I .V.I.'S NURSES RESPONSIBILITY
1. Checking infusion container for
faults.
2. Checking prescribed fluid goes to
correct patient.
3. Checking I.V. line is patent.
4. Inspecting entry site is
normal-report if not.
5. Controlling rate of flow as
prescribed.
6. Monitoring condition of patient -
reporting changes.
7. Maintaining appropriate records.
ADDITIONAL GUIDE-LINES
1. Infusion containers should not hang
for more than 24 hours (8 hours for blood products).
2. Administration set must be changed
every 24 hours. (Time it is put up
should therefore be recorded).
3. Regular checking of entry site,
inflammation or infiltration.
4. Sterile dressing covering entry
site should be changed daily at time of inspection.
FURTHER RECOMMENDATIONS
1. Use as few connections and
stopcocks as possible - keep system closed.
2. Remind doctors when a cannula has
been in place for 48 hours.
3. Covering dressings should be
sterile - entry site is an open wound - Removal should be aseptic.
4. Ensure cannula stability.
PRINCIPLES
Asepsis, Safety, Comfort.
ADVANTAGES
- Rapid delivery of drug -
therapeutic effect
- Total absorption of drug - good
dose calculated
- Controlled rate of administration
- Less pain
- For drugs which can not be given
by other route
DISADVANTAGES
- Inability to recall drug
- Drugs may be given too rapidly
- Complications - Microbial
contamination
- Vascular irritation
- Drug complications or
interactions.
DHSS 1976 after Breckenridge Report.
Intravenous additives
Administration
of a drug directly into the venous circulation over a period of time, usually diluted in a medium.
May use an I.V.I. bag (a drip)
or an infusion pump eg.Graesby.
Not to be confused with I.V.
bolus injection.
I.V. access is already
established.
AS WITH ALL PARENTAL PROCEDURES
Ensure asepsis
Ensure no air enters the
circulation
Use bacterial filters for
longer term administration
NURSING OBSERVATION
1. Is
there any pain? (local or systemic)
2. Any
oedema swelling developing? i.e. ensure drug is entering venous flow
3. Any
oedema of the limb developing?
4. Any
systemic oedema developing?
5. Any
signs or symptoms of inflammation/infection/erythema - due to sepsis, chemical
or mechanical irritation?
- local -
redness, pain, red lines, lymph nodes?
- systemic - malaise, pyrexia, tachycardia?
6. Is
the drug working?
7. Any
drug side effects?
8. Is
the rate of flow constant
Patient position
Limb position or venous obstruction
Administration set
Cannula
Know your equipment.
9. Any
signs of embolism, air or particle
BP
Tachycardia
Cyanosis
Unconsciousness
Temperature
P.E. (pulmonary embolism)
Chest pain
Cough
Dyspnoea
Avoid glass shards by drawing
up with a blue needle.
10. Any allergic reaction, from fluid, additive
or drug?
itching
rash
shortness of breath
11. Any sign of Anaphylaxis (please ensure you
attend a separate lecture on anaphylaxis)
12. Circulatory overload is a particular danger when there is
cardiac compromise and in children.
KNOW YOUR DRUGS
I, S.E. C.I. S.P. Dose
eg. I.V. Diamorphine
I. Moderate
to severe pain. Pain with anxiety
S.E. Respiratory
depression - Narcan to hand?
Constipation
Euphoria
Nausea
and vomiting - give with Metoclopramide
C.I. Poor respiratory states
S.P. As above. History of abuse eg.,
addiction. Muchhausens, pregnancy
Dose Start 5 - 10 mg, 4 -
6 hourly May increase with tolerance
after some weeks of use.
KNOW
How many mg per minute and per
ml are being given.
REMEMBER
Use
correct dilutant, (BNF and National Formulary and enclosed
literature).
Check prepared fluid for
crystalisation or precipitation (crystalisation normal in cold Mannitol)
Check for any precipitation in
the giving system.
If in
doubt do not give.
When
using solutions containing sugars remember to pay attention to blood sugar
levels.
Ensure complete homogenous
mixing of additives to prevent bolus administration, eg.,
a high concentration of KCl, (potassium Chloride) can cause cardiac arrest.
Correctly complete label.
Policy is for two nurses to
check the drug AND the patient AND the rate of administration eg., 5 mm per hour.
Follow hospital protocol for
drug administration.
