Hazleton Area Career CenterPractical Nursing Program

COURSE TITLE: ADMINISTRATION OF INTRAVENOUS THERAPYPLACEMENT: Level IIITOTAL HOURS: 30 Hours

DESCRIPTION OF COURSE: This course will include theory and skills in the administration of intravenous therapy.Integrated in this course will be class demonstrations and practice on simulated models in the skillslaboratory.

METHODS OF INSTRUCTION: To implement the program, the instructor will utilize the following methods of instruction:1. Lecture and discussion2. Visual aids3. Use of chalk board and bulletin board4. Handouts and related readings and discussion of readings5. IV Therapy Video

METHODS OF EVALUATION: 1. Class participation2. Achievement of the course objectives3. Successfully perform a venipuncture on a simulated arm/hand

TEXTS:

Linton, Introduction to Medical Surgical Nursing, Elsevier, 6th

Edition, 2016Linton, Introduction to Medical Surgical Nursing Study Guide, Elsevier, 6

th Edition, 2016

Wolters Kluwer: IV Therapy Made Incredibly Easy 4th

Edition, Lippincott, Williams, Wilkins, 2010

REFERENCES:

Lynn, Pamela; Lippencott’s Photo Atlas of Medication Administration, 3rd Edition, Lippincott, Williams, Wilkins, 2008Roach, Sally; Ford, Susan; Introductory Clinical Pharmacology, 9th Edition, Lippincott, Williams, Wilkins, 2010Timby, Barbara; Smith, Nancy; Introductory Medical-Surgical Nursing, 10th Edition, Lippincott, Williams, Wilkins, 2010

Phillips, Lynn D: IV Therapy Notes, FA Davis , 1st Edition

Phillips, Lynn D: IV Therapeutics, F.A. Davis, 5th Edition, 2010

OBJECTIVES:

At the completion of this course, the student practical nurse will:

1. Define Intravenous Therapy

2. Discuss Indications for IV Therapy. 3. Identify the role of the L.P.N. regarding PN rules and regulations in the administration of intravenous therapy. 4. Identify those IV solutions that under state legal limitations, LPN's cannot administer. 5. Discuss principles of fluid and electrolyte balance. 6. Identify general fluid maintenance requirements. 7. Assess the patient for symptoms of fluid and electrolyte imbalances. 8. State the effects of isotonic, hypotonic and hypertonic fluid infusions on body cells. 9. Discuss IV medications and compatibilities/incompatibilities. 10. Utilize universal precautions in the administration of IV therapy. 11. Identify the equipment necessary for intravenous administration. 12. Discuss procedure for venipuncture & maintenance of intravenous solutions to include site care, tubing and IV solutions maintenance. 13. Identify types of vascular access devices. 14. Identify local and systemic complications of intravenous therapy. 15. Discuss methods of trouble-shooting intravenous therapy. 16. Identify the various types of central venous catheters. 17. Discuss central venous catheter care & maintenance. 18. Identify the role of the LPN in the maintenance of central catheters. 19. Successfully perform venipuncture on a simulated arm/hand in the clinical laboratory. 20. Discuss how to document the venipuncture and documentation of IV Maintenance. 21. Discuss what is involved in patient teaching concerning IV Therapy. 22. Receive an I.V. certificate for successful venipuncture performance.

ADMINISTRATION OF INTRAVENOUS THERAPY COURSE OUTLINE

Objectives Content Teacher Activity Student ActivityThe student practical nurse I. Discuss 49 PA Code CH. 21 Lecture The student will:upon completion of the 21.145, 21.145a, 21.145b 1. Discuss the function of thecourse, will: Discussion LPN in the administration of

IV Therapy

Review the PN Law, Rules and II. Legal implications of IV Therapy Handouts 2. Identify State legal limitationsRegulations. for LPN's in administering IV

a. Discuss the prohibited acts for therapy LPNs in performing IV Therapy. b. Legal implications of IV Therapy 3. Identify prohibited acts for 1. Review guidelines and agency LPNs. policies. Regarding LPN IV administration and maintenance. 2. Proper use of IV equipment. 3. Accurate documentation of IV administration.

Define IV Therapy and I. Describe the process of infusing Lecture The student will:indications for IV administration. intravenous fluids and maintenance 1. Discuss the process of infusing

of IV Equipment involved in venipuncture and IV Therapy maintenance.

