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Section 2 Exam > CH.14 medication administration IV Access, Blood Sampling, and IO Infusion > Flashcards

CH.14 medication administration IV Access, Blood Sampling, and IO Infusion Flashcards

1
Q

Indications of IV ? (3)

A
  • Fluid and blood replacement
  • Drug administration
  • Obtaining venous blood specimens for laboratory analysis
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2
Q

What is unique to neonate and infant vein access?

A

They allow scalp vein access, adults do not

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3
Q

When would you see peripheral veins collapse? (3)

A
  • Hypovolemia
  • Circulatory failure
  • Hypothermia
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4
Q

3 people it would be difficult to find veins in?

A
  • Geriatric
  • Pediatric
  • Peripheral vascular disease
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5
Q

Who are PICC lines most often used for?

A

Infants and children requiring long term care

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6
Q

Central venous access is typically restricted in the hospital setting because of its invasive nature and high risk of complications such as… (3)

A
  • Arterial puncture
  • Pneumothorax
  • Air embolism
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7
Q

When would you not find central vein access?

A

During CPR

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8
Q

4 different FORMS of IV fluids

A
  • Colloids (help maintain vascular volume, high cost, short shelf life)
  • Crystalloids (the primary prehospital IV solution)
  • Blood
  • Oxygen-carrying fluids
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9
Q

3 most commonly used IV fluids

A
  • Ringers Lactate (isotonic)
  • Normal saline solution (isotonic)
  • Five-percent dextrose in water (D5W-hypotonic)
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10
Q

Why is 2/3 of Ringers or saline lost to extravascular space within one hour?

A

Because of the movement of electrolytes and water

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11
Q

What 2 materials are most IV fluids and blood packaged in?

A
  • Soft plastic bags

- Vinyl bags

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12
Q

GTTS

microdrip vs. macrodrip

A

Microdrip: 60 gtts = 1mL (stylet)
Macrodrip: 1gtt = 1mL (large circular opening)

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13
Q

How full should the drip chamber be for optimal fluid delivery?

A

1/3 full

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14
Q

Which IV drug is chemically incompatible with regular tubing and requires special tubing?

A

Nitroglycerine

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15
Q

3 patients that measured volume administration sets are good for?

A
  • Pediatrics
  • Renal failure
  • Other pt.’s who cannot tolerate fluid overload
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16
Q

Burette chamber

  • Increments
  • Volume
A
  • Marked in 1 mL increments

- Can hold 120-150mL of fluid

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17
Q

What happens if blood is stored or delivered over an extended period of time?

A

It is prone to form fibrin clots or to accumulate other debris. If they enter the circulatory system, they can travel in the form of an embolus

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18
Q

2 ways blood tubing can come

A
  • Straight (blood)

- Y (one side for blood, the other side for IV normal saline)

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19
Q

3 types of IV cannulas

A
  • Over the needle catheter (preferred for peripheral venous access)
  • Hollow needle catheter/butterfly catheter (does not have Teflon tube, preferred for peds or people with tiny, delicate veins)
  • Plastic catheter inserted through a hollow needle (intracatheter)
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20
Q

Typical uses for the various sizes of cannula (3)

A
  • 22 gauge: used for fragile veins such as those of the elderly or children
  • 20 gauge: average adult
  • 18, 16, 14 gauge: used to increase volume or to administer viscous medication
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21
Q

What size of cannula does blood have to be administered through

A

16 gauge or larger

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22
Q

2 things to remember with IV cannulas

A
  • The largest gauge cannula that will fit into a vein is not always appropriate
  • IV access is painful and causes discomfort to pt. AND family members watching
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23
Q

What is the maximum time you can leave a venous constricting band on a patient?

A

2 minutes

24
Q

How much farther should you insert a hollow needle catheter (no teflon tube) into the vein after you hear the “pop”?

A

0.5cm further

25
Q

What do you need in a jugular IV instead of a venous constricting band?

A

A 10mL syringe

26
Q

How could you get the neck veins to distend during jugular IV?

