INTAVENOUS THERAPY (RLE SKILLS)

INTRAVENOUS THERAPY thus, they draw interstitial and intracellular

water towards the intravascular fluid
• Insertion of a needle or catheter/cannula
compartment.
into a vein based on physician's written
prescription. Examples: Whole blood, plasma, packed red blood
• The needle or catheter/ cannula is attached cells, plasma substitutes (Dextran, Hespan, Plasma
to a sterile tubing and fluid container to Protein Fraction/Plasmanate)
provide medicine and fluid.
B. Crystalloids
• A therapy that delivers fluids directly into a
➔ solutions made by dissolving crystals into
vein.
water.
• The intravenous route of administration can
➔ They are good fluid replacers and are
be used both for injections, using a syringe
categorized by tonicity (the amount of
at higher pressures; as well as for infusions,
particle present in a solution)
typically using the pressure supplied by
gravity.
i. Isotonic Solutions - have roughly the same
• The intravenous route is the fastest way to amount of dissolved particles as plasma and
deliver medications and fluid replacement good choice for fluid replacement (0.9%
throughout the body, because they are saline, Lactated Ringers, D5w*)
introduced directly into the circulation. ii. Hypertonic Solutions - have more dissolved
IV Statistics particles than plasma and have initial effect
of drawing water from intracellular spaces
➔ 85% of all hospitalized patients have some to intravascular space but once sugar
type of IV therapy content is metabolized, solution becomes
PURPOSE hypotonic. (D5LR, D10W, D50.45% Na Cl)
iii. Hypertonic Solutions - have more dissolved
1) To maintain/ correct hydration in clients particles than plasma and have initial effect
unable to tolerate sufficient volume of oral of drawing water from intracellular spaces
fluids/medicine. to intravascular space but once sugar
2) Parenteral Nutrition content is metabolized, solution becomes
3) Administer drugs hypotonic. (DSLR, D10W, D50.45% Na CI)
4) Transfusion of blood or blood components
5) To provide lifeline for rapidly needed
medications or blood EQUIPMENT:
6) Supplement (Vitamins, Minerals,
Electrolytes, etc.) 1. Container of Sterile Intravenous Solution

IV solutions comes in different sizes

Type of Access 150 ml - 250 ml - 500 ml · 1000 ml

A. PERIPHERAL LINE - a peripheral intravenous • Solution should be sterile and in proper

line is used on peripheral veins (the veins in condition
the arms, hands, legs and o feet). This is • Check expiration date
the most common type of IV therapy used. • There should be no particulate matter in
B. CENTRAL LINE- central IV lines have their the solution Check for any leaks indicative
catheters that are advanced through a vein of contamination
and empty into a large central vein (a vein
2. Administration set
within the torso) usually the superior vena
cava, inferior vena cava or even the right • Macrodrip or Macroset (10, 15, or 20 drops
atrium of the heart. per ml of solution)
• Microdrip or microset (60 drops per ml of
Common types of IV Solution
solution)
A. Colloids • Insertion spike - inserted into the solution
➔ contain proteins or other molecules of container and kept sterile
higher molecular weight that tend to • Drip chamber - to prevent air from entering
remain intravascular for long periods of the line
time. • Roller or screw clamp - to control the rate
➔ They exert osmotic pressure (the pressure of flow of the solution
generated by the tendency of water to • Tubing
follow high concentrations of molecules)
 INTAVENOUS THERAPY (RLE SKILLS)

• Protective cap - maintain the sterility of the

end of the tubing so that it can be attached
to a sterile needle inserted in the clients
vein
• Needle adapter
• Volume-control set or soluset

IV ADMINISTRATION SET

➔ An intravenous administration set,

consisting of an insertion spike with a
protector cap, an access port, a drip
(drop) chamber, plastic tubing with a
roller control clamp, rubber injection
port, and a needle adapter (luer
connector) covered by a protective cap.

3. IV Poles

- the higher the solution container is suspended,

the greater the force of the solution as it enters the
client and the faster the rate of flow.

4. Intravenous needle or catheter

butterfly or wing-tipped needles (26 - 14G)

(The larger the gauge number, the smaller the

diameter of the shaft.)

