1229 Exam 2: IV Skills/Venipuncture Flashcards
Intravenous
- -within the vein
- -IV
Purpose of IV Therapy
Maintain or replace body’s store of water, electrolytes, proteins, calories, nitrogen-to maintain F/E balance
Restore acid-base balance
Replenish blood volume
Medication administration
Provide route for maintaining nutritional status
IV Therapy
- -infusion of liquid substance directly into the vein
- -sometimes called a drip
Drip
–IV commonly called a “drip” due to the drip chamber that prevents air from entering the vein
Venipuncture
–a technique in which vein is punctured by needle thru the skin
Regulating Mechanisms
Kidneys: filters and maintains fluid balance by determining amount and composition of urine that is released. Things that can alter our kidneys; trauma, shock, post traumatic stress. Adrenal glands release aldosterone and increase the reabsorption of sodium.
Lungs: fluid loss through respirations
Skin: fluid loss through perspiration
Pituitary Gland: release ADH, prevents the dieresis through reabsorption of water
Body Fluids
Body is 50% water, carried through the cells and that is how we maintain homeostasis.
Extravascular is the fluid outside the cell–main electrolyte is sodium
Intravascular is the fluid in the vascular space–main electrolyte is potassium
Intracellular fluid is inside the cells, each compartment is interchangeable so a change in one place will be a change in another.
Osmolality
- -NEVER use pure water since causes of RBCs to rupture due to rapid entry
- -this is the concentration of the solution
- -the body’s electrolyte-water balance
- -the number of dissolved particles contained in a unit of water
- -separated by semipermeable membrane
- –Normal Serum Osmolality-275-300 mOsm/kg*****
Isotonic
–have equal osmotic pressure
–same concentration in and out at the same rate
Examples:
-0/9% NaCl (Normal Saline)–Expands ECF volume, also treats diabetic ketoacidosis. Is the only thing hung with blood products.
-Lactated Ringer’s (LR)–Used in the treatment of hypovolemia, burns, fluid lost as bile or diarrhea, & mild metabolic acidosis
-D5W (Dextrose in water)–a primary treatment for patients in need of fluid replacement
Hypotonic
–a lesser concentration of solutes than is surroundings, attempts to balance concentrations(push fluid into cells)
–Hemolysis-cell burst
Examples:
-0.45% NaCl (1/2 NS)–used to treat hypernatremia (because this solution contains a small amount of Na, it
dilutes the plasma sodium while not allowing it to drop too rapidly)
-0.33% NaCl (1/3 NS)–to aid kidneys in elimination of solutes
Hypertonic
–a higher concentration of solutes on the outside of the cell (draw fluids out of the cell)
–more particles than solution
–Crenation-cells shrink
Examples:
-5% Dextrose in 0.45% NaCl– used to treat hypovolemia and to maintain fluid intake
-10% Dextrose in water (D10W)–used for peripheral parenteral nutrition (PPN)
-5% Dextrose in 0.9% in NaCl (normal saline)–used to treat hypovolemia
Types of IV’s: Central Line Placement
- -placed by the physician
- -generally sutured into the skin
- -when assessing it will be marked the depth it was placed, check mark and be sure it has not been pulled out any
Types of IV’s: Peripherally Inserted Central Line (PICC)
- -physician or specially trained nurse inserts
- -go in through AC
- -used with patients with prolong med therapy (cancer pt)
Types of IV’s: Cutdown (Porta-Cath)
- -done by physician, an advanced skill
- -special cleaning process for this procedure
- -usually in saphenous vein
- -when pt goes home needle comes out
- -can access the port when pt comes back
- -for Hematology and Oncology pts
Veins accessed for IV Therapy
Digital- fingers–hurts
Metacarpal- hands–hurts
Cephalic- forearm–best option
Basilic- backside of forearm
Internal & External Jugular-(physician or advanced nurse or paramedics)
Legs-only with MD order esp if diabetic or PVD-will see some in pediatrics, high risk of thromboembolism, this is last resort
Avoid the side if they have a shunt or below IV, or post mastectomy
IV Equipment
IV Fluids Primary IV tubing Secondary IV Fluids Secondary IV tubing IV start kit Saline lock adapter IV Cathlons
Size of Catheter
- Based on reason for IV access
- Available veins
- Use size smaller than the vein to reduce trauma, allow blood to flow freely pass the cath and allow for dilution of IV fluid quickly
- The smaller the gauge # the larger the lumen of the cath
- Take two needles with you to the pts room of the recommend size you need
Responsibility to Pt
- Ask about past IV-“Have you had an IV before?”
- Explain procedure
- Explain activity impairment
- ASK ABOUT ALLERGIES
- Don’t forget the 5 med rights (TRAMP)
Responsibilities to the Elderly
- Do not use the hand if possible–loss of subq tissue
- Meticulous skin care–decreased immunity
- May not need to use a tourniquet
- Skin protectant to prevent skin tears from tape
- Veins roll easier so be sure the vein is stabilized before sticking
- Rate must be controlled b/c of the reduced renal and cardiac function
Responsibilities to Pediatric
- Hand insertion should not be first choice
- Do not use feet on children who can walk
- Do not replace peripheral catherters in children unless clinically indicated
- Do not use isopropyl alcohol on neonates
- —recommend use of iodine or chlorhexidine
- Chlorhexidine is not to be used on infants weighing less than 1000g