A

Put the patient in trendelenburg position

27
Q

3 disadvantages of jugular IV?

A
  • Painful
  • May inadvertently puncture the airway
  • May damage nearby arterial vessels
28
Q

How much fluid should you administer in a Burette chamber during IV access with a measured volume administration set?

A

20mL of fluid

29
Q

What is one of the most common mistakes both in and out of the hospital during IV’s?

A

Leaving the venous constricting band on

30
Q

Factors affecting IV flow rate

A
  • Constricting band
  • Edema at the puncture site
  • Cannula abutting the vein wall or valve
  • Administration set control valves
  • IV bag height
  • Completely filled drip chamber
  • Catheter patency
31
Q

When would you expect to see signs of a local infection after IV administration?

A

Several hours later

32
Q

What are pyrogens? How long do they take?

A

Foreign proteins capable of producing fever. A pyrogenic reaction will occur within 30-60 minutes after you initiate an IV.

33
Q

What can you do if a pt. is experiencing a lot of pain ? (2)

A
  • Use a smaller gauge catheter

- Use a 1% Lidocaine solution to anesthetize the skin

34
Q

How long should you apply pressure when arterial puncture occurs?

A

5 minutes

35
Q

Signs of circulatory overload? (4)

A
  • Rales
  • Tachypnea
  • Dyspnea
  • Jugular venous distention
36
Q

When should you change an IV bag?

A

When the volume is at 50mL of solution left

37
Q

What are the 2 ways you can administer IV drugs?

A
  • IV bolus (18-20 gauge needle, 2.5-3.5cm long)
  • IV infusion

Never administer intravenous infusions as a primary IV line

38
Q

How much fluid should you flush after IV bolus meds given?

A

20mL

39
Q

Most infusions require what kind of drip?

A

Microdrip

40
Q

How big of a gauge does a needle adapter typically accept?

A

20 gauge

41
Q

What kind of lock should be used for short term? Long term?

A

Short term: Saline lock

Long term: Heparin lock

42
Q

What kind of needle is compatible with a venous access device?

A

Huber needle (has an opening on the side of the shaft instead of the tip)

43
Q

When using a venous access device, how much saline should you fill a syringe with?

A

Fill a 10mL syringe with 7mL of normal saline. Inject at a 90 degree angle

44
Q

Why shouldn’t you use a blood tube after its expiration date?

A

Because both the vacuum and anticoagulant lose their effectiveness

45
Q

What happens if you do not follow the proper sequence when blood tubing?

A

The various anticoagulants will cause cross-contamination

46
Q

What are the sizes of blood tubes for adults vs. children?

A

Adults: 5-7mL
Pediatrics: 2-3mL

47
Q

Blood tube sequence

A
  1. None Red
  2. Citrate Blue
  3. Heparin Green
  4. EDTA Purple
  5. Fluoride Grey
48
Q

What should you label on a blood tube? (4)

A
  • Patients name
  • Patients age and gender
  • Date and time drawn
  • Name of person drawing the blood
49
Q

Causes of hemolysis (3)

A
  • Vigorous shaking of the blood tube
  • Using too small of a needle
  • Forceful aspiration of blood into or out of syringe
50
Q

T of F: IO infusion is more common in adults

A

False. It is more common in children

51
Q

At what point should you decide to do an IO infusion?

A

Only after 90 seconds or three unsuccessful attempts to establish peripheral IV access

52
Q

What kind of needle will you need for an IO infusion?

A

A 14-18 gauge needle

53
Q

Where is the adult and children IO infusion access site?

A

Adult: 2 fingers above the medial malleolus
Pediatric: 2 fingers below the tibial tuberosity

54
Q

How far should you insert the IO needle?

A

2-4mm

55
Q

IO access complications

A
  • Fracture
  • Infiltration
  • Growth plate damage
  • Complete insertion
  • Pulmonary embolism
56
Q

IO contraindications (4)

A
  • Fracture to the tibia or femur on side of access
  • Osteogenesis imperfecta
  • Osteoporosis
  • Establishment of a peripheral IV line

Section 2 Exam (8 decks)

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