4.

Inform client / folfs and explain the purpose of IV

IV THERAPY PPT therapy
Intravenous 5. PRIME IV tubing to expel air. This will prevent
embolism.
MOST RAPID ROUTE OF ABSORPTION OF
MEDICATION 6. Clean the insertion site of IV needle from center to
peeiphery with
THIS ROUTE CAN BE USED FOR CLIENTS alcoholized cotton swab.
COMPROMISED
GASTROINTESTINAL FUNCTION 7. Shave the area of needle insertion if hairy
A LARGER DOSE OF MEDICATION CAN BE 8. Change IV tubing every 72 hours. To prevent
ADMINISTERED BY contamination
THIS ROUTE and complication
Types of IV Fluids 9. Change / alter IV needle insertion site everyc72
hours. To
1. ISOTONIC SOLUTION = has the same pevent thrombophebitis.
concentration as the
body fluids. Ex D5Water, 0.9 % NaCl, Plain LR, 10. Regulate IV every 15 to 20 minutes. To ensure
plain administration of proper volume of IV Fluid as
Normosol M ordered
2. Hypotonic = has lower concentration than body 11. Observe for any potential complications.
fluids Ex. 0.3
% NaCl COMPLICATIONS OF IV INFUSION
3. Hypertonic = has higher concentration than the 1. Infiltration . The needle is out of vein and fluids
body fluids. accumulate in the
Ex D10 W, D50 W, D5 LR, D5 NM subcutaneous tissues : SIGNS
Indications of IV THERAPY PAIN
1. To maintain hydration and / or correct dehydration SWELLING
in patienta
unable to tolerate sufficient volumes of oral fluids / SKIN IS COLD AT THE NEEDLE SITE
medications.
PALLOR OF THE SITE
2. Parenteral nutrition
FLOW OF IV RATE DECREASES OR STOPS.
3. Administration of drugs like chemo , other dugs
such as ABSENCE OF BACKFLOW OF BLOOD INTO
antibiotics THE TUBING AA
THE IV FLUID IS PUT DOWN, OR THE IV
4. Transfusion of blood or blood components TUBING IS KINKED
NURSING FUNCTION IN IV INFUSION Infiltration
1. Verify doctors’ order Nursing intervention:
2. Know the type, amount and indication of IV Change the of needle
therapy
Apply warm compress. This will reabsorb edema
3. Practice strict asepsis fluids and
reduce swelling.
Complications Notify physician

2. Circulatory Overload -- results from administration COMPLICATIONS

of excessive volume of IV Fluids. SIGNS:
4. Superficial Thrombophlebitis. It is due to overuse
HEADACHE of a vein,
irritating solutions or drugs, clot formation, large
FLUSHED SKIN bore catheters

RAPID PULSE Signs: Pain along the course of vein.

INCREASED BP Vein may feel hard and cordlike.

WEIGHT GAIN Edema and redness at needle inserion site

SYNCOPE OF FAINTNESS Arm feels warmer than the other arm

PULMONARY EDEMA Thrombophlebitis

INCREASED VENOUS PRESSURE Nursing intervention

COUGHING Change IV site very 72 hours.

SHORTNESS OF BREATH Use large veins for irritating fluids.

TACCHYPNEA Stabilize venipuncture at area of flexion

SHOCK Apply cold compress immediately to relieve pain and

inflamation,
Circulatory overload later follow with warm compress tos stimulate
circulation and promote
Nursing intervention absorption

Slow infussion KVO --- 10 gtts / min DO NOT IRRIGATE THE IV BECAUSE THIS
COULD PUSH CLOT
Place patient in high fowler’s position. To ease INTO THE SYSTEMIC CIRCULATION.
breathing.
Complications
Administer diuretic, bronchodilator as ordered.
5. AIR EMBOLISM
Complications
Air manages to get into the circulatory system
3. DRUG OVERLOAD... The patient receives an
excessive 5 ml of air or more causes air embolism
amount of fluid containing drugs. Signs:
ASSESSMENT
Dizziness
Chest, shoulder or back pain
Shock
hypotension
Fainting
Dyspnea
Intervention:
Complication
Slow infusion to KVO.
Assessment: air embolism
PURPOSES:
Cyanosis
1. To administer required blood component by the
Tachycardia patient

Increased venous pressure 2. To restore the blood volume

Loss of consciousness 3. To improve oxygen carrying capacity of tge blood.

