Fundamental Fundamental NursingNursing

Chapter 16Chapter 16

Fluid and Chemical Fluid and Chemical

BalanceBalanceInst.: Dr. Ashraf El - JediInst.: Dr. Ashraf El - Jedi

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Infusion Monitoring and Infusion Monitoring and MaintenanceMaintenance

Regulating the Infusion RateRegulating the Infusion Rate

The nurse is responsible for calculating, The nurse is responsible for calculating, regulating, and maintaining the rate of infusion regulating, and maintaining the rate of infusion according to the physician's order. If an infusion according to the physician's order. If an infusion device is used, the electronic equipment is device is used, the electronic equipment is programmed in milliliters per hour. If the solution programmed in milliliters per hour. If the solution is infused without an electronic infusion device is infused without an electronic infusion device ((ii..ee.., by gravity, by gravity)), the rate is calculated in drops , the rate is calculated in drops ((gttgtt) ) per minuteper minute. . Formulas for calculating infusion Formulas for calculating infusion rates are provided in rates are provided in Box 16-5Box 16-5. .

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Assessing for ComplicationsAssessing for Complications

Complications associated with the infusion of IV Complications associated with the infusion of IV solutions (solutions (Table 16-7Table 16-7) are circulatory overload ) are circulatory overload (intravascular volume that becomes excessive), (intravascular volume that becomes excessive), infiltrationinfiltration (escape of IV fluid into the tissue), (escape of IV fluid into the tissue), phlebitisphlebitis (inflammation of a vein), (inflammation of a vein), thrombus thrombus formationformation (stationary blood clot), (stationary blood clot), pulmonary pulmonary embolusembolus (blood clot that travels to the lung), (blood clot that travels to the lung), infection (growth of microorganisms at the site or infection (growth of microorganisms at the site or within the blood stream), and within the blood stream), and air embolismair embolism (bubble (bubble of air traveling within the vascular system).of air traveling within the vascular system).

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Caring for the SiteCaring for the Site

Because the venipuncture is a type of wound, Because the venipuncture is a type of wound, it is important to inspect the site routinely. The it is important to inspect the site routinely. The nurse documents its appearance in the client's nurse documents its appearance in the client's record. A common practice is to change the record. A common practice is to change the dressing over the venipuncture site every 24 to dressing over the venipuncture site every 24 to 72 hours72 hours

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Replacing EquipmentReplacing Equipment

Solutions are replaced when they finish Solutions are replaced when they finish infusing or every 24 hours, whichever occurs infusing or every 24 hours, whichever occurs first (first (Skill 16-4Skill 16-4). IV tubing is changed every ). IV tubing is changed every 72 hours, depending on agency policy, with 72 hours, depending on agency policy, with some exceptions.some exceptions.

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Blood AdministrationBlood Administration

Blood is collected, stored, and checked for Blood is collected, stored, and checked for safety and compatibility before it is safety and compatibility before it is administered as a transfusion.administered as a transfusion.

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Blood Collection and StorageBlood Collection and Storage

Blood donors are screened to ensure they are Blood donors are screened to ensure they are healthy and will not be endangered by the healthy and will not be endangered by the temporary loss in blood volume. Refrigerated temporary loss in blood volume. Refrigerated blood can be stored for 21 to 35 days, after blood can be stored for 21 to 35 days, after which it is discarded.which it is discarded.

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Blood SafetyBlood Safety

Once collected, the donated blood is tested for Once collected, the donated blood is tested for syphilis, hepatitis, and human syphilis, hepatitis, and human immunodeficiency virus (HIV) antibodies to immunodeficiency virus (HIV) antibodies to exclude administering blood that may transmit exclude administering blood that may transmit these blood-borne diseases.these blood-borne diseases.

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Blood CompatibilityBlood Compatibility

Antigens determine the characteristic blood Antigens determine the characteristic blood group—A, B, AB, and O—and Rh factorgroup—A, B, AB, and O—and Rh factor. . Rh Rh positive means the protein is present; Rh positive means the protein is present; Rh negative means the protein is absentnegative means the protein is absent..

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Before donated blood is administered, the Before donated blood is administered, the blood of the potential recipient is typed and blood of the potential recipient is typed and mixed, or cross-matched, with a sample of the mixed, or cross-matched, with a sample of the stored blood to determine whether the two are stored blood to determine whether the two are compatible. To avoid an incompatibility compatible. To avoid an incompatibility reaction, it is best to administer the same blood reaction, it is best to administer the same blood group and Rh factor. group and Rh factor.

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Blood TransfusionBlood Transfusion

Before administering blood, the nurse obtains Before administering blood, the nurse obtains and documents the client's vital signs to and documents the client's vital signs to provide a baseline for comparison should the provide a baseline for comparison should the client have a transfusion reaction.client have a transfusion reaction.

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Blood Transfusion Blood Transfusion EquipmentEquipment

Catheter or Needle GaugeCatheter or Needle Gauge it generally is infused through a 16- to 20-gaugeit generally is infused through a 16- to 20-gauge

—preferably an 18-gauge—catheter or needle—preferably an 18-gauge—catheter or needle..

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Blood Transfusion TubingBlood Transfusion Tubing Blood is administered through tubing referred Blood is administered through tubing referred

to as a Yto as a Y--set set ((Fig. 16-20Fig. 16-20).). The normal saline always is administered before The normal saline always is administered before

the blood is hung and follows after the blood has the blood is hung and follows after the blood has been infusedbeen infused. . It also is used during the infusion if It also is used during the infusion if the client has a transfusion reaction the client has a transfusion reaction

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Figure 16-20 • Blood transfusion tubing.

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Transfusion Reactions

Serious transfusion reactions generally occur Serious transfusion reactions generally occur within the first 5 to 15 minutes of the infusion, within the first 5 to 15 minutes of the infusion, so the nurse usually remains with the client so the nurse usually remains with the client during this critical timeduring this critical time

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Total Parenteral NutritionTotal Parenteral Nutrition

Total parenteral nutritionTotal parenteral nutrition (TPN; hypertonic (TPN; hypertonic solution of nutrients designed to meet almost solution of nutrients designed to meet almost all caloric and nutritional needs) is preferred all caloric and nutritional needs) is preferred for clients who are severely malnourished or for clients who are severely malnourished or may not be able to consume food or liquids for may not be able to consume food or liquids for a long period.a long period.

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Because TPN solutions are extremely Because TPN solutions are extremely concentrated, they must be delivered to an area concentrated, they must be delivered to an area where they are diluted in a fairly large volume where they are diluted in a fairly large volume of bloodof blood. . This excludes peripheral veinsThis excludes peripheral veins. . TPN TPN solutions are infused through a catheter solutions are infused through a catheter inserted into the subclavian or jugular vein; the inserted into the subclavian or jugular vein; the tip terminates in the superior vena cavatip terminates in the superior vena cava. . This This type of a catheter is referred to as a central type of a catheter is referred to as a central venous catheter venous catheter ((Fig. 16-21Fig. 16-21) )

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Figure 16-21 • Central venous catheter inserted into the subclavian vein and threaded into the superior vena cava.