INTRAVENOUS FLUIDS AND COMPUTATION - NURSING FOUNDATION
- 1. CLINICAL FOCUS: IV FLUIDS AND COMPUTATION Jhonee Balmeo
- 2. PRESENTATION FOR: PARENTERAL FLUID AND ELECTROLYTE REPLACEMENT IV SITES AND THE COMPUTATION PRACTICE QUESTIONS
- 3. PARENTERAL FLUID AND ELECTROLYTE REPLACEMENT ◦ IVfluid therapy is essential when clients are unable to take sufficient food and fluids orally. It is an efficient and effective method of supplying fluids directly into the intravascular fluid compartment and replacing electrolyte losses. IVfluid therapy is usually ordered by the primary care provider. ◦ The nurse is responsible for administering and maintaining the therapy and for teaching the client and significant others how to continue the therapy at home if necessary.
- 4. Intravenous Solutions. ◦ IV solutions can be classified as isotonic, hypotonic, or hypertonic. ◦ Most IV solutions are isotonic, having the same concentration of solutes as blood plasma. ◦ Isotonic solutions are often used to restore vascular volume. ◦ Hypertonic solutions have a greater concentration of solutes than plasma; ◦ hypotonic solutions have a lesser concentration of solutes.
- 7. TYPE/EXAMPLE COMMENTS/NURSING IMPLICATIONS Isotonic Solutions • 0.9% NaCl (normal saline) • Lactated Ringer’s (a balanced electrolyte solution) • 5% dextrose in water (D5W) Isotonic solutions such as NS and lactated Ringer’s initially remain in the vascular compartment, expanding vascular volume. Hypotonic Solutions • 0.45% NaCl (half normal saline) • 0.33% NaCl (one-third normal saline) Hypotonic solutions are used to provide free water and treat cellular dehydration. These solutions promote waste elimination by the kidneys. Hypertonic Solutions • 5% dextrose in normal saline (D5NS) • 5% dextrose in 0.45% NaCl (D5 1/2NS) • 5% dextrose in lactated Ringer’s (D5LR) Hypertonic solutions draw fluid out of the intracellular and interstitial compartments into the vascular compartment, expanding vascular volume Watch for signs of hypervolemia
- 8. COLOR CODING IN IVF IV FLUIDS COLOR D5 LRS PINK D5 NM ORANGE D5 NSS YELLOW D5 NR LIGHT GREEN D5 WATER RED D5IMB VIOLET D5 0.3 NaCl LIGHT BLUE P NSS DARK GREEN P LRS BLUE
- 9. COLOR CODING IN IVF
- 10. COLOR CODING IN IVF
- 11. Venipuncture Sites. ◦ The site chosen for venipuncture varies with the client’s age, length of time and infusion is to run, the type of solution used, and the condition of veins.
- 12. ◦ For adults, veins in the arm are commonly used; ◦ for infants, veins in the scalp and dorsal foot veins are often used.
- 13. General Tips for Easier IV Starts ◦ Review the client’s medical history. Avoid using an arm affected by hemiplegia or with a dialysis access, on the same side as a mastectomy, or near infections, below previous infiltrations or extravasations, and veins affected by phlebitis.
- 14. General Tips for Easier IV Starts ◦ Dilate the vein. Ways to do this include ◦ (a) dangle the client’s arm over the side of the bed to encourage dependent vein filling, ◦ (b) ask the client to open and close his or her fist, ◦ (c) stroke the vein downward or lightly tap the vein, or ◦ (d) apply warm compresses to the site for 10 minutes.
- 15. General Tips for Easier IV Starts ◦ Make sure the client is positioned comfortably and has been medicated for pain if appropriate. Pain and anxiety stimulate the sympathetic nervous system and trigger vasoconstriction.
- 16. General Tips for Easier IV Starts ◦ If the ordered IV medication is irritating to veins and therapy is expected to last more than a few days, consult with the IV nurse or medical team to determine whether the client is a candidate for a midline catheter, a peripherally inserted central catheter, or another type of central venous access device.
- 17. General Tips for Easier IV Starts ◦ Use the smallest gauge catheter that will accommodate the therapy and allow good venous flow around the catheter tip. ◦ For routine hydration or intermittent therapy, ◦ use 22- to 27gauge catheters; for transfusion therapy, ◦ use 20- to 24gauge catheters; and for therapy for neonates or clients with very small, fragile veins, ◦ use 24- to 27-gauge catheters.
- 18. General Tips for Easier IV Starts ◦ Raise the bed or stretcher to a comfortable working height, and keep all equipment within reach. Stabilize the client’s hand or arm with your nondominant arm, tucking it under your forearm if necessary to prevent movement ◦ Limit your attempts to two. If you’re not successful after two tries, ask another nurse to try.
