授课题目

Intravenous Therapy

授课形式

Bilingual lecture

Demonstrate

授课时间

2006．12．11

授课学时

4

教学目的

与 要 求

1.  State the purpose and fluids of intravenous infusion

2.  Expatiate the principles for choosing venipuncture sites

3.  Expound the principle for adjusting flow rate

4.  Expatiate the cause and intervention of complication of intravenous infusion

5.  Demonstrate the steps of intravenous infusion

6.   Deal with the problems during procedure

基本内容

1.  Objective

2.  Iintravenous fluids

3.  Venipuncture sites

4.  Equipment

5.  Propcedure

6.  Flow rate

7.  Problems

8.  Complication

重 点

难 点

1.  Procedure of intravenous infusion

2.  Complication of intravenous infusion

主要教学

媒 体

PPT，video

主 要 外

语 词 汇

Intravenous infusion, venipunture, complication, crystalloids, colloids 

有关本内容的新进展

New equipment for intravenous infusion

主要参考资料或相关网站

1、Zhou Kexiong. Basic Nursing Skills

2、SABDRA F.SMITH. Clinical Nursing Skills. Prentice Hall Health.

系、教研室

审查意见

已审合格，同意授课。

课后体会

1.  医学术语较多，学生应提前预习。

2.  可是当增加举例。

教学内容

时间分配和

媒体选择

Unit 11  　Intravenous Therapy

Ⅺ－Ⅰ Intravenous Infusion

Using the principles of hydrostatics, infuse aseptic solution into vena.

【Purpose】 

To maintain fluid and electrolyte balance.

To provide nutrients and energy.

To administer medications through the most therapeutic IV route.

To maintain blood pressure and improve microcirculation.

【Intravenous Fluids】

Crystalloid Solution

Dextrose solutions or glucose:

Isotonic Electrolytes Solutions:

Alkaline solutions

Hyperisotonic Solutions:

Colloid Solution

Dextran

Plasma Substitutes

Blood Products 

Parenteral Nutrition Solution 

【Venipuncture Sites】

Peripheral Superficial Veins

They are usually used for adults

Veins in the Scalp 

A good site in infants

Other Sites

the deep and big vein for intravenous infusion. The other sites include external jugular vein, internal jugular vein, subclavian vein, femoral vein and so on.

Select a vein

• Considering the site

• Considering the vein

• Considering objective of IV therapy

• Larger veins are preferable for viscous fluids, blood and irritating medicine( medicine for chemotherapy)

• Distal end of vein → proximal sites

• Larger veins

【Equipment】

Medication tray:

l Infusion set

drip chamber, roller clamp, filtration set, spike, tubing, vent holwww.med126.com/rencai/e or tube

l Sterile needle or intravenous catheter

l IV solution as ordered by the physician

l Tourniquet

l Protective pad

l Adhesive tape

IV record card

Sterile needle

Disposable, size number 6~7 for adult, and number 4~5 for child.

IV pole

IV pumps if necessary

【Procedure】

Start intravenous infusion

Change solution

Stop intravenous infusion

【Flow Rate】

Principle

Regulate the flow rate according to the client's age, state of illness and medication and objective of infusion.

For adult: 40~60gtts/min; for child: 20~40gtts/min.

For the client who is infant, older, or weak, or has disease in heart, lung or kidney, the speed should be slow.

For some special medication, the speed should be slow.

Objective.

Calculation

To find the number of hours for infusion:

Total solution×drop factor＝No. of hours to run

Gtts/minute×60min

To find the drops per minute:

Total solution×drop factor＝gtts/minute

No. of hours to run×60min

Infusion Pump

Summary

1.  Objective

2.  Iintravenous fluids

3.  Venipuncture sites

4.  Equipment

5.  Propcedure

6.  Flow rate

Question

1. what kinds of fluids are used for Intravenous Infusion

2. how to select a venipuncture site

3. how to calculate the flow rate

【Problems】

Slow Flow Rate or No Infusion 

Relating to needle:

Needle dislodged from the vein:

Bevel of needle against the vein wall:

Needle occluded:

Relating to pressure:

Inside pressure is too high

Vasospasm:

Outside pressure is too low

Level of solution is too low:

Vent hole is occluded. Sometimes we would forget to open it,

Tubing is occluded

Liquid surface in chamber too low

Liquid surface in chamber too high

Liquid surface in chamber declining automatically

【Complication】 

Fever: the most familiar

Causes: Fever can be caused by infusing pyrogen. 

