IVT Handouts NSG

History of IVT in the Philippines
Philosophy
Envisions itself to be a cohesive, pro-active, professional association, committed to
excellence in nursing.
Believes that safe and quality nursing care to patients is the primary responsibility of
nurses.
Believes that those who practice I.V. therapy nursing are only those R.N.s who are
adequately trained and have completed the training requirements prescribed by ANSAP.
RA 7164 The Philippine Act of 1991 Sec. 27 (a) Art. V states that I.V. injection is within
the scope of nursing practice.
1993 Nursing Standards on Intravenous Practice was established.
October 1993 Training for Trainers for ANSAP Board Members and Advisers.
February 4, 1994 PRC-BON Resolution No. 08
June 9-11, 1994 Training for Trainers at Cagayan de Oro City.
May 17, 1995 Protocol Governing Special Training on the Administration of I.V.
Injections for RNs adopted ANSAP's I.V. Nursing Standards of Practice.
2002 Special Committee by ANSAP in collaboration with PRC-BON was founded.
RA 9173 Philippine Nursing Law of 2002.
August 25, 2006 Nursing Standards on Intravenous Practice 7th ed was released.
Why do we need to be updated regarding I.V. therapy?
More medications are being administered intravenously now than before.
Nurses are assuming greater responsibilities related to I.V. medication administration.
Many technical improvements have been made in equipment, and innovative as well as
time-saving measures have been developed to increase the efficacy of the therapy.
STANDARDS ON IV THERAPY
1.
2.
3.
4.
5.
6.
Initiation Technique
Drug Administration
Maintenance
Termination
Documentation
Infection Control and Complications
DEFINITION OF IV THERAPY
Intravenous (IV) Therapy insertion of a needle into a vein, based on the physician's
written prescription. The needle is attached to a sterile tubing and a fluid container to
provide medication and fluids.
Objectives of the IV Therapy Standards

Serves as a guide for nurses in providing safe and quality nursing care to patients
relative to I.V. therapy.
Promotes the application of principles underlying the administration of I.V. therapy.
Recognizes the ethico-legal implications of I.V. therapy.
THE ETHICO LEGAL ASPECTS OF IV THERAPY
BASIC
DUTIES AND RESPONSIBILITIES OF IV THERAPISTS
1. Interpret and carry out the physicians prescriptions for IV therapy.
2. Prepare, initiate and terminate IV therapy based on physicians written prescription.
3. Perform peripheral venipuncture (all types of needles and cannulas) excluding the insertion of
subclavian and cut down catheter.
4. Determine solution and medication incompatibilities.
1
5. Administer computed medications, chemotherapeutic drugs, flow rates of solutions,

compatible blood/blood components and parenteral nutrition as prescribed by the physician.
6. Assess all adverse reactions related to IV therapy and initiate appropriate nursing
interventions.
7. Establish nursing care plan related to IV Therapy.
8. Adhere to established infection control practices.
9. Maintain proper care of IV equipments.
10. Document relevant data in the preparation, administration and termination of all forms of IV
therapy.
LEGAL BASIS
IV THERAPY AND LEGAL IMPLICATIONS
R.A. 7164 The Philippine Nursing Act of 1991 Section 28 states that in administration
of IV injections, special training shall be required.
IV Nursing Standards of Practice developed by the ANSAP should be used.
In giving IV injections, nurses should follow the policies of their agencies.
Board of Nursing Resolution No.8 Sec.30 (c) Art.VII or administratively under Sec.21
Art.III states that any registered nurse without training and who administers IV
injections to patients shall be held liable, either criminally, administratively or both.
R.A. 9173/The Philippine Nursing Act of 2002, Article VI Nursing Practice,

SEC.28.Scope of Nursing (a) Provide nursing care through the utilization of the nursing
process. Nursing care includes, but not limited to administration of written presentation
for treatment, therapies, oral, topical and parenteral medications. That in the practice of
nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses
and uphold the standards of safe nursing practice.
ETHICAL ISSUES
CODE OF ETHICS FOR NURSES IN THE PHILIPPINES
ETHICS according to Webster Dictionary, is the study of the standards of conduct and moral
judgment.
NURSING ETHICS is concerned with the principles of right conduct as they apply to the nursing
profession.
NURSES AND PEOPLE
Values, customs and spiritual beliefs held by individuals are to be respected.

Nurses hold in strict confidence personal information acquired in the process of giving
nursing care.
NURSES AND PRACTICES
Nurses are accountable for their own nursing practice.

Nurses maintain or modify standards of practice within the reality of any given situation.
Nurses are the advocates of the patients.
Nurses are aware that their actions have professional, ethical, moral and legal
dimensions.
NURSES AND CO-WORKERS
Nurses maintain collaborative working relationships with their co-workers and other
members of the health team.
2
They recognize their capabilities and limitations in accepting responsibilities and those of
their co-workers when delegating responsibilities to them.
NURSES AND SOCIETY
Nurses are contributing members of society. They assume responsibilities inherent in

being members and citizens of the community/society in which they live/work.
Nurses recognize the need for change and initiate, participate, and support activities to
meet the health and social needs of the people.
NURSES AND THE PROFESSION
Nurses are expected to be members of professional organizations of nurses.

Nurses help to determine and implement desirable standards of nursing practice and
nursing education.
Nurses should initiate and involve themselves in structured and non-structured research
activities within their existing milieu.
Nurses should assert the implementation of labor standards and lobby for favorable
legislations to improve existing socio-economic conditions of nurses.
The Nursing Service Administrators of the Philippines
MISSION
Provision of efficient and effective nursing services.

Promote quality health care for people as a basic human right.
Be responsible for planning, organizing, directing and controlling the programs and
activities of the Nursing Service towards optimum quality nursing care.
ARTICLE II
THE ANSAP CREED; CORE VALUES & BELIEFS
1. The nursing profession is a commitment to God and people;

2. The nursing service is responsible and accountable for quality nursing care;
3. The nursing service is a major function in any health care delivery system and deserves
a corresponding importance in the organizational structure;
4. A high level of self-discipline and committed leadership are essential factors in the
effective management of health care services;
5. The nursing services is most important asset, aside from its clients, are its caring,
competent and productive personnel;
6. Competence enhances the publics assurance of quality nursing care, therefore, nursing
personnel must be selected and appointed to positions consistent with their
qualifications;
7. The client is the reason for the existence of the nursing profession; all efforts should be
directed to his care and should consider his uniqueness, personal worth, dignity, and
socio-cultural values;
8. The implementation and maintenance of approved standards of nursing practice and
nursing administration are bases for effective and efficient nursing service;
9. Nursing service is integral in the quality of education of students; and
10. A unified stand is vital in achieving their objectives through membership in professional
organizations, such as the Philippine Nurses Association (PNA), the Association of
3
Nursing Service Administrators of the Philippines (ANSAP), and other specialty groups in
nursing.
ARTICLE III
NORMS OF PROFESSIONAL CONDUCT
SECTION 1. Dedication to God and people.
SECTION 2. Responsibility and accountability for quality nursing service.
SECTION 3. Leadership and Technical Competence.
SECTION 4. Responsibility and Accountability for Nursing Practice.
SECTION 5. Commitment to the Nursing Profession.
ARTICLE IV
GENERAL PROVISIONS
Section 1. Creation of Ethics Committee that shall be responsible to adjudicate violations
against the NSA Code of Ethics and adopt such rules and sanctions as the association is
authorized to do.
SECTION 2. Legal Force.
SECTION 3. Moral Force.
SECTION 4. Dissemination.
SECTION 5. Sanctions.
SECTION 6. Amendment.
SECTION 7. Effectivity
CODE OF GOOD GOVERNANCE FOR THE PROFESSIONS IN THE PHILIPPINES
E.O. No. 220 - Directing the adoption of the Code of Good Governance for the
Professions in the Philippines on June 23, 2003.
General Principle of Professional Conduct
Professionals are required not only to have an ethical commitment, a personal resolve to act
ethically, but also have both ethical awareness and ethical competency.
Specific Principles of Professional Conduct
1.
2.
3.
4.
5.
6.
7.
Service to Others
Integrity and Objectivity
Professional Competence
Solidarity and Teamwork
Social and Civic Responsibility
Global Competitiveness
Equality of All Professions
PROFESSIONAL VALUES
CARING
is the locus of all attributes used to describe NURSING. It is not only the main value of
NURSING but the Essence. It is not only a nursing act because to care is human and to be
human is caring.
5 Cs of Caring
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Compassionate
Concern
Caring
Committed
Willingness to perform her responsibilities
Confident
Assertive
Smart
Conscientious
Honest
Competent
Knowledgeable
Effective/ Efficient
RELATED LAW OFFENSES
LEGAL ASPECTS AND THE NURSE
The Republic Act 9173 or the Philippine Nursing Act of 2002 is the best guide the nurse can
utilize as it defines the scope of nursing practice.
Negligence
Commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the
same or similar circumstance would or would not do.
The Doctrine of Res Ipsa Loquitur
Three conditions are required to establish a defendants negligence without proving specific
conduct:
1. That the injury was of such nature that it would not normally occur unless there was a
negligent act on the part of someone;
2. That the injury was caused by an agency within control of defendant;
3. That the plaintiff himself did not engage in any manner that would tend to bring about the
injury.
Example:
A patient came in walking to the out-patient clinic for injection. Upon administering the
injection to his buttocks, the patient experienced extreme pain. His leg felt weak and he was
subsequently paralyzed.
Malpractice
Refers to a negligent act committed in the course of professional performance.
Example is the giving of anesthesia by a nurse or prescribing medicines.
Incompetence
The lack of ability, legal qualificationsor fitness to discharge the required duty.
Example:
Although a nurse is registered, if shes not yet an IV therapists, she is not allowed to give IV
medications or do the IV insertion.
Assault and Battery
Assault is the imminent threat of harmful or offensive bodily contact.
Battery is an intentional, un consented touching of another person.
It is, therefore, important that before a patient can be touched, examined, treated or subjected to
medical/surgical procedures, he must have given a consent to this effect.
Example: If a patient refuses an injection and the nurse gives it anyway, the latter can be
charged for battery.
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LEGAL TERMINOLOGIES THAT ALSO APPLY IN IV THERAPY
CIVIL ACTION
a non-criminal action whereby one seeks to protect, enforce, or declare a right or
address a civil wrong close to him or her. When the harm occurs, the guilty party may be
required to pay damages to the injured person.
CRIMINAL ACTION
an action brought about by a state or federal law enforcement agency or by an official
agency on behalf of an individual, to protect ones person or property or to protect society in
general. Punishment includes imprisonment, fine or both.
DEPOSITION
a discovery procedure which is an oral question and answer proceeding, under oath and
recorded, wherein the attorneys seek to find out what testimony and evidence will be
confronting them in a lawsuit. It is an informal proceeding with lawyers of all parties present.
INTERROGATORY
another discovery procedure which is the written equivalent of a deposition.
RULE OF PERSONAL LIABILITY

