Download - ECG Basics and IV
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ECG Basics
Outline:
1. Review of the conduction system2. ECG waveforms and intervals3. ECG leads4. Determining heart rate
THE NORMAL CONDUCTION SYSTEM
WHAT IS AN ECG?
The electrocardiogram (ECG) is arepresentation of the electrical events of the
cardiac cycle.
Used to measure the rate and regularity ofheartbeats, as well as the size and position of
the chambers, presence of any damage to the
heart, and effects of drugs or devices used
WHAT TYPES OF PATHOLOGY CAN WE IDENTIFY AND
STUDY FROM EKGS?
Arrhythmias Myocardial ischemia and infarction Pericarditis Chamber hypertrophy Electrolyte disturbances (i.e. hyperkalemia,
hypokalemia)
Drug toxicity (i.e. digoxin and drugs whichprolong the QT interval)
ECG LEADS
Leads are electrodes which measure the difference in
electrical potential between either:
1. Two different points on the body (bipolar leads)
2. One point on the body and a virtual reference point
with zero electrical potential, located in the center of
the heart (unipolar leads)
EKG Leads
3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads
The axis of a particular lead represents the viewpoint
from which it looks at the heart.
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DETERMINING THE HEART RATE
Rule of 300 10 Second Rule
RULE OF 300
Take the number of big boxes betweenneighboring QRS complexes, and divide this into
300. The result will be approximately equal to
the rate
Although fast, this method only works forregular rhythms.
10 SECOND RULE
As most EKGs record 10 seconds of rhythm perpage, one can simply count the number of beats
present on the EKG and multiply by 6 to get the
number of beats per 60 seconds.
This method works well for irregular rhythms.
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INTRAVENOUS THERAPY
Insertion of a needle or catheter / cannula into a vein
based on a physicians written prescription. The needle
or catheter / cannula is attached to a sterile tubing and
fluid container to provide medicine and fluid.
PURPOSE:
To maintain / correct dehydration inclients unable to tolerate sufficient
volume of oral fluids / medicine. Parenteral nutrition Administer drugs Transfusion of blood or blood
components
To provide a lifeline for rapidly neededmedications or blood
COMMON TYPES OF IV SOLUTIONS
a.) Hypotonic Solutions have less dissolvedparticles than plasma, good route for
medications but not good choice for fluid
replacers because it leaves the vascular space
(D5W)
b.)Hypertonic Solutions have more dissolvedparticles then plasma and have initial effect of
drawing water from intracellular spaces to
intravascular space but once sugar content is
metabolized, solution becomes hypotonic.
(D5LR, D10, 0.45%NaCl)
c.) Isotonic Solution have roughly the sameamount of dissolved particles as plasma and
good choice for fluid replacement (NSS, LR)
SITES FOR IVF INFUSION
Dorsal metacarpal veins Cephalic vein Basilic vein Radial vein Medial antebrachial vein
Accessory cephalic vein Select a site distal to the heart and move
proximally as necessary
CONSIDERATION IN THE SELECTION OF THE
SITE
Select a vein large enough toaccommodate the needle that will be
used
Type of solution Clients age
Equipments
1. Container of sterile intravenous solutionIV solutions comes in different sizes
a) 150 mlb) 250 mlc) 500 mld) 1000ml
2. Solution should be sterile and in proper
conditiona) Check expiration dateb) There should be no particulate
matter in the solution
c) Check for any leaks indicative ofcontamination
3. Administration set
1. Macrodrip or macroset (10,15 or 20drops per ml of solution)
2. Microdrip or microset (60 drops per mlof solution)
d)
Insertion spike inserted intothe solution container and kept
sterile
e) Drip chamber to prevent airfrom entering the line
f) Roller or screw clamp tocontrol the rate of flow of the
solution
g) Tubingh) Protective cap maintains the
sterility of the end of the tubing
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so that it can be attached to a
sterile needle inserted in the
clients vein
i) Needle adapter3. Volume-control set or solute set
4. IV poles
The higher the solution container issuspended, the greater the force of the
solution as it enters the client and thefaster the rate of flow.
5. Intravenous needle or catheter
a. Butterfly or win-tipped needles (25 to17 gauge)
b. Catheter or angiocatheterc. The larger the gauge number, the
smaller the diameter of the shaft
6. IV Tray
Contains sterile swabs, antisepticsolution, plaster, tourniquet, splint,
local anesthetic, sterile 2X2 gauze
squares
The initiation ofIV therapy is upon the writtenprescription of a licensed physician which is
checked for the:
Type of solution Flow rate Amount of solution Dose and frequency of medicine to be
incorporated
Setting up:
1. Check doctor's order and make IVlabel
2. Prepare necessary set, IV stand orIV hook, IV tray, cotton balls with
alcohol, plaster, tourniquet and
splint.
