KVV E-Modules

1. Intravenous Infusion Therapy- Set up for IV Saline

INTRAVENOUS THERAPY  Intravenous therapy refers to infusion of fluid, directly into the venous circulation of patient through a venous cannula. Utmost sterile precautions are taken while setting up this procedure.  Intravenous (iv) therapy is the insertion of a needle or catheter/cannula into a vein, based on the physician’s written prescription.  The needle or catheter / cannula is attached to a sterile tubing and a fluid container to provide medication and fluids.  Drip rate can be calculated by presuming there are approximately 16 drops in 1 mL of crystalloid fluid. This quantity may vary between 12 drops to 22 drops. In micro drip sets, the number of drops may vary from 45 to 60 drops in 1 ml.  Number of drops in 1 ml, is also called as DROP FACTOR. INDICATIONS FOR INTRAVENOUS THERAPY:  Replacement of electrolytes  Restoration of blood volume  Parenteral nutrition before and after surgery to maintain the fluid and electrolyte balance.  Administration of drugs (antimicrobials, central nervous system drugs, cardiovascular drug, anticancer drugs, and many other agents).  Keep a vein open for quick access INTRAVENOUS DRIP SETTING GENERAL INSTRUCTIONS  Aseptic precautions-cleanliness of equipment and material.  Proper waste disposal at all stages including used containers, cotton swabs, packing materials, waste papers, equipment, etc.  Confirm right patient, right drug, and right procedure.  Double check the prescription/order on the patient's chart.  Confirm that the patient is not allergic to the medications you are going to inject.  Check and verify your calculations of the dose, drip rate, and number of drops to be adjusted per minute.  Check and confirm-expiry date, the contents, and the strength mentioned on the fluid bag.  Confirm that the IV set is clean and within the date of use.  Confirm that the fluid bag is not damaged or leaking, and the solution in the fluid bag looks clean, clear, without any suspended or particulate matter, precipitate, cloudiness or bubbles.  Hang the IV bag at least 3 feet above an adult patient's heart to ensure there is enough pressure to keep the IV running at a constant rate.  The drip chamber must always be half full. If the drip chamber is too full, we will not be able to see the drops to count them, and so we will be unable to determine the rate at which the IV is infusing. If the drip chamber is not full enough, then this will allow air to get into the IV tubing, which means that air would get into the patient's circulatory system, which leads to air embolism.  Transfusion bottles are in inverted position during use, it is likely that microparticles in the infusion may settle down. Therefore, the last portion of the fluid (around 40-50 ml) should be discarded.  The chances of local thrombophlebitis increase with duration of the infusion therefore, it is advisable to change the site of infusion after 24 hrs. PRECAUTIONS ABOUT DRUG ADMINISTRATION Sometime drugs when mixed with each other in a syringe or infusion bottle may inactivate each other or may get precipitated or may lose potency or may have pH incompatibility. This is called an in vitro drug interaction (outside the body) or 'Pharmaceutical drug interaction.’ So, it is necessary to rule out such interaction while adding substances in syringes or bottles or intravenous infusions. 1. DO NOT MIX THE FOLLOWING DRUGS IN A SYRINGE OR IN INTRAVENOUS INFUSION  Phenytoin and 5% dextrose (For phenytoin, normal saline is preferred)  Beta lactam antibiotics and Tetracyclines/Macrolides/Chloramphenicol  Heparin and Hydrocortisone/Penicillins/Aminoglycosides  Hydrocortisone and Penicillin/Aminoglycosides  Norepinephrine and Sodium bicarbonate (For norepinephrine, epinephrine & dopamine -dextrose is preferred)  Thiopental and Succinylcholine/Pancuronium/Atracurium/ketamine/Morphine 2. Drugs should not be added to blood and blood products. 3. Sodium nitroprusside infusion bottle and set should be covered with aluminium foil or colored black paper, as nitroprusside is degraded by light. 4. Amphotericin B is always used in 5% dextrose, because it precipitates with electrolytes. 5. Do not use PVC tubing for Glyceryl Trinitrate, Paraldehyde, and Paclitaxel. 6. When you want to add any drug to an infusion, if it is a preformed formulation, open it fresh just before adding. If it needs to be prepared, then prepare it fresh just before use. Do not keep the drug open or prepared for long time before actually adding it

1. Intravenous Infusion Therapy- Set up for IV Saline

ASSESSMENT QUESTIONS: 1. What are the precautions to be taken with intravenous therapy? 2. How many drops are in the micro drip sets? 3. Enumerate 4 indications for intravenous therapy. 4. What are the 4 indications for intravenous drip setting? 5. Why the trip must always be half full? 6. Why transfusion bottles last portion of fluid 30 to 40 mL should be discarded? 7. What is the pharmaceutical drug interaction, give two examples 8. Why sodium nitroprusside infusion bottle and set should be covered with aluminium foil or with black paper? 9. Why Amphotericin B is always used in 5% dextrose only? 10.Why Norepinephrine, epinephrine, and dopamine are not infused through NS?

2. Assignments- Intravenous Infusion Therapy- Set up for IV Saline

Fill in the blanks 1. In drip rate quantity may vary between ______ drops to ____drops 2. Number of drops in one ml is also called as ___ 3. It is advisable to change drip set after ___ hrs 4. IV bag should be hanged at least ____ feet above adult patient’s heart. 5. One drug inactivates another drug when mixed in syringe or infusion bottle. The drug may lose potency. It is called _______ 6. Phenytoin should not be mixed with_____ 7. Heparin should not be mixed with_____ 8. Nor epinephrine can be mixed with_____ 9. Amphotericin B is always used with dextrose 5% because_____ 10.Replacement of electrolytes and blood volume is an indication of_____

1. Validation Certificates

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