IV Therapy For Dummies E-Book

Bettie Lilley Nosek

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 530

Veröffentlichungsjahr: 2012

Beschreibung

The fast and painless way to ace your IV Therapy course Are you an aspiring nurse, nurse practitioner, or physician's assistant struggling with IV therapy? Help is here! IV Therapy For Dummies tracks to a typical IV therapy course and gives you current, easy-to-follow guidance on everything you'll encounter in class, such as delivery methods, flow rates, legal issues, profession standards, and documentation. IV Therapy For Dummies also discusses the necessary components of peripheral and central venous therapy, including access sites, equipment, preparation, maintenance, and the discontinuation of therapy. Plus, you'll get the 4-1-1 on the administration of IV medications, including special considerations for pediatric, elderly, and home care patients. * Tracks to a typical IV Therapy course * Provides current, comprehensive information in plain English If you're enrolled in an IV Therapy course or a healthcare worker looking for a refresher on this important form of medical treatment, IV Therapy For Dummies has you covered.

Leseprobe

IV Therapy For Dummies®

Visit www.dummies.com/cheatsheet/ivtherapy to view this book's cheat sheet.

Table of Contents

Introduction

About This Book

Conventions Used in This Book

What You’re Not to Read

Foolish Assumptions

How This Book Is Organized

Part I: Tapping Into IV Therapy

Part II: What’s Your Type? Components of IV Therapy

Part III: Getting Down to IV Therapy Business

Part IV: Administering IV Therapy

Part V: Considering Unique Populations

Part VI: The Part of Tens

Icons Used in This Book

Where to Go from Here

Part I: Tapping Into IV Therapy

Chapter 1: Introducing IV Therapy: A Purpose-Driven Practice

What’s the Point? The Purpose of IV Therapy

Administering emergency fluids and medications

Delivering pharmacological agents

Replacing blood and blood products

Administering chemotherapy medications

Maintaining fluid and electrolyte balance

Providing nutrition

The Main Ways to Administer IV Therapy

Understanding the Important Role You Play in IV Therapy

Getting down to brass tacks: Starting IVs

Preventing infection

Monitoring infusions and managing complications

Supporting your actions by keeping careful records

Familiarizing Yourself with Standards of Care

Understanding the importance of the Infusion Nurses Society

Implementing INS standards of care in your daily practice

Avoiding lawsuits by following standards of care

Staying focused on ethical principles

Working within your scope of practice

Implementing evidence-based infusion practice

Documenting informed consent

Complying with your employer’s policies and procedures

Chapter 2: Keeping within the Letter of the Law

Understanding the Legal Standard of Care

Making Sense of Federal and State Regulations

Seeing who’s watching your back at the federal level

Looking at oversight of the state

Maintaining Professional Standards

Defining a competent level of care: The American Nurses Association

Improving the quality of healthcare: The Joint Commission

Maintaining the standard of care: The Infusion Nurses Society

Following facility policy

When Bad Things Happen to Good People: Comprehending Malpractice

Do you owe a duty of care?

Has there been a breach of duty?

Are there grounds for legal causation?

Are the damages legally compensable?

