198300FM-rev2.qxd 3/16/09 2:07 PM Page i I.V.Therapy 198300FM-rev2.qxd 3/16/09 2:07 PM Page ii 198300FM-rev2.qxd 3/16/09 2:07 PM Page iii I.V.Therapy 198300FM-rev2.qxd 3/16/09 2:07 PM Page iv Staff The clinical treatments described and recommended in this pub- lication are based on research and consultation with nursing, medical, and legal authorities. To the best of our knowledge, Executive Publisher these procedures reflect currently accepted practice. Neverthe- Judith A. Schilling McCann, RN, MSN less, they can’t be considered absolute and universal recom- mendations. For individual applications, all recommendations Clinical Director must be considered in light of the patient’s clinical condition and, Joan M. Robinson, RN, MSN before administration of new or infrequently used drugs, in light Art Director of the latest package-insert information. The authors and pub- lisher disclaim any responsibility for any adverse effects result- Elaine Kasmer ing from the suggested procedures, from any undetected errors, Clinical Project Manager or from the reader’s misunderstanding of the text. Jennifer Meyering RN, BSN, MS, CCRN © 2010 by Lippincott Williams & Wilkins. All rights reserved. This Editor book is protected by copyright. No part of it may be reproduced, Diane Labus stored in a retrieval system, or transmitted, in any form or by any means — electronic, mechanical, photocopy, recording, or oth- Clinical Editors erwise — without prior written permission of the publisher, ex- Robyn Wang RN, MPH, APRN cept for brief quotations embodied in critical articles and re- views and testing and evaluation materials provided by publisher Dorothy P. Terry, RN to instructors whose schools have adopted its accompanying Illustrator textbook. Printed in the United States of America. For informa- Bot Roda tion, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756. Design Assistant Kate Zulak IVMIE—4051109 Associate Manufacturing Manager Beth J. Welsh Editorial Assistants Karen J. Kirk, Jeri O’Shea, Linda K. Ruhf Library of Congress Cataloging-in-Publication Data I.V. therapy made incredibly easy!. — 4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-60547-198-3 1. Intravenous therapy. 2. Nursing. I. Lippincott Williams & Wilkins. II. Title: IV therapy made incredi- bly easy! [DNLM: 1. Infusions, Intravenous—Nurses’ In- struction. 2. Drug Therapy—Nurses’ Instruc- tion. WB 354 I93 2009] RM170.I25 2009 615'.6 — dc22 2009009702 198300FM-rev2.qxd 3/16/09 2:07 PM Page v Contents Contributors and consultants vii Not Another Boring Foreword ix 1 Introduction to I.V. therapy 1 2 Peripheral I.V. therapy 35 3 Central venous therapy 81 4 I.V. medications 145 5 Transfusions 191 6 Chemotherapy infusions 227 7 Parenteral nutrition 259 8 Pediatric I.V. therapy 291 9 Geriatric I.V. therapy 315 Appendices and index 331 Practice makes perfect 332 I.V. drug compatibility 350 Using a flow sheet to document I.V. therapy 352 Glossary 353 Selected references 363 Index 364 v 198300FM-rev2.qxd 3/16/09 2:07 PM Page vi 198300FM-rev2.qxd 3/16/09 2:07 PM Page vii Contributors and consultants Catherine B. Amero, MSN/Ed, CRNI, LNC Ruth K. Seignemartin, MOL, CRNI, CNAA Nurse Educator Co-owner/Chief Operations Officer Infusion Nurses Society Integrated Health Professionals Norwood, Mass. Spokane Valley, Wash. Jane Banton, RN, BSN Angelia Sims, RN, CRNI, OCN Oncology Clinic Nurse Staff Nurse, Infusion Services University of Wisconsin Hospitals and Clinics Tuality Healthcare Madison Hillsboro, Ore. Sandra J. Hamilton, RN, BSN, MEd, CRNI Denise Stefancyk, RN, BSN, CCRC Faculty Staff Nurse Great Basin College University of Massachusetts Medical Center Elko, Nev. Worcester Hospice Nurse Nathan Adelson Hospice Allison J. Terry, RN, MSN, PhD Pahrump, Nev. Director, Center for Nursing Alabama Board of Nursing Susan K. Poole, RN, BSN, MS, CRNI, CNSN Montgomery Senior Director, Accreditation Walgreens OptionCare Buffalo Grove, Ill. Donna Scemons, RN, MSN, MA, FNP-C, CNS President Healthcare Systems, Inc. Castaic, Calif. vii 198300FM-rev2.qxd 3/16/09 2:07 PM Page viii 198300FM-rev2.qxd 3/27/09 1:44 PM Page ix Not another boring foreword If you’re like me, you’re too busy caring for your patients to have the time to wade through a foreword that uses pretentious terms and umpteen dull paragraphs to get to the point. So let’s cut right to the chase! Here’s why this book is so terrific: 1. It will teach you all the important things you need to know about I.V. therapy. (And it will leave out all the fluff that wastes your time.) 2. It will help you remember what you’ve learned. 