ALL GRAESBY PUMPS
Use 10 ml BD luer lok syringe
for heparin infusions and any other infusion requiring small graesby pump.
Draw up to 8 mls = 48 mm
i.e.
heparin 40,000u made up to 8 mls with 4 mls N/Saline over 24 hrs = 2 mm per
hour
Insulin 48 units made up to 8
mls = 1 unit/mm.
48 mm =
8 mls.
This is to be standardised all
over the hospital.
Please remind Doctors to
prescribe this way.
What it is
Additives
Bolus
How may iv additives be given
Advantages
of giving drugs intravenously
By-passes barriers to absorption
Avoids first pass metabolism
Rapid speed of action
Titration of dose
Accurate assessment of dose given - total absorption -
equal systemic distribution
Comfort
Some drugs may only be given iv.
May be given when nil by mouth
Patients may remain mobile
Easy to account for variations in half life
Control over rate of administration
Prevents muscle damage
May be patient controlled
Rates of
administration
Bolus
Infusions
Consider the dose of drug going into the patient not
into the infusion set
Possible
complications of intravenous therapy
Inability to recall drug
Rapid onset of any adverse reactions
Speed shock
Overdose
Allergies and anaphylaxis
System disconnection
Extravasation
Phlebitis
Emboli introduction
Fluid or drug incompatibility
Bacteraemia and septicaemia
Particulate introduction
Systemic fluid overload
Practical considerations
Variations in dose
Infusion slows down or stops
Loading dose
Half life
Check with two nurses
Prevent puncture of infusion bags
Ensure all of the dose enters the
fluid vehicle
Ensure homogenous mixing of drug and vehicle
Always use a label with patients name, drug dose time,
date and concentration
Checking fluids and drugs
Record keeping
Changes of containers, giving sets and cannular
Maintain cannular sterility
and stability
Stages in
the procedure for infusions
Explain the procedure to the patient.
Wash hands.
The drugs to be given and their dilutants are checked
according to local protocols.
Check the labelling information to ensure that the preparation
may be given by the intravenous route.
Ensuring asepsis, drugs are drawn up into the syringe
appropriately to prevent aerosolization.
Solids must be completely dissolved.
When using syringes add the vehicle to the drug to
ensure homogeneity
A green needle or smaller is used to draw up
preparations from glass vials to prevent injection of glass micro-shards.
Inspect the entry site of the cannula for inflammation,
infection and patency.
Flush the cannula through with
0.9% normal saline if required.
Connect the primed system and start to give the drug at
an appropriate rate.
Monitor the patient for any local pain, reactions or
tissuing.
Monitor the patient for any systemic effects throughout
the procedure ie. side effects and adverse reactions.
If more than one drug is to be given, flush the cannular
through with normal 0.9% saline after each drug has been administered.
Flush with 0.9% normal saline at the end of the
procedure to ensure complete administration of the drug and continued cannula
patency.
Close any taps on entry ports.
Safely dispose of all clinical materials used.
Continue to observe the patient for effects, side
effects or adverse reactions.
Stages in the procedure for bolus injection
Explain the procedure
to the patient.
Wash hands.
The drugs to be given
and their dilutants are checked according to local protocols.
Check the labelling
information to ensure that the preparation may be given by the intravenous
route.
Ensuring asepsis,
drugs are drawn up into the syringe appropriately to prevent aerosolization.
Solids must be completely dissolved.
A green needle or
smaller is used to draw up preparations from glass vials to prevent injection
of glass micro-shards.
Inspect the entry
site of the cannula for inflammation, infection and patency.
Flush the cannula through with 0.9% normal saline if required.
Connect the syringe
and start to give the drug at an appropriate rate.
Monitor the patient
for any local pain, reactions or tissuing.
Monitor the patient
for any systemic effects throughout the procedure ie. side
effects and adverse reactions.
If more than one drug
is to be given, flush the system through with normal 0.9% saline after each
drug has been administered.
Flush with 0.9%
normal saline at the end of the procedure to ensure complete administration of
the drug and continued cannula patency.
Close any taps on
entry ports.
Safely dispose of all
clinical materials used.
Continue to observe
the patient for effects, side effects or adverse reactions.
Legal and ethical aspects
Scope of Professional Practice Code of Professional Conduct Local procedures
Practitioner safety
Avoid contact with preparations Develop a safe way to open
ampoules
Ensure no contact with body fluids Safe disposal of used clinical materials