Cheever K.H.I.V. Therapy Demystified: A Self-Teaching Guide

I.V.

Therapy Demystified

S,

.u.

B

~.,

1I"J'f"O"'JI<

.

,ia

i,

a

C""""OtI

clinical "",,,;frstation

of

Phosphate Balance

Typ;cal

..

rum pho<phoru, 1",..,1. r.tnge from

2S-4.5

mEqIL

POOopbonls

h.as

an

i

mpon.n,

ro~

in

ffilIi

nlainin g ATf'

.tore.,

>h2re

...

ole

wi,h o.lcium in maintaining

bore

malri,

. •

nd

aid>

in the

"",

taboli.m

of

nu,rient>, f'ho

.pbonI.

1e

..

1s

lend

'0

beh

..

·• in > manne, 'm '

i.

,eciproc.I,o

caloium 1",..,Is.

Th.at

i

.,

hypoo>

nmia

is

commonly

CODComi'an' "'i'h hype<p/>o>phat<mi>. and ,,'ocn hYl"'fC.lcemia occurs.

hypoJ>ho>phatemi> ,yp;cally

oc<

..... in

,.oo.m,

Tabl.

2r7 di

.p

l

.}'.

rommoo

cau",s

and clinic.1

manifrna'ioo.

of

both h),poJ>ho>phalemia and hyperpho>ph.lemi

.,

HYPOPHOSPHATEMIA

•

1f)'P

op/losp/uJ"mia occurs when ,he serum phosphorus

1e

..

1

drop>

bel"",'

2.5 mEqlL,

It

OCCUfS

most

froqucn'ly when hYl"'fCanmi> occms,

It

al",

may

oc<u,

in pa,i.nt> wbo are

t",

...

d

'1IC~

..

fully

fOf

diabctic ketoacidosis (DKA)

with

i

n",

lin

bee,u.e

phosphorus may be pulled into the

cell.

"" • r

e.u

l,

of

in.ulin·s

effect on the cellular

"",mbu"".

I.V.

phosphorus

'"pplemcn"

""'y

be

prescribed

fOf

pati.nt> wbo

are

..

, ..... ly hypophooph>lemic

Of

who exhibit clinic. 1

manife.tatioo. ofhypoJ>ho>phatemia,

In

these

in"""",,

•. ,be suppl."",nt.al infu,ioo

should proc.oo

slowly

"'

ith f,,,,!,,,,n' monitoring

of

both the

..

rum phosphorus

leuls

and ,be serum calcium level.

bee""..,

hypoo.lcemi. m. y

«.u

l,

if

too moch

phosph"""

i.

administered

.'

,

-

,-

a;.;.,01 M.

oi_'

....

"w=ok<ma

s .....

..

,

~

..

ood

'1

__

ofhyp""'

.........

_"'

t O

KA

(_T>Nt,_61

Ovr

..

"I

..

,_

01

...

,,

01.

,

,-

a;.;.,01

Moo

___

'

....

")pOCoh",;,

s .....

..

,~

..

..a '1

__

oIhypocok<aoU.

...... r ......

(_

T>Nt

2_6)

RhobdooorofyW

_ I

)",

.-

CHAPTER

2 Fluids

and

Electrol

tes

HYPERPHOSPHATI:MIA

I'bo<phoru< level. in

..

co

..

of

4.5 mEqIL are

Nfl.;"ont

",ith /rJP"rp/w'pha-

"mid.

H),poc.lcemia i

••

freq""nt CODromitant

OCCUlTence,

It .

Iw

is.

freq""nt

COIl",!""""e

of

re",,1

failure. t

Wlo

The t

re.tment

for hYP"!pI>osphatemi.

i.

the

..

"",

'"

for

h),po<.kemi.

beeau><-)"",

..

rum calcium

1e",1s

carry more

seriou.

COIl>e-

qococe> than

doe.

an

..

ce

..

of

pho.phorus.

Summary

~luid

and electrolytes perf

0l1'Il

vitol fuoctioo. in

....

in

..

ining homeostlI.i

.,

Ur>derstand

in

g the

COH\f>05itioo

of

fluid and <Iertrol

)1",

in body fluid oom p2C1m<n",

their homeostatic mechanism •. and the

role

of

ley

electrolyte> in maint1ining the

fuoctioo

of

the",

fluid

compartment.

and in maintoining metlIbolic fuoction

i.

requi,ite to ur>de"tandinB indications

fC4"

LV.

the~,

Quiz

I.

