Exam 2; Week 1 Flashcards
(81 cards)
1
Q
What are 6 things you want to look at during your patient assessment before starting an IV?
A
- physical findings - mastectcomy or fistula?
- lab values
- age
- mobility
- skin
- allergies
2
Q
What is 1 thing about the patient’s past that you want to look at?
A
- patient history or IV experience - education needed
3
Q
Where do we see a 24 gauge catheter being used?
A
- pediatric
2. frail elder
4
Q
Where do we see a 22 gauge catheter being used?
A
- IVFs and antibiotics
2. low fluids
5
Q
Where do we see a 20 gauge catheter being used?
A
- blood products
2. hypertonic solutions
6
Q
Where do we see an 18 gauge catheter being used?
A
- L&D
- blood products
- high flow fluids
7
Q
Where do we see a 16 gauge catheter being used?
A
- trauma
8
Q
What is a stylet?
A
goes inside the catheter
9
Q
What is a catheter?
A
a flexible tube left inside the vein
10
Q
Where is the flash chamber?
A
beyond the hub
11
Q
What are the two safety devices on an IV catheter?
A
- retraction
2. metal tip
12
Q
What are 7 characteristics of a good vein?
A
- superficial
- smooth
- bouncy
- no pulsation - only arteries have this
- avoid vein bifurcation
- not close to a joint
- skin is normal
13
Q
What does a lumpy veins?
A
multiple valves
14
Q
What do hard veins mean?
A
sclerosis
15
Q
If you can’t find the perfect vein, if there are no options of a peripheral IV then what?
A
put in a peripherally inserted central catheter
16
Q
What is super important to do to provide patient comfort before putting in the IV?
A
- positioning - have them dangle their arm off the bed
- non pharmacological measures
- anesthetic use
- Using the non-dominant hand
17
Q
What are 6 vein dilation techniques?
A
- tourniquet - single & multiple
- tapping
- rubbing
- moist heat
- gravity
- fist clench
18
Q
When should you not use a tourniquet?
A
- garden hose veins - very large
- fragile skin
- steroid use
19
Q
What are 4 reasons why an IV catheter insertion could be unsuccessful?
A
- loss of blood return - may have pierced through vein
- severe pain - may be in surrounding tissue, may have pierced a nerve
- during flushing - vein puffs up
- no blood return - may have missed the vein
20
Q
What is the rule for unsuccessful IV catheter insertion?
A
two strikes and you are out! Know your IV start backup resources.
21
Q
A nurse assesses a patient’s IV site and notes redness, swelling, and warmth at the site. Vein feels hard when palpated. Which of the following complication of IV therapy does the nurse suspect? A. Infiltration B. Phlebitis C. IV infection D. Hypervolemia
A
PHLEBITIS
22
Q
A nurse assesses a patient’s IV site and notes pain at site, swelling around site, and coolness around the site. The IV dressing is leaking and pump is beeping occlusion on patient side. Which of the following complication of IV therapy does the nurse suspect? A. Infiltration B. Phlebitis C. IV infection D. Hypervolemia
A
INFILTRATION
23
Q
A nurse assesses a patient’s IV site and notes no redness, swelling, and a dry and intact dressing. The patient complains of dyspnea, palpitations, and puffy feet. Which of the following complication of IV therapy does the nurse suspect? A. Infiltration B. Phlebitis C. IV infection D. Hypervolemia
A
HYPERVOLEMIA
24
Q
A nurse assesses a patient’s IV site and notes redness at insertion site and a dry intact dressing. The patient complains of feeling “hot with chills” and “yucky”. Which of the following complication of IV therapy does the nurse suspect? A. Infiltration B. Phlebitis C. IV infection D. Hypervolemia
A
IV INFECTION
25
What are 6 important comparison points of peripheral IVs to central venous catheters?
1. inserted to small peripheral vein
2. IV catheter is short, length varies depending on gauge
3. short term use
4. inserted by RNs
5. clean dressing changes
6. saline only flushes
26
What are 6 important comparison points of central venous catheters to central venous catheters?
1. Inserted to large central vein
2. Line is long and tip terminates near the heart (SVC)
3. Long term use
4. Inserted by specially trained staff and surgeons
5. Sterile dressing changes
6. Generally require saline and heparin flushes
27
What are 4 types of central venous catheters?
1. PICC - peripherally inserted central catheters
2. tunneled
3. non-tunneled
4. implanted port
28
Where are central venous catheters placed?
Into large veins (internal jugular, subclavian, femoral)
29
What are central venous catheters used for?
1. IV fluids
2. medication (antibiotics, chemotherapy)
3. frequent blood draws
4. nutrition - Total Parenteral Nutrition
30
What is a Tunneled central venous catheter?
1. Intravenous central catheters enter the skin in one place and the vein in another.
- -> part of the catheter is tunneled under the skin to the point of vein entry
31
How is a tunneled central venous catheter secured?
with sutures
32
When not in use, what should you do with a tunneled central venous catheter?
flush with saline, followed by heparin to maintain patency
33
When you flush a central venous catheter what fluid is used before use?
saline only
34
When you flush a central venous catheter what fluid is used after use?
saline and heparin
35
When you flush a central venous catheter what fluid is used when not in use?
saline followed by heparin
36
What are 4 complications of CVCs?
1. infection - local and systemic
2. air embolism
3. thrombosis
4. fibrin sheath
37
Where does a PICC line go?
placed peripherally to upper extremity and threaded into the superior vena cava
38
How long can a PICC line be used?
1. days
2. weeks
3. months
39
Who receives PICC lines?
infants to adults
40
What is used to manage pain of inserting a PICC line in an adult?
local anesthesia
41
What is used to manage pain of inserting a PICC line in children?
sedation
42
Is PICC line-dressing changes sterile or non-sterile?
sterile technique
43
How often is a PICC line dressing changed?
