ecg basics and iv

8/3/2019 ECG Basics and IV

1/8

ECG Basics

Outline:

1. Review of the conduction system2. ECG waveforms and intervals3. ECG leads4. Determining heart rate

THE NORMAL CONDUCTION SYSTEM

WHAT IS AN ECG?

The electrocardiogram (ECG) is arepresentation of the electrical events of the

cardiac cycle.

Used to measure the rate and regularity ofheartbeats, as well as the size and position of

the chambers, presence of any damage to the

heart, and effects of drugs or devices used

WHAT TYPES OF PATHOLOGY CAN WE IDENTIFY AND

STUDY FROM EKGS?

Arrhythmias Myocardial ischemia and infarction Pericarditis Chamber hypertrophy Electrolyte disturbances (i.e. hyperkalemia,

hypokalemia)

Drug toxicity (i.e. digoxin and drugs whichprolong the QT interval)

ECG LEADS

Leads are electrodes which measure the difference in

electrical potential between either:

1. Two different points on the body (bipolar leads)

2. One point on the body and a virtual reference point

with zero electrical potential, located in the center of

the heart (unipolar leads)

EKG Leads

3 Standard Limb Leads

3 Augmented Limb Leads

6 Precordial Leads

The axis of a particular lead represents the viewpoint

from which it looks at the heart.


2/8


3/8

DETERMINING THE HEART RATE

Rule of 300 10 Second Rule

RULE OF 300

Take the number of big boxes betweenneighboring QRS complexes, and divide this into

300. The result will be approximately equal to

the rate

Although fast, this method only works forregular rhythms.

10 SECOND RULE

As most EKGs record 10 seconds of rhythm perpage, one can simply count the number of beats

present on the EKG and multiply by 6 to get the

number of beats per 60 seconds.

This method works well for irregular rhythms.


4/8

INTRAVENOUS THERAPY

Insertion of a needle or catheter / cannula into a vein

based on a physicians written prescription. The needle

or catheter / cannula is attached to a sterile tubing and

fluid container to provide medicine and fluid.

PURPOSE:

To maintain / correct dehydration inclients unable to tolerate sufficient

volume of oral fluids / medicine. Parenteral nutrition Administer drugs Transfusion of blood or blood

components

To provide a lifeline for rapidly neededmedications or blood

COMMON TYPES OF IV SOLUTIONS

a.) Hypotonic Solutions have less dissolvedparticles than plasma, good route for

medications but not good choice for fluid

replacers because it leaves the vascular space

(D5W)

b.)Hypertonic Solutions have more dissolvedparticles then plasma and have initial effect of

drawing water from intracellular spaces to

intravascular space but once sugar content is

metabolized, solution becomes hypotonic.

(D5LR, D10, 0.45%NaCl)

c.) Isotonic Solution have roughly the sameamount of dissolved particles as plasma and

good choice for fluid replacement (NSS, LR)

SITES FOR IVF INFUSION

Dorsal metacarpal veins Cephalic vein Basilic vein Radial vein Medial antebrachial vein

Accessory cephalic vein Select a site distal to the heart and move

proximally as necessary

CONSIDERATION IN THE SELECTION OF THE

SITE

Select a vein large enough toaccommodate the needle that will be

used

Type of solution Clients age

Equipments

1. Container of sterile intravenous solutionIV solutions comes in different sizes

a) 150 mlb) 250 mlc) 500 mld) 1000ml

2. Solution should be sterile and in proper

conditiona) Check expiration dateb) There should be no particulate

matter in the solution

c) Check for any leaks indicative ofcontamination

3. Administration set

1. Macrodrip or macroset (10,15 or 20drops per ml of solution)

2. Microdrip or microset (60 drops per mlof solution)

d)

Insertion spike inserted intothe solution container and kept

sterile

e) Drip chamber to prevent airfrom entering the line

f) Roller or screw clamp tocontrol the rate of flow of the

solution

g) Tubingh) Protective cap maintains the

sterility of the end of the tubing


5/8

so that it can be attached to a

sterile needle inserted in the

clients vein

i) Needle adapter3. Volume-control set or solute set

4. IV poles

The higher the solution container issuspended, the greater the force of the

solution as it enters the client and thefaster the rate of flow.