every person is liable for his own wrongdoing. No one can bypass this rule with
personal assurance.
STATUTE OF LIMITATIONS
the time limit set by each state legislature in which civil or criminal action can be
brought.
TORT
a private wrong by act or omission, which can result in a civil action by the harmed
person.
SUBPOENA
the process or "paper command" by which the person served must appear at a certain
time and give testimony to the court. It is an order under the seal of the court for which one can
be held for contempt of court for ignoring the subpoena.
SUMMONS
notification served upon defendant to appear before the court.
NURSING LIABILITIES AND PREVENTIVE MEASURES
Points to Observe in Order to Avoid Criminal Liability
1. Be very familiar with the Philippine Nursing Law.
2. Beware of laws that affect nursing practice.
3. At the start of employment, get a copy of your job description, the agencys rules, regulations
and policies.
4. Upgrade your skills and competence.
5. Accept only such responsibility that is within the scope of your employment and your job
description.
6. Do not delegate your responsibility to others.
7. Develop good interpersonal relationships with your co-workers, whether they be your
supervisors, peers or subordinates.
8. Consult your superiors for problems that may be too big for you to handle.
9. Verify Doctors prescriptions that are not clear to you or those that seem to be erroneous.
10. The doctors should be informed about the patients conditions.
11. Keep in mind the value and necessity of keeping complete and accurate recording.
12. Patients are entitled to an informed consent.
STANDARDS OF NURSING INFUSION CARE REQUIREMENTS TO BECOME AN IV THERAPIST
1. Entrance Requirements
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Level of academic preparation: A BSN graduate, RN, with a current license from the
PRC.
Behavioral characteristics :Honesty, reliability, initiative, flexibility and judgment.
Demonstrates communication and technical skills.
2. Completion Requirements
3 days Basic IV Therapy Training Program must have successfully participated.
3. Renewal/Revalidation of an IV Therapy Card
The IV Therapy Card is renewable every three (3) years.
Attendance to IV related Updates equivalent to 24 CEU.
4. Loss of The IV Therapy Nurse Card
Presenting an affidavit of loss.
Submitting Certificate of Training.
Photocopy of the official list of participants of the IV therapy training attended.
5. Cancellation of the IV Card
PRC License is not renewed.
Any violation of Nursing Law 9173.
IV Card is not renewed for more than 3 years.
Violations in the Standards of IV Therapy practice.
The IV Therapy Program consists of discussions of concepts in IV therapy and demonstration
of skills in access-related situations. It has a twenty-four (24)-hour didactic lecture and a
practicum with the following evaluation methods:
1. Written examinations: pre and post tests
2. Completion of the required number of actual cases for each of the following competencies:
Initiating and maintaining peripheral IV infusion (3 cases).
Administering IV drugs (3 cases)
Administering and maintaining blood and blood components (2 cases).
The participants will be rated as follows: (a) Didactic 50%; and (b) Practicum 50%.
Dehydration: Definition
defined as "the excessive loss of water and electrolytes from the body
Dehydration can be caused by losing too much fluid, not drinking enough water or fluids,
or both.
Infants and children are more susceptible to dehydration than adults because of their
smaller body weights and higher turnover of water and electrolytes.
So are the elderly and those with illnesses
dehydration occurs when losses are not replaced adequately and a deficit of water and
electrolytes develop.
These may occur in Vomiting or diarrhea
Presence of an acute illness where there is loss of appetite and vomiting:
Pneumonia
DHF
Other Acute Ilnesses
Excessive urine output, such as with uncontrolled diabetes or diuretic use
Excessive sweating (sports)
Burns
Since diarrhea and vomiting are the most common causes of dehydration in children, the
volume of fluid loss may vary from 5 ml/kg (normal) to 200 ml/kg
Concentration of electrolytes lost also varies
NaCl and K are the most common electrolytes lost through stools
Dehydration:Checking the main sx
In order to diagnose the type of dehydration, you need to know the History and you must
do a thorough physical examination
We classify type of dehydration depending on the amount of water and electrolytes lost
These are reflected by the signs and symptoms the child will present
Dehydration: Classification
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Dehydration is classified as no dehydration, some dehydration, or severe dehydration

based on how much of the body's fluid is lost or not replenished.
When severe, dehydration is a life-threatening emergency
Graded according to the signs and symptoms that reflect the amount of fluid lost.
There are usually no signs or symptoms in the early stages
As dehydration increases, signs and symptoms develop. Initially, thirst, restlessness,
irritability, decreased skin turgor, sunken eyes and sunken fontanelles.
As more losses occur, these
effects become more pronounced.
Signs of hypovolemic shock (SEQUELAE)

1.
2.
3.
4.
5.
6.
7.
diminished sensorium (lethargy)

Lack of urine output
Cool moist extremities
A rapid and feeble pulse
Decreased BP
Peripheral cyanosis
DEATH.
Clinical Signs of Dehydration
Poor Skin Turgor

Summary of Management According to Degree of Dehydration
WHO Treatment Plan A

Three rules of home treatment:
1. give extra fluids
2. continue feeding
3. advise when to return to the doctor
Do not give:
Very sweet tea, soft drinks, and sweetened fruit drinks. These are often hyperosmolar
(high sugar content). Can cause osmotic diarrhea, worsening dehydration and
hyponatremia.
Also to be avoided are fluids with purgative action and stimulants (e.g., coffee, some
medicinal teas or infusions).
WHO Treatment Plan B
ORS(ml) the mother slowly gives the recommended amount of ORS by spoonfuls or sips
Note: If the child is breast-fed, breast-feeding should continue.
After 4 hours, reassess and reclassify dehydration, and begin feeding to provide
required amounts of potassium and glucose.
WHO Treatment Plan B
WHO Treatment Plan C
WHO Treatment Plan C
MAINTENANCE REQUIREMENTS
1. HOLIDAY-SEGAR METHOD
Estimates caloric expenditure in fixed weight categories
Assumption
100 cal metabolized : 100 mL water
Not suitable for neonates < 14 days
Overestimates fluid needs
EXAMPLE
What is the maintenance fluid rate for a an 8 year old child weighing 25 kg using the
Holiday-Segar Method?
100 x 10
=
1000 ml
8
50 x 10
20 x 5
4 x 10 =
2 x 10 =
1x 5 =
=
=
500 ml
100 ml
1600 ml/day
40 ml
20 ml
5 ml
65 ml/hr
EXERCISE
Using the Holiday-Segar Method, what is the full maintenance requirement and rate for a 10
year old patient who weighs 37 kg?
BODY SURFACE AREA METHOD
Assumption: caloric expenditure is related to BSA
Not used in children < 10 kg
BSA METHOD
BSA Formula
Surface area (m2) =
ht (cm) x wt (kg)
3600
EXAMPLE
Using the BSA method, what is the maintenance requirement of an 8 year old who weighs 25 kg
and is 132 cm tall?
BSA Formula
0.92 m2
132 cm x 25 kg
3600
Water = 1500ml/0.92/day
= 1630 ml
Na+
= 40 mEq/0.92/day = 43.5 mEq
K+
= 30 mEq/0.92/day = 32.6 mEq
EXERCISE
Using the BSA Method, what is the maintenance requirement of a 12 year old boy who weighs
37 kg and is 142 cm tall?
DEFICIT THERAPY
Calculated Assessment
Clinical Assessment
CALCULATED ASSESSMENT
Fluid deficit (L) = preillness weight (kg) illness weight (kg)

% Dehydration = (preillness weight illness weight)/preillness weight x 100%
CLINICAL ASSESSMENT
FLUID REPLACEMENT
ICF & ECF COMPARTMENTS
ICF & ECF COMPARTMENTS
In dehydration, there are variable losses from the extracellular and intracellular
compartments
Percentage of deficit is based on total duration of illness
BASIC
MATH CONCEPTS
DECIMALS
All figures to the left of the decimal point are whole numbers
All figures to the right of the decimal point are decimal fractions
9
. 385 =
.3 8 5
CHANGING FRACTIONS TO DECIMALS:
Fractions can be changed to decimals by dividing the numerator and the denominator
= 3 4 = 0.75
PERCENTAGE
Percentage ( % ) means hundredths
Percent ( % ) is the same as a fraction with denomination as 100.
3%
=
CHANGING PERCENT TO A DECIMAL & CHANGING DECIMAL TO PERCENT

To change percent to a decimal, remove the percent sign and divide the number by 100
or move the decimal point two places to the left.
4% = 4/100 = .04 or
0.04
To change a decimal to a percent, multiply by 100 or move the decimal point two places
to the right and place % sign.
0.04 X 100
= 4% or 0.04 = 4%
RATIO
A Ratio consists of two numbers as separated by a colon ( : )

e.g.
1:4
A ratio indicates that there is a relationship between the two numbers.
A ratio is an indicated fraction.
e.g.
=
1:4
The numbers in ratio must be expressed in the same terms.
e.g.
3 inches : 2 feet
=
3 : 24
(feet changes to inches)
PROPORTION
It is a statement showing that the two ratios have equivalent values
1 : 50 = 2 : 100
If one value is not known, it can be solved by using the term X.

1 : X = 2 : 100
or
THE METRIC SYSTEM

It is the international decimal system of weights and measures
In the metric system, fractions are expressed as decimals
In the decimal system, the fraction is written as 0.5

METRIC SYSTEM
Liter = vol. of fluids
Gram = weights of solids
Meter = measure of length
milli = one thousandths

centi =
one hundredths
deci = one tenth
mcg = one thousandths
RULE OF CONVERSION
When converting from a larger unit of measure to a smaller unit, multiply the larger unit
by (1000, 100, 10) or move the decimal to the right.
When converting a smaller unit of measure to a larger unit, divide the smaller unit by
(1000, 100, 10) or move the decimal to the left.
e.g.
2.5 grams =
___________ mg.
APOTHECARIES SYSTEM
Grain (gr)
Dram
Ounce
Minims
Pounds
Approximate Equivalent Value:

1 gr
=
60 mg
10
1 ml
1 ounce
1 ounce
1 kg
=
=
=
=
15 minims (16 minims)

30 ml
30 Gm
2.2 pounds
e.g. 60 gr = _________ mg.

