Infusion Therapies

Question 1

Define crystalloid solutions.

Answer 1

Composed of electrolytes dissolved in H2O and include: dextrose sodium, sodium chloride solutions, balanced electrolyte solutions, alkalizing and acidifying solutions.

Question 2

Define colloidal solutions.

Answer 2

Composed of larger molecules- usually protein or starch suspended in fluid and are NOT a true solution.

Also called “plasma volume expanders”.

Used to maintain intravascular volume & prevent shock after major blood or fluid losses.

Examples: albumin, dextran & mannitol.

Question 3

Isotonic solution

Answer 3

250-375 mOsm/L
>0.9% sodium chloride=NS
>5% dextrose= D5W
>Lactate ringer’s solution=LR)

Fluid deficits
Dehydration
Fluid challenges

Same osmolarity as plasma.
No movement of fluid into or out of cells.

Question 4

Hypotonic solutions

Answer 4

Less than 250 mOsm/L

Diabetic ketoacidosis
Hyperosmolar hyperglycemia

Lower concentration than plasma.
Fluid moves of intravascular space into both intracellular space and interstitial space.

Question 5

Hypertonic solutions

Answer 5

Greater than 375 mOsm/L

Severe dehydration
Severe electrolyte imbalance

Higher concentration than plasma.
Fluid moves from the cells in to the intravascular space.

Question 6

Define osmolarity.

Answer 6

Measure of the concentration of the solution that is expressed in terms of number of particles (osmoles) per liter of solution.

Question 7

Antibiotics are more (acidic/basic) than blood.

What can it cause?

Answer 7

Acidic

Phlebitis (vein inflammation)

Question 8

Most IV solutions and medications are slightly (acidic/basic).

Answer 8

Acidic.

Question 9

If medication’s pH is too acidic or too basic, it must be given in a _________ ___________.

Answer 9

Central line

Question 10

What are veins? What are the layers?

Answer 10

Low-pressure blood vessels that return deoxygenated blood to the heart.

> Tunica intimate (innermost layer)
Tunica media (middle layer)
Tunica adventitia (outermost layer) {tough}

Veins have valves.

Question 11

What are the 2 types of intravenous access devices (IVAD)?

Answer 11

Peripheral- outer vessels
Central- superior/inferior vena cava

IVAD's should be:
>least invasive
>smallest gauge possible
>shortest catheter possible (possible infection)
>least number of lumens

Question 12

What are the standard colors to identify catheter gauge?

Answer 12

16G = Grey
18G = Green
20G = Pink
22G = Blue
24G = Yellow

Question 13

Catheter gauge/ Clinical indication

Answer 13

14, 16 & 18G = trauma, surgery, blood transfusion (rapid administration of large volumes)

20G = continuous/intermittent infusions, blood transfusions

22G = continuous/intermittent infusions in small veins

24G = continuous/intermittent infusions in fragile veins

Question 14

What are the types and time lengths of peripheral IV’s (PIV)?

Answer 14

Over-the-needle: less than 1 week

Steel winged: single infusion (radiology)

Midline: 1-4 weeks (not a central line)

Question 15

What are the types of central intravenous access devices (CVAD)?

Answer 15

Non-tunneled: inserted directly through the skin into the subclavian or jugular vein (for emergencies).

Tunneled: inserted under the skin, tunneled to insertion site (secured, for long periods)

Implanted ports: inserted under skin, assessed by noncoring needle, minimal care. (PIC line)

Question 16

What are other types of IVADs?

Answer 16

Femoral vein insertion: long cath inserted into the inferior vena cava, in emergency situation when upper extremities aren’t available, HIGH risk for infection.

Intraosseous route: into bone marrow, rapid infusion (1800ml/hr), recommended during CPR.

Question 17

List the equipment used in infusion therapy.

Answer 17

Needleless system: port that contains a valve, Leur Lock at the end of syringe, friction cleansing.

Infusion systems: primary & secondary tubing, SMART pumps (increase safety).

Question 18

During infusion therapy, what would you assess for fluid status?

Answer 18

I&O’s, weight, edema, lungs for crackles, moist mucous membranes, blood pressure and pulse.

> Lab tests: Na+ & K+ (electrolytes) & specific gravity

Question 19

How often should you change IV tubing?

Answer 19

Every 96 hours

Question 20

List administration IV terms.

Answer 20

Continuous

Intermittent
> Piggyback & saline lock

Bolus infusion (large amounts in short period)

IV push
>Dilution
>Rate
>Flush @ same rate

Question 21

Identify and name most commonly used veins for blood collection.

Answer 21

Median cubital vein (elbow)
Cephalic vein (thumb)
Median antebrachial vein (middle/center)
Basilic vein (pinky)

Question 22

What is the difference between active and passive transport?

Answer 22

Active: requires energy

Passive: doesn’t require energy

Question 23

Know the normal levels of electrolytes.

Answer 23

Na+ = 135 to 145
K+ = 3.5 to 5
Cl- = 97 to 107
Mg++ = 1.6 to 2.6
Ca++ = 8.2 to 10.2