II. Identify indications for IV Therapy. A. IV Fluid replacement. 2. Identify reasons for IV B. Administration of IV medications. Therapy. C. Long Term IV Therapy D. Short Term IV Therapy

Discuss the anatomy I. Circulatory System Lecture The student will:& physiology associated A. Structure 1. Identify the Vascular System.with the vascular system. 1. Heart Discussion 2. Identify on a diagram major

2. Arteries veins on the forearm and 3. Veins Simulations hand. B. Function 3. Recognize the guidelines for

1. Cardiac circulation Handouts vein selection.

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity

C. Major and or 3. Locate on a superficial veins diagram, major veins and D. Similarities and arteries. differences of veins and arteries

Age Related considerations for I. Elderly Lecture The student will:IV Therapy. A. Fragile veins 1. Identify that fragile veins will

B. Skin (paper thin) Discussion infiltrate quickly. C. High risk for circulatory overload 2. Describe proper securing of IV D. Unstable veins in elderly patients.

3. Prevent skin tears caused by improper stabilization. 4. Identify that veins in elderly roll easily. 5. Discuss at risk patients for circulatory overload.

Discuss principals of fluid and I. Body Fluids Lecture The student will:electrolyte balance. A. Water 1. Discuss body fluid

1. Normal balance Discussion compartments and the role that . 2. Imbalance they play in body losses and

replacements.

Identify general fluid B. Body Fluid Compartments Handouts 2. List the primary function of requirements C. Organs of Regulation each of the electrolytes

1. Kidneys 2. Lungs 3. Discuss the organs involved 3. Heart in fluid and electrolyte 4. Pituitary gland regulation.

Assess the patient for 5. Adrenal cortex glandsymptoms of fluid and 6. Parathyroid Gland 4. Describe the signs andelectrolyte imbalances 7. Skin symptoms of major body

8. GI tract fluid and electrolyte imbalance.

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity II. Electrolytes 5. Discuss assessment A. Sodium techniques for detecting B. Potassium fluid imbalance C. Calcium D. Magnesium 6. List nursing interventions E. Chlorides to prevent or correct F. Phosphates electrolyte imbalance G. Bicarbonate

III. Laboratory Values 7. State normal electrolyte 1.Electrolytes laboratory values. 2.Hematocrit 3.BUN 8. Identify normal laboratory 4.Serum Creatinine values. 5.Serum Osmalality 6.Urine Specific Gravity

Identify Acid-Base Imbalances IV. Acid-Base Balance Handout The student will: A. Ph of blood Interpret Arterial Blood Gases B. Buffering pathways 1. Metabolic Acidosis/ Alkalosis 2. Respiratory Acidosis/ Alkalosis 3. Metabolic and Respiratory Compensation

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity

Identify Parenteral Solutions I. Classification of IV Solutionsand indications for each. A. Isotonic Lecture The student will:

1. 0.9% Saline-N.S.S. 1. List examples of 2. 5% Dextrose & Water Discussion commercially prepared 3. Ringer's Solution isotonic, hypotonic and 4. Lactated Ringer's Solution Handouts hypertonic solutions B. Hypotonic 1. 0.45% N.S.S. 2. Identify the indications for the C. Hypertonic following: 1. 10% Dextrose in Water A. Water Solutions 2. 3% Saline B. Balanced Solutions D. Balanced Solutions C. Therapeutic Solutions 1. Ringer's Solutions

2. Lactated Ringer's

3. Plasma Lyte 56 in Water 3. List examples of Balanced 4. Plasma Lyte 56 in 5% Solutions and Therapeutic Dextrose Solutions and Indications for E. Therapeutic Solutions each. 1. Hyperalimentation 2.Aminosyn 3.5% 3. Procalamine

Identify common classifications I. IV Medication Discussion The student will:of IV Medications. 1. Antibiotics List examples of common IV

2. Bronchodilators Handout medication. 3. Chemotherapy 4. Steroids

II. Indications and uses

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity

Discuss compatibility and I. Incompatibilities The student will: incompatibility of IV drugs 1. Identify the drug and solutions incompatibilities and the

undesired chemical/physical reaction between drug and solution and IV solution and IV solution.

II. Nursing Interventions 2. Discuss adverse reactions A. Adverse reactions and nursing interventions.

Discuss universal precautions, III. Universal precautions Lecture The student will:aseptic technique, infection A. Occupational hazards 1. Practice universal precautionscontrol, safety in the associated with intravenous Discussion for the protection of client administration of IV fluids therapy and self.

