Question

As a senior student you are assigned to work with a preceptor in the Emergency Department. It is a very busy day and it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and/or acid-base balance. The first patient you see is a 37-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but is able to tell you he feels dizzy and weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.

The preceptor tells you to go ahead and initiate an IV site and start the fluids. The fluid order is to start 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL.

This infusion will run by gravity rather than an infusion pump. How many drops per minute should you time the infusion at to ensure the correct hourly rate?

What factors should you be concerned about that may compromise the gravity infusion rate? How will you intervene for these factors?

The patient has a “full sleeve” tattoo on both arms. Discuss the implications of this finding and how you will initiate the intravenous site.

You have difficulty finding a vein in the presence of the deficient fluid volume. What strategies can you employ to help make a vein more visible/palpable?

Answer 1

1.Calculate Drops Per Minute:

Total volume of fluid(TV) = 1000ml

Drops factor (DF) = 15

Total Time= Total volume / flow rate per hour

= 1000/150

= 6.7

= 6 hours 42 minutes

Drops Per Minute:

Total volume *Drops factor/ Total Time in Mts.

1000 * 15 / 6.7 *60 = 37.3= 37drops per mt.

2. Concerned Factors compromise gravity infusion rate and the needed interventions:

* Position of the fluid bag: The bag should placed at least 3feet above from the patient's heart to get enough pressure to keep the IV running at the constant rate.

* Temperature of the fluid: The fluid temperature is inversely proportional to the flow rate. Because the raise in temperature increases the viscosity of the fluid and decreases the flow rate. Hence, before administration fluids should be selected at the proper temperature .

*Location of IV Cannula : Iv lines placed on the hands can handle only less amount of fluid as peripheral veins are smaller and it slows the maximum infusion rate.

* IV Cannula Gauge : The size of the cannula can affect the gravity infusion rate. Therefore, it is essential to select appropriate gauge cannula according to patient's physical condition. For example: Trauma patients and surgical cases require cannula with large bores like 16G, 18G to maintain flow rate.

3. Implications of tattoos over Iv line site:

* It will consume time to find the proper site for cannulation

* If might he a daunting task to different tattoos from veins

* Some may experience vein collapse after cannulation

* will require devices with advanced technology to find the vein.

Initiating Intravenous line this patient:

The nurse should feel the vein rather searching for veins visiblity

The experience of Iv cannulation in a nurse helps to determine the best location

Use of vein detectors help to find the veins

Strategies to employ to make the vein more visible and palpable :

1.Hydrate the patient : it will help for vein dilation and visiblity

2. Get the hands warm: soak the hand in warm water and if will cause vasidilation

3. Making a fist or squeezing a ball also helps to find the veins more prominently

4.Relax : As anxiety can constrict the blood vessels relax the patient first

5.Palpation: To find the difficult veins palpation plays the vital role

6. Gentle massage: Gently massaging the site we have chosen will help us while cannulation