Injectables Flashcards
Why may a person receive intravenous therapy, four answers:
- Resuscitation: are given to correct an intravascular volume deficit in the case of absolute or relative hypovolemia
- Replacement: are administered to correct fluid deficits that cannot be compensated by oral intake. Such fluid deficits have a number of potential origins, like drains or stomata, vomiting, burns, diarrhoea, vacuum dressings
- Maintenance: are given, specifically, to cover the patient’s daily basal requirements of water, glucose, and electrolytes. As such, they are intended to cover daily needs.
- Nutrition: Often overlooked, it is about time to consider parenteral nutrition as another source of intravenous fluids that may contribute to fluid overload or accumulation. On the other hand, enteral nutrition can also contribute to fluid overload in critical illness as the adaptive mechanisms to avoid water and sodium retention may not always function properly. Likewise, nutritional therapy in the critically ill should be seen as “medication” helping the healing process.
What maybe a symptom which may indicate a problem with and IV cannula, five answers:
- Infiltration: The IV cannula becomes dislodged from the vein or
passes through the wall of the vein. Infusion fluid
enters into the surrounding tissue. Often caused by
poorly secured cannulas
2.Thrombosis: A blood clot forms in the vein at the tip of the
cannula causing an obstruction in the cannula. Do
not force the flush as this can dislodge the clot into
the systemic circulation
- Extravasation: Vesicant medication enters into the surrounding
tissue. This may be caused by a dislodged cannula,
increased pressure or irritation of the vesicant fluid
on the vein wall, or vein wall being punctured on
insertion of the cannula - Phlebitis: Inflammation of the vein may be caused by
irritating medications or fluids, or from the cannula
irritating the vein wall - Haematoma: Infiltration of blood into the tissues commonly
caused by trauma to the vein wall on insertion of
the cannula
The Enrolled Nurse Scope of Practice in IV Administration?
Whilst it is important to check with local policies regarding EN scope of practice within each facility in regard to IV administration, the EN is expected to attain the knowledge regarding the therapeutic and adverse effects of the IV medications to be administered, the rationale for IV therapy and the fluid and electrolyte balance of the individual receiving the treatment (Broyles et al, 2016). The nurse may additionally require skills to assist with the following under direct supervision of a Registered Nurse.
- Preparation of IV administration including:
o gathering equipment
o priming a line
o assisting with insertion of a PIVC
o connecting IV tubing to a PIVC - Administration of IV Medications as per workplace policies and procedures
- Management of IV therapy including:
o Assessing intravenous access site and line for abnormalities
o Monitoring an accurate rate and drip rate
o Changing a fluid bag - Removing a PIVC
- Documentation of medication management
When obsering an IV cannula, when should it be replaced?
- Indications for dressing change include when it becomes insecure or if there is blood or fluid leakage under the dressing.
- The possible reasons for removal of PIVC’s include a number of complications which range from infiltration, extravasation, phlebitis, occlusion, dislodgement and migration. Once the child’s treatment is over, the PIVC should be removed to avoid any additional complications.
Complications of Blood Transfusion, two answers and how long must blood be out for + handle?
- Blood incompatibility: ABO incompatibility may cause an acute haemolytic reaction leading to potentially life-threatening events (Lewis, 2017). Symptoms of this may include hypotension, tachycardia, increased body temperatures, shock, rigors, tachypnoea, wheeze or stridor, nausea, vomiting and/or chest pain (Lewis, 2017). Blood incompatibility may also include circulatory overload whereby a blood product is infused quickly over a short timeframe. Signs and symptoms of this include anxiety, dyspnoea, orthopnea and crackles to the lung base on auscultation (Lewis, 2017).
- Blood transfusion reaction: Transfusion reactions associated with allergies often have mild symptoms such as increased body temperatures or rash. An individual may also react to the white blood cell content of a donor blood product causing mild reactions such as fever or chills from a febrile non-haemolytic reaction. Mild allergic reactions may respond to antihistamines or antipyretics (Lewis, 2017). In more severe cases, a patient may experience an anaphylaxis. The nurse must be prepared at all times to perform life- saving measures. For all types of blood transfusion reactions, the nurse must stop the transfusion and urgently report to the medical officer for review. (Australian and New Zealand Society of Blood Transfusion Ltd, 2018). The transfusion should not be re-commenced until a medical review has been completed.
Blood products and room temperature:
Red cell components must not exceed 30 minutes at room temperature on each occasion. Maintain components in a controlled temperature environment until administered. Handle and store components in a way that minimises the possibility of product tampering.