1. Physical Handouts 2. Utilize asceptic technique for a. Sharp instruments and venipuncture procedure/IV needles maintenance/disposal of. b. Disposal of used equipment. equipment 3. Discuss Occupational Hazards 2. Chemical exposure related to IV Therapy. a. Anti-neoplastic drugs 3. Infectious Hazards a. Hepatitis B b. Acquired Immune Deficiency c. Staphylococcus Aureus

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity

Discuss peripheral infusion I. Steel needle (wing tip) The student will:devices A. Description 1. Identify peripheral vascular

B. Indications devices. C. Advantages/Disadvantages 2. Discuss indications for

peripheral devices. II. Over-the-Needle Plastic Cannula 3. Discuss Advantages and A. Description Disadvantages B. Indications C. Advantages/Disadvantages

Discuss central infusion devices I. Central Catheters Lecture 1. Identify the differences in A. Subclavian (Hickman & Boviac) peripheral and central catheters B. Single Lumen, double lumen, Discussion triple lumen (CVP line 2. Identify the patients that are C. Groshong central venous catheter potential candidates for central D. Implantable venous access ports venous catheters ( Infuse-A-Port, Port-A-cath/ Mediport) 3. Discuss the characteristics of E. Peripheral inserted central each type of central catheter. catheters (PICC line )

Student will:Discuss the procedure for I. Initiating Intravenous Therapy Lecture 1. Identify the equipment thevenipuncture A. Physician's Order nurse should prepare when

B. Patient Assessment Discussion a patient will receive intra- C. Handwashing venous fluids D. Patient Identification Demonstration of E. Psychological Preparation equipment 2. Discuss factors that serve F. Infusion Selection and Prep as guidelines for selecting

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity 1. Infusate Container Handouts an infusion site a. Bags b. Bottles Simulate starting IV on 3. Describe the actions 2. Infusion Sets manikin in skills involved in starting an a. Spiking and priming a laboratory intravenous infusion basic infusion set 3. Use of filters 4. Calculate infusion rates 4. Use of electronic devices using common drop factors a. IV infusion pumps b. PCA pumps 5. Demonstrate proper G. Vein Selection technique in starting an 1. Needle/cannula intravenous infusion on selection manikin in skills laboratory 2. Vein dilatation methods a. Tourniquet 6. State procedure for proper b. Gravity documentation of c. Milking intravenous therapy d. Tapping e. Fist clenching f. Warm compresses I. Initiating Intravenous Therapy (cont'd) H. Skin Preparation 1. Shaving 2. Cleansing of Site a. Povidone-iodine b. 70% Alcohol I. Vein Entry 1. Direct method 2. Indirect method J. Methods of Stabilization 1. Chevron method 2. "U" method 3. "H" method

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity K. Topical Ointments L. Types of Dressings 1. Occlusive dressings 2. Transparent/Nonocclusive dressings M. Flow Rate 1. Calculating the flow rate utilizing macrodrip/ microdrip tubing N. Documentation

Identify IV equipment I. Gravity flow system Lecture The student will: A. Microdrip 1. Identify the difference between B. Macrodrip Discussion gravity system and electronic

infusion. II. Electronic infusion pump/controller Handouts A. Volumetric 2. Discuss the difference in B. Non volumetric containers and their advantages

disadvantages. III. Container A. Plastic 3. Identify all components of the B. Semirigid administration set. C. Glass

4. Identify the difference in IV. Components of the administration intermittent administration sets set. V. Types of administration sets. A. Standard (Macrodrip) B. Mini (Microdrip) C. Low volume tubing

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity

VI. Intermittent administration set A. Secondary B. Piggy back C. Volume Controlled

Describe local and systemic I. Maintaining and Discontinuing Lecture The student will:complications of intravenous Intravenous Therapy 1. Describe actions involvedtherapy A. Solution Discussion in caring for venipuncture

B. Tubing site, changing infusion C. Needle/Cannula/Catheter containers, changing infusion D. Dressings/Site assessment tubing, attaching a piggyback E. Piggyback Solutions solution, discontinuing an F. Nursing Interventions infusion and documentation 1. Observations 2. Patient education 2. List possible local and 3. Documentation systemic complications of G. Discontinuing Intravenous intravenous therapy Therapy 1. Heparin Locks 3. Discuss nursing interventions a. Conversion of related to complications continuous infusion to Heparin Lock 4. Evaluate the effects of b. Maintenance of Heparin intravenous therapy on a Lock with N.S.S. and patient in the clinical area Heparin Flush (i.e. SASH method) 5. Identify nursing interventions H. Documentation related to local and systemic

complication.

