Definition Flashcards
IV Therapy
Assessment – renal/cardiac function Monitor patient status (Wt, I/O, lab studies) Doctor’s orders - rate and solution Patient Safety Be aware of “high alert” drugs (KCL) Smart pump Computerized physician order entry
Flow rates via Gravity (without pump)
Patency of cannula
Venous spasms
Size of cannula
Blood in tubing
Present of local complications
The higher you hang a bag, the faster it will go
Patency – there should be nothing obstructing it (blood clot will cause drip rate to slow down or just blood in the tubing)
If you suspect blood in tubing, you can try and flush, but if there is a clot, DO NOT force it back into the body
Spasms – can slow flow; caused by cold temp (constricting vessels), cold temp of IVs/IV meds that are in the refrigerator
Peripherally Inserted Central Catheters (PICC)
Placed in the antecubital fossa Tip resides in SVC Low complication rates and less expensive No BP/blood draws in this extremity Fluid comes out in superior vena cava and can handle more meds because it is bigger than a vessel Nurses need to protect PICC lines BP cuff could collapse/destroy Do not draw blood
Multi-Lumen Catheter
Can deliver two or more solutions at same time via separate pathways
Necessary for patients who are getting multiple meds, especially blood because blood can only be given with saline
By the time they mix in the blood, all of the meds are well diluted
Implanted Ports
No part of catheter is visible
Venous system most common placement
Accessed with a needle through the skin
Helpful for kids because they will not grab at it like they would with the lines
In the SVC
Can be accessed when needed, but okay to stay there without use as well (small lump)
Can stay in for months-years
Common for chemo patients so they can administer it at home
There may be a small incision over the top of the port from where it was inserted
Indications for Central Venous Access Device (CVAD)
Medication Administration
Nutrition
Blood samples/transfusions
Conditions (renal failure, burns etc.)
Intraosseous Route
High infusion rates are possible
Pain meds may be required
Good for severely dehydrated or during cardio/resp. emergencies
Proximal humerus, proximal and distal tibia
Instills meds directly into the bone
Severe dehydration and cant get a line or in the middle of a code
Used more in ER during traumas
Central Line Care
X-Ray before starting fluids Sterile dressing change Observe site for S/S infection Observe for IV systemic complications Care depends on complication assessed Cannot start anything until we know for sure that the tip is inserted in the correct area (SVC)
Complications of Central Venous Access Devices (CVADs)
Catheter Occlusion Embolism Infection Pneumothorax Catheter Migration
What is the nurse’s role in IV therapy?
Assessment and listen to the patients
Always investigate if there seems to be a problem
Local Complications: Infiltration/Extravasation
Infiltration/Extravasation: Skin is pulled away – fluid going into interstitial space
Edema
Pain
Cool temperature
Red
When assessing IVs, you need to look at site at least every hour (fluid build up, red, open, etc)
Compare to other area (hand v. hand, etc)
Pull the IV out if you suspect something is wrong
Make sure you think about what to do next (what med/saline was going in and why?) – what needs to be done next to keep patient safe and stable
Local Complications: Nerve Damage
Nerve damage is a big concern Fluid compresses nerves Tingling Numbness in fingers (Emergent situation) Fluid can be reversed, but nerve damage may not Prioritize what needs attention
Hematomas/Ecchymosis
Hold pressure after removal to avoid hematomas
Phlebitis
Phlebitis is warm feeling – take catheter out of the arm to avoid more harm
Thrombophlebitis
Thrombophlebitis = clot (this warrants a call to physician, do not press on clot b/c you could dislodge it)
Site infection
Redness
Swelling
Possible fever
Catheter Related Infection
Caused by poor sterile technique/contamination
Pay attention to ABCs
BP stable
Call RR
Abrupt rise in temp, severe chills, shaking, increase HR, RR, headache
Circulatory Overload
Patient got too much fluids and body couldn’t handle it
Increase head of bed
Give O2
Turn to KVO rate (keep vein open) – slow down so your don’t do more harm to patient
If bad, call RR
If you catch it early, call physician – they will likely order Lasix to get rid of fluid excess quicker
Increase BP, distended neck veins, Shortness of breath
Pneumothorax
Generally occurs when they are putting a central line in
Intervention with chest tube
Decreased or absent breath sounds, respiratory distress, distended unilateral chest
Air embolism
BP is low unlike circulatory overload where it increases
Occurs when you change a central line – if you don’t cap it correctly
Prime line incorrectly
Intervene by positioning in left lateral modified Trendelenburg (head slightly down, feet slightly up, left side) – traps air in right atrium and it gets pulled out
Chest pain, SOB, decrease BP, increase HR, cyanosis, anxiety, confusion
IV Push
Always flush before and after to make sure all meds are in patient
We don’t want to mix meds if there is some left over from previous push
Push slowly
Not all drugs can be pushed
Faster reaction from patients
If they do have a reaction, the nurse will be there to intervene quickly
Disadvantage: cant take back and cant slow down, adverse reaction could be more severe and quicker
IV Piggyback
Assess patients and teach them meds
Goes into primary line with drip rate (over longer course of time)
Make sure it is diluted in the correct type of solution***
Advantage: Don’t have to be in the room the whole time, less risk of adverse rxn because it is diluted, if there is a rxn majority of med will still be in bag so we can stop it
Disadvantage: Not in the room the whole time to see reaction when it occurs
PCA Pumps
Enables the patient to self administer medication on prn. basis
Programmed according to medical orders (dosage, time intervals between doses, and lock-out intervals)
Can record the amount of medications received and the number of requests by the patient
Perfusion
refers to the flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells.
Central Perfusion
Force of blood movement generated by cardiac output
Requires adequate cardiac function, blood pressure, and blood volume
Cardiac output (CO) = Stroke volume × heart rate
Central perfusion is cardiac output – need blood volume to maintain perfusion
If the heart is not pumping, you will see signs all over the body
Peripheral Tissue or Local Perfusion
Volume of blood that flows to target tissue
Pressure generated from each myocardial contraction supplies blood to peripheral vascular system
Valve in each vein keeps blood flowing in direction toward heart
Local perfusion or tissue perfusion is a local effect (ex. Blood not flowing to feet)
Local manifestations
Most of the effects stay local, although it could create a chain reaction and become systemic
