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201 IV therapy part 1 Flashcards

1
Q

what are the different types of IV catheters?

A

-angiocatheter - new IH Nexiva
-butterfly (wing tipped) IV needle
-arrow midline catheter (new started in nov 2023)

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2
Q

what are the different types of IV therapy?

A

-peripheral access: tip of catheter remains in the peripheral vein, usually used for treatments less than 7-10 days (IH)
-central venous access: tip remains in the superior vena cava, usually for txts lasting more than 7 days up to years
-infusion (continuous) vs intermittent
-long term vs short term therapy

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3
Q

what is an angiocatheter?

A

-in IH its new and its called Nexiva)
-the catheter/hub is the colored part
-there are different colors that correspond to sizes
-there are 6 sizes starting from 14g to 24 g (the smaller the catheter size, the larger the lumen)

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4
Q

what is a butterfly (wing tipped) IV needle?

A
  • has a metal needle with tubing,
  • short term (less than 24hs), -used for infants
    -once the catheter is in the vein, the needle is taken out
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5
Q

what is an arrow midline catheter

A

-new started in nov 2023
-a soft flexible catheter referred to as a “long cannula”
-usually between 10-25 cm in length (meaning longer than angiocatheters)
-inserted to the upper arm
-size (usually 3fr, 4fr, 5fr)
-has an increased diameter and longer length
-inserted by the Iv team
-usually used for pt that require IV meds for 7 days up to 4-6 weeks
-the care is the same for PVAD, but because they reside deeper, complications may be less detectable
-only used as a peripheral line

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6
Q

what are colors correspond to which gauge for angiocatheters?

A

-red (14g)
-black (16g)
-green (18g)
-pink (20)
-blue (22)
-yellow (24)
-the bigger the number, the smaller the gauge size

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7
Q

what does a positive displacement device mean and what are important things to know?

A

-it means that when the syringe is disconnected from the needless connecters (end cap), a small amount of fluid is automatically pushed through the end
-should be clamped after finishing the flush and disconnecting the syringe
-provides little to no blood reflex (meaning little to no blood is going back into the catheter
-has low residual volume (meaning a small amount of fluid is retained)
-all of these things help prevent IV infections
-change cap per policy (eg. every 4-7 days)

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8
Q

if there’s two IV bags, which one is the primary and secondary one?

A

-the secondary one is hanged higher (usually for meds)
-the primary one is hanged lower, so that when the secondary one runs out, the primary one will still keep going

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9
Q

what is a micro vs macro drip?

A

-micro: also known as a mini drip, has slower rates less than 100ml/hr, 60 gtt/1ml, usually used for pediatrics, has a small opening
-macro: also known as a maxi drip, has faster rates more than 100ml/hr , 10 gtts/1ml, most common, large opening

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10
Q

what is the average requirement for adult fluids?

A

2500-3000 plus electrolytes

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11
Q

when would you give less than 20ml/h?

A

continuous med admin

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12
Q

when would you give 20-50 ml/h?

A

to leave/keep a vein open for prn or intermittent med admin

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13
Q

when would you give 75ml/h?

A

elderly, history of heart failure

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14
Q

when would you give 100-125ml/h?

A

to maintain f/e balance, NPO

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15
Q

when would you give 150ml/h?

A

to hydrate and replace fluid losses

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16
Q

when would you give 250-500 ml/h?

A

fluid bolus infusion, rapid fluid replacement

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17
Q

when you’re assessing the IV site, what are you looking out for and how often are you assessing?

A

-assessing the insertion site, the track of vein (the visible/palpable part of the vein), and the surrounding tissues for redness, swelling, inflammation, tenderness, exudate or leakage from IV site and for other complications (ONCE PER SHIFT and PRN)
-also assess distal to the site for color, warmth, movement, and sensation
-document site assessments every shit referring to the phlebitis scale (0-4)
-monitor

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18
Q

for a continuous infusion, how often are you monitoring IV site?

A

every hour

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19
Q

when should an IV be changed?

A

-if it’s clinically indicated
-meaning look for pain, erythema, blanching, edema, induration, fluid leak, purulent drainage

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20
Q

what is phlebitis?

A

inflammation of the vein

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21
Q

what score indicates the PVAD can stay on?

A

0, anything greater than a 0 means the PVAD should be removed

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22
Q

what does 0 mean on the phlebitis scale?

