INTRAVENOUS INFUSION
OBJECTIVES:
At the end of the demonstration, the students will
be able to:
·
Enumerate
the purposes of infusion.
·
Discuss
physiological mechanism of infusion.
·
List
the types of fluid used for infusion.
·
Describe
the procedure used for infusion.
·
Discuss
the complications of I.V infusion.
INTRODUCTION:
Fluid is an essential component required for a
living being. Both fluids and electrolytes are essential for a person to
maintain good health and their homeostasis. Fluid balance depends on the
balance between the fluid intake and fluid output, that is, gain in the body
fluid must be equal to the fluid loss. When the fluid intake is less than the
fluid loss, it causes fluid imbalance. Excess fluid loss causes dehydration. An
average adult having moderate activity requires about 2600 ml of fluid. The
body may lose fluid by vomiting, diarrhoea, hemorrhage, gastric and intestinal
suction, etc, dehydration and Hypovolemia, that is characterised by dryness of
skin, mucus membrane, acute weight loss, coated tongue, decreased urinary
output, loss of skin texture, sunken eye balls etc. To overcome this loss,
fluids have to be replaced in body through the intravenous route called
infusion.
DEFINITION:
It is an introduction of a large amount of fluid into
the body through veins.
PURPOSE:
·
To
restore the body fluids in case of bleeding and dehydration.
·
To
meet the basic requirement of the body e.g. calorie, water, minerals and
vitamins.
·
To
overcome and prevent shock and collapse.
·
To
supply the body, an adequate amount of electrolyte, nutrients, when the patient
is unable to take orally in case of oral surgery, oral cancer.
·
To
restore acid-base balance.
·
To
monitor central venous pressure.
TYPES OF FLUID AND
SITES OF INFUSION:
Types of fluids:
SOLUTION
|
ACTION
|
NURSING INTERVENTIONS AND CONCERNS
|
Hypotonic
solutions (less than 250 mOsm/L)
·
2.5%
dextrose in water.
·
0.25% sodium
chloride solution.
·
0.33% sodium
chloride solution.
·
0.45% sodium
chloride solution.
|
Will hydrate
the cells; pulls fluid from the vascular space into the cellular space.
|
These
solutions may further exaggerate hypotension due to fluid shifting out of
vascular space; do not administer these fluids to hypotensive patients.
|
Isotonic
solutions (250-375 mOsm/L)
·
5% dextrose
in water.
·
0.9% sodium
chloride solution.
·
Ringer’s
injection.
·
Lactated
ringer’s solution.
|
Will hydrate
the extracellular compartment; replace fluid volume without disrupting the
intracellular and interstitial volumes.
|
5% dextrose
is isotonic when infused but becomes hypotonic when the dextrose has been
metabolised. Use cautiously in patients who is fluid overloaded or who would
be compromised if vascular volume would increase, such as renal and cardiac
patients.
|
Hypertonic
solutions (greater than 375 mOsm/L)
·
5% dextrose
in 0.45% sodium chloride solution.
·
5% dextrose
in 0.9% sodium chloride solution.
·
5% dextrose
in lactated ringer’s lactate solution.
|
Will draw
out fluid of intracellular space, leading to increased extracellular volume
both in vascular and interstitial space.
|
These
solutions can be very irritating to the veins, so observing the IV site for
inflammation is imperative; may cause circulatory overload , so these
solutions should be infused slowly to prevent this in vulnerable patients;
may increase serum glucose in patients with glucose intolerance, which would
make more frequent glucose monitoring an important intervention.
|
Plasma
expanders
·
Dextran 70
(isotonic)
·
10% mannitol
(hypertonic)
·
20% mannitol
(hypertonic)
·
5% albumin
·
25% albumin
·
0.9% sodium chloride
·
10% hetastarch in 0.9% sodium chloride.
|
Increases
volume in the vascular space. Will draw fluid out of intracellular space,
leading to increased extracellular volume both in vascular and interstitial
space.
|
Monitor
patients carefully for circulatory overload; monitor for hypersensitivity
reactions; medications should not be given with or added to these solutions.
