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Cheat Sheet

IV Therapy For Dummies

From IV Therapy For Dummies by Bettie Lilley Nosek, Deborah Trendel-Leader

Starting infusions, administering IV medications, and managing IV therapy in children and adults are among the most important skills you'll use in your nursing career. After all, nurses use these skills daily in all types of healthcare settings to restore their patients' health and save lives. The following sections give you an insider's glimpse of the practical aspects and real-world techniques associated with IV therapy.

Tricks of the Trade for Starting Peripheral IVs on Adults

Starting peripheral IVs on adults is one of the most basic yet fear-evoking experiences in nursing. But don't worry; whether you're administering fluids and electrolytes, medications, or blood components, you can use the following tips to get a head start to success:

  • Start by slowly and deliberately assessing the hand, wrist, forearm, and then antecubital area. Using your finger, palpate (feel for) a vein that's straight, soft, and bouncy when a tourniquet is applied.

  • Apply an anesthetic cream, such as EMLA (a mixture of equal quantities of lidocaine and prilocaine), or a freezing spray (such as Pain Ease), or inject a small amount of normal saline with preservative at the insertion site to numb the area and decrease the patient's pain (and fear) when you insert the needle into the skin.

  • Gently tighten the skin by placing your thumb a few inches distal to the site and pulling down on the skin to anchor the vein. Doing so tightens the skin and eliminates the possibility of vein movement.

  • Place the needle directly above the vein and insert it, bevel up, at a shallow angle to the vein. The closer the needle approximates the actual angle of the vein, the easier it will be to land the tip inside the vein.

  • Penetrate all layers of the vein in one motion. You know the needle is in the vein when you feel less resistance or see blood flashback (when the blood flashes into the catheter or blood chamber).

Starting IVs on Children: Insider Advice from Pediatric Nurses

IV therapy in children presents many challenges. As a pediatric IV nurse, you have to deal with squirming infants, anxious parents, chubby extremities, and smaller veins. To start off on the right foot, use the following tips to involve the patient and his parents before you even begin the infusion:

  • Use hands-on teaching tools to show the steps of starting an IV and encourage your patient to feel the soft catheter that will go inside his vein.

  • Be honest and tell your patient that the procedure will hurt for about the count of 50.

  • Ask your patient's parents to distract him with videos, games, or comfort items.

  • For infants, use sucrose water or pacifiers for distraction.

To make starting IVs on children a little easier, try using the following helpful techniques:

  • Illuminate veins in chubby extremities with approved fiber-optic or infrared light sources.

  • Use anesthetic creams, such as EMLA, to reduce pain, and use vasodilating agents, such as warm compresses, to help distend local blood vessels.

  • When possible, practice starting your first IVs on older children and then make your way to younger kids as you get more experience.

How to Safely Administer through a Central Line and Monitor the Infusion

Central vascular access devices (CVADs) are catheters placed in large, central veins, like the superior or inferior vena cava, for long-term infusions of medications, parenteral nutrition, and chemotherapy drugs. From the moment the doctor or specially trained nurse inserts a central catheter, the IV nurse is responsible for ensuring that the line is patent, free of clots, used for appropriate medications, and protected from bloodstream infections. Use the following guidelines to properly administer through and monitor a central line:

  • Properly administer medications. When administering medications through central lines, you need to make sure you administer them by using an infusion pump and any recommended filters if needed. Designate specific lumens for incompatible medications.

  • Change the dressing. You should usually change the dressing every seven days or PRN (as needed), if soiled or coming off, to minimize the risk of bacteria-related central line bloodstream infections. When changing the dressing, clean the insertion site with 2 percent chlorhexidine and cover it with a transparent semipermeable dressing. Chlorhexidine dressings are the dressings of choice for the Infusion Nurses Society (INS), and the Centers for Disease Control and Prevention (CDC) specifically indicates chlorhexidine-impregnated sponge dressings to reduce the incidence of bloodstream infections.

  • Flush the line to ensure catheter patency. To do so, scrub the hub of the catheter for at least 30 seconds with an appropriate antiseptic and let it dry; then administer at least 10 milliliters (mL) of 0.9 percent sodium chloride solution through the catheter hub. Be sure to flush the line after every medication administration to ensure that the line is clear of medications, to prevent drug incompatibility and to reduce the possibility of infection.

  • Lock central lines that are used intermittently. Locking refers to infusing heparin or normal saline solution to prevent clots and maintain patency in central lines that are used intermittently (less often) while the CVAD is in.

Infusing with Technology: IV, Auto-Syringe, and PCA Pumps

You can trace infusion pump technology back to the 1960s, when healthcare institutions used pumps mainly to improve accuracy and relieve IV nurses from constant monitoring and frequent medication administration. Today, smart infusion pumps help nurses deliver a vast array of complex medical therapies, including the following:

  • Delivery of insulin and IV nutrition timed to coincide with regular meals

  • Escalating flow rates to start slowly, allowing nurses to monitor the patient for adverse reactions

  • Intermittent options and IV pushes that allow for closer monitoring of patient responses

  • Tapered dosages to enable nurses to wean patients from medications

Additional innovations in smart pump technology include

  • Barcode readers and dose error reduction software (DERS)

  • Drug libraries that help prevent medication interactions

  • Safety alarms that signal infusion completion or complications

  • Sophisticated clinical advisories that provide practical information, such as reminders to administer a particular medication only through a central line

In addition to smart pumps, another significant advancement in pump technology is the auto-syringe pump, which allows nurses to insert preloaded medication-filled syringes into a pump chamber that automatically delivers a specific amount of medication at a controlled flow rate. Auto-syringe pumps deliver very small amounts of fluid at very slow rates, sometimes as low as 0.01 milliliters per hour, making them ideal for use with infants and fluid-restricted adults.

One of the most popular features of modern infusion pump technology is patient-controlled analgesia (PCA). PCA enables the patient to administer her own pain medication by pressing a control button attached to a continuous IV pump. When she presses the PCA button, a prescribed amount of analgesic or narcotic is released into the IV tubing and delivered by the primary infusion.

The key to safely administering IV medications is being knowledgeable about the medication, equipment, and supplies associated with the drug's administration. In some states, the IV nurse is primarily responsible for being knowledgeable even when a physician administers the drug. To become knowledgeable and promote patient safety, study the drug's circular about dosage, side effects, and management of adverse reactions. Then check out the infusion pump and associated supplies to make sure they're in proper working condition.

Advanced IV Therapy Techniques

Everyone agrees that IV infusions are the fastest way to deliver medications to a patient's bloodstream, but did you know you can deliver IV meds even faster by using the following two advanced techniques? The first technique, the IV push, involves the nurse pushing medication from a syringe directly into the patient's vein. The second, the IV piggyback, uses gravity to allow a secondary infusion to go before the primary infusion. Here's a little more info about each technique:

  • IV push: An IV push, also called an IV bolus, is the administration of more concentrated IV medications from a syringe directly into the bloodstream. It's one of the quickest and most effective ways to deliver drugs into the bloodstream, but it's also one of the fastest ways to induce adverse drug reactions. To prevent complications, IV nurses usually dilute IV push medications and deliver them slowly over several minutes.

  • Piggyback administration: This useful IV technique involves hanging a smaller, secondary piggyback infusion bag at least 6 inches higher than the primary infusion bag. From its higher position, the piggyback solution infuses first, and then the primary infusion automatically resumes flow, reducing the possibility for empty-bag air embolism. Nurses use piggyback infusions, sometimes referred to as IVPBs, to deliver a small volume of fluid or dosage of medication over a short period of time.

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