I'm currently doing this assignment on the role of the nurse in the administeration of IV fluids and fluid balance. The patient in teh case study has two lines running, one with Hartman's solution and the other concentrated red blood cells. Can anyone give me some information on the safety aspects and importance of having two lines running. Also, i need to write about the nurse's role in admin of iv fluids which includes the equipments that are to be used (does the nurse select the equipments? Is there any further info on this topic). It would be great if i can get some information, websites, articles, experience on these topics.
Apr 16, '04
I assume with the Hartman's that you are referring to a Lactated Ringer's solution. Usual reason for the two lines is so that you can give medications at the same time. You would not want to stop the blood to hang an antibiotic as an example or hold other meds if at all possible. Normally the regular IV fluids would be on a pump, type is dependent on what your facility is using or has available. Some hospitals have gone to a special tubing where you can actually dial in the rate, but they still need to be closely watched. Rate of your blood is dependent on your patient's condition. Usually on average over about two hours unless you are concerned with failure and then you would slow the rate down to about three hours or so. Remember that no blood product should be hanging over four hours, at this time, if there is still some left in the bag it needs to be discarded. PRBCs also need special tubing for infusion, usually Y-type tubing and an additional filter that is spiked above the tubing and into the blood bag. If you were trying to infuse the blood in a hurry such as in ICU, ER, or the OR, you could use a pressure bag over the blood to deliver it in the quickest amount of time.
Without knowing any more about the patient, this is what I can come up with off of the top of my head. Hope that it helps. If you have any other questions, do not hesitate to post them.
Apr 16, '04
FYI: the reason that blood absolutely cannot hang over 4 hours is due to the extreme increased risk of bacterial growth & "acute sepsis" if-you-will. Additional info r/t nurse's role in IV administration: osmolality of IV fluid & dx of patient, fluid balance & IV rate r/t pt dx (i.e., CHF), electrolyte balance, IV site appearance (s/s infxn).
Fluid & electrolytes are some of my favorite topics. There is a really good book on the subject: "Fluid & Electrolytes made Incredibly Easy!"
I also concur with above posting on all points.
Apr 16, '04
thank you guys! I really appreciate the help.
i'm also wondering, what about the devices that is used in iv therapy? What role does a nurse in regards to choosing the equipments etc
Apr 16, '04
As I stated above, it won't be based as much on the nurse but what the policy is of the facility where you are working. Some hospitals use only one type of pump, others use two different pumps, one for macro tubing and one for micro tubing. There are also syringe pumps that are usually used in PICU or NICU for IVPBs. If you are working in ICU, some also use a pump similar to what anesthestists use at some facilities for their drips. Again, a large part is dependent upon what your facility uses or supplies for you to use.
Hope that this helps...................
Apr 17, '04
well..I am an IV nurse...my equipment is..me Two sites is because one of the first signs of transfusion reaction is pain at the IV insertion site. redcell hemolysis(death) causes trauma and pain to the walls of the veins and the patient will feel it quickly. This is why the nurse takes a baseline set of vital signs including temp and educates the patient about pain at the IV site and starte the transfusion very slowly for the first 15 minutes. Checking that the blood matches the patient and the patient ID band is incredibly important. You should always have a dedicated IV for transfusion to ensure that if the patient complains of pain at the site there can be no way to ignore that complaint.
As an IV nurse I only insert the IV according to the doctors order for what it will be used for. IV's come in a lot of different sizes so we pick a size according to how fast the fluids must go through or how caustic the fluid is. Smaller cannulas allow for more blood flow so if a solution is caustic like potassium a smaller cannula would be used to allow for greater amount of blood flow to dilute the solution.
ALL fluids should be on a pump NO EXCEPTIONS EVER....... I cannot tell you how many IV's are lost because nurses are just too overworked to have time to flush saline locks as often as they need to be. Every 8 hours is not enough...every 6 hours is barely enough for healthy day surgery patients..those elderly long term patients would need it every 2 hours...just put it on a pump and take it off when you get them up....it would save them getting an IV stick every other day...and save them from looking like they did 12 rounds with mike tyson
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