Whioh

of

the fonov.'ing poIion"

i,

1m"

,u",eptible

to

dehydn

t

ion'

(a) An obese middle_

.ge

female

(b) A

IIOfTTIOI"izN.

he.lthy

adult

ITIlIle

(e) An elderly but he. lthy

IIIlIle

(d) A

IIOfTTIOI"izN.

he.lthy

12

_

month-<>1d

iofatlt

2. The majority

of

body fluids

<OIl

he

fOllnd

in

"'hioh

compartment'

,.)

lntr-.rellular

''l

E.""""

lIu

lar

(0)

lnte",

jtium

''l

lntnv

......

l..-

"

I.V.

Therapy

Demystified

].

Which

of

the

followin~

i.

the major <iel<rmimnl

of

colloidal

o,motic

f'I"'''u",

(COP)

"'

j

ohin

,he

in"",,,,,,ul

..

compartment'

(.J Sodium

<'J

F\:.t

...

ium

(,)

Fibrino~e"

!',

Album

in

4. Movement

of

water

""roM

• ><mipenneable

membnne

from

an

are.

,,'i'"

a

""""'

«>ne<!I'r>.t

ioo

of

",

l

u'e

to an >rea with .

""'k'

roocontr:ation

of

",Iule

i.

the definition

of

(

0)

diffu,ion.

(b)

osrJI05;'.

(oj the pon .ystem.

(d)

the

""mpy'tem.

~,

Aldosterone f""ilila

""

,m.1

r<absorpiioo

of

which

of

the following

electrolyte,?

(

0)

Sodium

(b) Chloride

(cj

I\:.t.

"ium

(d) M.gnesium

6. A ""II .......

Id

shrink

if

it

were placed in a bath

of

,",'h",h

of

the f<>lm'ing

t

)'I""

of

""1,,,;00,'

(0)

lS<JIooi<

(b)

H)'poIooi<

(cj

H)'penoo",

(d)

Saline

7 Which type

of

rondi

tioo

can

cau"" hyperchlocemi.?

(

.j

M

o.molic

.Ik

.....

i.

(b) Mo.molic acidosis

(o

j Respiratory

.I

h

l",;.

(d) Re.piratory acidosis

CHAPTER

2 Fluids and Electrolytes

!.

WhaI i. Ill< """",,,,,,ndcd

illlnO".""'"

inf

......

"It.

of

poIU>i.m

in

•

ptiIOnt

"'00

..

hypok

...

mit:

1

(.)

N<>

mon

than

10

ml:.q.1l

in

...

MImo","

od

...

iooI

. l

fa

antnoll.V

.

~".

i •

....d.

""

""""

than

:!O

ml'4h

(b)

N<>

""""

"""

20

mEq

by

tV

puolo

(e)

N<>

""""

""'"

Xl

mEq

'"

•

bolus

_

(d)

N<>

""""

""'"

10

mI:q

in

•

«fIltaltV

I;'"

bal.

9.

T,""""",

of

~~"moll)

'

pooaIly

i ....

'hu

(.)

m.ydrsuoo

tV

.

thofapy.

(b)

p"',,'rm

LV

. .......... .

(e)

hrmodialy

...

.

(d)b~

.......... _ .

CHAPTER

3

Intravenous

Therapy

Delivery

Systems

learning Objectives

Aftef oompl

..

in~

this

chaf>l<r.

m.

I.""""

"'ill

De.<ribe f.>lure,

of

commonly

">Cd

iolnve""".

(

LV

.)

,be",!,),

ron""oeB.

iocluding gl

...

boul

••

and

plastic

bag

•.

D<fioe

common

terms

u<ed in d....,ribing the

""up

of1.

V.

administr:a,ioo sets.

iocluding

spiking

.nd

priming.

Compare

and

o<>n'",,' indic>tion. for use

of

primary

.nd

secondary

infu.ion

"'

...

OI!I Identify indicaI;oo, for rue

of

""",h2nic. 1 and elec1ronic inru,ioo deli,'ery

'Y'l<m"

eopyr.,

...

""""

by

r .................

Como

.....

, ,

...

COot

__

........

'"

".

"

I.V.

Therapy

Demystified

Accu

.....

ly

cak"h

te

J.

v. drip

",te

. when

~

i

"en

..

"""ific

LV.

admin;"""ion

prescripti"" and a >pe<ific

tYJ><

of

LV.

admini>!"",on

..

t.

Describe featu,e> commonly

.vai

lab

l.

in m. ny electronic infu,ion de·,ice •.

Luer locl .

Spil

inB

Key

Terms

Primary infu,ion

....

SecoOOary

infu,ion

..

ts

futen.ion

~

Primin~

Dropf

....

