IVP Medications
Manual admin of a relatively small volume of a concentrated solution or medication directly into the venous system via a peripheral or central venous access device.
Steps for IVP (if med is compatible)
- Attach med syringe to Y-site port
- Occlude IV line
- Inject medication at correct rate
- Flush injection port with 0.9% sodium chloride
IVP Technique (if med is not compatible)
- Stop IV infusion and scrub Y-site
- Flush with 10mLs 0.9% sodium chloride
- Inject the medication at correct rate
- Scrub Y-site port and flush again with 10mLs 0.9% sodium chloride
- Re-establish infusion and ensure correct rate.
Potential Complications of IVP
Speed Shock
Infiltration
Extravasation
Thrombophlebitis
Allergic Reaction
Infection
Speed Shock
Sudden, toxic, adverse physiological reaction to IV medication or drugs administered too quickly
Signs of Speed Shock
- flushed face
- headache
- tight chest
- irregular pulse
- loss of consciousness
- cardiac arrest
Infiltration
IV fluids enter surrounding space instead of staying in the vasculature
Signs and symptoms of Infiltration
- blanching
- edema
- coolness
- pain
- numbness
Extravasation
When interstitial medications causes damage to the surrounding tissues
Thrombophlebitis
Inflammation of the vein
Signs of Thrombophlebitis
- pain
- edema
- redness
- warmth
Allergic Reaction
Can cause histamine release at site
Signs and symptoms of infection
- pain
- warmth
- redness
- drainage
Pneumothorax
Accumulation of air in the pleural cavity that leads to partial or complete lung collapse.
Hemothorax
Accumulation of fluid or blood in the pleural cavity that leads to partial or complete lung collapse.
Pneumohemothorax
Accumulation of air AND blood/fluid in the pleural space
Chest tube insertion for pneumothorax
Placed anteriorly in the 2nd intercostal space
Chest tube insertion for hemothorax
Placed posteriorly through the 8th or 9th intercostal space
Dry Suction Water Seal System
A - suction/regulation
B - Water seal chamber
C - Air leak monitor
D - Collection Chamber
E - Suction monitor bellows
Nursing Care of Chest Tubes
Monitor suction (ordered by Dr)
Drainage units below chest level in upright position and tubing in nondependent loops on the bed
Bottle of sterile water at bedside
Two chest tube clamps at bedside
When can Chest tubes be clamped for > 1 minute
- to change drainage unit
- to locate air leak
- to assess bubbling and fluctuation (tidaling) of the unclamped chest tube
Nurses Assessment of Patient with chest tube
Inspection: Distress, calm, SOB, cyanotic
VITALS
Resp and O2: auscultation, LOC, ABGs, Sp02, skin, mucous membranes, resp effort
Level of pain
Chest tube insertion site: D&I, occlusive, excessive bledding, subcutaneous emphysema.
Encourage DB&C
Complications r/t chest tubes
- Chest tube placement (cause of tension pneumothorax)
- infection at the insertion site
- pneumonia
- shoulder disuse
PICC Line
Line in the basilic or cephalic vein and threaded through the subclavian vein into superior vena cava