4 oz = _________ ml.
HOUSEHOLD MEASURES
1 teaspoon (tsp)
= 4 5 ml
1 Tablespoon (Tbsp) = 3 teaspoons (tsp)
1 Tablespoon
= 15 ml
1 milliliter
= 15 drops (gtts)
e.g.
5 ml = ______
CONVERSION OF TEMPERATURE
Normal Temperature =
37C
= 98F
Conversion of Centigrade (Celsius) to Fahrenheit:
Conversion of Fahrenheit to Centigrade (Celsius):
Interpretation of Doctors Order for Drugs
The nurse must understand the order perfectly before acting on it
> The Drug
> The Dose
> The Route
> The Frequency
If any of the above are unclear or open for interpretations, it is the Responsibility of the nurse to
clarify the order with the physician.
Example:
The order reads : Inderal 2 x4
a. What is the Drug?
b. What is the Dose?
c. What is the Route?
d. What is the Frequency?
e. Does this order need clarification?
The order reads : Lasix 10 mg IV 1 ml O.D.
a. What is the Drug?
b. What is the Dose?
c. What is the Route?
d. What is the Frequency?
e. Does this order need clarification?
GENERAL FORMULA FOR DRUG CALCULATION
1.
D
x Q
S
2.
Calculation by Ratio : Proportion

8 mg : x = 16 mg : 1 tab
(works for any computation of Dosage if you have a given and a need to determine the
unknown).
Rule :
1. Units for each ratio must be the same.
2. Units for each ratio must be placed in the same order.
Computation of Dosages:
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When the dose prescribed is in milligram (mg) and the dose available is in Gram (Gm)
or vice versa.
E.g. The order reads : 0.008 Gm of Morphine Sulfate IV q 4 hours prn for pain.
Ampule available is labeled 10 mg/ml.
1. What do you know?
0.008 Gm - 8 mg
10 mg/ml 2. What do you need to know? Known amount in cc for 0.008 Gm dose
3. Setting up the proportion:
a. the units for each ratio must be placed in the same order
b. the units for each ratio must be the same ( mg to mg )
8mg : X = 10 mg : ml
c. solve for the correct dosage
8 mg : X = 10 mg : ml
10 mg X = 8 mg/ml
X = 8 mg/ml
10 mg
X = .8 ml
When the dose is ordered in one system and the dose on hand is in another system.
E.g. The order reads : codeine sulfate gr P.O. q 8 hrs PRN for pain. Tablets
on hand are labeled 0.015 Gm tablets.
1. What do you know? Known
gr
1 gr = 60 mg
0.015 Gm / tab
1 Gm = 1000 mg
= .25
2. What do you need to know?
# of tablets for gr dose
3. Setting up the proportion
a. the units for each ratio must be the same
b. the units for each ratio must be placed in the same order.
.25 gm : X = 0.015 gm : 1 tab
15 mg : x =
15 mg : 1 tab
4. Solve for the correct dosage:
15 mg : x = 15 mg : 1 tab
15 mg x = 15 mg / tab
x = 15 mg / tab
15 mg
x = 1 tab
Computation of Correct Insulin Dosage

U - 40 means
U - 80 means
U - 100 means
Insulin syringes are calibrated according to the strength of insulin with which it is to be
used.
U 40 insulin needs a U 40 syringe
U 80 insulin needs a U 80 syringe
If this can not be done, the dose can be converted to milliliters
Dose Required
Dose on Hand
Fractional Dosages in Infants and Children
Childrens Doses
Clarks Rule:
weight of child in pounds X A.D. = childs dose
150
Body Surface Area e.g. Wt = 10 kg
BSA X A.D. = childs dose
12
1.7
BSA = 4(wt in kg) + 7 = BSA in m
wt in kg + 90
= 4(10 kg) + 7 = 47
10+ 90
= .47 m
Childs dose = .47 m X 500
1.7
Youngs Formula:
Age of child in Years X A.D.
Age of child + 12
= Childs dose
CALCULATION OF FLUID VOLUME (BASED ON BODY WEIGHT)

1. WEIGHT --- 1 10 kg. --- 100ml/kg.
Eg. Wt = 8 kg. --- 800cc
2. WEIGHT --- 11 20 kg.--- 1,000+50ml/excess b.wt.
Eg. Wt = 15 kg.
1,000=250ml = 1,250ml
15 50
-10 X 5
5 250
3. WEIGHT
> 20 kg.
Eg. Wt = 27 kg.
1,500 + 20 ml/excess b.wt.
1,500 + 140 ml = 1640 ml.
27
20
-20 X 7
7 140
Calculation of IV Flow Rates
Calculation of cc/hr is essential in most IV therapy.
Volume
# of hrs
E.g. 1 L over 8 hrs = 125 cc/hr
50 cc over 20 minutes = 150 cc/hr
Calculation of gtt/min (Long Method)
STEPS :
1. Need to know cc/hr to calculate
2. Gtt factor = gtt / ml
gtt factors : macrodrip 10, 15, 20 gtts/ml
microdrip 60 gtt/ml
EXAMPLE : LONG METHOD
Doctors Order : Run 1L D5W over 8 hours
Microdrip - 1000 ml 8 hours = 125 cc/hr
125 cc x 60 gtt/ml = 125 gtt/ml
60 min
1
10 gtt/ml set 125cc x 10 gtt/ml
= 20 21 gtt/min
60 min
1
15 gtt/ml set
125cc x
15 gtt/ml
= 31 gtt/min
60 min
1
20 gtt/ml set
125 cc x
20 gtt/ml = 41 42 gtt/min
60 min
1
SHORT METHOD
cc / hr 6
for
cc / hr 4
for
cc / hr 3
for
cc / hr = gtt / min for
10 gtt / min
15 gtt / min
20 gtt / min
microdrip set
Pharmacology at IV Therapy
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R.A. # 9502 - An act providing for cheaper and quality medicines, amending for the
purpose Republic Act No. 8293 or the Intellectual Property Code, Republic Act No. 6675
or the Generics Acts of 1988, and Republic Act No. 5921 or the Pharmacy Law, and for
other purposes
R.A. # 9165 Dangerous Drug Act of 2002 - An Act Instituting the Comprehensive
Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the
Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other
purposes
RA 9173 Philippine Nursing Law of 2002 have stated that parenteral injection is in the
scope of nursing practice.
Board of Nursing Resolution No.8 Sec.30 (c) Art.VII or administratively under Sec.21
Art.III states that any registered nurse without training and who administers IV
injections to patients shall be held liable, either criminally whether causing or not an
injury or death to the patient.
Pharmacokinetics
- The process by which a drug is absorbed, distributed, metabolized, and
eliminated by the body.
PHARMACOKINETICS - what the BODY does to the DRUG (processes)
Pharmacokinetic PROCESSES
Absorption
Distribution
Metabolism
Excretion
Pharmacodynamics
The study of the action or effects of drugs on living organisms.
PHARMACODYNAMICS - what the DRUG does to the BODY (EFFECTS)
Pharmacodynamics
Symptomatic
Curative
Restorative
Preventive
Diagnostic
An I.V. Medications may be ordered when:
rapid therapeutic effect.
cant be absorbed by the GI tract.
The client may receive nothing by mouth.
controlled administration rate
I.V. Medication may be given by:
Drug injection
Intermittent infusion
Continuous infusion
Benefits
Rapid Response
Effective Absorption
Accurate Titration
Less Discomfort
Risks
Solution and drug incompatibilities.
Poor vascular access in some clients.
Immediate adverse reactions.
Incompatibility
Drug + Diluent = must be compatible
-The more complex the solution, the greater the risk of incompatibility
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An incompatibility results when two or more substances react or interact so as to change

the normal activity of one or more components.
Incompatibility may result in the loss of therapeutic effects and may occur when:
Several drugs are added to large volume of fluid to produce an admixture.
Drugs in separate solutions are administered concurrently or in close succession
via the same IV line
A single drug is reconstituted or diluted with the wrong solution
One drug reacts with another drugs preservative
Hazards of intravenous medications
Mixing of two incompatible drugs in a solution can cause an adverse interaction.
Poor Vascular Access
Clients who require frequent or prolonged I.V. therapy may developed small, scarred,
inaccessible veins from repeated venipunctures or infusion of irritating drugs.
If peripheral venous access isnt possible, the doctor may use a central vein, commonly by the
subclavian route.
Adverse Drug Reaction
- A response to a drug that is noxious and unintended and occurs at doses normally
used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of
physiological function (WHO).
The following are some adverse drug reactions that you might notice:
Skin rash
Easy bruising
Bleeding
Severe nausea and vomiting
Diarrhea
Constipation
Confusion
Breathing difficulties
What should you do if you suspect an ADR?
Stop the medication immediately.
Report the incident to the physician.
Monitor the client.
10 GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY
Administer the right drug.