When should an IV cannula be replaced?
Every 48-72 hours or as per local policies and procedures. 24 hours if inserted in emergency
IV infusion administration methods, two answers
An IV infusion is a controlled administration of medication into your bloodstream over time. The two main methods of IV infusion use either gravity or a pump to send medication into your catheter:
Pump infusion. Generally the most common method used. The pump is attached to your IV line and sends medication and a solution, such as sterile saline, into your catheter in a slow, steady manner. Pumps may be used when the medication dosage must be precise and controlled.
Drip infusion. This method uses gravity to deliver a constant amount of medication over a set period of time. With a drip, the medication and solution drip from a bag through a tube and into your catheter.
What is Intramuscular (IM)?
Intramuscular (IM) is a medical term that refers to the injection of medication into a muscle. IM injections are often used to administer vaccines and other drugs
Notes about Intramuscular? Depth, angle, length, sites chosen and effectiveness
- A deep injection
- 90-degree angle
- 3mls or less
- Rapid action
- Sites chosen where minimal risk of puncture to large blood vessels or nerves
- Works quicker than subcutaneous as increased blood supply and flow
Examples of Intramuscular injections? and the recommended location
Antibiotics
(e.g. penicillin)
Hormonal agents
(e.g. testosterone)
Vaccinations
Locations: upper arm, hip, thigh, and buttocks.
What is the Z-Tract Technique?
Method used when highly irritating or may stain
patient skin
Examples of Z-Tract Technique injections?
Iron injections, to ensure leakage isn’t going to stain the skin
What is Subcutaneous (S/C)?
a method of administering medication or fluids into the fatty tissue just below the skin.
Notes of Subcutaneous (S/C)? injections? Depth, angle, sites chosen, difference between adult length and children length
- Into subcutaneous layer of the
skin - Above the muscle layer
- 45-degree angle
- Usually, 25g needle
- 2mls or less in adults
- 1ml or less in children
Examples of where we would inject a Subcutaneous and why?
- Middle 3rd of upper, outer,
lateral arm - Middle 3rd of upper thighs
abdomen 2.5cm clear of
umbilicus - To the margins of the iliac crest
Insulin
(hypoglycaemic)
Heparin
(anticoagulant)
What is an Intradermal injections?
injections administered into the dermis, just below the epidermis.
Notes about Intradermal injections? Degree, length, location
- Into the dermis
- Inserted at 15–30-degree
angle - 1ml or less
- Usually, 25g needle
- Bleb under skin surface
- Usually inner forearm/back
Examples of why we should give an Intradermal injections?
Allergy patches
Some vaccinations
(Mantoux, Hep B, BCG)
What is Intravenous (IV)?
a medical procedure that involves inserting a needle or tube into a vein to deliver fluids, nutrients, or medications directly into the bloodstream
What would we supply when giving an Intravenous Administration?
- Blood or blood products
- Normal Saline (0.9% - 0.45%)
- 4% Dextrose and 1/5 Normal Saline
(4% + 1/5) 5% Dextrose - Hartmann’s Solution
- Medications
What three types of Intravenous Administration would you apply to the patient?
IV ‘push’ -fluid or drug given IV via syringe over a short time
Bolus Dose –large volume or dose of drug given IV at one time
Continuous Infusion – via pump over a long time
Notes about IV
- Short term use
- Usually in forearm or
hand - Sterile IV fluids
delivered via an IV
tubing line - Continuous infusions
- Intermittent infusions
What does stand for PICC?
A peripherally inserted central catheter (PICC) is a long, flexible tube that’s inserted into a vein in the arm or leg and threaded into a large vein near the heart.
What is PICC used for?
Give intravenous fluids, blood transfusions, chemotherapy, and other drugs
Take blood samples
Provide nutrition directly into the bloodstream
Immediate effect of medications as it’s via heart
IV Complications, what symptoms may you observe?
Redness
Tenderness
Warmth
Swelling
Pain
IV Complications
- Extravasation (tissued)
- Incorrect IV therapy administration
- Medication errors
- Fluid overload – pulmonary effusion, CCF
- Under-hydration
- Air embolus
- Bacteraemia
- Septicaemia
Medication Safety, 5 answers
NEVER recap needles
NEVER re-use needles
ALWAYS place used sharps directly into a sharp’s container
ALWAYS check MIMS, IV Injection and Don’t Rush to Crush
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