5-7 days
44
What is an implanted port?
reservoir under the skin, port pocket that is placed in the OR. It comes in many shapes and sizes
45
How long can an implanted port be used?
2+ years
46
What does an implanted port require as far as access?
Requires monthly access with saline followed by heparin flush when not in use/not accessed
47
How is the implanted port accessed?
With non-caring needle or huber needle
48
If you access the implanted port, how often should it be changed?
every 5-7 days
49
Where will you find a PICC line?
arms
50
Where will you find Broviac, Hickman, Hohn, Groshong?
Generally on the chest, can be on the leg for infants or people who have history of multiple line placements
51
Where will you find implanted ports?
Reservoir is palpable on the chest
52
When do you want to use euros caps and tips? 4 times
1. Place a green disinfectant cap on the needleless adaptor of central line lumens not in active use
2. Place on all central line IV tubing side ports
3. Place on peripheral access too, if patient also has a central line
4. Use green disinfectant tips when IV tubing is temporarily disconnected
53
What is the order of flushing PIVs when administering med? noncontinuous infusion
1. saline
2. administer
3. saline
54
What is the order of flushing PIVs when administering med? continuous infusion
1. pause infusion
2. saline
3. administer
4. saline
5. resume infusion
55
whether it is a PIV or Central line, if you are not using it what should you do?
clamp that line
56
How often should IVs should be flushed?
every 4 to 6 hours
57
What makes starting a pediatric IV so hard?
child's veins are located in the same areas as an adult's, but SQ fat makes them more difficult to find
58
What kind of veins are preferred in pediatrics?
1. a large vein in the leg (i.e. the greater saphenous vein)
2. Foot veins are good as long as the child has not begun walking
59
Who are scalp veins great for?
9 moths of age and younger
60
What do you want to explain with scalp IV's?
explain that starting a scalp IV does not hurt any more than starting an IV somewhere in the body
61
How do you want to start a scalp IV?
insert at a 30 degree angle with the tip of the cathlon pointed down towards the heart
62
Why is starting a scalp IV ideal on a baby?
veins in hands, arms, legs, and feet are hidden by lots of baby fat, it may be easier to start a scalp IV
63
What does using a small-gauge cathlon do when giving a scalp IV?
a small cathlon will allow hemodilution of the meds/fluids by the blood as it flows around the cathlon
64
What does the cold do to veins?
causes them to shrink and become flat
65
What is super important when you are about to give an IV?
to be honest
1. explain the procedure
2. show parents and age-appropriate kids an IV Cath and plastic cathlon
3. admit that it may hurt
4. inform the parents that restraining is necessary
66
What are the 3 choices you can give parents when you start the IV?
1. Be an observer who watches quietly.
2. Sit near the head of their child and quietly talk to child, possibly stroke child’s hair.
3. Step outside the room. Perhaps get a cup of coffee or buy a snack at the cafeteria or vending area and wait until the procedure is completed.
67
If parents choose to stay, make sure they understand what 3 things?
1. They cannot interfere with the procedure in any way.
2. If their presence appears to be upsetting the child, they will be asked to leave the room.
3. If they become uncomfortable with the procedure, the sight of blood, etc., they may leave the room at any time.
68
With a baby that is 1 year of age or younger what do you want to focus on before giving an IV?
educating the parents. Generally, the younger the child, the more worried a parent is.
69
What do you want to provide for a baby that is 1 year of age or younger before giving an IV?
comfort measures; pacifier, possibly dipped in an oral sucrose solution
70
What can you encourage with a baby that is 1 year of age or younger what do you want to focus on before giving an IV?
encourage the baby to hold his or her favorite blanket or toy
71
Before giving a toddler (1-3) an IV, what do you want to do?
keep the explanation simple and short
72
What is not ok for a toddler (1-3) to do if they are getting an IV?
kick, bite, or hit
73
Is using a pacifier in the toddler years ok?
yes!
74
What do you want to encourage a toddler to hold before getting an IV?
his or her favorite blanket or toy
75
What is the show and tell age?
the preschool years: 3-5
76
What are some things you could do with a child who is between ages 3 and 5 before starting an IV?
1. Talk to the child. Get Child Life involved!
2. Perform modified IV start on a stuffed animal or doll
3. Offer chance to start an IV on the stuffed animal/doll
4. Allow child to touch and handle the tourniquet, alcohol pad/ChloraPrep, tape, and plastic IV cathlon
77
What do you want to do as soon as possible with a child who is between 3 and 5?
start the IV. the longer the wait, the more apprehensive the child will become
78
During the pre-school years what kind of comfort measures can you provide?
1. Encourage the child to hold his or her favorite blanket or toy.
2. Talk to the child as you are performing the procedure
- -> Praise child for his or her cooperation (even if child is not being cooperative).
- -> Tell the child that he or she is being very brave.
79
Who are in the want to know years?
school age: 6-12 years old
80
what are 3 things to do before giving an IV to a child that is in their school age years (6-12)?
1. Give a brief step by step explanation of what you will do & why you will do it.
2. Stress the benefits of the procedure.
3. Assure the child that you will try hard not to put the IV in his or her dominant hand and that the dominant hand will remain free to color, write, use cell phone, etc.
81
What are 4 other comfort measures you can provide before giving an IV to a child that is in their school age years (6-12)?
1. Give the child a sense of control by allowing child to help decide if mom or dad stays in the room.
2. Distraction actually works at this age.
3. If a parent stays, have parent hold the child’s hand and talk to the child.
4. Tell the child to focus on something else such as the TV, an electronics game, or iPod brought from home.