C4"

Macrodrop

..,,,

Microdrop

..

"

Introduction to Intravenous

(!.V.) Therapy Delivery Systems

1he

nu

'

'''

mu>! be

comfortable

wa-

ki

og

with

commonly

used LV. !he",!,),"'1" i

""",n

t

in

oru.r

to

...

".re

Ill

..

,he patient

"""'>es

!he

;"fu.;on

of

fluid •.

bloOO

component •.

....

die

..

i

""

•.

or

"utrie"

I>

Ill

..

i.

prescribed

by

!he physic i. n

or

the advanced_

pnc

t

;c.

clinic;""

"'jill

prescript;,

..

authority authorized by

hi.

or

","

""I""',;ve

gm..,ming

"",e

bootd

of

"""ing

or

med",jflf,

An

advaoced_pnctico clinic;"" ,,-he has Ihi.

l),pe

of

"uthoriz>,ion may include a n""",,

~ili"""r.

nu""

midwife.

nu""

""',,"'.,,;

...

or

pill

';";""

..

,i'l2Ill.

Any infu';oo

deli.erN

to.

!"'tien!

by

lhe

LV

. roo

..

mo"

be

oterile.

Of

p,,,hogeRS

that are introduced may

cau",

septicemia,

n.e",fore.

,II

connecting po." bet

..

""n

LV,

cooa i ....... , lilIeS, filters.

,nd

"""""

device. must "'lTIlIin

secure.oo

.terile.

It

i.

oot

nec=ary

th, t the nu"",

"'0'"

~k",.".

when

""tin~

up

, n odmini.tnItKln

""

.

H

ow"wr.

the n

.....

mu

..

wash

hi.

or

her

h.nd.

thorou~hly

.00

vigorou.Jy prioI to

..

tt

in

~

up

""

l.

V,

admini

..

"'tioo

..

t

.00

must be <

....

ful

not

to touch

or

otberwise

<OIItaminate

open

port.

or tips before they

"'"

oonnec1M into the .ystem. Connec1OB

"

"""'"

:.s

Loec

l

ocks

"'"

odvoc,t..J

bee,use

they provide •

"""u",

""",,

·_type

<OIInertiOll

bet

..

'""n connecting I,

V,

li"" •

.oo

hub>

of

l.V. o<ce

..

dev;"",

.'

T""in~

in

to

rroonertin~

part.

of

the

I,

V,

><Imini

.....

tiOll

"""I'.

thoogb performed commonly

in

years 1"".

i.

oot

><IVOC.

t

M,·

CHAPTER

3

Intravenous

Therap

'i

Delive

ry

Sy

e

>le",mc'

'--'

''

'-'

Infusion Containers

Intr;,.."""

...

infu.ion

coot';""B

«>me

in • ,.,.m.,.y

of

size> that ~ge from

50

to

over 2000

mL

One

liter (i,e., 1000 mL)

i,

the most

rommoo

LV,

infuYon COII!:';""r

size .mpJoyed

fC4"

infuYon

of

the

......

f"""",ndy

u>ed

LV

.....

ution •. which arecalled

Cf)"laIloid, and >re discu..oo in

Olapter

7. 'I. The

nu""

obould

.iwally

in>pect

the

lV

. infu.ion

coot.i"...

pric4"

to

. pi

ki

ng

it

with an infuOOa oct,

Sp

il;

in~

an

lV.

OOfltlIiner

with an infu.ion

oct

"",an,

that the

>teri

Ie

ti p

of

the infuOOa

..

t

1=

pen!'tr;ued

the

..

al

of

the

cont.aillCl.

If

the ..,]ulion "I'P""'"

di>OOlored.

noI

of

unifonn

ooIor,

0.-

oonta

i".

any panicul

..

e matter. the oont>iller

i.

di",;uded. The ronLaincf

srould

noI

he

crxked

0.-

otherwi", "I'JI<2' viol.ted. or

it

li

k

.".,i",

srould

he discarded.

There

...

two type>

of

lV,

infuYon con

..

in<=-~l.ass

boItle. and plastic bag •.

No matte!

"hich

type

of

container

i.

u>ed. and no matter whetherC4"

noI

on

infu,ion

pump

i.

used to

.id

in

the

preci«

deli~

of

the prescribed

",

lut

iOll.

i,

i.

good

prxtice

to

adhere.

time tape

to

the

.ide

of

the ront>i

nero

The

ti

me

tape

...

mini mum

srould

note

the

,ime . nd date

Ib

..

the

coot.iner

",..

