Retdem
Retdem
Retdem
- involves the administration of water, nutrients (e.g. dextrose, protein, fats, & vit.), electrolytes,
blood products & medications.
- used for fluid replacement or fluid maintenance to treat disorders like dehydration,
malnutrition, and electrolyte imbalance
IV catherers/cannula
Types:
Insyte
Venflon
Neoflon (for pediatric px)
Advantages:
Needle Selection
Recommended Gauges:
IV parts:
Roller clamp
Bag spike
Needle end
Auxillary clap
Drip chamber
Injection part/ Y port
Complications
Local:
INFILTRATION
- Results when the infusion cannula becomes dislodged from the vein and fluids are infused into
the surrounding tissues
S/S:
Interventions:
Lower IV bottle
Kink tubing near insertion site. If there’s blackflow = patent
Nursing considerations:
EXTRAVASATION
- Occurs when fluids seep out from the lumen of a vessel into the surrounding tissue
Causes:
Examples of Vesicants:
S/S:
- Swelling
- Discomfort
- Burning
- Tightness
- Coolness in the adjacent skin
- Slow flow rate
Nursing Interventions
THROMBOSIS
- Injury to the endothelial cells of the vein wall, allowing platelets to adhere and thrombus to
form
S/S:
Nursing Interventions
Remove the device; restart the infusion in the opposite limb if possible
Apply warm soaks
Watch for IV therapy-related infection
Notify the physician
THROMBOPHELIBTIS
- Presence of clot plus inflammation of the vein
S/S:
- Localized pain
- Redness
- Warmth
- Swelling at insertion site
- Immobility of extremity
- Sluggish flow rate
- Malaise
- Leukocytosis
Treatment
- Discontinue IV
- Apply cold compress first (to decrease flow of blood and increase platelet aggregation;
- Followed by warmth compress
- Elevate extremity
- Restart IV in opposite extremity
PHLEBITIS
- Inflammation of the vein in which endothelial cells of venous wall becomes irritated
Causes
S/S:
Nursing considerations
Systemic:
HEMATOMA
- Blood leaks into tissues surrounding IV insertion site
- Manifested as ecchymosis and immediate swelling at site
Treatment
- Remove IV
- Apply light pressure with a sterile, dry dressing
- Apply ice for 24hrs
- Elevate extremity
- Restart in other extremity
SYSTEMIC INFECTION
- Successful transmission or encounter of hosts with potentially pathogenic organism
- Major hazard – septicemia
- Caused by: S. aureus, Klebsiella, Serratia, P. Aeruginosa
S/S:
Causes
Preventions:
SPEEDSHOCK
- Body’s reaction
Circulatory overload
Allergic reaction
- Tapping
- Curling
- Aspiration of air using syringe
- Bouncy
- Soft
- Above previous sites
- Refills when depressed
- Visible
- Has a large lumen
- Well supported
- Straight
- Easily palpable
Vein dilation
Technique
- Tourniquet
- BF cuff
- Gravity
- Fist clenching
- Tapping vein
- Warm compress
- Multiple tourniquets
- Wash hands
- Use sterile technique
- Change IV solution q 24 hrs