Administer the right drug to the right patient.
Administer the right dose.
Administer the drug by the right route.
Administer the drug at the right time.
Document each drug you administer.
Teach your patient about the drug he is receiving.
Take a complete patient drug history.
Find out if the patient has any drug allergies.
Be aware of patient drug drug or drug-food interactions.
Common Medication Errors

Wrong dose (overdose, underdose, missed dose)
Wrong medication to wrong patient
Wrong medication to right patient
Wrong medication due to wrong dispensing
Wrong interpretation of doctors prescriptions for drugs
Wrong infusion rate ( over infusion, under infusion, missed order )
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Transcription of medication and treatment orders

Interpretation of Doctors Order for Drugs
The nurse must understand the order perfectly before acting on it
> The Drug
> The Dose
> The Route
> The Frequency
If any of the above are unclear or open for interpretations, it is the Responsibility of the
nurse to clarify the order with the physician.
Definition of Terms:
Transcription of medical orders- is the act of writing out medical orders.
Kardex- is the summarize written presentation of all the care and treatment of the
patient.
Medication/Treatment sheet- is the legal documents in the patients chart were
medicines and treatments administered to the patient are written, acknowledged and
administered by nurses.
Physicians Order Sheet- is a legal document wherein medical orders are written and
use as reference of nurses in the transcription and executing nursing care.
All medication and treatment orders must be written legibly and must contain the following:
a. generic name and brand name of medicines
b. Dosage of the medicines
c. Frequency of administration
d. Route of administration
e. Signature over printed name of attending physician or authorized representative
f. Date and time order was written
The registered nurse indicates that he/she has checked and completely transcribe the
medical order by signing his/her name with the date and time directly right after the doctors
order. As a general rule, telephone orders are received and carried out only in emergency cases
by nurses. Nurses receive telephone orders only from consultants.RNs will review all orders
immediately after the physician writes.
Patient / Family Teaching
Inform the client about the medication you are about to administer.
Reason why the medication is to be give.
Adverse effect he may experience
Pain
Redness
Swelling
Documentation
Type and amount of drug given
Date and time given
Confirmation that the I.V. line was patent
Patients response to the medication
Condition of the insertion site
Ongoing monitoring that you provided
Where to Document
Nurses Progress Notes
Medication Sheet
Infusion Sheet
Vital Signs Monitoring Sheet
Input and Output Monitoring Sheet
Nomogram
Find your weight in the right column and your height in the left column. Place a straightedge on
the nomogram so the weight and height are connected. The point where the straightedge
crosses the center column denotes your body's surface area in square meters.
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Coming to the Surface

Basal Surface Area
Childs Dose =
Childs BSA
X
173 m2
(average adult BSA)
average
adult dose
GENERAL FORMULA FOR DRUG CALCULATION

1.
desired strength x total ml of solution

strength on hand
2.
Calculation by Ratio : Proportion

8 mg : x = 16 mg : 1 tab
(works for any computation of Dosage if you have a given and a need to determine the
unknown).
Rule :
1. Units for each ratio must be the same.
2. Units for each ratio must be placed in the same order.
Calculating Administration Rates
One must know two key components before using the formula:
Drop factor of the IV administration set
Amount of solution to be infused over one hour
Rate Calculations
Macrodrip Set
10 drops = 1 ml
15 drops = 1 ml
20 drops = 1 ml
Microdrip Set
60 drops = 1 ml
Blood Set
10 drops = 1 ml
FORMULA
Drip Rate (gtts or mgtts/min) =
Total no. of ml
FORMULA
ml per hour =
Drip Factor Total no. of min.
Total no. of ml
Total no of hours
Other factors affecting Flow Rate:
1. Gauge of the catheter
2. Viscosity of the infusate
3. Height of the IV stand
4. Condition of the veins
5. Condition of the patient
VENIPUNTURE
The Integumentary and Vascular System
Integumentary System
Two Main Layers:
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1. Epidermis outer layer composed of squamous cells.

2. Dermis inner, thicker layer consisting of blood vessels, hair follicles, sweat glands, small
muscles, and nerves.
Sensory Receptors
Mechanoreceptors skin tactile perceptions
Thermoreceptors process cold, warmth, and pain
Nociceptors process pain
Vascular System
Variations:
1. Arteries carries blood from the heart to the body.
2. Veins carries blood from the capillaries towards the heart.
3. Capillaries resembles a hair follicle.
Layers of the Blood Vessel:
2. Tunica Media middle layer; is formed by a layer of circumferential smooth muscle
and variable amounts of connective tissue; collapses or distends as pressure changes.
3. Tunica Intima innermost layer; delimits the vessel wall towards the lumen of the
vessel and comprises of endothelial lining and connective tissue.
Peripheral Vascular
MAJOR TYPES OF VEINS (ARM)
1.) Digital Veins
2.) Metacarpal Veins best choice
3.) Cephalic Veins
4.) Basilic Veins
Major Types of Veins:
1. Digital lateral and dorsal portions of fingers
2. Metacarpal dorsum of hand
3. Cephalic along radial bone of forearm
4. Basilic runs up to the ulnar bone
Key Points Prior to IV Initiation
1. Physicians order
2. Patient assessment
3. IV set and equipment preparation
4. Medications
Physicians Order
1. Initiation is based upon the written order of a licensed physician.
2. The order must indicate:
a. Patients name
b. Type and amount of solution
b. Flow rate
c. Type, dose, and frequency of medications to be incorporated/pushed.
d. Orders affecting the procedure
Patient Assessment
1. Clinical status of the patient
2. Patients diagnosis
3. Patients age
4. Dominant arm
5. Condition of the vein/skin
6. Cannula size
7. Type of solution
8. Duration of therapy
Choosing the Right Vein
Prioritize the ideal veins for venipuncture.
Begin with distal veins.
Watch out for bifurcated or branched veins.
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Do not perform venipuncture at the palm side of the wrist and cephalic veins of the wrist.
Palpate for arterial pulse in order to avoid puncturing the arteries if the site chosen is
cephalic or the inner aspect of the arm.
Other sites to avoid include:
Veins below a previous IV infiltration.
Veins below a phlebitic area.
Sclerosed or thrombosed veins.
Areas of skin inflammation, disease, bruising, or breakdown.
An arm affected by a radical mastectomy, edema, blood clot, or infection.
An arm with an arteriovenous shunt or fistula.
IV Set and Equipment Preparation
1. Check for expiration date.
2. Check for clarity.
3. Check label against physicians written prescription.
4. Label any medications added.
5. Functionality of infusion pumps, PCA.
Medications
1. Nurses should have a knowledge on all medications administered including:
a. Dosages
b. Drug interactions
c. Possible clinical effects
Venipuncture Techniques
1. Vein dilatation
2. Site preparation
3. Catheter insertion
4. Securing the catheter
Vein Dilatation
1. Tourniquet place 6-8 inches above the venipuncture site.
2. Gravity position the extremity below the heart.
3. Fist clenching open and close his fist.
4. Warm compress maximum of 10 minutes.
5. Multiple tourniquet technique use of 2-3 tourniquets.
Site Preparation
1. Do not shave site. Remove hair with clippers only.
2. Depilatories are not recommended.
3. Cleanse with one of the following solutions:
a. 2% Chlorhexidine gluconate
b. Povidone-iodine
c. 70% Isoprophyl alcohol
4. Work from the center outward in a circular motion.
Catheter Insertion
1. Hold skin taut.
2. Adjust angle of insertion.
3. Puncture vein and observe flashback.
4. Release tourniquet.
5. Upon flashback visualization, lower catheter parallel to skin.
6. Advance needle and catheter together 1/8 inch.
7. Thread catheter into vein.
8. Place middle finger over vein distal to catheter tip
9. Stabilize catheter hub with index finger
10. Withdraw needle with a swift, continuous motion parallel to the skin
11. Dispose of needle immediately into sharps container
Securing the Catheter
Basic Methods:
1. Chevron method
2. U method
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3. H method
Chevron Method
Cut a strip of tape then place under the cannula, parallel to the hub.
Cross the end of the tape over the cannula.
U Method
Cut a strip of tape and place it under the hub of the cannula.
Bring each side of the tape up, folding it over the wings of the cannula in a U shape.
H Method
Cut three strips of tape and place one strip over each wing of the cannula.
Place the third strip over the wings perpendicular to the first two.
Reminder for all methods:
Maintaining Peripheral IV Therapy:
1. Changing the dressing
2. Changing the IV solution
3. Changing the administration set
4. Changing the IV site
MANAGING COMPLICATIONS OF IV THERAPY
Risks Associated with IVT
Risks
1. Needlestick Injury
An AIDS patient became agitated and tried to remove the intravenous catheters.
Hospital staff struggled to restrain the patient. During the struggle, an IV infusion line was
pulled, exposing the connector needle. A nurse recovered the connector needle at the end of
the IV line and attempted to reinsert it. The patient kicked her arm, pushing the needle into the
hand of the second nurse. Three months later, the nurse who sustained the needlestick injury
tested positive for HIV1.
Prevention:
Avoid the use of needles where safe and effective alternatives are available.
Avoid recapping needles.
Report all needlestick and other sharps related injuries to ensure that you receive
appropriate follow-up care.
Create/maintain a safe, comprehensive disposal system.
2. Infectious Organism Exposure
Prevention:
Do proper hand hygiene.
Do not reuse tourniquets.
Wear gloves.
Cleanse insertion sites with the recommended solutions.
IV Therapist, How Safe Are You?
In a CDC study, 89 percent of HCW exposure to HIV were caused by percutaneous
injuries.
As many as 40 percent of HCW who sustain needlesticks become infected with HBV
In 2004, more than 1,000 HCW became infected with HBV
Occupational Risks Associated With IV Therapy
Physical hazards;
Accidents , abrasions, contusions and chemical exposure
Exposure to Infectious Agents
The following list is a summary of some of the rules to be observed in the workplace:
HEPATITIS B vaccine
STANDARD PRECAUTIONS
SHARPS AND WASTE DISPOSAL
PROTECTIVE DEVICE/EQUIPMENT
GLOVES
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LAUNDRY
COMMUNICATING HAZARDS
COMPLICATIONS ASSOCIATED WITH IVT
PROCEDURAL PROBLEMS ASSOCIATED WITH IV THERAPY