.p

iked

(or

"""e.sed

by

.n

LV

.

infu.ioo

set),

t

he

init

i.l

.

of

the

nu""

who

.p

i

kod

the

cooLaine.-.

and inc",,,,,,ntal

RWlinp

that denole

"PP"'-'ima

te

time.

that solu,ion

srould

empty from the

oontainer, If there i • • change in

order

of

'Il< delivery n te

of

the ..,Iution, then the

time

tape

.1",

should he oltered to refleet this change,

GLASS

I.V.

BOTTLES

Glas.

LV

. boItle. ,,-ere the

fir:sl

clo><d t)'pe>

of

LV.

ron

ta

i"""

u.ed, They tend to

noI

he

u>ed

..

freql><

ndy

..

plastic

LV.

bog>

fo.-

deli",ry

of

mos'

solut

ion.

tod.y

bee

.....

they

are

harder

10

"ore

and e •• ier to

c.xl.

GI

...

I,

V,

bold

e.

are

indicated

for

admixin~

medic. t

ion.

and nutrWn" ,hat migh'

in

t

erac1

with the pl

..

tic.

commonly used in pl

..

tic

LV.

bag •. Example.

of

odmi"ure

. thai are known to

in"'rxt

wilb plastic ioclude nilroglycerin and

fat

emu!>;"" •. "

GI

...

LV.

bol,b

fe

..

ure • rubber disk plug that

is

rovered

by.

"erile

se.

l,

After

the seal

i.

remo.ed.

the rubber

di,k

i, penetrated wilb 'Il<

,to

rile lip.

0<

spike.

of

the

lV,

infuYon

..

t.

The

boIll

••

ore

varuum

_

p>o<ked.

'"

.ir

mu"

he

permitted to fl"",'

into the bolde

to

displace the solu,ioo.

If

the

bolde

i.

p>o<kod

..,

,h

..

il ronLains •

ven"ng

"",,

'.

then .irfl"",'

i.

alreody

en",red,

If the boIlie

doe.

noI

ront.in

•

ven'ing

"nw

.

then.

,..,nted

I,V,

infu,ion set

mu"

he

..

Iocted

0.-

flow

of

solution

I.V.

Therapy

Demystified

.·Igu

..

J·I

V,nt«l

and

OOO"""t«l 81

...

I. V.

tKltUes.

(UI<d

~'

it

h

p«mi

..

ion t

fOOl

1'<,.",.

R:

lofu.ion

ltl<nj»' "'Iuipm<nt:

Ty",.

of

in

t

..

ion tIl<.-.py "'Iuipm<n'- In

Han.in. J.

Loo'''''y

RAW.

Ji«lric.

C.

P<rd

...

MB

(<"-'.):

TIodnfi""'"

N."

..

s",,;"J'

Inp';""

n.,"'FY

;"

C/;n;call'"",hc

•.

,tid

.....

Phil

....

l

~i>:

s..unde.-s.

2001. Fig.

I~

· I

.

)

from lhe

b01l1e

"'ill 00< occur,"

F

i

~ure

3· 1

di,play.

",.led

and

,,,,,..-.nled glass

b

ollie.

,,'i'"

""peel

i

",

"""""nl

....

and

,..,n"

,<1

lubin~,

The glas,

bootie

i.

,p

iked with

an oppropri>le LV. infu.ion set

.flef

the lubing

i.

d>mp<"d.

and

the

boolle

then

i.

hu.~

on IUIl.V, pole as

di,pI'yed

in til<

fi~u""

PLASTIC

I.V.

BAGS

Pl

lStir

LV

.

b:igs

...

the..-

commonly used

LV

.

COIllai

.....

"""""'"

""-"Y

are

""'y

to

store

and

Ie>S

vul!ll"r.lble

IO<iarnose

than

gla.s

cootai

......

Fi~ure

J.2.row..

,-.ricty

of

plastic I

,V.

b:igs,

B<=u.e

these plastic bags

C2/I

001"""".

u..y

do

000

need to

be

.. ented

to

<=<R

1\01<'

of

...

lutioo from the

bas

inlO

the

LV, infusim

....

n.e.e

bags rootain

...

CHAPTER:3

Intravenous

Therapy

Delivery

Systems

41

IOOOH

pDII.

..

"".

";1<

"-10.

.",

..........

-*

""*"

i

.................

><en<

pDII.

of

....

~iiopikDd

..

idI

....

~of ....

I.Y

inI'uoiooo

.............

cb<npon

....

inIitWoo

...

ii-.

..

dnpb)'<d

..

npn: 3-1 The t Y

~

......

ii

.....