5. Intravenous needle or catheter

a. Butterfly or win-tipped needles (25 to17 gauge)

b. Catheter or angiocatheterc. The larger the gauge number, the

smaller the diameter of the shaft

6. IV Tray

Contains sterile swabs, antisepticsolution, plaster, tourniquet, splint,

local anesthetic, sterile 2X2 gauze

squares

The initiation ofIV therapy is upon the writtenprescription of a licensed physician which is

checked for the:

Type of solution Flow rate Amount of solution Dose and frequency of medicine to be

incorporated

Setting up:

1. Check doctor's order and make IVlabel

2. Prepare necessary set, IV stand orIV hook, IV tray, cotton balls with

alcohol, plaster, tourniquet and

splint.

3. Explain procedure to client andassess client's vein.

4. Check the solution and set forsterility.

5. Place IV label on IVF bottle.6. Wash hands before and after

setting up IV.

7. Maintain sterility ofIV solutioncontainer while opening port

8. Disinfect rubber port with cotton

ball dipped in alcohol

9. Open administration set aseptically

(Venoset) and close the roller clamp


6/8

10.Spike the container without

contaminating port.

11.Hang the IV bottle using the IV

stand or hook.

12.Fill drip chamber to at least half

13.Prime the tubing while maintaining

sterility of the end of tubing (use

kidney basin)14.Remove all air from tubing (get

ready for IV insertion)

A. Changing an IV Infusion1. Check doctor's order in the Doctor's

Order Sheet and IV sheet;

Countercheck IV label, IV card, bottle

number or bottle sequence, type,

amount, additives (if any), duration of

infusion.

2. Prepare necessary materials (IVsolution, IV label, disinfectant, kidney

basin or tray)

3. Check sterility of IV solution4. Calibrate IV bottle according to

duration of infusion

5. Bring necessary materials at thebedside and explain procedure to the

client

6. Wash hands before and afterprocedure

7. Disinfect rubber port of new IV solution

prior to inserting spike of the previous

administration set8. Close roller clamp or kink tubing of

administration set when changing IV

solution bottle

9. Spike the container without

contaminating port

10.Regulate the flow rate based on

duration of infusion. Remove air

bubbles (if any)

11.Document in client's IV sheet and

Kardex

B

. DISCONTINUING AN IV INFUSION

1. Verify written doctor's order todiscontinue IV

2. Prepare necessary materials (IV traywith cotton balls with alcohol, plaster)

3. Wash hands before and afterprocedure

4. Explain procedure to client5. Wet all adhesive tapes with alcohol

before removing them.

6. Clamp tubing7. Get another cotton ball with alcohol;

Remove needle or IV cannula quickly

8. Place cotton ball with pressure andtape

9. Document time of discontinuance,status of insertion site.

Calculating the Infusion Rate

Total number of ml to be given = ml to

be given / hour

Hours in which the solution is to be infused

Volume X drop factor = drops per min.

#of hours X 60 min.

INCORPORATION OF DRUG INTO IVF

BOTTLE / BAG

1. Verify the written medication cardagainst the M.D. prescription; observe

hospital policy on drug administration.

2. Observe 10 Rs when preparing andadministering medication.

3. Explain procedure (medication andaction) to reassure patient and

significant others and check patency

and IV site.

4. Verify for skin test of drug of IVincorporation (if skin testing is

necessary)

5. Do hand hygiene before and after theprocedure.

6. Prepare necessary material needed forthe procedure such as: injection tray,

syringes needed, right drug to be

incorporated either in vial or ampule.

7. Disinfect injection port of the vial &

the ampule before breaking then

aspirate the right dose aseptically.

8. Remove the cover of the

administration set, maintain sterility andincorporate prepared drug into the

airway aseptically.

Note: if the administration set has no airway,pull out the set and incorporate the prepared

drug and re-spike the IV set to the bottle then

place the label. (all these should be done

aseptically)

9. Swirl the IV bottle to mix the drug

with the IVF and regulate the

flow rate accordingly.


7/8

10. Observe for 5-10 minutes for any

drug interaction while reassuring the

patient; monitor VS.

11. Document in the patients chart

12.Discard the sharp and other wastes

according to Health Care Waste

Management (DOH / DENR)

IV PUSH THROUGH THE IV PORT1. Verify the written medication card

against the M.D. prescription; observe



3. Explain procedure to reassure patientand significant others (the name of the

medicine and action / interaction of

medication) before administration.

4. Do hand hygiene before and after theprocedure. (use gloves especially for

chemotherapeutic & other vesicant

drugs)

5. check patency and other signs ofswelling, redness, phlebitits, etc do

not give the drug

6. check for skin test result of drug for IVpush, drug-drug, drug IV fluid

incompatibility, dosage (computation)

7. Prepare the necessary materials forthe procedure such as: right drug, right

diluent needed, IV injection tray,

syringes and needles, alcohol, etc

8. Disinfect the injection port of the

diluent, vial or ampule as appropriate

9. Aspirate right amount of diluent for the

drug (if drug needs to be diluted)

10. Aspirate the right drug dose; disinfect

the Y- injection port of the IV

administration set / catheter IV

port.