Understanding Common Areas of Malpractice and Negligence

Improper administration of medications

Improper use of equipment

Failing to act in a timely manner

Not keeping a close enough eye on your patient

Causing or contributing to infection

Lack of communication with the ordering doc

Having joint responsibility

Reducing Your Risk with Risk-Management Strategies

Listening to your patient

Completing an unusual occurrence report

Documenting accurately

Carrying professional liability insurance

Maintaining prudent patient relations

Chapter 3: Tools of the Trade

Vascular Access Devices

Choosing the best peripheral access device

Keeping it centralized with a central vascular access device

Solution Containers

When your infusate can’t adapt: Using a glass container

Being aware of the challenges of plastic containers

Knowing your limitations: Alternate solution containers

Saving time with ready-to-use drug delivery systems

Administration Sets

The main event: The primary administration set

Piggybacking with a secondary administration set

Limiting fluids with a metered-volume chamber set

Isn’t that special? Considering a specialty set

Characteristics of administration sets

Flow-Control Devices

Relying on the manual method: Gravity

The pressure is on: Adding pressure with a pressure bag

Relying on its own power: The mechanical infusion pump

Pumping up the volume: The electronic infusion pump

Characteristics of every infusion pump

More to Think About When Choosing IV Equipment

Using an inline filter

Adding to your line with add-on devices

Stabilizing your device

Protecting the IV site

Part II: What’s Your Type? Components of IV Therapy

Chapter 4: Medications Made to Order: Pharmacological IV Therapy

Understanding How Pharmacological IV Therapy Works

Pharmacokinetics: How the body works on a drug

Pharmacodynamics: How a drug works on the body

What’s the point? Recognizing the reasons for IV medication administration

Understanding Adverse Effects

Identifying Drug Incompatibilities

Reconstituting IV Therapy Medications

Understanding the basics

Working with single-strength medications

Working with multi-strength medications

Storing leftovers

Practicing for perfection

Familiarizing Yourself with Common Classes of Pharmacological Agents

Chapter 5: Beefing Up on Blood Component Therapy Basics

Defining Blood Component Therapy

Knowing when blood component therapy is necessary

Understanding the risks involved

Breaking Down Blood Composition

Finding a Match: Compatibility Is Key

Donor plus recipient: A match made in heaven

Identifying antigens and antibodies in the blood

When antigens and antibodies go to war: The hemolytic hazards of a mismatch

Types of Blood Component Therapies

The whole in every part: Whole blood versus individual blood components

Sending them packing: Packed red blood cells

Cleaning up their act: Modified packed red blood cells

Skipping the leukocytes: Leukocyte-reduced packed cells

Pass the platelets, please

Keeping it fresh: Fresh frozen plasma

Adding granules with granulocytes

Chapter 6: Chemotherapy 101

Getting with the Program: The Principles of Chemotherapy

Defining chemotherapy

Taking a closer look at cell cycles

Slowing down cancer: How chemotherapy works in the body

Considering the risks

Determining the Goals of Treatment

Using chemo to cure

Controlling the spread

Providing comfort: The palliative side of chemotherapy

It’s Classified: Classifying Chemotherapy Drugs

Chapter 7: Maintaining Equilibrium with Fluids and Electrolytes

Getting Your Fill: Introducing Fluids and Electrolytes

Appreciating your body fluids’ full-time job

Getting a charge out of electrolytes

On the Move: Following Fluids between Compartments

Catching a free ride with passive transport

Going against the grain with active transport

Assessing Your Patient’s Fluid Requirements

Taking a peek at the labs

Maintenance fluids: Accounting for everyday losses

Replacing existing and ongoing losses from illness or injury

Restoring Volume with Crystalloids and Colloids

Getting acquainted with crystalloids

Cozying up with colloids

Correcting Fluid and Electrolyte Imbalances

Hypovolemia: Getting low on fluids

Hypervolemia: Having excess fluid

Simplifying sodium imbalances

Catching on to chloride

Playing it safe with potassium imbalances

Making calcium less complicated

Picking apart phosphate imbalances

Managing magnesium imbalances

Acid-Base Balance Made Easy

Sorting out types of acid-base imbalances