These solutions can be very irritating to the veins, so observing the IV site
for inflammation is imperative; may cause circulatory overload, so these
solutions must be infused slowly to prevent this in vulnerable patients; may
increase serum glucose in patients with glucose intolerance, which would make
frequent glucose monitoring an important nursing intervention.
|
Composition of fluids:
·
Saline
solution – water and electrolytes.
·
Dextrose
solution – water or saline and sugar.
·
Ringer’s
lactate – water and electrolyte and sugar.
·
Balance
isotonic – water, electrolytes and some sugar.
·
Whole
blood and blood components.
·
Plasma
expanders – albumin, dextrin, plasma protein fraction (plasmanate).
Sites:
When selecting a site for I/V check:
·
Condition
of the vein.
·
Characteristics
of the tissue over the vein.
·
Purpose
and duration of infusion.
·
Type
and amount of fluid prescribed.
·
Diagnosis
and general condition of the patient.
Most
commonly used veins are:
·
Veins
of the forearm (basilic and cephalic veins).
·
Veins
in ante cubital (median cubital, cephalic and basilic veins).
·
Veins
in radial area (radial veins).
·
Veins
in hand (dorsal metacarpal veins).
·
Veins
in the foot (dorsal).
·
Femoral
and saphenous veins.
·
Veins
in the scalp (for infants).
CALCULATION
OF THE FLOW RATE OF I/V INFUSION:
Flow rate of the fluid is calculated by
using a formula
Total time of infusion in
minutes
e.g. total volume infused = 3000 ml in
24 hrs
1 ml = 15 drops (depends on the lumen of
the needle)
Total time in minutes = 24 X 60 = 1440
minutes
1440
COMPLICATIONS
OF I/V INFUSION:
1.
Circulatory
overload.
2.
Infiltration.
3.
Extravasation
of blood (hematoma).
4.
Thrombophlebitis.
5.
Air
embolism.
6.
Pyrogenic
reaction.
7.
Infection.
8.
Allergic
reaction.
9.
Serum
hepatitis.
10. Nerve damage.
11. Osmotic diuresis.
General
instructions for I/V infusion:
·
Have
a clearly written prescription, before starting I/V infusion.
·
Follow
a strict aseptic technique throughout the procedure.
·
Maintain
the prescribed rate of flow.
·
Observe
the patient constantly for any unfavourable symptoms, dislodgement of needle,
fluid level of bottle, Thrombophlebitis.
·
Check
and recheck the solutions used for infusion for the expiry date, sediments,
suspended particles, colour and cloudy appearance.
·
Observe
five rights – right patient, right medicine, right dose, right route and right
time.
·
Make
sure that the drip set is sterile and in a good working order.
·
Select
the proper site for infusion.
·
Check
the rate of flow, if it is slow or stopped check for
a)
Displacement
of needle.
b)
Spasm
of vein.
c)
Kinking
of tube.
d)
Low
pressure within the I/V fluid.
·
Never
allow the bottle to get empty completely to prevent entry of air, if I/V has to
be continued have a new bottle ready at hand.
·
Always
use isotonic saline before blood and after blood transfusion to prevent haemodialysis
of blood cell in the tubing.
·
Keep
the patient warm and comfortable.
·
If
the needle is in place near a joint, use splints to immobilize the joint.
·
Observer
the vital signs throughout the procedure to prevent complications.
·
Offer
a bedpan or urinal before infusion.
·
Reassure
the patient often, and keep an attendant near the bed side.
PREPARATION
OF THE PATIENT:
·
Identify
the patient’s name bed no. And diagnosis.
·
Check
the purpose of infusion.
·
Check
the physicians prescription for the type of infusion fluid, strength, amount
rate of the flow, duration.
·
Check
the condition of the patient to see his ability to follow the instructions,
·
Check
the site of infusion.
·
Check
the limitation of the patient.
·
Observe
the need for an additional restraint or an attendant.
·
Check
the articles for their working order.