3. Explain procedure to client andassess client's vein.
4. Check the solution and set forsterility.
5. Place IV label on IVF bottle.6. Wash hands before and after
setting up IV.
7. Maintain sterility ofIV solutioncontainer while opening port
8. Disinfect rubber port with cotton
ball dipped in alcohol
9. Open administration set aseptically
(Venoset) and close the roller clamp
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10.Spike the container without
contaminating port.
11.Hang the IV bottle using the IV
stand or hook.
12.Fill drip chamber to at least half
13.Prime the tubing while maintaining
sterility of the end of tubing (use
kidney basin)14.Remove all air from tubing (get
ready for IV insertion)
A. Changing an IV Infusion1. Check doctor's order in the Doctor's
Order Sheet and IV sheet;
Countercheck IV label, IV card, bottle
number or bottle sequence, type,
amount, additives (if any), duration of
infusion.
2. Prepare necessary materials (IVsolution, IV label, disinfectant, kidney
basin or tray)
3. Check sterility of IV solution4. Calibrate IV bottle according to
duration of infusion
5. Bring necessary materials at thebedside and explain procedure to the
client
6. Wash hands before and afterprocedure
7. Disinfect rubber port of new IV solution
prior to inserting spike of the previous
administration set8. Close roller clamp or kink tubing of
administration set when changing IV
solution bottle
9. Spike the container without
contaminating port
10.Regulate the flow rate based on
duration of infusion. Remove air
bubbles (if any)
11.Document in client's IV sheet and
Kardex
B
. DISCONTINUING AN IV INFUSION
1. Verify written doctor's order todiscontinue IV
2. Prepare necessary materials (IV traywith cotton balls with alcohol, plaster)
3. Wash hands before and afterprocedure
4. Explain procedure to client5. Wet all adhesive tapes with alcohol
before removing them.
6. Clamp tubing7. Get another cotton ball with alcohol;
Remove needle or IV cannula quickly
8. Place cotton ball with pressure andtape
9. Document time of discontinuance,status of insertion site.
Calculating the Infusion Rate
Total number of ml to be given = ml to
be given / hour
Hours in which the solution is to be infused
Volume X drop factor = drops per min.
#of hours X 60 min.
INCORPORATION OF DRUG INTO IVF
BOTTLE / BAG
1. Verify the written medication cardagainst the M.D. prescription; observe
hospital policy on drug administration.
2. Observe 10 Rs when preparing andadministering medication.
3. Explain procedure (medication andaction) to reassure patient and
significant others and check patency
and IV site.
4. Verify for skin test of drug of IVincorporation (if skin testing is
necessary)
5. Do hand hygiene before and after theprocedure.
6. Prepare necessary material needed forthe procedure such as: injection tray,
syringes needed, right drug to be
incorporated either in vial or ampule.
7. Disinfect injection port of the vial &
the ampule before breaking then
aspirate the right dose aseptically.
8. Remove the cover of the
administration set, maintain sterility andincorporate prepared drug into the
airway aseptically.
Note: if the administration set has no airway,pull out the set and incorporate the prepared
drug and re-spike the IV set to the bottle then
place the label. (all these should be done
aseptically)
9. Swirl the IV bottle to mix the drug
with the IVF and regulate the
flow rate accordingly.
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10. Observe for 5-10 minutes for any
drug interaction while reassuring the
patient; monitor VS.
11. Document in the patients chart
12.Discard the sharp and other wastes
according to Health Care Waste
Management (DOH / DENR)
IV PUSH THROUGH THE IV PORT1. Verify the written medication card
against the M.D. prescription; observe
hospital policy on drug administration.
2. Observe 10 Rs when preparing andadministering medication.
3. Explain procedure to reassure patientand significant others (the name of the
medicine and action / interaction of
medication) before administration.
4. Do hand hygiene before and after theprocedure. (use gloves especially for
chemotherapeutic & other vesicant
drugs)
5. check patency and other signs ofswelling, redness, phlebitits, etc do
not give the drug
6. check for skin test result of drug for IVpush, drug-drug, drug IV fluid
incompatibility, dosage (computation)
7. Prepare the necessary materials forthe procedure such as: right drug, right
diluent needed, IV injection tray,
syringes and needles, alcohol, etc
8. Disinfect the injection port of the
diluent, vial or ampule as appropriate
9. Aspirate right amount of diluent for the
drug (if drug needs to be diluted)
10. Aspirate the right drug dose; disinfect
the Y- injection port of the IV
administration set / catheter IV
port.