Complication Blood transfusion

Air Embolism Nursing intervention / procedure

Nursing intervention 1. Verify doctors’ order. Inform client and explain

the peurpose
Do not allow IV bottle to run dry of the procedure. Secure signed consent.

Prime IV Tubing before starting insfusion 2. Check for cross- matching and blood typibg. To
ensure
turn to left side in a trendelenburg position. To allow compatibility
air to rise
in the right side of the heart. This prevents pulmonary 3. Obtain and record baseline VS ... CPS
embolism.
4. Practce strict ASEPSIS.
Complication
5. At least 2 nurses to check the label of the blood .
6. NERVE DAMAGE
BT
May result from tying the arm too tightly to the splint 2 nurses to check the following

Assessment: 1. Serial number

Numbness of fingers and hands 2. Blood component

Nursing Intervention: 3. Blood type

massage area and move shoulder through its ROM 4. Rh factor

Instruct the patient to open and close hand several 5. Expiration date
times
6. Screening test ( VDRL for sexually tranamitted
NOTE: APPLY SPLINT WITH FINGERS FREE TO dissease; hepatitis,
MOVE malarial smear

Complications THIS IS TO ENSURE THAT THE BLOOD IS

FREE FROM BLOOD –
7. SPEED SHOCK may result from administration of CARRIED DISEASES AND THEREFORE, SAFE
IV push FOR TRANSFUSION.
medication rapodly.
BT
To avoid speed shock and possible cardiac arrest, PROCEDURE
give the IV
push medication over 3 to 5 minutes. 6. Warm blood at room temperature before
transfusion. To
BLOOD TRANSFUSION prevent chills.
 Laryngeal edema, difficulty of breathing.
7. Identify client properly. Two nurses to chk the
identification 2. Febrile, Non hemolytic. ... It is caused by
hypersensitivity to donor
8. Use needle gauge 18 or 19. To allow easy flow of white white cells, platelets or plasma proteins. This is
blood. the most
symptomatic complication of blood transfusion.
9. Use BT set with filtwr. To prevent administration
of blood clots BT complications
and other particles.
Signs of febrile non hemolytic
10. Start infusion slowly at 10 gtts / min. Remain at
besside for 1. Sudden chills and fever
15 to 30 minutes. Adverse reaction usuall occurs
during the first 2. Fluahing
15 to 20 minutes.
3. Headache
BT
4. Anxiety
11. Monitor VS. Altered VS indicates adverae
reactions. 3. Septic Reaction. It is caused by the transfusion of
blood or components contaminated by
12. Do not mix medication into blood transfusion. bacteria.

DO NOT incorpprate medication into the blood
transfusion.
DO NOT use the blood transfusion line fr IV push
medication
Signs 1. Rapid onset of chills 2. High fever
3 Vomiting 4. Marked hypotension
BT complications

13. Administer 0.9% NaCl before , during or after 4. Circulatory Overload ... It is caused by
BT. NEVER adminster IV administration of
fluids with DEXTROSE . DEXTROSE can cauae blood volume at rate greater than the circulatory
hemolysis. system can
accommodate.
14. Administer BT for 4 hours ( whole blood, packed
RBC). For plasma, Signs 1. Rise in the venous pressure
platelets, cryoprecipitate, transfuse quickly ( 20
minutes) clotting factors can 2. Dyspnea
easily destroyed.
3. Crackles or rales
15. Observed for potential complications. Notify the
physician. 4. Cough

