OBJECTIVES - Answer: After reviewing this, you should be able to: 1. Identify common IV (intravenous) solutions and abbreviations. 2. Calculate the number of specific components in IV solutions. 3. Define the following terms associated with IV therapy: peripheral line, central line, primary line, secondary line, saline/heparin locks, IV piggyback (IVPB), and IV push. 4. Differentiate among various devices used to administer IV solutions such as PCA (patient-controlled anesthesia) pumps, syringe pumps, and volumetric pumps. 5. Identify best practices that prevent IV administration errors and ensure client safety 6. Identify how technology related to IV therapy can enhance client safety Intravenous Therapy - Answer: --IV therapy—fluids, blood, and blood products, nutrients, as well as medications administered via a vein --RAPID acting Replacement fluids: --Vomiting, diarrhea, nutritional imbalances, or hemorrhage Maintenance fluids: --Sustain normal levels of fluids and electrolytes Provide IV medication therapy Intravenous Therapy (NOTES) - Answer: The goal of IV fluid administration is to correct or prevent fluid and electrolyte disturbances. IVs allow direct access to the vascular system, permitting continuous infusion of fluids over a period of time. To provide safe and appropriate therapy to patients who require IV fluids, you need knowledge of the correct ordered solution, the reason the solution was ordered, the equipment needed, the procedures required to initiate an infusion, how to regulate the infusion rate and maintain the system, how to identify and correct problems, and how to discontinue the infusion. [Table 41-11 on text p. 905 presents types of IV solutions.] An IV solution may be isotonic, hypotonic, or hypertonic. Isotonic solutions have the same effective osmolality as body fluids. Sodiumcontaining isotonic solutions such as normal saline are indicated for ECV replacement to prevent or treat ECV deficit. Hypotonic solutions have an effective osmolality less than body fluids, thus decreasing osmolality by diluting body fluids and moving water into cells. Hypertonic solutions have an effective osmolality greater than body fluids. If they are hypertonic sodium-containing solutions, they increase osmolality rapidly and pull water out of cells, causing them to shrivel. The decision to use a hypotonic or hypertonic solution is based on the patient's specific fluid and electrolyte imbalance. Additives such as potassium chloride (KCl) are common in IV solutions. A health care provider's order is necessary if an IV is to have additives added. Administer KCl carefully because hyperkalemia can cause fatal cardiac dysrhythmias. Under no circumstances should it be administered by IV push (directly through a port in IV tubing). Verify that a patient has adequate kidney function and urine output before administering an IV solution containing potassium. Patients with normal renal function who are receiving nothing by mouth should have potassium added to IV solutions. The body cannot conserve potassium, and the kidneys continue to excrete potassium even when the plasma level falls. Without potassium intake, hypokalemia develops quickly. Vascular access devices (VADs) are catheters or infusion ports designed for repeated access to the vascular system. Peripheral catheters are for short-term use (e.g., fluid restoration after surgery and short-term antibiotic administration). Devices for long-term use include central catheters and implanted ports, which empty into a central vein. Remember that the term central applies to the location of the catheter tip, not to the insertion site. Peripherally inserted central catheters (PICC lines) enter a peripheral arm vein and extend through the venous system to the superior vena cava, where they terminate. Other central lines enter a central vein such as the subclavian or jugular vein or are tunneled through subcutaneous tissue before entering a central vein. Central lines are more effective than peripheral catheters for administering large volumes of fluid, parenteral nutrition (PN), and medications or fluids that irritate veins. Proper care of central line insertion sites is critical for the prevention of catheter-related bloodstream infections (CRBSIs).