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PCP > chapter 8: vascular access and medication administration > Flashcards

chapter 8: vascular access and medication administration Flashcards

1
Q

medical asepsis

A

the practice of preventing contamination of the patient by using aseptic techniqie

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2
Q

aseptic technique

A

method of cleansing intended to prevent contamination of a site when performing an invasive procedure

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3
Q

vascular access

A

cannulation of a peripheral extremity vein

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4
Q

standing orders

A

a form of indirect medical control, in which the paramedic performs certain predefined procedures without any consultation

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5
Q

direct medical control

A

some EMS system medical directors may not allow paramedics to perform certain procedures before making contact with the medical director or a designated physician

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6
Q

sterile technique

A

the destruction of all living organisms and is achieved by using heat, gas, or chemicals

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7
Q

antiseptics

A

used to cleanse an area before performing an invasive procedure

the most common antiseptics are rubbing alcohol and iodine

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8
Q

disinfectants

A

toxic to living tissues, you should never use them on a patient

ex) virex, cidex, microside

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9
Q

the first rule of routine precautions

A

treat any body fluid as being potentially infectious

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10
Q

sharps

A

any contaminated item that can cause injury

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11
Q

total body water

A

constitutes 60% of the weight of an adult

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12
Q

intracellular fluid

A

the water contained inside the cells; 45% of body weight

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13
Q

extracellular fluid

A

the water outside the cells; 15% of body weight

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14
Q

interstitial fluid

A

the water bathing the cells; 10.5% of body weight

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15
Q

intravascular fluid

A

the water within the blood vessels, carries red blood cells, white blood cells and vital nutrients; ~4.5% of body weight

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16
Q

solvent

A

the fluid that does the dissolving

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17
Q

solute

A

the dissolved particles contained in the solvent

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18
Q

sodium

A

the principal extracellular cation needed to regulate the distribution of water throughout the body in the IV and interstitial fluid compartments

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19
Q

potassium

A

the principal intracellular cation, plays a major role in neuromuscular function and in the conversion of glucose into glycogen

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20
Q

calcium

A

principal cation needed for bone growth

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21
Q

magnesium

A

has an important role as a coenzyme in the metabolism of proteins and carbohydrates

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22
Q

bicarbonate

A

the primary buffer used in all circulating body fluids

bicarbonate levels are the determining factor between acidosis and alkalosis in the body

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23
Q

chloride

A

a primary determinant of stomach pH

it also regulates ECF levels.

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24
Q

phosphorous

A

an important component in adenosine triphosphate, the body’s powerful energy source

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25
Q

nonelectrolytes

A

solutes that have no electrical charge

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26
Q

diffusion

A

the process of particles moving from an area of higher concentration to an area of lower concentration along a concentration gradient

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27
Q

filtration

A

another type of diffusion commonly used by the kidneys to clean blood

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28
Q

antidiuretic hormone ADH

A

prevents the loss of water from the kidneys by causing its reabsorption into the tubules while the hormone aldosterone is responsible for sodium reabsorption

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29
Q

tonicity

A

the concentration of a solution or ability to draw or give water

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30
Q

osmosis

A

the movement of a solvent such as water from an area of low solute concentration to an area of high concentration through a selectively permeable membrane

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31
Q

homeostasis

A

the internal environments resistance to change

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32
Q

dehydration

A

inadequate total systematic fluid volume

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33
Q

overhydration

A

when the body’s total systemic fluid volume increases

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34
Q

3 basic types of IV solutions

A

crystalloids, colloids, blood products

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35
Q

crystalloid solution

A

dissolved crystals in water

  • best choice for fluid replacement
  • 3 to 1 replacement rule
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36
Q

isotonic solutions

A 
- normal saline 0.9% 
sodium chloride
- lactated ringer
- d5W (5% dextrose in water)
-  has almost the same osmolarity as serum and other body fluids
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37
Q

hypotonic solutions

A
  • osmolarity less than serum
  • dilutes serum
  • hydrate the cells
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38
Q

hypertonic solution

A
  • osmolarity higher than serum
  • stabilize blood pressure
  • increase urine output
  • reduce edema
  • rarely used in prehospital setting
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39
Q

colloid solutions

A
  • very high osmolarity

- reduce edema

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40
Q

oxygen- carrying solutions

A
  • best fluid to replace lost blood is whole blood
  • o- neg blood (universally compatible)
  • synthetic blood substitutes
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41
Q

intravenous (IV)

A

within a vein

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42
Q

intravenous therapy

A

cannulation of a vein with a catheter to access the patients vascular system

(one of the most invasive techniques that you will perform)

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43
Q

two ports of an IV bag

A
  • injection port

- access port

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44
Q

choosing a solution

A
  • is the patients condition stable or critical
  • does the patient need fluid replacement
  • will the patient need medications
45
Q

in the prehospital setting the choice of IV solution is usually limited to 2 isotonic crystalloids