BT COMPLICATIONS 5. Elevated BP

1. Allergic reaction.... Caused by sensitivity to BT Complications

plasma protein or donor
antibody, which reacts with recipient antigen. 5. Hemolytic Reaction .... It is caused by infusion of
incompatible
Sign : flushing blood products.

rashes / hives Signs: 1. Low back pain ( first sign ) due to

inflamatory response
Pruritus of the kidneys to incompatible blood
2. Chills 3. Feeling of fullness

4. Tachycardia 5. Flushing

6. Tachypnea 7. Hypotension

8. Bleeding 9. Vascular collapse

10. Acute renal failure

Parenteral Nutrition=Hyperalimentation
Delivery of nutrients intravenously, via the
bloodstream
Central Parenteral Nutrition= Total Parenteral
Nutrition (TPN)-delivered into a central vein
Peripheral Parenteral Nutrition (PPN)-
delivered into a smaller or peripheral vein
Parenteral Nutrition Central Access
May be delivered via internal jugular lines,
and subclavian vein catheters
Central access are required for infusions that
are toxic to small veins due to medication pH,
osmolarity, and volume
PICC Lines (peripherally inserted central
catheter)
PICC lines may be used in ambulatory settings
or for long term therapy
Used for delivery of medication as well as PN
Inserted in the cephalic, basilic, median
basilic, or median cephalic veins and threaded
into the superior vena cava
Can remain in place for up to 1 year with
proper maintenance and without
complications
PN: Peripheral Access
Therapy is expected to be short term (10-14
days)
Parenteral nutrition may be administered via
peripheral access when:
Energy and protein needs are moderate
Formulation osmolality is <600-900 mOsm/L
Fluid restriction is not necessary
The Solution
Manually mixed in hospital pharmacy or
nutrition-mixing service
Premixed solutions
Separate administration for every element at
one in a separate line.
INDICATIONS
When specialized nutritional support is
indicated, EN should generally be preference
to PN
PN should be used when the gastrointestinal
tract is not functional or cannot be accessed
and in patients who cannot be adequately
nourished by oral diets or EN
The anticipated duration of PN should be > 7
days
What to do before starting TPN
Nutritional Assessment
Venous access evaluation
Baseline weight
Baseline lab investigations
Nutritional Assessment
Dietary history
Significant weight loss within last 6 months
> 15% loss of body weight
compare with ideal weight
Beware in patient with ascites/ edema
IBW
Physical Examination
Evidence of muscle wasting
Depletion of subcutaneous fat
Peripheral edema, ascites
Features of Vitamin deficiency
eg nail and mucosal changes
Ecchymosis and easy bruising
COMPONENTS Solution without lipids ( 2-in-1 )

Protein as amino acid Calories from amino acids 20% – 25%

CHO as dextrose Calories from dextrose 75% - 80%

Fat as lipid emulsion ADVANTAGES OF (3-in-1 )

Electrolytes, vitamins and minerals Lower cost of preparation

Indications for TPN Less administration time

Weight loss of 10% Potentially reduced risk of sepsis

Little or no intake for 7 days DISADVANTAGES OF (3-in-1)

Continuous weight loss despite adequate Precipitants cannot be seen

intake
Expiration date for 2-in-1 is 21 days
Serum albumin < 3.5 gm/100ml
Expiration date for 3-in-1 is 7 days
Poor tolerance to tube feeding
can remain at room temperature for 24
Chronic vomiting or diarrhea hours

COMMON INDICATIONS Infusion schedule

Patients has failed EN with appropriate tube Continuous

placement
Cyclic
Severe acute pancreatitis
Infusion Schedules
Severe short bowel syndrome
Continuous parenteral nutrition
Mesenteric ischemia
-Non-interrupted infusion of parenteral
Paralytic ileus nutrition solution for 24 hours via a central or
peripheral venous access
Small bowel obstruction
Advantages of continuous parenteral nutrition
Venous Access Device
Well tolerated by most patients
Multilumen Catheter
Requires less manipulation
Implantable Port
decreased nursing time
2 Types of TPN
decreased potential for “touch”
Solution with lipids ( 3-in-1 ) contamination