Fluctuating flow rate
Runaway IV
Sluggish IV
Tubing / loose connection/ disconnection
Blood back up in tubing
IV line obstruction/kinking of IV tubing
Clogged filter
Break in aseptic technique
Leaks; due to inappropriate device
TROUBLESHOOTING PROMPTLY AND EFFECTIVELY
I.V. therapy is the preferred mode of treatment because of its rapid onset.
Nurses are assuming more nursing responsibilities in I.V. therapy.
More nursing time is allotted to I.V. therapy
I.V. Therapy is a risk specialty area.
WHAT TO DO WHEN INFUSION SLOWS DOWN OR STOPS
1. Assess the I.V. system to locate the problem. Start at the insertion side. Check for
infiltration, extravasation, or phlebitis.
2. Check for patency. Obstruction of flow is caused or affected by the following factors:
2.1Patients limb is flexed; patient lying on the side. Reposition limb to release
venous pressure.
2.2Tip of needle or cannula is against the vein wall. Lift or pull-back the needle
or cannula a little.
2.3 Adhesive taping maybe too tight, release every apply tapes.
2.4. Small cannulas or tubing may kink or fold, gently adjust.
2.5. Local edema or poor tissue perfusion from disease can block venous flow.
Transfer I.V. line to an unaffected site.
2.6. Presence of precipitates in solution either from incompatibility of fluids and
medications or from infusion. Replace the entire venipuncture device and solution. It
may expose the patient to embolism.
3. Check the clamps. Some sets have two:the roller clamp and the side clamp. Check if both
are open or if these are properly adjusted.
4. Check the patency of the air vent; reposition it if needed.
5. Check fluid level: if empty replace as prescribed. If solution is too cold, it may cause
venous spasm and decrease the flow; keep room temperature regulated. Check the
spike of the set; push it more inside the fluid bag or adjust it.
6. Check filters: ordinary sets usually do not have in-line filters. If it has, follow the
manufacturers guide instructions. Blood transfusion filters retain blood product debris. If
flow rate decreases or stops after
more than one unit has been transfused you may
have to change the set.
7. Check tubings: if patient is lying on it or if it is kinked or
it may be crimped with too
tight roller clamps, release and round-up the tubing to its original shape
8. Is gauge of the needle too small? Is fluid container too low above the venipuncture site?
Adjust it around 36-48 inches above the site.
NOSOCOMIAL INFECTION is:
Also known as healthcare acquired infection
Traditionally referred as hospital acquired infections
Infections that develop during hospitalization
One of the leading causes of death and increased morbidity for hospitalized patients
Of which are mostly caused by drug resistant strains of bacteria
INFECTION RELATED TO IV THERAPY DEVICES
Local Infection
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Invasion and multiplication of microorganisms in body tissues which may be

clinically unapparent or result in local cellular injury due to competitive
metabolism toxins, intracellular replication or antigen antibody response
Systemic Infection
A systemic disease caused by pathogenic organisms or their toxins in the
bloodstream
Catheter Colonization: The isolation of 15 colony forming units (CFUs) of any
microorganism by semiquantitative culture (roll-plate method) or 103 CFUs by
quantitative culture (sonication technique), from a catheter tip or subcutaneous segment
in the absence of simultaneous clinical symptoms.
Local catheter-related infection:

Exit site Infection: purulent drainage from the catheter exit site, or erythema,
tenderness, and swelling within 2cm of the catheter exit site.
Port-pocket infection: erythema and necrosis of the skin over reservoir of totally
implantable device, or purulent exudates in the subcutaneous pocket containing
the reservoir.
Tunnel infection: erythema, tenderness, and indurations of the tissues overlying
the catheter and more than 2cm from the exit site.
Systemic Catheter infection: isolation of the same microorganisms from catheter culture
and from the blood of a patient with accompanying clinical symptoms of a BSI and no
other apparent source of infection.
Catheter-related bloodstream infection is the isolation of the same microbe from blood
cultures that is known to be significantly colonizing the catheter of a patient.
Primary BSI is one that arises without apparent local infection elsewhere due to the
same microbe.
Other Nosocomial Infection

Urinary tract infection
Surgical site infection
Ventilator-associated pneumonia
Intravascular device-related bloodstream infection
Clostridium difficile- associated diarrhea
MODE OF TRANSMISSION
It is the method of transfer by which organism moves or is carried from one place to
another
E.g. Hands of the health care worker may carry bacteria from one person to
another.
How does catheter-related infection occur?

Infection of short-term catheters is frequently been due to microbes from the skin moving
along the catheter surface where the catheter enters the skin.
Risk Factors
Type of catheter used
The number of lumen of the catheter has.
Total parenteral nutrition
Duration of catheterization
Catheter site insertion
Expertise of the person inserting
Management of catheter after insertion
Guidewire exchange
Use of dressing
Use of triple antibiotic ointment
Common pathogens of BSI
Candida albicans
Staphylococcus aureus
Enterobacter cloaceae
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Staphylococcus epidermidis
Pseudomonas aeruginosa
Enterococcus fecalis
Breaking the Chain of Infection Levels of Aseptic Control

PRINCIPLES OF PREVENTION OF INFECTION
Consider every person (patient of staff) infectious
Wash hands the most practical procedure for preventing cross contamination
(person to person)
Wear gloves before touching anything wet broken skin, mucous membranes, blood or
other body fluids (secretions or excretions) or soiled instruments and other items
Use physical barriers (protective goggles, face masks and aprons) if splashes and spills
of any body fluids (secretions or excretions) are anticipated
Use safe work practices, such as not recapping or bending needles, safely passing
sharp instruments and properly disposing of medical waste
Isolate patients only if secretions (airborne) or excretions (urine and feces) cannot be
contained
Decontaminate process instruments and other items (decontaminate, clean, high level
disinfect or sterilize using Infection Prevention Practices
Prevention
Selection of a subclavian, basilic, or cephalic vein site rather than an internal jugular or
femoral site
Avoid use of TPN catheters for other infusion purposes
Use of special team for insertion and maintenance of catheter
Avoid the use of triple antibiotic ointment on central venous catheter
REVIEW INFECTION RISK FACTORS AND PRACTICES
Infection is the presence and growth of a microorganisms that produces tissue death
Wash your hands
Routinely clean and disinfect surfaces
Handle and prepare food safely
Get immunized
Us antibiotics appropriately
Keep pets healthy
Avoid contact with wild animals
PRINCIPLES OF SAFE IV CARE / PRACTICES
Use aseptic technique to avoid contamination of sterile injection equipment
Do not administer medications from a syringe to multiple patients, even if the needle of
cannula on the syringe is changed
Use fluid infusion and administration sets for one patient only and dispose after use
Use single dose vials for parenteral medications whenever possible.
Use proper personal protective equipment (PPE).
Adhere to safety waste protocol according to institutions policy.
VENIPUNCTURE TECHNIQUES USING VARIOUS CATHETERS AND DEVICES
The use of needleless system
Proper use of sharp containers
Monitoring and Assessment
The use of appropriate dressing
Health Care Worker Education and Training
Surveillance for Catheter Related Infection
Handwashing
Barriers Precautions During Catheter Insertion and Care
Catheter Insertion
Catheter Site Care
Selection and Replacement of Intravascular Devices
General Recommendations For Intravascular Device Use
Health Care Worker Education and Training
Surveillance for Catheter Related Infection
Handwashing
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Barriers Precautions During Catheter Insertion and Care

Catheter Insertion
Catheter Site Care
Selection and Replacement of Intravascular Devices
Replacement of Administration Sets and Intravenous Fluids
Intravenous Injection Ports
Preparation and Quality Control of Intavenous Admixtures
In line Filters
Intravenous Therapy Personnel
Needleless Intravascular Devices
Prophylactic antimicrobials
Parenteral Nutrition Solution

Hyperalimentation-iV Hyperalimentation -may contain two or more of the following elements:
Carbohydrates
Proteins
Lipids
Electrolytes
Vitamins and Minerals
Trace Elements
Water
Total Parenteral Nutrition-It is given when a patient requires an extended period of
intensive nutritional support.
Peripheral Parenteral Nutrition (Partial Parenteral Nutrition)
Normally prescribed for patients who can tolerate some oral feedings but cannot
ingest adequate amounts of food to meet their nutritional needs.
Indications for Total Parenteral Nutrition
Long term therapy (2 weeks or more)
Supply large quantities of nutrients and calories (2,000 to 3,000 calories/day or more)
Debiliating illness lasting longer than 2 weeks.
Inability to sustain adequate weight with oral or enteral feedings.
Deficient or absent oral intake for longer than 7 days , as in cases of multiple trauma,
severe burns, or anorexia nervosa.
Loss of at least 10% of pre illness weight.
Serum albumin level below 3.5g/dl.
Chronic vomiting or diarrhea.
GI disorders that prevent or severely reduce absorption.
Poor tolerance of long-term enteral feedings.
Inflammatory GI Disorders.
Indications for Peripheral Parenteral Nutrition

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Short term Therapy (3 weeks or less) is used to:

Maintain nutritional state in patients who can tolerate relatively high fluid volume.
Indications for Peripheral Parenteral Nutrition
Who usually resume bowel function and oral feedings in a few days, and who arent
candidates for CV catheter.
Provide approximately 1,300 to 1,800 calories/day.
Methods of Administration
Central Venous Infusion
-long term parenteral nutrition
Peripheral Infusion
-short term parenteral nutrition (1-3 weeks)
Administering Parenteral Nutrition
Continuously- 24 hour period
Cyclically-receives the entire 24-hour volume over a shorter period, perhaps 8,10,14 or
16 hours.
Verify doctors orders.
Explain the procedure.
Obtain consent.
Select best available vein as the insertion site.
PPN should be at room temperature.
Proper use of infusion pump.
Check the written order against the written label on the bag.
Proper labeling.
Watch out for swelling at the peripheral insertion site.
Maintain the infusion rate and care for the tubing, dressing, infusion rate and I.V.
devices.
Monitor patient for signs and symptoms of sepsis:
-glucose in urine
-altered level of consciousness
-chills
-malaise
-hyperglycemia
-leukocytosis
-elevated temperature
Dont allow TPN solutions to hang for more than 24 hours.
Change the tubing and filter every 24 hours, using strict aseptic technique. Make sure
that all tubing junctions are secure.
Perform IV site care and dressing changes.
Check the infusion pumps volume meter and time tape to monitor for irregular flow rate.
Gravity should never be used to administer TPN.
Record the patients vital signs when you initiate therapy. Be alert for increased body
temperature- one of the earliest signs of catheter-related sepsis.
Monitor your patients glucose levels.
Accurately record the patients daily fluid intake and output.
Assess the patients physical status daily. Weigh him at the same time each morning.
Suspect fluid imbalance if the patient gains more than 1lb. per day.
Monitor the results of routine laboratory tests .
Provide emotional support.
Provide frequent mouth care for the patient.
Document all assessment findings and nursing interventions
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Discontinuing therapy
When to wean and when not to weanTOTAL PARENTERAL NUTRITION
- wean for 24 hours to prevent rebound hypoglycemia.
PARTIAL PARENTERAL NUTRITION
- can be discontinued without weaning.
Handling PN Hazards
Catheter Related
Metabolic
Mechanical
Catheter Related Complications
Clotted catheter
Reposition the catheter.
Dislodge catheter
Place a sterile gauze pad treated with antimicrobial agent on the insertion site
and apply pressure.
Cracked or broken tubing
Change the tubing immediately.
Pneumothorax
Assist with chest tube insertion.
Maintain chest tube suction as ordered.
Sepsis
Remove the catheter and culture the tip.
Give appropriate antibiotics as ordered.
Metabolic Complications
Hyperglycemia
Start insulin therapy as ordered.
Adjust the TPN flow rate as ordered.
Hypoglycemia
Infuse dextrose as ordered.
Metabolic acidosis
Adjust the formula and assess for contributing factors.
Mechanical Complications
Air Embolism
Clamp the catheter.
Place the patient in trendelenburgs position on the left side.
Give oxygen as ordered.
If cardiac arrest occurs, initiate cardiopulmonary resuscitation.
Venous Thrombosis
Notify the doctor.
Administer heparin as ordered.
Venous flow studies may be done.
Too rapid an infusion
Check the infusion rate.
Check the infusion pump.
Extravasation
Stop the I.V. infusion.
Assess the patient for cardiopulmonary abnormalities.
Phlebitis
Apply gentle heat to the insertion site.
Elevate the insertion site, if possible.
Patient and Family Education
Assess patient and familys level of understanding.
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Inform the patient and family everything about all that they need to know regarding
parenteral nutrition in a manner that they comprehend.
Secure inform consent about the procedure if the patient needs to have a central line for
total parenteral nutrition.
Inform patient regarding the proper regulation of the parenteral nutrition.
Inform the patient to report any unusual feelings such as chest pain, tachycardia, pain at
the insertion site and the likes that may indicate air embolism.
Inform the patient regarding the importance of blood sugar monitoring while on
parenteral nutrition.
Inform the patient the signs and symptoms of hyper and hypoglycemia and report it if
ever experienced.
Documentation
TPR blotting Sheet/Vital Signs Monitoring Sheet
Infusion Sheet
Diabetic Record Sheet
Nursing Care Plan
Progress Notes
Intake and Output Sheet
WHAT IS CANCER?
Large group of malignant diseases with some or all of the ff characteristics:
a. Abnormal cell proliferation
b. Lack of controlled growth and division
c. Ability to metastasize
A few diseases that result from faulty or abnormal genetic expression caused by changes that
have occurred in the DNA.
The uncontrolled growth of cells due to damage to DNA (mutations) and,
ocassionally due to an inherited propensity to develop tumors.
Chemotherapy
A systemic intervention used in the treatment of certain disease conditions
In modern-day use, refers primarily to the use of cytotoxic agents to treat CANCER.
CHEMOTHERAPEUTIC AGENTS- Used only when disease prognosis shows that
patient would benefit from the treatment
The Cell Cycle
Broadly, most chemotherapeutic drugs work by impairing mitosis (cell division),

effectively targeting fast-dividing cells.
In cancer, cells rapidly divide and does not enter the resting phase because they are
unresponsive to growth-inhibitory signals.
Only a percentage of the cancer cells are killed with each course of chemotherapy.
Therefore, repeated dosesor cycles of chemotherapy must be done.
GOALS
CURE
CONTROL
PALLIATION
Chemotherapy may be used as
1.) Adjuvant therapy
2.) Neoadjuvant therapy
3.) Chemoprevention
4.) Myeloablation
Classification of Chemotherapy Drugs
CYCLE-SPECIFIC
Antimetabolites
interfere with nucleic acid synthesis
Attack during S phase of cell cycle
Cytatabine, floxuridine, fluorouracil, hydroxyurea, methotrexate,
thioguanine
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Enzymes
Useful only for leukemias
Asparaginase
Plant Alkaloids
Cycle-specific to M Phase
Prevent mitotic spindle formation
Vinblastine, vincristine
CYCLE-NONSPECIFIC
Alkylating Agents
Disrupt deoxyribonucleic acid (DNA)
Carboplatin, Cisplatin, Cyclophosphamide, Ifosfamide, Thiotepa
Antibiotics
Bind with DNA to inhibit synthesis of DNA and RNA
Bleomycin, doxorubicin, idarubicin, mitomycin, mitoxantrone
CYTOPROTECTIVE AGENTS
Protect normal tissue by binding with metabolites of other cytotoxic drugs
Dexrazoxane
Mesna
FOLIC ACID ANALOGS
Antidote for methotrexate toxicity
Leucovorin
HORMONE AND HORMONE INHIBITORS
Interfere with binding of normal hormones to receptor proteins
Manipulate hormone levels
After hormone environment
Usually palliative,not curative
Androgens, Antiandrogens, Antiestrogens, Estrogens, Gonadotropin,
Progestins
Other AntiCancer Agents
Novel Agents
Monoclonal Antibody
Trastuzumab (Herceptin)
Rituximab (Mabthera)
Cetuximab (Erbitux)
Tyrosine Kinase Inhibitor
Imatinib (Glivec)
EGFR Inhibitors
Erlotinib (Tarceva)
Gefitinib (Iressa)
VEGF Inhibitors
Bevacizumab (Avastin)
BIOLOGICAL THERAPY
Consists mostly of the administration of biological response modifiers
Also includes the use of immunotherapy
Biological response modifiers
Alter the bodys response to therapy
May cause direct cytotoxicity
Immunotherapy
Uses drugs to enhance the bodys ability to destroy cancer cells
Seeks to evoke effective immune response to human tumors by altering the way
cells grow, mature, and respond to cancer cells
May include the administration of monoclonal antibodies and immunomodulatory
cytokines
Immunotherapy
Monoclonal antibodies
28
Specifically target tumor cells

More recent form of biotherapy that manipulates the bodys natural resources
instead of introducing toxic substances that arent selective and cant differentiate
between normal and abnormal processes or cells
Recognizes only a single unique antigen
Rituximab (Rituxan)
Trastuzumab (Herceptin)
Immunotherapy
Immunomodulary cytokines
Intracellular messenger proteins (proteins that deliver messages within cells)
Colony-stimulating factors
Erythropoietin (Epogen), Granulocyte colony-stimulating factor
(Neupogen), Granulocyte-macrophage CSF (Leukine)
Interferon
Interleukins
Tumor Necrosis factor
Routes of Administration
Oral Route
Subcutaneous and Intramuscular
IV administration
IV push
IV piggy back (large volume)
Direct Introduction
Intrathecal
Intrapleural
Intraperitoneal
Chemoembolization
Ommaya reservoir
Safehandling Chemotherapeutic Agents

Chemotherapeutic Drugs are hazardous drugs.
a hazardous drug is defined as an agent that presents a danger to healthcare personnel
due to its inherent toxicity.
They are carcinogenic
They are genotoxic
They are teratogenic
There is evidence of toxicity at low doses
PREPARING CHEMOTHERAPEUTIC DRUGS
1. GATHERING THE EQUIPMENT
Before preparing chemotherapeutic drugs, be sure to gather all the necessary
equipment, including:
Patients medication order or record
Prescribed drugs
Appropriate diluent (if necessary)
Medication labels
Long-sleeped gown
Chemotherapy gloves
Face shield or goggles and face mask
20G needles
Hydrophobic filter or dispensing pin
PREPARING CHEMOTHERAPEUTIC DRUGS
Syringes with luer-lock fittings and needles of various sizes
IV tubing with luer-lock fittings
70% alcohol
Sterile gauze pads
Plastic bags with hazardous drug labels
Sharps disposal container
Hazardous waste container
29
Chemotherapy spill kit
ORGANIZING DRUG PREPARATION AREAS

Prepare chemotherapeutic drugs in well-ventilated workspace
Perform all drug admixing or compounding within a Class II Biological Safety
Cabinet or a vertical laminar airflow hood with a HEPA filter, which is vented to
the outside
If a Class II Biological Safety Cabinet isnt available, it is recommended to use a
special respirator
Have close access to a sink, alcohol pads, and gauze pads as well as
Chemotherapy hazardous waste containers, sharps containers, and
chemotherapy spill kits
Make sure that all hazardous waste containers are made of punctureproof,
shatterproof, leakproof plastic
Make sure that yellow biohazard labels are available for labeling all
chemotherapy-contaminated IV bags, tubings, filters, and syringes
Make sure that red sharps containers are available for disposal of all
contaminated sharps such as needles.
2.
WEAR PROTECTIVE CLOTHING
Essential protective clothing includes a cuffed gown, gloves, and a face shield or
goggles and a face mask
Gowns should be disposable, water-resistant, and lint-free with long sleeves, knitted
cuffs, and a closed front
Gloves should be disposable, powder-free, and made of thick latex or thick nonlatex
material
Double gloving is an option when the gloves arent of the best quality.
SAFETY MEASURES
GENERAL MEASURES
At the local level, most health care facilities require nurses and pharmacists involved in
the preparation and delivery of chemotherapeutic drugs and care of the patient with
cancer.
Take care to protect staff, patients and the environment from unnecessary exposure to
chemotherapeutic drugs
Make sure your facilitys protocols for spills are available in all areas where
chemotherapeutic drugs are handled, including patient-care areas
Refrain from eating, drinking, smoking or applying cosmetics in the drug-preparation
area.
ACCIDENTAL EXPOSURE
If a chemotherapeutic drug comes in contact with your skin, wash the area thoroughly
with soap and water to prevent drug absorption into the skin
If the drug comes in contact with your eye, immediately flush the eye with water or
isotonic eyewash for at least 5 minutes, while holding the eyelid open
After an accidental exposure, notify your supervisor immediately.
WASTE DISPOSAL
Place all contaminated needles in the sharps container; dont recap needles
Use only syringes and IV sets that have a luer-lock fitting
Label all chemotherapeutic drugs with a yellow biohazard label
Transport the prepared chemotherapeutic drugs in a sealable plastic bag thats
prominently labeled with a yellow chemotherapy biohazard label
Dont leave the drug-preparation area while wearing the protective gear you wore
during drug preparation.
HANDLING A CHEMOTHERAPY SPILL
Put on protective garments, if you arent already wearing them
Isolate the area and contain the spill with absorbent materials from a chemotherapy spill
kit
Use the disposable dustpan and scraper to collect broken glass or desiccant absorbing
powder.
30
Carefully place the dustpan, scraper

and collected spill in a leakproof, punctureproof, chemotherapy-designated hazardous
waste container
Prevent aerosolization of the drug at all times
Clean the spill area with a detergent or bleach solution
ADMINISTERING CHEMOTHERAPEUTIC DRUGS