Correcting acid-base imbalances

Chapter 8: Serving Up Parenteral Nutrition

From Soup to Nuts: Reviewing Parenteral Nutrition Basics

Knowing when to use parenteral nutrition

Identifying the many nutrients of PN

Pointing out the two types of PN

Creating a Balanced PN Recipe for Success

Incorporating the main ingredients

Moistening the mix with fluids

Mixing in a little medication

Preparing the finished product

Part III: Getting Down to IV Therapy Business

Chapter 9: Documenting Diligently: The Backbone of Infusion Therapy

Seeing Why Accurate Documentation Matters

Improving communication for continuity of care

Acting as your insurance policy: The importance of legal records

Following protocol: Outlining steps to reach successful patient outcomes

Providing info necessary for insurance reimbursement

Making Your Documentation Rise above the Rest

Just the facts: Keeping it accurate and focused

Making it complete

Ensuring it’s legible and correcting writing mistakes

Building on timeliness

Making sure it’s accessible and easily retrievable

Putting It into Practice: Documenting IV Therapy

Before you begin

The insertion of a peripheral VAD

The administration of the infusion

The ongoing monitoring of the site

The removal of the device

Chapter 10: Calculation Central: Figuring Drug Dosages, Drips, and Flow Rates

Calculating Correct Drug Dosages

Understanding the metric system

Using different calculation methods

Practicing dosing calculations

Going with the Flow: Calculating Drip Rates, Flow Rates, and Infusion Times

Using drop factors to calculate drip rate

Using two different methods to calculate flow rates

Using the flow-rate formula to calculate infusion time and total volume

Chapter 11: Gravity, Pumps, and Syringes: The Many Ways to Deliver IV Therapy

Flowing with an Invisible Force: Gravity-Fed Infusions

Optimizing Therapy with IV Pumps

Administering by continuous infusion

Delivering intermittent IV therapy

Infusing through smart pumps

Giving Infusions a Little IV Push

Going Automatic with Auto-Syringe Pumps

Empowering Patients with PCA Pumps

Chapter 12: Going for the Hand or Arm: Peripheral IV Essentials

Getting Started with a Few Peripheral IV Basics

Performing an Initial Vascular Access Assessment

Verifying the order

Preparing your patient

Checking for allergies

Confirming the five rights

Gathering Your Equipment: Selecting the Appropriate Peripheral VAD

Size does matter: Choosing the correct catheter size

Considering the type of device

Determining the Best Peripheral IV Site

Beginning the Insertion Process

Prepping the site

Administering an anesthetic

Inserting the peripheral IV

Securing the catheter

Dressing your site

Initiating therapy

Labeling the infusion bag and line

Verifying and documenting your actions

Monitoring the Infusion

Assessing the site for complications

Flushing the line

Watching for complications

Documenting your actions

Replacing Peripherals at Regular Intervals

Discontinuing the Peripheral Line

Chapter 13: The ABCs of the CVAD

Starting from Scratch: CVAD Basics

First Things First: What to Do Before Using the CVAD

Ordering a chest X-ray

Obtaining an order to infuse

Gathering the Supplies You Need to Infuse through a CVAD

Choosing the right infusion device

Surveying the different types of CVADs

Preparing the Line and Starting the Infusion

Monitoring the Line

Checking out the surroundings

Assessing the site

Flushing the line

Locking the line

Checking for and preventing common complications

Maintaining CVADs

Changing ports, access caps, and IV tubing

Performing site care and dressing changes

Documenting your actions

Drawing Blood through the CVAD

Obtaining an order

Withdrawing the blood

Discontinuing and Removing the CVAD

Following the right procedure

Inspecting the catheter

Documenting your actions after the removal

Using an Implanted Port Instead

Applying a local anesthetic

Gaining access with a non-coring needle

Administering therapy through the port

Communicating with your patient

Part IV: Administering IV Therapy

Chapter 14: Practical Pharmacological IV Administration

Assessing Your Pharma Patient

Considering five critical safety issues

Asking patients about their problems

Knowing your patient’s medication history from past to present

Initiating Pharmacological IV Treatment

Before you begin: Getting ready for the infusion

Starting IV medication therapy

Monitoring the infusion

Recognizing and Managing Adverse Drug Events (ADEs)