11. Close the roller clamp of the IV tubing
from the bottle and push IV
drug aseptically and slowly or
according to the manufacturers
recommendation.
12. Using same syringe aspirate 1-2cc of
IVF to flush the medicine given.
13. Regulate rate of IV fluid infusion as
prescribed. (if needed)
14. Reassure patient and observe for signs
and symptoms of adverse drug
reaction.
15. Discard sharps and other waste
according to Health Care Waste
Management.
DRUG INCORPORATION INTO VOLUMETRIC
CHAMBER1. Verify the written medication card
against the M.D. prescription; follow
hospital policy on drug administration.
2. Observe 10 Rs when preparing andadministering medication.
3. Explain procedure to patient (medicineand action) and check IV site. Verify for
skin test of the drug before IV
incorporation.
4. Do hand hygiene before and afterprocedure.
5. Prepare the necessary materials forthe procedure such as right drug and
dose, right diluent needed IV injection
tray. Syringes and needles.
6. Check the present IV fluid label, level
and the incorporated medicine in the
Volumetric Chamber or IV bottle if
with incorporated medicine, check for
drug-drug incompatibility and if the
ongoing IV fluid in the Volumetic
Chamber is to be consumed in 6-8
hours, request a prescription for IVF to
be used solely for drug administration
and keep whole set sterile for
succeeding doses.
7. Aspirate prepared right drug with
correct dose.
8. Add desired IVF diluent into Volumetric
Chamber by opening the sliding clamp
from the bottle then close the clamp.
9. Disinfect rubber injection port of thevolumetric chamber and incorporate
the drug, mix gently.
10. Open the clamp of the airway at the
volumetric chamber.
11.Regulate flow rate of IVF infusion
accordingly.
12.Place IV label on volumetric chamber
indicating drug incorporated and flow
rate.
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13.Reassure / monitor patient when
incorporated medicine is consumed,,
clamp airway of V. C add IVF &
regulate flow rate of main IVF as
prescribed.
14.Discard waste according to Health Care
Waste Management (DOH / DENR).
15.Document in patients chart the drug
administered & patient condition.16.Document in patients chart IVF sheet
and Kardex (of changes in IV rate /
time due)
PUSH THROUGH HEPARIN LOCK DEVICE
1. Check medication card against thewritten doctors prescription.
2. Observe 10 Rs when preparing andadministering medication.
3. Explain procedure to the patient (nameof medicine and action) before
administration.
4. Do hand hygiene before and after theprocedure (use gloves especially in
chemo drugs)
5. Gather equipment to include / but notlimited to IV tray, Heparin solution,
normal saline diluent or isotonic
solution, 2.5 cc syringes 3 pieces
tuberculin / TB syringe 1pc.
6.Prepare medication to be administered
e.g., antibiotic, and draw it up into a
syringe.
7.Fill in tuberculin syringe with HeparinSolution. N.B. Heparin solution is
usually prepared with 0.1cc Heparin
plus .9cc Normal Saline or Isotonic
solution.
8.Fill the 2.5cc syringe with Isotonic
solution or Normal Saline 1cc each.
9.If using Hep. Loc device with 3 way stop
cock with luer-lock, rotate the stop
cock so that the line going to the
patient is closed (this will prevent
backflow of blood)10.Remove the cover of the injection port
aseptically and keep the sterility of the
cover.
11.Check the patency, open the IV line, and
inject NSS or Isotonic Solution to flush
the Heparin solution.
12.Close the IV line & remove saline
syringe and insert medication syringe
into port.
13.Open the IV line & inject medication
into the vein, timing the flow rate
according to doctors prescription of
drug manufacturers instructions.
14.Observe patient for any adverse
reactions & do nursing intervention
accordingly.
15.Close the IV line and remove
medication syringe.16. Insert the saline syringe, open the line
& flush Catheter tubing / IV cannula to
flush the line.
17. Close & remove saline syringe.
18. Close the IV line, remove syringe and
return the cover of the injection port
aseptically.
19. Document in the patients chat and
Kardex.
20.Discard waste according to Health Care
Waste Management. (DOH / DENR).
Note: Normal saline can take the place ofHeparin. Studies have shown the efficacy of
NSS. Heparin solution can be used if normal
saline or isotonic solution is not available.