

• Electronic Infusion Devices

– Controller
– Positive-Pressure Infusion Pumps
– Volumetric Pumps
– Peristalic Pumps
– Syringe Pumps/PCA
– Ambulatory Pump
– Multi/Dual –Channel Pumps
Summary