Discontinuing IV Medications

Staying Safe: Disposing of Pharmacological Agents

Chapter 15: Transfusing Blood Components

Preparing for a Blood Transfusion

Verifying the physician’s order and the patient’s blood type

Preparing your equipment

Preparing your patient

Obtaining informed consent

Administering pretransfusion medications

Initiating Treatment

Verifying blood at the bedside

Going with the flow: Starting a blood transfusion

Monitoring the transfusion

Recognizing and Managing Adverse Reactions

Identifying the type of reaction

Managing blood transfusion reactions

Discontinuing the Transfusion

Safely Handling and Disposing of All Blood Products

Chapter 16: Infusing Chemotherapy with Caution

Preparing for Chemotherapy

Protecting yourself

Protecting your patient

Educating your patient

Preparing the chemotherapy agent

Handling the chemotherapy agent

Administering Chemotherapy

Before you begin

Initiating the infusion

Monitoring chemotherapy

Reacting to Adverse Reactions

Taking action as soon as you identify a reaction

Dealing with vesicant extravasation

Managing Common Side Effects

Dealing with nausea, vomiting, and other GI disturbances

Facing hair loss and fatigue

Watching for bone marrow suppression

Discontinuing Chemotherapy

Safely Disposing of Chemotherapy Waste

Chapter 17: A Balancing Act: Administering Fluids and Electrolytes

Focusing on Fluids and Electrolytes As You Assess Your Patient

Taking a complete patient history

Obtaining baseline assessments

Reviewing lab results

Administering IV Replacement Therapy

Starting therapy

Monitoring the infusion

Recognizing and Managing Adverse Reactions

Avoiding common pitfalls

Identifying adverse reactions with some common symptoms

Responding to adverse reactions

Discontinuing the Replacement Infusion

Chapter 18: Making Every Calorie Count: Parenteral Nutrition

Planning around Your Patient’s Baseline Nutritional Status

Obtaining your patient’s weight

Reviewing your patient’s blood work

Assessing your patient physically

Asking questions about dietary history

Using a clinical scoring system

Calculating your patient’s energy requirements

Concentrating on concentrations

Administering Parenteral Nutrition Products through a CVAD

Getting started

Monitoring the infusion

Managing Common PN Complications

Discontinuing Parenteral Therapy

Tapering off versus stopping abruptly

Considering when to withhold or withdraw

Disposing of Parenteral Nutrition Products

Part V: Considering Unique Populations

Chapter 19: A Little Dab’ll Do Ya: IV Therapy for Infants and Children

Understanding How Pediatric IV Therapy Is Different

Making equipment modifications

Dealing with fear and establishing a positive relationship

Avoiding complications: Keeping a watchful eye

From Preemies to Teens: Dosing for Peds

Understanding the importance of age and weight

Practicing your dosage calculating skills

Considering alternative methods for calculating dosing

Peds-Specific Peripheral IV Considerations

Selecting the best venous access site

Choosing the most appropriate peripheral IV

Using special techniques in venipuncture

Knowing what to do after a successful IV start

CVAD IV Therapy for Kids

The non-tunneled percutaneous CVAD

The tunneled catheter

The PICC line

The implanted port

Chapter 20: When Aging Is an Issue: IV Therapy for the Elderly

Understanding How Advanced Age Impacts IV Therapy

Optimizing Therapy for the Older Adult

Assessing the elderly patient

Obtaining informed consent

Considering the dose

Selecting the best venipuncture site

Choosing the most effective equipment

Gentleness Is Key: Following Some Basic Insertion Guidelines

Prepping your elderly patient’s skin

Inserting the VAD

Stabilizing the device

Monitoring the Infusion to Prevent Complications

Preventing infection

Dealing with equipment issues

Identifying adverse drug reactions

Managing dehydration

Replacing and Discontinuing Peripheral IVs

Chapter 21: There’s No Place Like Home: IV Therapy for the Homebound Patient

Ensuring Safety: Assessing the Home Environment

Checking out the neighborhood

Dealing with safety issues in the home

Optimizing IV Therapy for a Homebound Patient

Completing a patient assessment

Developing a patient care plan