5. IV Tray

-Contains sterile swabs, antiseptic solution, plaster,

tourniquet, splint, local anesthetic, sterile 2x2 gauze
squares

Complications associated with Intravenous

Infusions
 INTAVENOUS THERAPY (RLE SKILLS)

Prevention

▪ Hand washing
▪ Sterile technique
▪ Catheter size
▪ Insertion site
▪ Site inspection every two hours
▪ Encourage patient to report any discomfort

Calculating the Infusion Rate

CONSIRERATION IN THE SELECTION OF THE SITE

▪ Select a large vein large enough to

accommodate the needle that will be used
▪ Type of solution
▪ Client's age

Correct way to anchor and secure the IV catheter

 INTAVENOUS THERAPY (RLE SKILLS)

BLOOD TRANSFUSION ii. White blood cell- play a major role in

defense against microorganism
• A mixture of cells
iii. Platelet- play a major role in blood clotting
• A complex transport mechanism

✓ Transport hormones
Blood transfusion may be necessary for any of the
✓ Removes waste products
following reasons:
✓ Regulated boy temperature
✓ Protects the body ✓ Hemorrhage (blood loss) caused by
✓ Promotes homeostasis trauma or high blood loss surgery
✓ Supplies oxygenation ✓ Red cell destruction
✓ Decreased red cell production

Transfusion- refers to administration of an of

Blood Volume- 7-8% of total body weight vary by
several blood products
age and body composition

Estimated Blood Volume

National Blood service act of 1994
❖ Men- 75 ml/kg
❖ Women- 65 ml/kg • Also known as the Republic act 7719
❖ Infant- 85 ml/kg • An act promoting voluntary blood donation
❖ Neonate- 80 ml/kg providing for an adequate supply of safe
blood, regulating blood banks and providing
penalties for violation thereof.
Composition of blood
Who CAN and CAN’T donate blood
Temperature- 38 C (100.4 F)
A. Eligible donors must:
pH- 7.35-7.45
▪ Be atleast age 18
specific gravity- 1.048-7.45
▪ Weigh at least 110lb (50kg)
body weight- 7%
▪ Free from skin disease
volume
▪ Not have donated in the past 56
a) male- 5-6 liters
days
b) female- 4-5 liters
▪ Have hemoglobin level of at least
Portions of the blood 12.5 g/dl (women) or 13.5
g/dl(men)
• composed of 55% plasma and 45% cellular
B. Ineligible donors include those:
components
▪ Who have HIV and AIDS
• Plasma- fluid portion ▪ Whi have taken illegal drugs
• Coagulation factors ▪ Who had sex with prostitutes in the
• Inorganic substances past 12 months
• Antibodies ▪ Who had sex with anyone above
categories
▪ Who have hepatitis
Plasma ▪ With certain types of cancer (other
than minor skin cancer
➔ Liquid part of the blood
▪ With hemophilia
➔ Consist of serum and fibrinogen
▪ Who have received clotting factor
➔ Contains plasma proteins such as:
concentration
✓ Albumin- nutrition, maintenance of
osmotic pressure, transport,
homeostasis, etc
✓ Serum globulins- play an important Blood collection methods
role in liver function, blood clotting 3 types of blood donor sources for routine blood
and fighting infection collection
✓ Fibrinogen
1. Unrelated donor (allogeneic)
Cellular Components: 2. Directed donor
Formed elements of blood 3. Autologous donor (self)

i. Red Blood Cell- bring oxygen to the tissue in

your body
 INTAVENOUS THERAPY (RLE SKILLS)

