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Nursing

Paediatric IV Therapy

Indications for IV Therapy

  • Supply parenteral fluids to:
    • maintain daily requirements
    • restore losses
    • replace ongoing losses
    • maintain electrolyte balances
    • correct fluid & electrolyte disturbances
  • Administer blood and its components
  • Administer parenteral medication (e.g. antibiotics, chemotherapy, analgesics)
  • Administer TPN (Total Parenteral Nutrition)
  • Provide intravenous access in case of an emergency
  • Provide access for diagnostic purposes (e.g. dye injection prior to a procedure)

Common IV Solutions

  • Sodium Chloride 0.9% (0.9 NaCl)
  • Sodium Chloride 0.45% (0.45 NaCl)
  • Dextrose 5% / Sodium Chloride 0.9% (D5W / 0.9 NaCl)
  • Dextrose 5% / Sodium Chloride 0.45% (D5W / 0.45 NaCl)
  • Dextrose 5% / Sodium Chloride 0.2% (D5W / 0.2 NaCl)
  • Dextrose 5% in Water (D5W)

Common IV Additives

  • KCl - Potassium Chloride
  • Mg++ - MagnesiumC
  • Ca++- Calcium
  • PO4 - Phosphate
  • NaHCO3 - Sodium Bicarbonate

IV Therapy

IV solutions are medications. It is the nurse’s responsibility to ensure that the patient receives the ordered solution and additives at the ordered rate. IV solutions often have similar packaging, therefore, ensure that you exercise care and use the double checking procedure when administering intravenous solutions.

IV Maintenance

  • IV maintenance is the bedside nurse’s ongoing responsibility
  • IV solution bags and syringes are to be replaced at least every 24 hours
  • IV tubing is changed at a minimum of every 72 hours
  • Tubing, bags and syringes are labelled with the date and time of change and documented in Kidcom/KidCare\
  • IV dressing changes are done as necessary based on assessment
  • At the beginning and end of your shift, or when hanging a new bag of solution, check the IV solution against the doctor’s order to ensure the correct solution is being administered
  • All IV therapy must be checked by two RNs at the change of each shift for rate, solution and additives

IV Site Assessment & Care

  • Assess IV site hourly (at a minimum), and document this on the flowsheet
  • Look specifically at insertion site, as well as above and below
  • Palpate and inspect site for puffiness, redness, skin temperature (very warm or very cool), wetness, streaking, and/or cording
  • Compare limbs - Is there generalized edema or is only the limb with the IV edematous?
  • Assess child's comfort level - Is the IV site tender to touch or painful ?
  • Remove interstitial or blocked PIV cannulas
  • Observe IV dressing for cleanliness and intactness
  • DO NOT REINFORCE wet or soiled tapes - change them and ensure that tapes and IV board are clean
  • Never rely on your IV pump as a means of confirming patency - the pump may continue to infuse the IV solution into the surrounding tissues of an infiltrated IV
  • Set the appropriate pressure limits
  • When disconnecting an IV, ensure that the end of the line is capped in an aseptic manner. If becomes contaminated, discard the line.
  • When the IV team is called in to assess an IV, saline lock the PIV. Do not put on hold or turn off the IV infusion pump while waiting for the team to arrive. This may result in line occlusion.
  • Use positive pressure to saline lock or hep-lock IVs. Positive pressure is established by clamping the T-Piece or catheter at the same time as saline is flushed.

Potential IV Complications

Severe IV complications are largely preventable. It is important to identify and treat complications, and the goal is to prevent them by:

  • closely monitoring
  • maintaining asepsis
  • thorough assessment
  • troubleshooting IV sites

Complications

  • Infiltration/ Extravasation: Dislodgment of cannula from the vein into the surrounding tissue
  • Site Infection: Infection at the IV insertion site
  • Haematoma: Localized swelling filled with blood resulting from a break in a blood vessel
  • Phlebitis: Inflammation of the vein

Tip Sheets

What do I do if  .....

Early in your placement you are required to read these SickKids policies:

  • IV Therapy 
  • Vascular Access Devices
  • Heparin/Saline Lock