Gathering the equipment
Prescribed drugs
IV access supplies
Sterile PNSS
IV syringes and tubings with luer lock
Leakproof chemical waste container
Chemotherapy gloves
Chemotherapy spill kit
Extravasation kit.
Preventing Infiltration
Use a low-pressure infusion pump to administer vesicants through a peripheral vein, to
decrease the risk of extravasation
Use a central venous catheter for continuous vesicant infusions
Guidelines in giving vesicants
Use a distal vein that allows successive proximal venipunctures
Avoid using the hand, antecubital space, damaged areas, or areas with compromised
circulation
Dont probe or fish for veins
Place a transparent dressing over the site.
Start the push delivery or the infusion with normal saline solution
Inspect the site for swelling and erythema
Tell the patient to report burning, stinging, pain, pruritus, or temperature changes near
the site
After drug administration, flush the line with 20mL of NSS.
Concluding Treatment
Dispose of all used needles and contaminated sharps in the orange sharps container
Dispose of PPEs in yellow chemotherapeutic waste container
Dispose of unused medications, considered hazardous waste, according to your facilitys
policy
Wash hands thoroughly
Document the ff.
sequence in which the drugs were administered
site accessed, the gauge and length of the catheter, and the number of attempts
name, dose, and route of the administered drugs
Type and volume of the IV solutions and adverse reactions and nursing
interventions
According to facility policy, wear protective clothing when handling body fluids from the
patient for 48 hours after
MANAGING COMPLICATIONS OF CHEMOTHERAPY
1. ALOPECIA
Hair loss that occurs as chemotherapeutic drugs destroy the rapidly growing cells of
hair follicles
May be minimal or severe
Occurs 2-3 weeks after treatment begins
Almost always temporary
Signs and Symptoms
Hair loss that may include eyebrows, lashes and body hair
Nursing Interventions
Minimize shock and distress by warning the patient of this possibility
Discuss with the patient why it occurs
31
Describe to the patient how much hair loss to expect

Emphasize to the patient the need for appropriate head protection against sunburn
Inform the patient that new hair may be a different texture or color
Give the patient sufficient time to decide whether to order a wig
Inform the patient that his scalp will become sore at times due to follicles swelling
Prevention measures
For patients with long hair, suggest cutting hair shorter before treatment because
washing and brushing cause more hair loss.
2. ANEMIA
Occurs as chemo drugs destroy healthy cells and cancer cells
RBCs are destroyed and cant be replaced by the bone marrow
Signs and symptoms
Dizziness, fatigue, pallor, and shortness of breath after minimal exertion
Low hemoglobin level and hematocrit
May develop slowly over several courses of treatment
Monitor hemoglobin level, hematocrit, RBC count; report dropping values
Be prepared to administer a blood transfusion or erythropoietin
Prevention Measures
Instruct the patient to take frequent rests, increase his intake of iron-rich foods, and
take a multivitamin with iron as prescribed
If the patient has been prescribed a drug such as epoetin, make sure he
understands how to take the drug and what adverse effects he should watch for and
report.
3. DIARRHEA
Occurs because the rapidly dividing cells of the intestinal mucosa are killed
Complications include weight loss, F&E imbalance, and malnutrition
Signs and symptoms
An increase in the volume of stool compared with the patients normal bowel habits
Assess frequency, color, and consistency of stool
Encourage fluids, give IV fluids and potassium supplements as ordered
Prevention measures
Use dietary adjustments and antidiarrheal meds
Provide good perianal skin care.
4. EXTRAVASATION
The inadvertent leakage of a vesicant solution into the surrounding tissue
Signs and Symptoms
Initial signs and symptoms may resemble those of infiltration blanching, pain,
swelling
Symptoms possibly progressing to blisters; to skin, muscle, tissue and fat necrosis;
and to tissue sloughing.
NOTE: Blood return is an INCONCLUSIVE test and shouldnt be used to determine if IV
catheter is correctly seated in the peripheral vein. To assess peripheral IV placement,
flush the vein with NSS and observe site for swelling.
Extravasation of Doxorubicin
Stop the infusion
Check your facilitys policy to determine if the IV catheter is to be removed or left in
place to infuse corticosteroids or a specific antidote.
Notify the physician
Instill the appropriate antidote according to facility policy. Usually, youll give the
antidote for extravasation either by instilling it through the existing IV catheter or by
using a 1 mL syringe to inject small amounts subcutaneously in a circle around the
extravasated area
After the antidote has been given, remove the IV catheter
Preventive measures
32
Verify IV line patency and placement by flushing with normal saline soln
Remember, When in doubt, take it out!
Use a transparent, semi-permeable dressing for inspection of site.
5. INFILTRATION
The inadvertent leakage of a nonvesicant solution or medication into the surrounding
tissue
Infusion-site related
Signs and symptoms
Blanching
Change in IV flow rate
Numbness and tingling in swollen area due to nerve compression injury leading to
compartment syndrome
Swelling around IV site (the swollen area will be cool to touch)
Remove the IV catheter
Insert a new IV catheter in a different location
Prevention Measures
Check for infiltration before, during, and after the infusion by flushing the vein with
normal saline solution.
6. LEUKOPENIA
Reduced leukocytes or WBCs
Occurs as WBCs and cancer cells are destroyed by chemo drugs
Signs and Symptoms
Susceptibility to Infections
Neutropenia
Watch for the nadir, the point of lowest blood cell count
Be prepared to administer colony-stimulating factors
Institute neutropenic precautions
Teach the patient and caregiver about:
Good hygiene practices
Signs and symptoms of infection
The importance of checking the patients temperature regularly
How to prepare low-microbe diet
How to care for vascular access devices
Instruct the patient to avoid
Crowds
People with colds or respiratory infections
Fresh fruit
Fresh flowers
Plants
7. NAUSEA and VOMITING
Can appear in 3 different patterns
Anticipatory
Acute
Delayed
ANTICIPATORY NAUSEA and VOMITING
Signs and Symptoms
Nausea and vomiting thats a learned response from prior nausea and vomiting after
a dose of chemotherapy
High anxiety levels (acts as a trigger)
Posttreatment control of nausea and vomiting may prevent future anticipatory
episodes
Prevention measures
Pretreat the patient with lorazepam (Ativan) at least 1 hr before arriving for treatment
Patients with overwhelming anxiety may need IV lorazepam before chemo is
administered
ACUTE NAUSEA and VOMITING
Signs and symptoms
33
Nausea and vomiting occurring within the first 24 hours of treatment

Treat the patient with acute nausea and vomiting with antiemetic drugs
Dexamethasone
Granisetron
Lorazepam
Metoclopramide
Ondansetron
DELAYED NAUSEA and VOMITING
Signs and Symtoms
Nausea or vomiting starting or continuing beyond 24 hours after chemo has begun
The administration of serotonin antagoninsts, corticosteroids, various antihistamines,
benzodiapines, and and metoclopramide is usually effective in treating patients
Prevention Measures
Administer antiemetic before chemo begins
Some patients with delayed nause and vomiting are treated with an antiemetic for 3
days or longer.
8. STOMATITIS
Inflammation of the lining of the oral mucosa
Can spread into the esophagus and pharynx
Signs and Symptoms
Painful mouth ulcers that range from mild to severe appearing 3 to 7 days after
certain chemotherapeutic drugs are given
Instruct the patient to perform meticulous oral hygiene
Administer topical anesthetic mixtures as appropriate
If pain is severe, opioid analgesics may be prescribed until the ulcers heal
Prevention Measures
Instruct the patient to suck on ice chips while receiving certain drugs that cause
stomatitis; this decreases the blood supply to the mouth, thus decreasing ulcer
formation.
9. THROMBOCYTOPENIA
Reduced blood platelet count
Signs and Symptoms
Bleeding gums
Coffee-ground emesis
Hematuria
Hypermenorrhea
Increased bruising
Petechiae
Tarry stools
Nursing interventions
Monitor patients platelet count
Avoid unnecessary IM injections or venipuncture
If an IM injection or venipuncture is necessary, apply pressure for at least 5 minutes;
apply a pressure to the site.
Instruct the patient to
Avoid cuts and bruises
Shave with an electric razor
Avoid blowing his nose
Stay away from irritants that would trigger sneezing
Avoid using rectal thermometers
Instruct the patient to report sudden headaches (which could indicate potentially fatal
intracranial bleeding).
10. VEIN FLARE
Occurs during infusion of an irritant into the vein
Signs and Symptoms
34
Bright redness possibly appearing in the vein along with blotches or hives on the
affected arm
Burning pain or aching along the vein as well as up through the arm
If the reaction is severe, injection of an IV steroid may be required
If the patient complains of pain or burning during the infusion:
Increase the dilution of the infused medication
Decrease the infusion rate
Restart the IV in a different vein.
BLOOD
A mixture of cells
A complex TRANSPORT mechanism
Transports hormones
Removes waste products
Regulates body temperature
Protects the body
Promotes hemostasis
Supplies oxygen
BLOOD VOLUME:
8% of total body weight = varies by age & body composition.
COMPOSITION OF BLOOD
Temperature
38C (100.4F)
pH
7.35 - 7.45
Specific Gravity
1.048 1.066
Body weight
7%
5 times the viscosity of water
Volume
Male
5 6 Liters
Female
4 5 Liters
1. Plasma
Liquid part of the blood
Consists of serum and fibrinogen
Contains plasma proteins such as:
Albumin = regulates & maintains
Serum globulins = for transportation
Fibrinogen, prothrombin, plasminogen = to stop the bleeding
Cellular Components
Formed elements of blood
2. RBC = responsible for oxygen transport
3. WBC = play a major role in defense against microorganisms
4. Platelets = function in hemostasis
Blood: An Emotional Topic
the sweeping story of a substance that has been feared, revered, mythologized, and
used in magic and medicine from earliest timesa substance that has become the center
of a huge, secretive, and often dangerous worldwide commerce.
From the publishers description of the book
TRANSFUSION
Refers to the administration of any of several blood products.
BLOOD TRANSFUSION
Is lifesaving therapy for patients with a variety of medical and surgical conditions in need
for blood.
Blood Transfusion may be necessary for any of the following reasons:
Hemorrhage (blood loss) caused by trauma or high blood loss surgery
Red cell destruction
35
Decreased red cell production