A
  • normal saline

- lactated ringer

46
Q

administration set

A

moves fluid from the IV bag into the patients vascular system

47
Q

2 primary sizes of administration sets

A
  • microdrip set: allows 60 drops/mL (ideal for pediatrics)

- macrodrip: allows 10, 15, 20 drops/mL (best used for rapid fluid replacement)

48
Q

preparing an administration set

A
  • verify the expiry date of the solution
  • check for solution clarity
  • prepare to spike the bag
49
Q

blood tubing

A

a macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or IV and blood replacement combinations

50
Q

Volutrol

A

allows you to fill 100- OR 200- mL calibrated drip chamber with a specific amount of fluid and administer only that amount

51
Q

choosing an IV site

A
  • locate the vein section with the straightest appearance
  • choose a vein that has a firm, round appearance, or is springy when palpated
  • avoid areas where the vein crosses over joints
  • avoid edematous extremities and any extremity with a dialysis fistula or on the side a mastectomy was done
  • avoid areas of overlying cellulitis

(avoid valves, and rolling veins)

start distally, work proximally

52
Q

criteria

A
  • purpose of the IV
  • age of the patients
  • location of the IV
  • available vessels for venipuncture
53
Q

needle types

A
  • over the needle catheters
    a teflon catheter inserted over a hollow needle
  • butterfly catheters
    a hollow, stainless steel with 2 plastic wings to facilitate its handling
  • through the needle catheters
    plastic catheters inserted through a hollow needle
    (rarely used in the prehospital setting
54
Q

contaminated stick

A

when a paramedic punctures their own skin with the same catheter that was used to cannulate the vein of a patient

55
Q

inserting the IV catheter

A
  • each paramedic has a unique technique to insert an IV
  • keep the beveled side of the catheter up
  • maintain adequate distal traction of the vein
  • apply a tourniquet above the site
  • remove tourniquet after the IV insertion, obtain blood samples and attach the line
  • have tape or securing devices ready
56
Q

penrose drain

A

a blood pressure cuff; or in a pinch, a surgical hose

57
Q

prep the site

A
  • alcohol or iodine swab
  • apply gentle downward or lateral traction
  • clean the site with iodine first in a circular motion, starting with small circles and moving to larger circles
  • use the alcohol to clean the iodine
58
Q

insertion angle

A

45 degrees

- advance the catheter into the vein until the vein is pierced (flash of blood in the flash chamber)

59
Q

inserting the IV catheter

A
  • immediately drop the angle down 15 degrees
  • advance the catheter a few more cms to ensure the catheter sheath is in the vein
  • slide the sheath off the needle and into the vein
  • apply pressure to the vein just proximal to the end of the indwelling catheter
  • remove the needle
  • dispose of it in the sharps container
60
Q

securing the line

A

tape the area
- tear the tape before you start the IV

  • double back the tubing
  • cover the insertion site with sterile gauze
  • avoid circumferential taping around the extremity
61
Q

steps of changing an IV bag

A
  • stop the flow of fluid
  • prepare the new IV bag
  • insert the piercing spike
  • ensure that the drip chamber is appropriately filled
62
Q

steps for discontinuing the IV line

A
  • shut off the flow
  • peel back the tape toward the IV site
  • stabilize the catheter while you loosen the tape
  • do not remove the IV tubing
  • place a 10 x 10 cm piece of gauze over the site
  • gently pull the catheter and the IV line
63
Q

factors affecting IV flow rates

A
  • check the IV fluid
  • check the administration set
  • check the height of the IV bag (must be hung high)
  • check the type of catheter used
  • check the tourniquet
64
Q

infiltration

A

the escape of fluid into the surrounding tissue, which causes a localized area of edema

65
Q

thrombophlebitis

A

inflammation of a vein and the presence of a clot

66
Q

occlusion

A

the physical blockage of a vein or catheter

67
Q

vein irritation

A

usually caused by a too-rapid infused rate

68
Q

hematoma

A

an accumulation of blood in the tissues surrounding an IV site
(resulting from vein perforation or improper catheter removal)

69
Q

nerve tendon and ligament damage

A
  • improper identification of anatomic structures
  • selecting an IV site near joints
  • sudden and severe shooting pain
  • immediately remove the catheter and select an other IV site
70
Q

systematic complication

A
  • allergic reaction
  • pyrogenic reactions
  • circulatory overload
  • air embolus
  • vasovagal reactions
  • catheter shear
71
Q

intraosseous (IO)

A

within the bone

72
Q

intraosseous infusion

A

technique for administering fluids, blood and blood products, and medications into the IO space of a long bone, usually the proximal tibia