- 19. Intravenous Equipment ◦ Butterfly, or wing-tipped, needles with plastic flaps attached to the shaft are sometimes used. The flaps are held tightly together to hold the needle securely during insertion; after insertion, they are flattened against the skin and secured with tape. The butterfly needle is most frequently used for short-term therapy (e.g., less than 24 hours) such as with
- 20. Schematic of a butterfly needle with adapter
- 21. A saline lock (sometimes called a “hep-lock” for historic reasons)
- 22. A saline lock (sometimes called a “hep-lock” for historic reasons)
- 23. A saline lock (sometimes called a “hep-lock” for historic reasons)
- 24. Schematic of an over-the-needle catheter
- 26. Color coding
- 27. A standard IV administration set.
- 28. Infusion set spikes and drip chambers: nonvented macrodrip, vented macrodrip, and nonvented microdrip
- 29. Regulating and Monitoring Intravenous Infusions. ◦ Orders for IVinfusions may take several forms, for example “3,000 mLover 24 hours,” “1,000 mLevery 8 hours x 3 bags,” or “125 mL/hr until oral intake is adequate.” ◦ The nurse initiating the IV calculates the correct flow rate, regulates the infusion, and monitors the client’s responses. Unless an infusion control device is used, the nurse manually regulates the drops per minute of flow using the roller clamp to ensure that the prescribed amount of solution will be infused in the correct time span.
- 30. Regulating and Monitoring Intravenous Infusions.
- 31. Regulating and Monitoring Intravenous Infusions. ◦ 1st is get the milliliters per Hour ◦ Hourly rates of infusion can be calculated by dividing the total infusion volume by the total infusion time in hours. For example, if 1,000 mL is infused in 8 hours, the number of milliliters per hour is: ◦ 1000ml / 8hrs = 125cc/hr
- 32. Regulating and Monitoring Intravenous Infusions. ◦ 2nd, get the drops per Minute ◦ The nurse who begins an infusion must regulate the drops per minute to ensure that the prescribed amount of solution will infuse. Drops per minute are calculated by the following formula:
- 33. Regulating and Monitoring Intravenous Infusions. ◦ If the requirements are 1,000 mLin 8 hours and the drip factor is 20 drops/mL, the drops per minute should be
- 34. Regulating and Monitoring Intravenous Infusions. Infusion sets: (Drop Factors) Macro set / Adult Set: 20 gtts/ml Micro set & Soluset: 60mgtts/ml Blood Transfusion set: 15gtss/ml Some institutions, drop factor is 15 gtts/min
- 35. Pedia Calculation ◦ For pedia: 500 x 60 =30,000 8 x (60)=480 ◦ =62.5 (or 62-63mgtts/min)
- 37. Factors Influencing Flow Rates ◦ The position of the forearm. Sometimes a change in the position of the client’s arm decreases flow. Slight pronation, supination, extension, or elevation of the forearm on a pillow can increase flow. ◦ The position and patency of the tubing. Tubing can be obstructed by the client’s weight, a kink, or a clamp closed too tightly. The flow rate also diminishes when part of the tubing dangles below the puncture site.
- 38. Factors Influencing Flow Rates ◦ The height of the infusion bottle. Elevating the height of the infusion bottle a few inches can speed the flow by creating more pressure. ◦ Possible infiltration or fluid leakage. Swelling, a feeling of coldness, and tenderness at the venipuncture site may indicate infiltration.
- 39. Practice Question No.1: ◦ Your duty is 7am-3pm. ◦ You received your client c D5LRS iL @full level to run for 12hrs, t/c. Quetion: 1. compute how much ml is being consumed q hr? 2. Compute the drops/minute? 3. What time are you going to remove the IVF? DF: 20gtts
- 40. Practice Question No.2: ◦ Your duty is 3pm-11pm. ◦ You are assigned in Mx Ward, the endorsement read as follows: you received your client c D5NSS iL @800cc level to run for 8hrs. Quetion: 1. compute how much ml is being consumed q hr? 2. Compute the drops/minute? 3. What time are you going to remove the IVF? DF: 20gtts
- 41. Practice Question No.3: ◦ Your duty is 3pm-11pm. ◦ You are assigned in Pedia Ward, the doctor’s order are as follows: IVF to replace c D5 0.3NaCl 500cc @3pm, for 45cc/hr. Quetion: 1. compute how much ml is being consumed q hr? 2. Compute the drops/minute? 3. What time are you going to remove the IVF? DF: 60mgtts
- 42. Tip! ◦ Computation of IVF made easy Use the short method formula: IVF (1000cc) ÷ IVF t/c (8hrs) ÷ 3 (constant) = 41-42gtts/min *if the drop factor is 20, constant will be 3, if DF is 15, then constant will be 4.
- 43. End of discussion ◦ Consultation time: ◦ Plz refer to our GC for the link