3. It will make you smile as it enhances your knowledge and skills. Don’t believe me? Try these recurring logos on for size: Best practice — Provides evidence-based standards for administering and monitoring I.V. therapy Warning — Alerts about possible risks or complications Running smoothly — Offers pointers on how to ensure that the patient and his equipment remain problem-free That’s a wrap! — Contains a succinct summary of key chapter information for a quick review Memory jogger — Reinforces learning through easy- to-remember anecdotes and mnemonics See? I told you! And that’s not all. Look for me and my friends in the margins throughout this book. We’ll be there to explain key ix 198300FM-rev2.qxd 3/16/09 2:07 PM Page x x FOREWORD concepts, provide important care reminders, and offer reassur- ance. Oh, and if you don’t mind, we’ll be spicing up the pages with a bit of humor along the way, to teach and entertain in a way that no other resource can. I hope you find this book helpful. Best of luck throughout your career! Joy 198301-rev.qxd 3/16/09 2:06 PM Page 1 1 Introduction to I.V. therapy Just the facts In this chapter, you’ll learn: ♦ uses of I.V. therapy ♦ I.V. delivery methods ♦ infusion flow rates ♦ legal and professional standards governing use of I.V. therapy ♦ patient teaching regarding I.V. therapy ♦ the proper way to document I.V. therapy. A look at I.V. therapy That’s One of your most important nursing responsibilities is to adminis- me, fast ter fluids, medications, and blood products to patients. In I.V. ther- and apy, liquid solutions are introduced directly into the bloodstream. accurate. I.V. therapy is used to: • restore and maintain fluid and electrolyte balance • provide medications and chemotherapeutic agents • transfuse blood and blood products • deliver parenteral nutrients and nutritional supplements. Benefits of I.V. therapy I.V. therapy has great benefits. For example, it can be used to administer fluids, drugs, nutrients, and other solutions when a patient is unable to take oral substances. On target and fast I.V. drug delivery also allows more accurate dosing. Because the entire amount of a drug given I.V. reaches the bloodstream imme- diately, the drug begins to act almost instantaneously. 198301-rev.qxd 3/16/09 2:06 PM Page 2 2 INTRODUCTION TO I.V.THERAPY Risks of I.V. therapy Like other invasive procedures, I.V. therapy has its downside. Risks include bleeding, blood vessel damage, fluid overload, infil- Well, tration (infusion of the I.V. solution into surrounding tissues rather nobody’s than the blood vessel), infection, overdose (because response to I.V. perfect. drugs is more rapid), incompatibility when drugs and I.V. solutions are mixed, and adverse or allergic responses to infused substances. Strings attached Patient activity can also be problematic. Simple tasks, such as transferring to a chair, ambulating, and washing oneself, can become complicated when the patient must cope with I.V. poles, I.V. lines, and dressings. No such thing as a free lunch — or I.V.! Finally, I.V. therapy is more costly than oral, subcutaneous, or intramuscular methods of delivering medications. Fluids, electrolytes, and I.V. therapy One of the primary objectives of I.V. therapy is to restore and maintain fluid and electrolyte balance. To understand how I.V. therapy works to restore fluid and electrolyte balance, let’s first review some basics of fluids and electrolytes. We’re all wet (well, mostly) The human body is composed largely of liquid. These fluids account for about 60% of total body weight in an adult who weighs 155 lb (70.5 kg) and about 80% of total body weight in an infant. Of solvents and solutes Body fluids are composed of water (a solvent) and dissolved sub- stances (solutes). The solutes in body fluids include electrolytes (such as sodium) and nonelectrolytes (such as proteins). Fluid functions What functions do body fluids provide? They: • help regulate body temperature • transport nutrients and gases throughout the body • carry cellular waste products to excretion sites. 198301-rev.qxd 3/16/09 2:06 PM Page 3 FLUIDS, ELECTROLYTES, AND I.V.THERAPY 3 Understanding body fluid distribution Body fluid is distributed between two main compartments—extracellu- With lar and intracellular. Extracellular fluid (ECF) has two components— optimal fluid interstitial fluid (ISF) and intravascular fluid (plasma). This illustration levels, you’re shows body fluid distribution for a 155-lb (70.5-kg) adult. riding a wave of good health! ECF About 19 L (20% of body weight) ISF About 15 L (20% of body weight) Intravascular fluid (plasma) About 3.5 L (5% of body weight) Intracellular fluid About 23 L (40% of body weight) Aim for the optimum When fluid levels are optimal, the body performs swimmingly; however, when fluid levels deviate from the acceptable range, organs and systems can quickly become congested.