Getting Comfortable with Home Infusion Equipment

Managing Your Home Patient’s Therapy

Having an emergency plan in place

Monitoring IV therapy in the home

Avoiding complications

Documenting your actions

Properly discarding hazardous waste in the home

Teaching Your Patients (And Their Families) How to Care for Themselves

Part VI: The Part of Tens

Chapter 22: Ten Things You Need to Know in IV Therapy

Start Your Site Search Distally

Avoid Starting IVs in Areas of Joint Flexion

Use Your Sense of Touch to Find a Vein

Avoid Inserting IVs into Vein Valves

Clip Excess Hair That Interferes with the IV Area

Choose the Right Gauge Based on the Patient’s Situation

Rely on a Blood Flashback

Follow the Two Strikes, You’re Out! Rule

Never Push or Pull against Resistance

Don’t Rely on an Alarm to Alert You

Chapter 23: Ten Tricks of the Trade for Starting IVs

Turn Up the Heat

Pump Up the Volume

Make Gravity Your Best Friend

Don’t Slap the Vein Silly, but Do Gently Tap It

Use an Alcohol Pad to Help with Visualization

Get Cozy with Your VAD

Use an Anesthetic

Anchors Away! Provide Vein Stability

Consider Using an Indirect Insertion

Never Let ’Em See You Sweat

Cheat Sheet

IV Therapy For Dummies®

by Bettie Lilley Nosek, RN, BA, and Deborah Trendel-Leader RN, BSN, PHN

IV Therapy For Dummies®

Published by John Wiley & Sons, Inc. 111 River St. Hoboken, NJ 07030-5774 www.wiley.com

Copyright © 2013 by John Wiley & Sons, Inc., Hoboken, New Jersey

Published by John Wiley & Sons, Inc., Hoboken, New Jersey

Published simultaneously in Canada

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ISBN 978-1-118-11644-9 (pbk); ISBN 978-1-118-22445-8 (ebk); ISBN 978-1-118-23766-3 (ebk); ISBN 978-1-118-26256-6 (ebk)

Manufactured in the United States of America

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About the Authors

Bettie Lilley Nosek is a registered nurse, published author, and entrepreneur. Bettie began her career working in the ICU-CCU at Memorial Baptist Hospital in Houston. She then moved to Denver, Colorado, and worked as the Staff Development Coordinator in the operating room at Porter Memorial Hospital.

While in Colorado, she obtained a journalism degree from Loretto Heights College and worked as a copy editor for the Rocky Mountain Medical Journal.

After moving to California, she created instructional videos demonstrating infusion pumps and conducted evaluations of infusion pumps at the University of California, San Diego, and Children’s Hospital in Los Angeles. She then worked as Director of Surgical Services at Garfield Medical Center in Monterey Park, where she supervised the operating room, recovery room, and central service.

Later, she worked as a Bureau Chief for International Medical News Group, covering medical conventions, and was published in physicians’ newspapers and healthcare magazines.

Bettie began her entrepreneurial career by joining her husband in owning a telecommunications company. After running and later selling the company, Bettie started her own consulting firm, helping small businesses develop sales.

She owns several patents, copyrights, and trademarks, and she’s a licensed California real estate agent and notary. She lives in Southern California and enjoys playing golf with her husband and being constantly amazed by her granddaughter.

Deborah Trendel-Leader is a registered nurse and freelance medical journalist with a bachelor’s degree in nursing. She holds current certifications in critical care, IV therapy, public health nursing, and advanced cardiac life support and has a teaching credential issued by the Board of Vocational Nursing. With her career spanning more than two decades, Deborah has worked in a variety of healthcare facilities, specializing in critical care, and has served as a clinical supervisor/nurse educator in both the hospital and home health settings. She has taught numerous IV therapy certification courses for vocational nursing programs and keeps her IV skills current with continuing education courses specific to the principles, administration, and management of IV therapy. Currently, she is an active member of the Infusion Nurses Society, works per diem in adult critical care, and is a freelance medical journalist for About.com, part of the New York Times Company.