Symptoms and signs: Client feels cold, trembling and with increased body temperature from 38°C to 40°C or higher, after starting intravenous infusion for a few minutes or hours. Systematic reactions may be present, such as headache, nausea, vomiting, tachycardia, and so on.

Intervention:

reduce the flow rate or stop infusion and notify physician immediately.

For the client with high fever, physical cold therapy should be given. If necessary, administer antiallergic medication or steroid according to physician’s order.

Keep the residual solution and equipment for the laboratory test.

To prevent fever reaction, nurse should inspect solutions, package and expiration of infusion set carefully, and abide by the principles of aseptic techniques strictly.

Phlebitis

Causes:  Phlebitis is caused by irritation to the lining of blood vessels.

Mechanical irritation

Chemical irritation

Bacterial phlebitis

Thrombophlebitis

Symptoms and Signs: red streak along the vein, In advanced case, a chord-like vein may be felt

Phlebitis local symptoms include erythema, edema, warmth, pain, and in severe instances, thrombus formation. Occasionally systemic reactions may be present, such as fever, chill and so on.

Intervention:

the IV line must be discontinued and a new line inserted in another vein;

Elevate the infected limb (facilitate the flowing back of blood) and don't move it (in case of superficial thrombus moving away ).

Apply a moist compress to the affected area.

Apply ultrashort-wave on local site.

Apply traditional Chinese medicine to treat it.

If there is infection, use antibiotics according to physician's order.

To prevent phlebitis is to protect vein. nurse should follow principles of aseptic techniques strictly(Bacterial phlebitis); Irritating medication should be diluted thoroughly and infused slowly（Chemical irritation); Needle should be secured firmly to prevent its sliding out of the vein in case of exudation; Venipuncture site should be changed frequently for the continuing infusion client in order to protact vein. Tape cannula properly to prevent in-out movement of cannula within vein（Mechanical irritation)

Acute Pulmonary Edema

Causes: Acute pulmonary edema occurs when client has received overinfusion of fluids in a short time.

Symptoms and Signs:

The client may suddenly present dyspnea, tachypnea, thoracic oppression, cough with a frothy pink sputum, cold extremities, moist rales, tachycardia and arrhythmia.

Intervention:

nurse should slow the rate of infusion or stop the infusion immediately, and notify physician. Client can assume a Folower’s position with the feet dangling at the bedside if the client's condition is allowed.

oxygen administration with greater flow rate if necessary.

According to the physician's order, administer the sedative, antiasthma, digitalis, diuretics, and vasodilators to the client.

If necessary, nurse can apply tourniquet to limbs of client alternately in order to reduce the venous return.

Comfort client, and relieve the tension of client

To prevent acute pulmonary edema, nurse should maintain the flow rate and observe client’s state of illness during the infusion, especially for the client with cardiac or lung function problems, the elderly or children.

Air Embolism

Causes: Air embolism occurs when air in the infusion system enters the circulatory system.

Symptoms and Signs: Unexplained cardiopulmonary dysfunction occurs suddenly. Client feels discomfort in chest or pain under the sternum, with the presence of dyspnoea, hypoxia, cyanopathy, hypotension, tachycardia, and unconsciousness. Clear and continuous bubble sound over left sternal border can be auscultated.

Intervention:

Turn on left side-lying position with head down and foot up immediately.

Oxygen therapy with high flow rate for the client is necessary.

Client’s state of illness should be carefully observed.

To prevent air embolism, nurse should check the infusion set, make sure there is no air in tubing, check the tubing below the chamber after changing solution, watch client with press infusion carefully.

Summary

1.   Problems

2.   Complication

Question

1.   how to deal with a problem--No Infusion during intravenous infusion?

2.   how to deal with the different complications during intravenous infusion?

The first

5’

tell them the history of it to emphasize the importance of it.

10’

Ask sutdents

10’

10’

picture

picture

picture

Ask student?

5’

Picture

picture

Picture

Picture

Picture

Picture

25’

Demenstrate the whole procedure,

And then see vedio of inserting

intruduce the main step.

10’

 Ask students?

5’

Summary

Question

The second

3’

Review

20’

Prepare the chamber for problem, first too low, and then too high

50’

7’

Summary

Question