After completing the chapter, you will be able to accomplish the following:

1. Initiate a peripheral intravenous catheter access and intravenous infusion.
2. Monitor an IV site and infusion.
3. Change an IV solution container and administration set.
4. Change a peripheral venous access device site dressing.
5. Cap for intermittent use and flush a peripheral venous access device.
6. Administer a blood transfusion.
7. Change the site dressing and flush a central venous access device.
8. Access an implanted port.
9. Deaccess an implanted port.
10. Remove a peripherally inserted central catheter.

• Assessment
• Clinical Decision Making/Clinical Judgment
• Fluids and Electrolytes
• Safety

• autologous transfusion
• blood typing
• crossmatching

This chapter discusses skills needed to care for patients with fluid, electrolyte, and acid-base balance needs. The total amount of body water makes up approximately 50% to 60% of body weight in a healthy person (Brinkman et al., 2021). The balance, or homeostasis, of fluid, electrolytes, and acid-base is interrelated and maintained through the functions of almost every organ of the body. In a healthy person, fluid intake and fluid losses are about equal. Fundamentals Review 16-1 lists the average adult daily fluid sources and losses. Abnormalities in fluid, electrolyte, and acid-base balance are also interrelated and may occur together.

The use of infused intravenous (IV) solutions may be prescribed as part of patient care related to fluid, electrolyte, and acid-base disturbances. The nurse is responsible for critically evaluating all patient orders prior to administration, as well as for initiating, monitoring, and discontinuing the therapy. If the prescribed intervention is unclear in any way or does not seem appropriate based on the patient's condition and/or status, it is the nurse's responsibility to ask the prescribing practitioner for clarification prior to beginning administration. The contents of selected IV solutions and comments about their use are listed in Fundamentals Review 16-2. As with other therapeutic agents, the nurse must understand the rationale for the use of IV therapy for the individual patient, the type of solution being used, its desired effect, and potential complications (Fundamentals Review 16-3). Blood product transfusions are other infusions that may be administered through IV access devices and include red blood cells, platelets, and coagulation factors.

1. Explain the reason the IV access is necessary and the rationale for IV fluid replacement. Discuss the potential complications related to peripheral venous access and IV fluid infusion, including infiltration, phlebitis, and infection. Explain the steps the nurses will take to prevent these complications; discuss the steps Ms. Lawrence can take to help prevent complications, as well as the signs and symptoms of which she should be aware. Encourage her to continue to ask questions and report any signs or symptoms she feels her son exhibits. Discuss the advantages related to using a topical anesthetic before peripheral venous access insertion. Explain any securement/stabilization devices that will be used with Simon to prevent accidental dislodgement or removal of the venous access device.
2. Ms. Cohen is exhibiting signs and symptoms consistent with a hemolytic transfusion reaction. This type of reaction typically occurs immediately and is the result of incompatibility of the donor blood with the recipient's blood. Stop the blood immediately. Disconnect the blood and begin infusing normal saline via a different, new administration set. Notify the health care team immediately. Monitor vital signs and symptoms. Anticipate the administration of medications to treat the reaction, including hypotension. Prepare to obtain required blood samples for serologic testing and a urine specimen. Return blood product and administration tubing to laboratory.
3. Provide Mr. Tracy with information regarding skin care and assessment related to his port site. Inform him about how to care for his port if it is accessed. It is important that he is aware of signs and symptoms that he should report to his health care provider. He also needs to be aware of the time interval for surgical follow-up and the interval for appointments to flush and lock the port, if not in use.