11. Close the roller clamp of the IV tubing

from the bottle and push IV

drug aseptically and slowly or

according to the manufacturers

recommendation.

12. Using same syringe aspirate 1-2cc of

IVF to flush the medicine given.

13. Regulate rate of IV fluid infusion as

prescribed. (if needed)

14. Reassure patient and observe for signs

and symptoms of adverse drug

reaction.

15. Discard sharps and other waste

according to Health Care Waste

Management.

DRUG INCORPORATION INTO VOLUMETRIC

CHAMBER1. Verify the written medication card

against the M.D. prescription; follow



3. Explain procedure to patient (medicineand action) and check IV site. Verify for

skin test of the drug before IV

incorporation.

4. Do hand hygiene before and afterprocedure.

5. Prepare the necessary materials forthe procedure such as right drug and

dose, right diluent needed IV injection

tray. Syringes and needles.

6. Check the present IV fluid label, level

and the incorporated medicine in the

Volumetric Chamber or IV bottle if

with incorporated medicine, check for

drug-drug incompatibility and if the

ongoing IV fluid in the Volumetic

Chamber is to be consumed in 6-8

hours, request a prescription for IVF to

be used solely for drug administration

and keep whole set sterile for

succeeding doses.

7. Aspirate prepared right drug with

correct dose.

8. Add desired IVF diluent into Volumetric

Chamber by opening the sliding clamp

from the bottle then close the clamp.

9. Disinfect rubber injection port of thevolumetric chamber and incorporate

the drug, mix gently.

10. Open the clamp of the airway at the

volumetric chamber.

11.Regulate flow rate of IVF infusion

accordingly.

12.Place IV label on volumetric chamber

indicating drug incorporated and flow

rate.


8/8

13.Reassure / monitor patient when

incorporated medicine is consumed,,

clamp airway of V. C add IVF &

regulate flow rate of main IVF as

prescribed.

14.Discard waste according to Health Care

Waste Management (DOH / DENR).

15.Document in patients chart the drug

administered & patient condition.16.Document in patients chart IVF sheet

and Kardex (of changes in IV rate /

time due)

PUSH THROUGH HEPARIN LOCK DEVICE

1. Check medication card against thewritten doctors prescription.


3. Explain procedure to the patient (nameof medicine and action) before

administration.

4. Do hand hygiene before and after theprocedure (use gloves especially in

chemo drugs)

5. Gather equipment to include / but notlimited to IV tray, Heparin solution,

normal saline diluent or isotonic

solution, 2.5 cc syringes 3 pieces

tuberculin / TB syringe 1pc.

6.Prepare medication to be administered

e.g., antibiotic, and draw it up into a

syringe.

7.Fill in tuberculin syringe with HeparinSolution. N.B. Heparin solution is

usually prepared with 0.1cc Heparin

plus .9cc Normal Saline or Isotonic

solution.

8.Fill the 2.5cc syringe with Isotonic

solution or Normal Saline 1cc each.

9.If using Hep. Loc device with 3 way stop

cock with luer-lock, rotate the stop

cock so that the line going to the

patient is closed (this will prevent

backflow of blood)10.Remove the cover of the injection port

aseptically and keep the sterility of the

cover.

11.Check the patency, open the IV line, and

inject NSS or Isotonic Solution to flush

the Heparin solution.

12.Close the IV line & remove saline

syringe and insert medication syringe

into port.

13.Open the IV line & inject medication

into the vein, timing the flow rate

according to doctors prescription of

drug manufacturers instructions.

14.Observe patient for any adverse

reactions & do nursing intervention

accordingly.

15.Close the IV line and remove

medication syringe.16. Insert the saline syringe, open the line

& flush Catheter tubing / IV cannula to

flush the line.

17. Close & remove saline syringe.

18. Close the IV line, remove syringe and

return the cover of the injection port

aseptically.

19. Document in the patients chat and

Kardex.

20.Discard waste according to Health Care

Waste Management. (DOH / DENR).

Note: Normal saline can take the place ofHeparin. Studies have shown the efficacy of

NSS. Heparin solution can be used if normal

saline or isotonic solution is not available.

ecg basics and iv

Documents