National Blood Services Act of 1994
Also known as the Republic Act 7719
AN ACT PROMOTING VOLUNTARY BLOOD DONATION PROVIDING FOR AN
ADEQUATE SUPPLY OF SAFE BLOOD, REGULATING BLOOD BANKS, AND
PROVIDING PENALTIES FOR VIOLATION THEREOF.
Who CAN and CANT give Blood
Eligible Donors Must:
Be at least age 18
Weigh at least 110 lb (50 kg)
Free from skin disease
Not have donated in the past 56 days
Have a hemoglobin level of at least 12.5 g/dl (women) or 13.5 g/dl (men)
Ineligible Donors include those:
Who have HIV or AIDS
Who have taken illegal drugs I.V.
Who have had sex with prostitutes in the past 12 months
Who have had sex with anyone above categories
Who have had hepatitis
With certain types of cancer (other than minor skin cancer)
With hemophilia
Who have received clotting factor concentrations.
Blood Collection Methods
3 Types of Blood Donor Sources for Routine Blood Collection:

Unrelated Donor (Allogeneic)
Directed Donor
Autologous Donor (Self)
NURSES MUST BE:
Knowledgeable about blood products
Safe administration
How to monitor patients before, during and after therapy
Assure that informed consent has been obtained before starting a transfusion.
Appropriate information to include in patient education includes:
Benefits
Risks
Alternatives to transfusion
Document all patient education regarding transfusion therapy, and the responses
of patients and family members after teaching.
Patient Education
Provide patient and family information to blood transfusion therapy:
The need for blood transfusion
Advantages of blood transfusion
Possible reactions related to the blood transfusion therapy
Voluntary blood donation act
Transfusion Precautions
Dont add medications to the blood.
Dont transfuse the blood product if you discover a discrepancy in the blood number,
blood slip type, or patient identification number.
Dont piggyback blood into the port of an existing infusion set.
Stop transfusion if your patient shows:
Shows changes in vital signs
Is dyspneic or restless
Develops chills, hematuria, or pain in the flank, chest or back
BEFORE TRANSFUSION
When assessing your patient before a transfusion:
Obtain important medical history information
Review pertinent laboratory values
Review the doctors order, including any special processing requested
36
Perform physical assessment

When you received the delivery from the blood bank, you should receive both the
product and the transfusion record that corresponds to it.
Inspect for the following:
Labels
Integrity of Unit
Appearance
Perform the verification process to ensure the correct blood is being given to the
correct patient.
Two qualified individuals should verify the patient and unit identification.
Assess the patency of the patients vascular access.
Check and recheck vital signs 15 minutes after starting the transfusion.
DURING TRANSFUSION
Administer the blood or component at the recommended rate.

Stay with the patient for the first few minutes of the transfusion
Review signs and symptoms of what the patient should report to you.
Discontinue transfusion immediately once the patient manifest symptoms of
transfusion reaction, assess the patient and notify the doctor.
Finally, document the transfusion in the patients chart.
AFTER TRANSFUSION
Continue to monitor patient for any signs and symptoms of reaction for at least one
hour after the transfusion.
Obtain any ordered post-transfusion laboratory studies.
SAFETY PRECAUTIONS
Make sure that YOU are protected too by:
Wear proper Personal Protective Equipment (PPE)
Always perform disinfection technique.
If possible, use a needleless system.
If using sharps, do not recap the needle.
Always observe proper waste disposal according to your institutions policy.
If there are spills, never touch the blood with bare hands.
Make sure that blood bag is secured.
Always double or triple check.
Always perform HAND HYGIENE
Acute Transfusion Reactions usually appear within the first 5-15 minutes after the
transfusion is started.
Types of Acute Transfusion Reactions:
Acute hemolytic Transfusion Reaction
Febrile nonhemolytic Transfusion Reaction
Mild allergic (Urticarial)
Anapylactic
Transfusion Associated Circulatory Overload
Transfusion Related Acute Lung Injury
Septic Transfusion Reaction
Symptoms you might see during an acute transfusion reaction include:
Temperature increase of more than 1C or 2F
Bloody urine
Chills
Hypotension
Severe low back, flank, or chest pain
Low or absent urine output
Nausea and vomiting
Dyspnea, wheezing
Anxiety, "sense of impending doom"
Diaphoresis
Generalized bleeding, especially from punctures and surgical wounds.
WHAT TO DO IF TRANSFUSION REACTION OCCURS
37
When they do occur, it is usually because of ABO incompatibility between patient and
donor during transfusion of red cells.
Ensure that the intended recipient is getting the intended unit at the time of transfusion.
Should any of these symptoms occur, discontinue the unit immediately, hang normal
saline (on a new tubing) to maintain vascular access, and call for assistance.
Closely monitor the patients vital signs and symptoms.
Notify the physician and obtain further orders to address the patients symptoms.
Recheck the patients identifying information against the transfusion record and blood
bag.
All bags, tubings, filters, and paperwork should be retained and forwarded per hospital
policy.
DOCUMENTING BLOOD TRANSFUSIONS

Date and time the transfusion was started and completed
Name of the health care professional who verified the information of the patient and the
blood
Catheter type and gauge
Total amount of the transfusion
Patients vital signs before and after the transfusion
Infusion device used
Flow rate and if blood warming was used
Vital signs obtain prior to, during, and after the transfusion
Name of the component, unit number
Evidence of possible transfusion reaction.
Document interventions done and to whom you notified.
Patients outcome.
Patient and Family Education and Documentation
Why patient and family education?
Many patients are not accustomed to IV therapy.
He may be apprehensive.
He may be concerned that his condition has worsened.
Pediatric patients may even be more afraid.
Teaching will help the patient and his family relax.
Based on past experience
Assess patients previous experience, his expectations, knowledge of venipuncture and
IV therapy.
Describe the procedure.
Explain that fluids will come from a bag through a tubing, then through the catheter into
his vein.
Explain how long the catheter might stay in place.
Give the patient as much as information as possible.
Tell the patient that he may feel pain as the needle goes in but will stop once the needle
is in place.
Explain why IV therapy is needed.
Explain that fluids may feel cold at first.
Instruct to report any discomfort.
Explain activity restrictions.
Easing anxiety
Give the patient time to express his concerns and fears.
Encourage the patient to use stress-reduction techniques.
Allow the patient and his family to participate in their care as much as possible.
But did they get it?
Be sure to evaluate how ell the patient and his family understand your instruction.
Evaluate while youre teaching and when youre done.
Ask frequent questions and have them explain or demonstrate what youve taught.
Dont forget the paperwork
Document all your teaching in the patients records.
Note what you taught and how well the patient understand it.
What to document?
38
1. During initiation of IV therapy:

Size, length and type of device
Name of person inserting the device
Date and time
Site location
Type of solution and any additives added
Flow rate
Use of an electronic infusion device or other type of flow controller
Complications
Patient response
Patient teaching, evidence of patient understanding
Condition of the site
Site care provided
Dressing changes
Tubing and solution changes
Teaching and evidence of patient understanding.
Date and time
Reason for discontinuing therapy
Assessment of site before and after venous access device is removed
Complications
Patient reactions
Integrity of the venous access device on removal
Follow-up actions
FORMS USED IN IV THERAPY
Patient and family education form
Infusion sheet
Medication sheet
Multi-disciplinary plan of care
Multi-disciplinary progress notes
Hand-over checklist
Blood transfusion monitoring sheet
Sample DAR charting
39

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History of IVT in the Philippines

Objectives of the IV Therapy Standards

5. Administer computed medications, chemotherapeutic drugs, flow rates of solutions,

R.A. 9173/The Philippine Nursing Act of 2002, Article VI Nursing Practice,

Values, customs and spiritual beliefs held by individuals are to be respected.

NURSES AND PRACTICES

Nurses are accountable for their own nursing practice.

NURSES AND CO-WORKERS

NURSES AND SOCIETY

Nurses are contributing members of society. They assume responsibilities inherent in

NURSES AND THE PROFESSION

Nurses are expected to be members of professional organizations of nurses.

Provision of efficient and effective nursing services.

1. The nursing profession is a commitment to God and people;

General Principle of Professional Conduct

Specific Principles of Professional Conduct

LEGAL TERMINOLOGIES THAT ALSO APPLY IN IV THERAPY

RULE OF PERSONAL LIABILITY

Dehydration is classified as no dehydration, some dehydration, or severe dehydration

Signs of hypovolemic shock (SEQUELAE)

diminished sensorium (lethargy)

Clinical Signs of Dehydration

Poor Skin Turgor

WHO Treatment Plan A

Fluid deficit (L) = preillness weight (kg) illness weight (kg)

CHANGING PERCENT TO A DECIMAL & CHANGING DECIMAL TO PERCENT

A Ratio consists of two numbers as separated by a colon ( : )

If one value is not known, it can be solved by using the term X.

THE METRIC SYSTEM

In the metric system, fractions are expressed as decimals

In the decimal system, the fraction is written as 0.5

milli = one thousandths

Approximate Equivalent Value:

15 minims (16 minims)

e.g. 60 gr = _________ mg.

Calculation by Ratio : Proportion

Computation of Correct Insulin Dosage

CALCULATION OF FLUID VOLUME (BASED ON BODY WEIGHT)

An incompatibility results when two or more substances react or interact so as to change

Administer the right drug.

Common Medication Errors

Transcription of medication and treatment orders

Coming to the Surface

GENERAL FORMULA FOR DRUG CALCULATION

desired strength x total ml of solution

Calculation by Ratio : Proportion

Drip Factor Total no. of min.

1. Epidermis outer layer composed of squamous cells.

PROCEDURAL PROBLEMS ASSOCIATED WITH IV THERAPY

Invasion and multiplication of microorganisms in body tissues which may be

Local catheter-related infection:

Other Nosocomial Infection

How does catheter-related infection occur?

Breaking the Chain of Infection Levels of Aseptic Control

Barriers Precautions During Catheter Insertion and Care

Parenteral Nutrition Solution

Indications for Peripheral Parenteral Nutrition

Short term Therapy (3 weeks or less) is used to:

Broadly, most chemotherapeutic drugs work by impairing mitosis (cell division),

Specifically target tumor cells

Safehandling Chemotherapeutic Agents

Chemotherapy spill kit

ORGANIZING DRUG PREPARATION AREAS