A

no symptoms

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23
Q

what does 1 mean on the phlebitis scale?

A

erythema at the access site with to without pain

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24
Q

what does 2 mean on the phlebitis scale?

A

pain at the access site with erythema or edema

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25
Q

what does 3 mean on the phlebitis scale?

A

-pain at access site with erythema or edema
-streak formation
-palpable venous cord (the vein feels hard, and rope like when touched)

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26
Q

what does 4 mean on the phlebitis scale?

A

-pain at access site with edema or erythema
-streak formation
-palpable venous cord greater than 2.5 cm (1inch) in length
-purulent drainage

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27
Q

when do you change the dressing?

A

when it has blood, moisture, exudate, edges lifted, awand for troublehsooting

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28
Q

what is the recommended antiseptic swab?

A

-chlorhexidine
-keep the antiseptic on the skin for atleast 30 seconds/when its dry and do not wipe off
-allow for it to dry

29
Q

what are some things the nurse should instruct the client to report?

A

-s/s of infiltration, phlebtiis and inflammation
-s/s catheter/flow occlusion
-numbness, tingling, discloration, heat/cold, pain in limb
-blood on dressing or in tube
-insecure (not fitted properly) or wet dressing

30
Q

when completing a VAD assessment what are you assessing?

A

assessing patency (open or unobstructed), insertion site and dressing

31
Q

when do you access the IV site for complications?

A

-continuous Iv (q1h)
-intermittent Iv (q shift)

32
Q

when working with a new continuous infusion and intermittent infusion (SL), when do you assess VAD patency and flush?

A

-before and after all medications
-before converting from a saline lock to running IV
-after converting from a running IV to a saline lock
-with all IV tubing, extension set, or needless cap changes
-if VAD occlusion suspected
-if blood seen in lumen or IV tubing
-remember to lock SL after final flush

33
Q

when the saline lock is not in use (meaning no meds and not connected to an IV), how often are you assessing VAD patency and flush?

A

at least every 24 hours, might consider removing

34
Q

what requires a patency check?

A

continuous and saline locks (intermittent)

35
Q

how do you complete a patency check and flush for a PAD?

A

-clean needless end cap wtih 70% alcohol and allow to dry
-attach 0.9% nacl 10 mL prefilled syringe (should be 10 ml or more to prevent adding more pressure which could rupture the catheter)
-assess if it is appropriate to aspirate for blood (eg, elderly with fragile veins)
-if no concerns, aspirate slowly and assess for blood return (aspirate only until the blood is seen in the lumen). If you can’t aspirate, flush with 1-2 normal saline and re-attempt to aspirate
-once patency is established, complete flush using “start-stop flush technique”, maximum flush is 3-5 ml
-then remove the syringe and close clamp

36
Q

when do you clean the end caps and iv ports? and how long should you clean and air dry?

A

-clean for 30s and dry for 30-60 second
-before every access
-for giving iv meds: the endcap is cleaned before doing a patency check, before connected med syringe, and clean before connected post med flush

37
Q

how often do you change the endless end caps?

A

every 4-7 days, and if the blood can not be cleared or has been removed for any reason

38
Q

should you loop the IV tubing on itself?

A

no, it’ll increase the risk for contamination of Iv tubing

39
Q

when do you change IV tubing for open system continuous or closed system continuous?

A

changed every 96 hours (4 days)

40
Q

when should you change the IV tubing for intermittent or secondary infusion?

A

every 24 hours

41
Q

what do you write on the tubing label?

A

date, time, and initial (when you changed the tubing or when the change is due)

42
Q

how long are do continuous IV solution (with no meds) running for?

A

96 hours (4days)

43
Q

how long are intermittent IV bags (not containing meds) running for?

A

24 hours

44
Q

how long are IV solutions with meds running for?

A

24 hours

45
Q

what are important things to know about IV rates?

A

-TKVO and KVO are not acceptable abbreviations
-a specific rate in ml/hr must be ordered
-infusion rate must be documented in the clients in/out form

46
Q

how will you keep open ends of tubing and syringes sterile?

A

-always keep the end caps on the IV even when priming
-if tubing end caps have been removed, maintain aseptic technique
-keep the cap on the sterile syringe until use
-taking taking the cap of the sterile syringe, do not touch the end of the syringe to any non-sterile object
-if you need to temporary disconnect an IV line, you can use a blue cap, a blunt fill needle or a white cap from the saline flush syringe, as long as it’s not contaminated

47
Q

what is the difference between osmolarity and toncity?