Calories from amino acids 20% – 25% Disadvantages of continuous parenteral

nutrition
Calories from lipids 20%
Persistent anabolic state
Calories from dextrose 55% – 60%
altered insulin : glucagon ratios

increased lipid storage by the liver
Reduces mobility in ambulatory patients
Infusion Schedules
Cyclic PN
The intermittent administration of PN via a
central or peripheral venous access, usually
over a period of 12 – 18 hours
Patients on continuous therapy may be
converted to cyclic PN over 24-48 hours
Advantages of cyclic parenteral nutrition
Approximates normal physiology of
intermittent feeding
Maintains:
Nitrogen balance
Visceral proteins
Ideal for ambulatory patients
Allows normal activity
Improves quality of life
Disadvantages of cyclic parenteral
nutrition
Incorporation of N2 into muscle stores may be
suboptimal
Nutrients administered when patient is less
active
Not tolerated by critically ill patients
Requires more nursing manipulation
Increased potential for touch contamination
Increased nursing time
Monitoring the Client
Daily Monitoring
Weight
Intake and output
Nitrogen balance
Electrolytes
Glucose
Monitoring the Client
Assess calorie, protein, carbohydrate, vitamin
and mineral intake twice weekly
Check serum potassium chloride, CO2,
phosphorous, BUN, creatinine and
triglycerides twice weekly
Assess complete blood count, prothrombin
time, albumin, calcium, magnesium, copper,
zinc and liver function test weekly
Obtain urinalysis weekly
Complications
Air embolism
Pneumothorax
bleeding
Infection
Arterial puncture
Catheter displacement
Sepsis
blockage
Complications
Glucose abnormalities are common.
Hyperglycemia can be avoided by
monitoring blood glucose often, adjusting
the insulin dose in the TPN solution and
giving subcutaneous insulin
Hypoglycemia can be precipitated by
suddenly discontinuing constant
concentrated dextrose infusions.
Complications
Abnormalities of serum electrolytes and minerals Adjust protein based on metabolic demand and organ
fu
should be corrected by modifying subsequent infu nction
sions or,
if correction is urgently required, by begin ning Monitor fluid/electrolyte/mineral status
appropriate
peripheral vein infusions. Provide standard vitamin and trace element preps
daily
Vitamin and mineral deficiencies are rare if solutio ns
are Stopping TPN
given correctly. E
Stop TPN when enteral feeding can restart
elevated BUN may reflect dehydration, which can be
corrected by giving free water as 5% dextrose via a Wean slowly to avoid hypoglycemia
peripheral vein.
Give IV Dextrose 10% solution at previous
Complications infusion rate for at least 4 to 6h

Volume overload (suggested by > 1 kg/day weight Alternatively, wean TPN while introducing enteral
gain) feeding and stop when enteral intak e meets TEE

may occur when high daily energy requirements Complications

require large fluid vo lumes.
Adverse reactions to lipid emulsions
Metabolic bone disease, or bone demineralization
(osteoporosis or ost dyspnea, cutaneous allergic reactions, nausea,
eomalacia), headache, ba ck
pain, sweating, dizziness
develops in some patients receiving TPN for > 3 mo.
uncommon but may occur early, particularly if lipids
Mechanism is unknown. are given at >
1.0 kcal/ kg/h.
Advanced disease can cause severe periarticular,
lower extremity, a nd back Temporary hyperlipidemia may occur, particularly in
pain. patients

Temporarily or permanently discontinuing TPN is the with kidney or liver failure

only known trea
treatment is usually not required.
tment.
Delayed adverse reactions to lipid emulsions include
Defense Against PN hepatom
Complications egaly, mild elevation of liver enzymes,
splenomegaly, thrombo
Select appropriate patients to receive PN cytopenia, leukopenia, and, especially in premature
infants wit h
Aseptic technique for insertion and site care of IV respiratory distress syndrome, pulmonary function
catheters abnormal ities.