PREPARATION
OF ARTICLES:
ARTICLES
A
tray containing:
|
RATIONALE
|
I.V
solutions or fluid bottles.
|
To
administer fluids without any interruption or delay.
|
A
sterile scalp vein or butterfly with a vein flow.
|
It
is used for a suitable vein and allows free movement.
|
A
sterile I/V set with tubing.
|
To
supply fluid into the patient.
|
A
sterile syringe with needle no. 20-22.
|
To
add medication to the I/V drip or initiate or start the procedure.
|
Sterile
cheatle forceps.
|
To
handle the sterile supplies.
|
Sterile
cotton swabs and gauze pieces in a sterile container.
|
To
clean the skin at the site of infusion.
|
A
bowl with a disinfectant.
|
To
discard the used syringes.
|
Tourniquet,
splint with bandage, mackintosh and towel.
|
To
occlude venous return and to make the vein visible.
|
A
kidney tray and a paper bag.
|
To
discard the used swabs.
|
Methylated
spirit in a container
|
To
clean the skin.
|
An
I/V pole.
|
To
hang the bottle at the desired height.
|
A
needle crusher.
|
To
crush the used needles.
|
An
adhesive plaster roll.
|
To
fix the needle and set.
|
STEPS
OF THE PROCEDURE:
1.
Explain
the procedure to the patient.
2.
Wash
hands with soap and water.
3.
Check
the physician’s order for the type and amount of fluid to be introduced.
4.
Prepare
the I/V solution carefully. Open the bottle seal and clean the top with a
sterile swab holding the bottle upright. Insert the needle drip set and air
vent into the bottle opening.
5.
Close
the screw clamp to prevent fluid loss.
6.
Hang
the bottle on the I/V stand about 18-20” high from the bed to facilitate flow
of fluid through gravity.
7.
Connect
the needle to the I/V tubing and remove the protective covering.
8.
Open
the clamp, flush I/V infusion fluid throughout tubing and needle into the
kidney tray until all air is removed. Clamp the tubing and reapply the
protective cap over the needle.
9.
Prepare
a few strips of adhesive tape and keep ready for use.
10. Prepare the site for giving infusion.
11. Place the extremity in a proper position
for easy introduction of the needle.
12. Apply tourniquet firmly 6-8” proximal to
the site.
13. Massage or stroke the vein distal to the
knot and in the direction of venous flow to the heart.
14. Encourage the patient to close and open
the fist rapidly to distend the vein.
15. Lightly tap the vein with finger tips.
16. Clean the area with a spirit swab and
dry.
17. Grasp the arm distally.
18. Hold the needle at 30o with
the bevel up and puncture the skin laterally. Once the needle enters the skin
it becomes parallel with the skin. Then pierce the site of the vein.
19. When the backflow of blood occurs into
the needle and tubing, insert the needle further.
20. Release the tourniquet and open thee
clamp to allow the fluid to flow in.
21. Secure the needle and tubing in place.
22. Secure the needle with H method.
23. Apple one adhesive strip beneath the
needle and one cross to the opposite.
24. Use splint to immobilize the site or
joint.
TERMINATION
OF THE PROCEDURE:
·
After
care of the patient and articles.
·
Remove
the mackintosh and towel.
·
Make
the patient comfortable.
·
If
the patient is conscious, instruct him not to move the site.
·
Dismantle
all the articles.
Record
the following:
·
Time
of starting the fluid.
·
Type
of fluid.
·
Concentration
of the solution.
·
Amount
of fluid.
·
Rate
of flow.
·
Any
medicine added to the bottle.
·
Any
reaction noted in the patient.
Observe
frequently for the following:
·
Fluid
chamber is not dripping.
·
Quantity
of I/V fluid in the bottle before it gets empty.
·
Any
back flow of the blood from the needle site.
·
Needle
and connection of the tubing are intact.
·
Swelling
of tissue around the needle site.
·
Any
unusual symptoms e.g. chills, rigor, restlessness.
Discontinuing
infusion:
·
Clamp
the tubing.
·
Loosen
the adhesive tape.
·
Withdraw
the needle by the hub in line with the vein and hold a dry sterile swab over
the needle site. When the needle is out, apple firm pressure over the site.
·
Discard
the bottle and tubing.
·
Record
the total amount of fluid infused.
·
Watch
the general condition of the patient after the fluid has been discontinued.
·
Record
the termination of infusion with relevant observations.
Storage
of articles:
Collect all the articles used for the
infusion, carry them to the treatment room, clean them first with cold water,
rinse thoroughly, disinfect them and store them in the right place. Discard the
needle, I/V bottle with tubing – all disposable items.
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