Nurses must be: 3. Develops chills, hematuria, or pain in flank,

chest or back are
a) Assure that informed consent has been
obtained before starting a transfusion
b) Appropriate information to include in
Indication of blood warming
patient education includes: benefits, risk
and alternatives to transfusion • To prevent cardiac arrhythmias and cardiac
c) Document all patient education regarding arrest
transfusion therapy, and the responses of • When transfusing large amount of blood
the patients and family members after • In pediatrics, blood warming should be used
teaching. for exchange transfusion in infants and for
blood transfusion rates exceeding 15
ml/kg/hr in children
Patient education:
Before transfusion
• Provide patient and family information to
blood transfusion therapy ➔ When you received the delivery from blood
✓ The need for blood transfusion bank, you should receive both the product
✓ Advantages of blood transfusion and the transfusion record that corresponds
✓ Possible reactions related to the to it
blood transfusion Inspect for the following:
✓ Voluntary blood donation act
▪ Labels
Basic Guidelines for blood administration ▪ Integrity of unit
1. Gloves should be worn when handling ▪ Appearance
blood products
2. Blood should not be out of controlled
refrigeration for no longer 30 minutes During transfusion
before initiating the blood transfusion ➔ Administer the blood component at the
3. Blood should not be stored in non-blood recommended rate
bank refrigerators to vast fluctuations in ➔ Stay with the patient for the first few
temperature minutes of transfusion
4. 0.9% NSS should be added to or ➔ Review signs and symptoms of what the
administered simultaneously with blood patient should report to you
5. Blood transfusion should be run in a main ➔ Discontinue transfusion immediately once
line that has been used in 0.9% NSS the patient manifest symptoms of
6. All blood components must be filtered using transfusion reaction, assess the patient and
in-line or add-om filters that are notify the physician
appropriate for the component or ➔ Document the transfusion in the pt chart
specifically requested by a physician
7. A new administration set and filters should
be used for each transfusion. A blood filter
BLOOD PRODUCTS
should not be used for more than 4 hours
BLOOD INDICATIONS NURSING
PRODUCTS CONSIDERATION
Transfusion Precautions Whole To restore blood -do not transfuse
blood volume in more than 4 hrs
1. Do not add medications to the blood hemorrhaging -warm blood if
2. Do not transfuse the blood product if you trauma or burn giving a large
discover a discrepancy in the blood number, patient quantity
blood slip type, or patient identification -avoid giving
number when the patient
3. Do not piggyback blood into the port of an cannot tolerate
existing infusion set the circulating
volume

PRBC -To restore or -do not transfuse

STOP transfusion if your patient shows: maintain oxygen more than 4 hrs
1. Change in vital signs carrying capacity -RBCs have the
same oxygen
2. Dyspneic or restless
carrying capacity
 INTAVENOUS THERAPY (RLE SKILLS)

-to correct anemia as whole blood Symptoms you might see during an acute
and surgical blood minimizing the transfusion reaction include
loss hazard of volume
overload • Temperature increases than 1C or 2F
Platelet -to treat -ABO • Bloody Urine
thrombocytopenia compatibility is • Chills
-to treat acute not necessary but • Hypotension
leukemia and is preferable with • Severe low back, flank, or chest pain
marrow aplasia repeated platelet • Low or absent urine output
transfusion, Rh
• Nausea and vomiting
type is preferred
• Dyspnea or wheezing
-infuse 100ml
over 15 min • Anxiety " sense of impending doom"
-avoid • Diaphoresis
administering • When they do occur, IT is usually because
platelets when pt. of the ABO incompatibility between pt and
has fever donor during transfusion of red cells
Fresh -to expand plasma -cross-matching: • Ensure that the intended recipient is
frozen volume ABO compatibility getting the intended unit at the time of
plasma -to treat post- is not necessary transfusion
surgical but is preferable
hemorrhage or with repeated What to do if transfusion reaction occurs?
shock plasma
-to correct an transfusion;Rh i. Should any of these symptoms occur,
undetermined type is preferred discontinue the unit immediately, hang
coagulation factor normal saline (on a new tubing) to maintain
defiency vascular access and call for assistance
ii. Closely monitor the patients vital signs and
symptoms
SAFETY PRECAUTION
iii. Notify the physician and obtain further
➔ Make sure that YOU are protected too by: orders to address the pt symptoms
➔ Always perform sonal Protective for iv. Recheck the pt identifying information
➔ Wear proper Personal Protective Equipment against the transfusion record and blood
(PPE). Always perform disinfection bag
technique.
➔ If possible use needleless system. - If using
sharps, do not recap the needle. DOCUMENTING BLOOD TRANFUSION
➔ Always observe proper waste disposal
• Date and time complete the transfusion
according to your
was started and completed.
➔ institution's policy. - If there are spills, never
• Name the health Care professional who
touch the blood with bare hands. - Make
verified the information of the patient and
sure that blood bag is secured.
the blood
➔ Always double check or triple check. Always
perform HAND HYGIENE • Catheter type and gauge
• Total amount of transfusion
• Patient's vital signs before and after the
ACUTE TRANSFUSION REACTION transfusion.
• Infusion device used
-usually appear within the first 5-15 minutes after
the transfusion started.

TYPES of ACUTE TRANSFUSION REACTIONS

• Acute hemolytic transfusion reaction

• Febrile nonhemolytic transfusion reaction
• mild allergic reaction
• Anaphylactic reaction
• Transfusion associated Circulatory
• Transfusion related Acute Lung, Reaction
injury