Do not overfeed Temporarily or permanently slowing or stopping

lipid emulsion infusio n may
Maintain glycemic control <150-170 mg/dl prevent or minimize these adverse reactions.

Limit lipids to 1 gm/kg and monitor TG levels Complications

Hepatic complications
liver dysfunction Cardiac decompensation and arrest

painful hepatomegaly Refeeding Syndrome

Prevention/Treatment
hyperammonemia.
Monitor and supplement electrolytes,
Transient liver dysfunction, evidenced by increased vitamins and minerals prior to and during
transaminases, bilirubin, and alkaline phosphatase, is infusion of P N until levels remain stable
common with the initiation of TPN.
Initiate feedings with 15-20 kcal/kg or 1000
Delayed or persistent elevations may result from ex kc als/day and 1.2-1.5 g protein/kg/day
cess
quantities of amino acids. Limit fluid to 800 ml + insensible losses (adjus
t per patient fluid tolerance and status)
Complications
Handling and Storage
Gallbladder complications
Refrigerate
include cholelithiasis, gallbladder sludge, and
cholecystitis. Protect from light

These complications can be caused or worsened by Check for integrity

prolon ged
gallbladder stasis. Administration of TPN

Stimulating contraction by providing about 20 to Infusion pump

30% of cal ories as
fat and stopping glucose infusion several hours a day Check solution for clarity
is helpful.
Aseptic technique
Oral or enteral intake also helps.
2000ml daily = maximum infusion time = 12H
Treatment with metronidazole, ursodeoxycholic acid,
phen per 1000ml
obarbital, or cholecystokinin helps some patients with
chole stasis. Equipment

Refeeding Syndrome Prescribed infusion

Patients at risk are malnourished IV tubing with extension tubing

particularly marasmic patients Filter for albumin or lipid

Can occur with enteral or parenteral Alcohol sponges

nutrition
Sterile dressing package
Results from intracellular electrolyte shift
Labels
Refeeding Syndrome
Sterile gloves
Reduced serum levels of magnesium,
potassium, and phosphorus Procedure

Hyperglycemia and hyperinsulinemia 1.Check physician's order and check it against the
Interstitial fluid retention listed
ingredients
Unclamp the tubing
2.Wash hands
8.Regulate the flow to the desired rate
3.Identify the client, provide privacy and explain the
9. Do not use the single lumen central line to infuse
procedure blood or draw blood. If possible, avoid giving an IV
medication during a parenteral nutrition. Before
4.Check the solution adding
a piggy back medication to parenteral nutrition,
Remove the solution from the refrigerator at least 1 check
hour with the pharmacist to make sure it is compatible.
before using it Never add a medication to a parenteral nutrition
solution.
Observe the solution for cloudiness, turbidity,
particles or 10.Ensure client safety and comfort
crack in the container
11.Remove and dispose gloves wash hands
If the solution has brown layer, return it to the
pharmacy 12.Wash hands
because the lipid emulsion has separated from the
solution 13.Monitor and document client’s vital signs,
laboratory values (including electrolytes),
Procedure glucose levels daily weight, urine output and
catheter site
5.Assess the client
14.Document the type of solution used, time
Check potassium, phosphorous and glucose values and date the bag was hang, the client’s response
and the amount of solution added on the intake
Look for any sign of inflammation or swelling at the output sheet
infusion site
Metabolic Complications
Assess the client's frame of mind to erase any fear,
reassure that the procedure is not painful Fluid Load

6.Prepare the tubing Electrolytes balance

Connect tubing, extension tubing and filter Glucose Levels

If the tubing does not have the luer-lock connection, Catheter Related Problems
tape all the connections
Infection (catheter site)
Hang bag to an IV pole ( or thread through infusion
pump) redness

7.Prepare the central line swelling

Flush the catheter, according to facility policy, tenderness

with saline
irritation
Put on sterile gloves
drainage
Clean the catheter cap with alcohol

Using aseptic tecnique,insert the needle into

the injection cap