A

-osmolarity: is the concentration of solutes in the solution, measured as osmoles/liter (OsM), or milli-osmoles/l (mOsM)
-tonicity: is the behaviour of whether the fluid moves in or out of the cells, has no units, determined by osmolariyt and by whether the solutes in the solution can enter the cell

48
Q

what are the 2 common types of Iv solutions?

A

crystalloids and colloid solutions

49
Q

what are crystalloids?

A

solutions that contain molecules that flow easily through cell membranes

50
Q

what fluids are under the crystalloid solutions?

A

-isotonic solutions
-hypotonic solutions
-hypertonic solutions

51
Q

what are the characteristics of isotonic sollutions?

A
  • osmolarity similar to serum (similar amounts of sodium, chloride and sometimes potassium)
    -initally stay in intravascular (spaces inside the blood vessels) space
  • they expand intravascular volume because they don’t cause fluid to move in or out of the cells
52
Q

what are examples of isotonic solutions?

A

-0.9% NaCl (0.9 NS)
-lactated ringers
-Dextrose 5% NS (D5NS)
-Dextrose 5% in lactated ringers
-all 4 of these solutions act isontonic

53
Q

what are indications for isotonic solutions?

A

-hypovolemic shock: isotonic fluid increases blood volume as it expands in the intravascular space
-mild hypoantremia: both NS and LR contain similar sodium concentrations similar to those in the blood
-fluid and sodium loss: fluid expands in the intravascular space and also LR and NS have similar sodium concentrations as compared to those in the body

54
Q

what are characteristics of hypotonic solutions?

A

-osmolarity lower than serum
-shift fluid out of the intravascular (inside of the blood vessels) compartment into the interstitual fluid (fluid surrounding cells which is outside of the blood vessels) and surrounding cells
-hydrate the cells and interstitial compartments

55
Q

what are indications for hypotonic solution?

A

conditions causing intracellular dehyration (hyperantremia, diabetic ketoacidosis, and hyperosmolar hyperglycemia state)

56
Q

what are contraindications for hypotonic solution?

A

-trauma, burns
-liver disease
-increased ICP, cerebral edema

57
Q

what are examples of hypotonic solutions?

A

-0.45 NaCl (1/2NS) : acts hypotonic in the body
-D5W : acts hypotonic in the body after being metabolized
-Dextrose 5% in 0.45%NaCl (D5 1/2 NS): acts hypotonic in the body after the glucose is metabolized

58
Q

what are the characteristics of hypertonic solutions?

A

-has osmolarity higher than serum
-draws fluid into the intravascular compartment from the cells and interstitual space
-expands vascular volume

59
Q

what are the indications for hypertonic solutions?

A

-hypovolemia
-severe critical symptomatic hypoantremia (3% NS).
-cerebral edema (3% NS)
-clinically significant hypoglycemia (D10W)

60
Q

what are contraindications for hypertonic solutions?

A

-fluid volume overload
-pulmonary edema

61
Q

what are colloid solutions?

A

-plasma volume expanders that draw fluid into the vascular space
-contain large molecules that do not pass through cell membranes
-examples (albumin and detran -glucose)

62
Q

what are the characteristics of colloid solutions?

A

-remain in the intravascular space
-always hypertonic
-increase osmotic pressure
draw fluid into vascular space

63
Q

what are the indications for colloid solutions?

A

used to expand intravascular volume

64
Q

what are the contraindications for colloid solutions?

A

hypervolemia and fluid volume overload

65
Q

if a person is outputing 2000ml, what should there input be?

A

2500, because you need to add 500ml to the input to account for insensible losses (fluid loss that isn’t easily meaured such as fluid loss through sweat)

66
Q

what is abnormal urine output that has to be reported?

A

less than 30ml/hour

67
Q

when documenting fluid intake, what should you measure?

A

-oral fluids (including ice chips)
-foods that become liquid at room temp
-tube feedings
-parental fluids
-IV meds
-catheter or tube irrigants

68
Q

when documenting fluid output, what should you measure?

A

-urinary output
-vomitus
-liquid feces
tube drainage
-wound and and fistula drainage

finals (12 decks)

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