CLASS 6 - IV FLUIDS + DEVICES + BP Flashcards
What are the 2 types of vascular access devices?
Central + Peripheral
Describe the function Central Venous Access Devices
Dump high concentrations of fluid / meds into a major central vein such as a jugular, vena cava, or subclavian. The fluid mixes w a large amt of blood immediately and therefore is immediately diluted.
Describe the function of Peripheral Venous Access Devices
Dump fluid / meds into a small peripheral vein (usually in the arm) where they mix with a small amt of blood and remain fairly concentrated before flowing to larger veins where it is eventually diluted.
Describe peripheral IVs (PIV). And the precautions associated with them.
IV inserted peripherally into a small vein in the arm.
PIVs can only be in one place for a few days and risk infection and leaking of fluid / meds into the local tissue.
Meds mix w very little blood and must be diluted enough not to irritate the small vessel or local tissue.
We change the location of PICs every few days to prevent local skin complications.
What is extravasation?
Leaking into local tissue
Describe CVAD IVs and some precautions associated with them.
inserted by a physician and secured in place by a suture or stitch.
Can be left in place for long periods of time - if cared for properly the risk for local infection and extravasation is lower.
Must be closely cared for to prevent blood infections, local infections, and risk of bleeding from bein accidentally disconnected or dislodged (larger vessel leads to more bleeding)
What is a Peripherally Inserted Central Catheter (PICC)? Who inserts them?
Very long IV inserted peripherally in the arm by a trained PICC nurse - travels inside a vein leading back to the heart
What is considered safer: CVADs or PICCs?
PICCs. They have all the advantages of a CVAD but are safer bc it is so long, well-held in place, and has a lower risk of hemorrhage if dislodged.
PICCs are inserted peripherally but dump the drug centrally, therefore the site of insertion is far away from the heart.
What are implanted Infusion Ports? Give an example.
Ex - port-a-cath
CVADs implanted under the skin of the chest wall w/ a needle inserted to access the port.
For long-term and intermittent use, reduces risk of infection through the skin or bleeding due to a disconnected or dislodged device.
What is an isotonic fluid? What effect does it have on the cell? Give an example.
Isotonic fluids have a concentration of dissolved particles (tonicity) equal to the ICF.
Osmotic pressure is therefore the same inside and outside the cells, so they neither shrink nor swell w fluid movement.
Ex - 0.9% NaCl
What is a hypertonic IV fluid? What effect does it have on the cell? Give an example.
Have tonicity greater than ICF, therefore osmotic pressure is unequal inside and outside the cells. Hypertonic fluids draw water out of the cells into the more highly concentrated ECF, therefore the cell shrinks.
Ex - 3% Saline, 50% DW
What is a hypotonic IV fluid? What effect does it have on the cell? Give an example.
Hypotonic fluids have a tonicity less than that of ICF, so osmotic pressure draws water into the cells from the ECF (cell swells).
ex - 1/2 NS
What is a Maintenance IV?
Slow, continuous infusion of IV fluid to keep patients hydrated
What is an IV bolus?
rapid infusion of IV fluid used as a treatment rather than simple fluid maintenance
What are crystalloids?
IV fluids composed of mostly water w some NaCl, glucose, or other electrolytes added in.
What is the [Na] in 1/2 NS? Is this iso, hyper, or hypotonic? What effect will this have on the blood?
0.45%
Hypotonic
Will dilute the Na in the blood
What does the effect of any IV concentration depend on?
The patient’s blood. Does it have high, low, or normal Na levels?
What effect would 1/2 NS have on normal plasma?
Would lower Na levels and cause fluid to move into the issues resulting in edema.
What effect would 1/2 NS have on hypernatremic plasma?
1/2 NS would bring the conc of plasma NA back to normal
What effect would 1/2 NS have on hyponatremic plasma?
It would make the hyponatremia worse.
If the [Na] in the IV fluid is 3.0%, what is it called?
Hypertonic saline. It has the opposite effect to 1/2 NS.
What effect will 3% Saline have on Normal Plasma?
You would not administer 3% saline to a person with normal plasma.
It will result in dehydration (cause fluid to leave tissues and flow into vessel)