Dedication

From Bettie: I dedicate this book to my wonderful husband and best friend, Jim, who has inspired, helped, tolerated, and believed in me for more than 30 years. His indomitable spirit and unconquerable soul fill me with life’s most valuable commodities — love, courage, and hope.

This book is also dedicated to our children, Tamitha, Jason, and Rebecca, who have inspired us with their accomplishments and blessed us with beautiful grandchildren.

I also dedicate this book to my sisters, Dortha and Lynda, who have always been a part of my life and have allowed me to be a part of theirs. I will cherish our love and memories forever.

Finally, I dedicate this book to my lifelong friends, who have grown up with me and shared all of life’s passages.

From Deborah: I would like to dedicate this book to my mother, Virginia Trendel, who has been a constant source of support for me throughout my life. I also dedicate this book to my dear friends, Lori Israel and Arlene Wyman, whose inspiration and encouragement have been the backbone of my adult life. Finally, I want to dedicate this book to all of the aspiring nurses and other healthcare professionals who read this book. You’re about to embark on one of the most rewarding journeys of your life, and I’m proud to be a part of your journey.

Authors’ Acknowledgments

From Bettie: I would like to thank my agent, Barb Doyen, for giving me the opportunity to write this book and the inspiration needed to see it through to the end. It’s been a wonderful journey!

Thanks to the great folks at John Wiley & Sons, Inc., especially Alissa Schwipps, Stacy Kennedy, and Amanda Langferman, who gave me direction and support every step of the way.

Thanks to my coauthor, Deborah Trendel-Leader, for her contributions.

Finally, I’d like to thank the countless hospital patients who knew I was a newbie at starting IVs but held out their arms anyway. Thanks for your vote of confidence and for helping me learn the life-sustaining skill of IV therapy.

From Deborah: This book would not have become a reality for me without the tremendous efforts of my agent, Barb Doyen. She believed in me from the start and served as a constant source of encouragement and support throughout the entire process. I would also like to extend a special thanks to my project editor, Alissa Schwipps, who was always patient and professional in spite of my many time constraints. Additional thanks go out to the great team at John Wiley & Sons, Inc. — my copy editor, Amanda Langferman, technical editors, Jeffrey Bohmer, MD, Kay Coulter, CRNI, and William E. Miller RN, BSN, CRNI, VA-BC, and medical illustrator, Kathryn Born — for their expertise in getting this book ready for print. Finally, I want to express my sincere appreciation to my coauthor, Bettie Lilley Nosek, for her many contributions to the project and for seeing the book with a similar set of eyes.

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments at http://dummies.custhelp.com. For other comments, please contact our Customer Care Department within the U.S. at 877-762-2974, outside the U.S. at 317-572-3993, or fax [phone].

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Introduction

I (Bettie) recently donated blood at a local blood bank, and I have to admit I was a little nervous. I knew that the needle would be a large- bore, 18-gauge needle and the unit of blood would be 500 cc of my own life-sustaining commodity. I worried that the IV nurse would need more than one try to get my vein and that I would feel sick as the blood drained from my body. It’s scary for a nurse to be on the other side of the needle!

Then the IV therapist said, “Hi, Bettie. My name’s Amanda, and I’ll be your nurse today. What’s your favorite television station?”

With just one sentence, she immediately established rapport and put me at ease for the impending procedure. After that, I experienced a successful one-stick venipuncture and a feeling of confidence that I was in the right hands at the right time.

Lying under a warm blanket, watching my favorite TV news station, with the blood draining from my vein, I thought, “This is the beautiful part of IV therapy nursing — it’s not only about providing a life-saving therapy. It’s about an opportunity to change a patient’s attitude about healthcare and transform a terrifying experience into a show-and-tell moment.”