<III

..

LV.

pol<.

F

Ip

"'

~

SlOp in

""1,,,

..

1 y!'"ll

....

ft

.~._

...

.... RoIIor<>mp

i>

po<Ud

.........

1J.

_~II..-

.c.

__

11.

__

LY

!'"IIpcnD

.

~

....

II.

__

""opIl;t

.

OIId""""II.

__

""

I.V.

~

(

u..d

_

pn

...

.

,I

..

tr<IIIl

p..,y...o.

""""'

fA

.

a--.r

N..-,.uolb_

T

............

~,

..

". Sl.

L_il

,

MOotIy.

2OOl;56f.)

"

I.V.

Therapy Demystified

I.V.

Lines

In""",,,,,,,,

Ii"".

can

i""lude primary infu,ion

..

os.

oecondary infu.ion

_.

and

"""".;00

..,IS.

f'rimary and secondary

i"[",ion

"",

boIh cootoin

'pike.

and

drip <hombers. wbe",

....

ten,ion

>eI.

do

_

con"'"

.p.:k

...

0<

drip

chamben.

1he

LV,

t"bin~

on both infu.ion

",II

.00

..

ten,ion

",

..

"""

be

of

• ,,.ne,y

of

Ie"glll.

ond

may

COIItain

one

0<

""

..

,,:oJ

clamps

and

on<

or

..,-=01

injecrion

()(

""res>

pons.

PRIMARY

INFUSION

SETS

A

pri

mal')' i

nfu."'"

..

I i. the main ,ubing t

ha

t canie> COIllinuoo<ly i

nfu'ing

",Iu,ion

from ,be LV, bag

or

boule inlo ,he pat;"n,",

""

in

by

"'Y

of.

,-.,.,oos

a<ce"

<levi«.

I'<:fiph=1

'-<DOlI'

""~"

devices are described in

OIapter

4. and

cen,

,,,1

'-

"DOIIS

acee

..

de"ice,

are

d.scribed

in Chapler 5. f'rimary infusioo >els

vary in length from

60

to

110 ioche>.

Minimum

charoc,e';>!;".

of

the

..

>e<s

iooloo.

a

'Pile

10

acee

..

the

LV.

bag or bottle. a drip

clwnber.

and

.,

I

...

, ooe

damp.

n..

damp

i. typically . roller clamp_ .

I.bough.

>lido

clamp

0<

a ""re

..

' clamp could

he

"=I.

M""

primary

infu,ion..,,,

.150

f",wre

one

or

moe.

injection

port.

or

inj<-crion

,i"'slll

..

may he used to inject medic

..

;oo.

by

eithe,

''pigHb>d''

infu,;oo

or

I.Y.

push. Injection

port.t),pic.lly

are designed

50

lhat lhey moy

he

or<:e>sed

by

eithe,

"""dleleY inject;oo

dev"'"

Of

by

"""dle-protec1oo

device.",

....

t

"'"

ri.k

of

r>e<"<!1

.

..

ick iniury

i.

minimized.

n.e.nd

of

the tubing that

i.

di,

..

1 to the .pike

t)'pi<>lIy

f<>lure>

a L .... ,

lod

de.ign

so

that the likelihood

of

dioroall<"<."lioo

from

"'"

hub

of

the

LV

. •

,""".

<lev",.

i.

minimized,"

Figu,.

3-4

.how.

two t)'pe.

of

primary

LV.

odministr.ilt;oo sets,

SECONDARY

INFUSION

SETS

s..,o

....

ary

i nrusion

..

t.

,hare

many

of

t

he

......

ch.rxteri<1

"'.

as primary i nfu,;oo

""

.

including.

'l'ik

a drip chambe,. one

or

se',enl

cI.mps,

and some1i"",.

one

or

.,,,,,,,,,1 occ

...

port •.

H"",."".

they are • .00 for

.i

ther

cOIItinOOll'

or

inlenni"ent

inf •

.;on

of

medic

..

i"".

that are

''pigHbacked''

into the prim"'}' line

by

e

i""'

, a

"""dleleY injection <lev",.

or

•

""""

le.protected device.

n.e

OOIl

ti

n""",ly

infused

..,Iutioo ckl

i",

..

d by the primary infu,ion

""

mu.t

he roml'"'ible with the

med",

..

iOll

deh

..

red

by the secondary infu.ion set. Second. ry infu.;on ><I.

tend

to

he shorte, than primary infu.ion sets and are rommooly de.igned

..

30-36

inches

in

length

."

Cheever K.H.I.V. Therapy Demystified: A Self-Teaching Guide

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