73
Q

manually inserted IO needles

A
  • original devices
  • solid boring needle inserted through a sharpened hollow the needle
  • pushed into the bone with a screwing, twisting action
  • solid needle is removed, leaving the hollow needle in place
  • requires immobilization
74
Q

FAST1

A
  • first IO device approved for use in adults

- placement in the sternum

75
Q

EZ-IO

A
  • hand held, lithium battery powered medical drill to which a special needle is attached
  • used to insert an IO needle into the proximal humerus or tibia or distal tibia of adults and children
  • different sized needle
76
Q

bone injection gun

A
  • spring loaded device
  • used to insert an IO needle into the proximal tibia
  • comes in adult and peds sizes
77
Q

extravasation

A
  • needle rests outside the bone
  • IV fluid will collect in the soft tissues
  • discontinue the infusion immediately
78
Q

osteomyelitis

A
  • inflammation of the bone and muscle
  • caused by an infection
  • fewer than 0.6% of IO insertions
79
Q

calculating fluid infusion rates

A

gtt/min= volume to be infused x gtt/ml of admin divided by total time of infusion in mins

80
Q

calculating medical doses

A

volume to be administered = desired dose x volume on hand divided by dose on hand

81
Q

converting lbs to kgs

A

divide the patients weight in pounds by 2 then subtract 10% of that number

step 1: 120 lbs divided by 2 = 60
step 2: 60 x 10% = 6
step 3: 60 - 6= 54kg

82
Q

methods for determining the appropriate dose of medication for a pediatric patient

A
  • length based tape measures

- tables or charts specific to pediatric patients

83
Q

enteral medications

A

given through some portion of the gastrointestinal tract

84
Q

oral medication administration

A
  • capsules, time-released capsules, lozenges, pills tablets, elixirs, emulsions, suspensions, and syrups
  • absorbed at a slow rate
85
Q

syringe and needles

A
  • prepackaged in colour coded packs with a needle
  • plunger, body, flange and tip
  • hypodermic needle lengths vary from 1 - 5 cm
86
Q

the gauge refers to

A

the diameter

87
Q

what end of the needle attaches to the syringe

A

the proximal end

88
Q

what end of the needle is beveled

A

the distal end

89
Q

ampules

A

breakable sterile glass containers that are designed to carry a single dose of a medication

90
Q

vials

A

small glass or plastic bottles with a rubber-stopper top; they may contain single or multiple doses of a medication

91
Q

prefilled syringes

A
  • packaged tamper-proof boxes

- designed for ease of use

92
Q

intradermal medication administration

A
  • small amount of medication into the dermal layer
  • avoid areas that contain superficial blood
  • slow rate of absorption and minimal systemic distribution
93
Q

subcutaneous medication adminstration

A
  • loose connective tissue between the dermis and the muscular layer
    ex) insulin
94
Q

intramuscular medication admininstration

A
  • penetrating a needle through the dermis and subcutaneous tissue into the muscular layer
  • allows for a larger volume of medication
95
Q

IV bolus medication administration

A
  • places the drug directly into the circulatory system
  • fastest route of medication
  • no room for error
  • bolus is a single dose
96
Q

stopcocks

A
  • allows multiple lines to be connected
  • can control from which direction the flow is coming from
  • “off” points to the direction that is being blocked
  • allows for precise dosage to be delivered
97
Q

saline locks

A
  • used for patients who are not in need of IV fluid but may need medication therapy
  • adding medication to an IV bag
98
Q

IV infusion pumps

A
  • medication maintenance infusion

- allow you to set the parameters of medication administration

99
Q

IO medication administration

A
  • critically ill or injured children and adults when IV access is difficult or impossible to obtain
  • larger syringe to infuse the fluid
  • pressure infuser device should be used when infusing fluids in adults
100
Q

percutaneous medication administration

A
  • applied and absorbed through the skin and mucous membranes

- absorption is predictable

101
Q

transdermal medication administration

A
  • surface of the skin
102
Q

sublingual

A

under the tongue

103
Q

buccal medication administration

A
  • between the cheeks and gums

- tablets

104
Q

ocular medication administration

A
  • directly into the eye

- drops or ointments

105
Q

aurul medication administration

A

mucous membranes of the ear canal

106
Q

nasal spray

A
  • rapidly absorbed

- mucosal atomizer device

107
Q

nebulizer and metered dose inhaler

A
  • respiratory emergencies
  • oxygen, beta 2 agonist bronchodilators, ipratropium bromide
  • patient with a history of respiratory problems will usually have a MDI
108
Q

tracheal medication administration

A
  • if IV or IO access is unavailable as a last resort
  • you must administer 2 to 2.5 times the standard IV dose
  • only 4 medications can be administered this way
    (lidocaine, epinephrine, atropine, naloxone)

PCP (8 decks)

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