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student Activity II. Complications of Intravenous Therapy A. Local complications 1. Vein irritation, phlebitis, thrombosis, thrombo- phlebitis a. Mechanical causes b. Chemical causes c. Biological causes 2. Infiltration 3. Cellulitis 4. Hematoma 5. Collapsed vessel 6. Venous spasm 7. Pain B. Systemic Complications 1. Septicemia, Bacteremia, Pyrogenic Reaction 2. Circulatory overload 3. Speed shock 4. Embolism 5. Pneumothorax, Hemothorax, Hydrothorax related to central lines 6. Hypersensitivity/Allergic Reactions III. Trouble-shooting Intravenous The student will: Solutions 1. List ways of trouble-shooting A. Reposition Cannula when IV flow is obstructed B. Reposition the Level of the Infusate 2. Identify manifestations C. Milk the Tubing involving outcome of IV

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student ActivityIdentify physiological means IV. Monitoring Patients therapy infusionof evaluating IV therapy A. Vital Signsinfusion B. Laboratory Values

C. Balance Between Intake and Output D. Skin Turgor E. Edema

Identify the elements of II. Catheter maintenance Lecture The student will:Nursing Management of A. Site care 1. Discuss site care & specificcentral venous catheters 1. Principles Handouts protocol for each device

2. Dressing changes 3. Flushing 2. Identify catheter care kit for B. Central venous catheter care dressing changes kits C. Male adaptor changes 3. Discuss heparinization D. Needle & tubing changes protocol E. Heparinization (flushing ports) F. Assessment of site

Discuss potential III. Nursing Assessments Lecture The student will:complications of centrally A. Air embolism 1. Identify the symptoms of aninserted catheters B. Catheter dislodgment Discussion air embolus

C. Catheter migration 2. Discuss catheter D. Catheter occlusion dislodgment, migration & E. Catheter sepsis occlusion F. Infiltration 3. List the symptoms of catheter G. Vessel thrombosis sepsis

4. Identify a vessel thrombosis 5. Identify signs of infiltration

ADMINISTRATION OF INTRAVENOUS THERAPY (cont'd)

Objectives Content Teacher Activity Student ActivityIdentify the steps to I. Steps to document for venipuncture Lecture The student will:documentation of IV Therapy. 1. Type, Length, and gage of catheter. 1. Identify the steps to

2. Date and Time Practice in lab setting documentation of venipuncture 3. Number/ location of attempts 2. Discuss documentation of

4. Name of vein maintaining an IV Site

5. Type of dressing applied

6. How the patient tolerated

7. Name of person inserting

II. Documentation of IV Maintenance

1. IV site solutions

2. IV tubing change

3. IV dressing change

4. Addition of new container or solution

5. Change in orders

6. Site Checks

7. Medication administration

8. IV related complications

9. Volume included in I&O

10. Discontinuance of IV therapy,

recording the condition of catheter

when discontinued.

Discuss Patient Teaching Patient Teaching Lecture The student will:

(Venipuncture Insertion) 1. Discuss patient teaching

1. Describe the procedure Discussion regarding venipuncture insertion

2. Inform patient how long the IV will be in and IV maintenance

3. Transient pain

4. Inform patient they may have the

sensation of cold at first and it will

subside

Patient Teaching

(IV Maintenance)

1. Report any discomfort

2. Explain any restrictions if ordered

3. Teach care of IV line

HAZLETON AREA CAREER CENTERPRACTICAL NURSING PROGRAMADMINISTRATION OF INTRAVENOUS THERAPY

BIBLIOGRAPHYAlexander,M.(2016). A culture of safety: it starts with you.Journal of Infusion Nursing,39(3).125-126.

Alexander,M.(2016). Standards to live by. Journal of Infusion Nursing. 39 (3). 13-14.

Meyer,B.(2015). Moving the needle forward:the imperative for collaboration in vascular access.38(2).138-151.

Yoder,M.(2015). The effect of as safe zone on nurse interruptions,distractions, and medication administration. Journal of Infusion Nursing 38(2). 140-151.

Internet Access to Articles

Updated 2017

Yoder,M.(2015). The effect of as safe zone on nurse interruptions,distractions, and medication administration. Journal