Intravenous Therapy Flashcards by Audrey Mejia

To Start an IV you must have

A provider’s order with type, kind, and rate of solution

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Type of nurse that inserts and manages IV’s the best

ICU nurses

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Nurses must know these to start an IV

Type of solution
Desired effect
Possible complications
Patient’s condition
Reason for IV

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Inserting needle or catheter into a vein using sterile technique

Venipuncture

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IV insertion site:

Extremities: hands, arms, feet, legs

Peripheral

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IV insertion site:

Subclavian or internal jugular veins

Central

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This IV is entered towards the IVC for chemo or potassium because they are caustic to veins

Central

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IVC

Inferior Vena Cava

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Fluids should be what temp?

Room temp and site dressed with sterile dressing

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What peripheral site is not recommended for adults? Why?

The foot because of possible circulation problems

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Use the _______ gauge cannula that can deliver the prescribed therapy at the desired rate

smallest

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Use _______ gauge cannula for rapid infusion of IV fluids, viscous medications, or blood components

18–20 gauge

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Use _________gauge shorter cannula (e.g., 3/4-inch) cannula for older adults and pediatric patients.

22–24 gauge

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Obese patients may have veins deeper in the subcutaneous tissue and may require _______.

Longer IV cannulae. May consider a peripherally inserted central catheter (PICC) as an alternative

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Macro tubing:

10,15,20 gtts/minute

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Micro tubing

60gtts/min

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IV fluid closest to ECF osmolality

Isotonic

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IV fluid used expand EC volume (plasma)in fluid loss, dehydration & hypernatremia

Isotonic

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IV fluid that does not provide nutrition-only 200 calories per liter!!

Isotonic

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D5W

Dextrose 5% in water: no sodium! If used for long time can deplete sodium…

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IV fluid that if used for long time can deplete sodium…

D5W

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Types of Isotonic fluids

D5W, Lactated Ringers, and NS

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NS –

0.9% Saline (normal)

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IV fluid that is a good ECF expander but is not completely like ECF because only has Na & Cl

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Isotonic fluids can cause

Fluid overload

IV fluid that contains many electrolytes found ECF

Ringers Solution

Fluid used to replace ECF loss such as: burns, hypovolemia & diarrhea

Ringers solution

Ringers are not enough to replace severe loss unless it states

“R” which is replacement fluid

Solution that is the same as Ringers but with bicarbonate!

Lactated Ringers Solution

Helpful in mild metabolic acidosis

Ringer solution

IV fluid used to replace CELLULAR FLUID (water)

Hypotonic

IV fluid that can lead to intravascular depletion

Hypotonic

IV fluid given for dehydration

Hypotonic

Iv fluid given for fluid overload

Hypertonic

Macro is what type of drip?

Gravity

Micro is what type of drip?

Pump

colloid is

hypertonic

IV solution that is commonly given in the OR

Lactated Ringers

Dextrose makes any solution it is added to

more hyper in osmolality-

Dextrose quickly metabolizes usually leaving

hypotonic fluids

HYPER is ____%

> 0.9 saline

Types of hypertonic fluids

D5W & 0.45 NS

Injection given to a hypoglycemic patient

D50

TPN is always given through

a central line

TPN is what kind of solution

Hypertonic

Type of IV fluid that draws fluid into vascular space

Hypertonic

Can be seen in IV nutrition TPN when 50% Dextrose used

Hypertonic

What vein would be used for TPN?

IVC/ central line

Length of needles (range)

1/2 in to 2 in

Needle gauges

16, 18, 19, 21, 23, 25

PICC

peripheral inserted central cath

Central Venous Access Devices:

PICC(peripheral inserted central cath) Implanted Ports Tunneled vs Non-tunneled

AMOUNT TO INFUSE IN ONE HOUR IS CALLED

DRIP RATE

Things that can affect drip rate:

solution used tubing used temperature solution

MACRO tubing -delivers:

10 per cc or 15 per cc

Used when fluid rates are for 1000cc/8hours or less in most cases or when fluid is >100cc per hour

Gravity Drip

MICRO tubing delivers=

60 drops a cc

Careful delivery of <100cc per hour

Micro drip

IV’s must be checked

HOURLY

Syringe pumps

insulin or fluids

IV dressings must be changed

q96h

Signs of fluid overload

cough increased BP dyspnea

Treatment of IV fluid overload

decrease IV rate, monitor VS, HOB high, MD contact

Air embolism is caused by

Failure to prime IV line

Signs of air embolism

dyspnea, decreased BP, weak pulse, chest pain

Air embolism is seen more often in

central vein

Treatment for air embolism

PLACE ON LEFT SIDE, Trendelenberg! VS, O2

Signs of septicemia

Abrupt Fever, headache, backache, increased pulse, RR chills, shaking

Treatment for septicemia

culture IV, antibiotics

Clot that forms on catheter & can break loose into circulation

Thrombus

Signs of thrombus

Redness, edema of site, tender

Treatment for Thrombus

Stop IV, warm compress, restart another spot

Treatment for infiltration or phlebitis

Warm compress & elevate extremity

Before any blood transfusion, the patient must

sign consent

Rh negative means the pt does not have

antigen in blood

If Rh negative gets Rh+

pt will develop antibodies & have red blood cell destruction

Whole Blood:

RBC’s, WBC’s, platelets, plasma & clotting factors

Whole blood is administered through

18g angiocath

Whole blood can only be given with what type of IV solution?

Packed RBC contains

RBC’s & 20% plasma

Packed RBC is good for what type of patients?

Fluid overload patients

Fresh frozen plasma is used to treat

clotting deficiency, expand volume

Fresh frozen plasma: one unit is to be given over

30 min

Platelet transfusion contains

platelets, WBC’s & plasma

Platelet transfusions are given to treat

Thrombocytopenia

Platelet transfusions are given over

1 unit over 30 min

Cryoprecipitate replaces

clotting factor

Cryoprecipitate is given over

10 mins

WBC transfusion contains

WBC’s & plasma

WBC transfusion treats

Low granulocytes

WBC transfusion patients must be premedicated with

antihistamine & Tylenol!

Albumin comes in

5% & 25% in 100cc

Albumin is

Plasma protein used to replace protein/fluid loss

Albumin is given

1ml/min with D5W

Normal Lab Values: Hemoglobin

(M=13-18) (F=12-16)

Normal Lab Values: Hematocrit

(M=45-52) (F=37-48)

Normal Lab Values: WBC

4,300-10,800

Normal Lab Values: Platelets

150,00-450,000

Blood products must run

slowly (2-5 ml/min) for 1st 15 min

TPN infused through

A peripheral or central vein

Lipids are given

To patients with catabolic states

Lipids may be given

piggybacked into TPN in either peripheral or central veins

Central catheter is inserted into

subclavian vein under sterile conditions

Central Venous Nutrition( TPN) is Indicated when

glucose concentration>10%

After Central Venous Nutrition( TPN) line insertion,

a CHEST XRAY MUST BE DONE before use, to insure proper placement

IV Nutrition may be started in a peripheral vein

if the glucose solution concentration is not > 10%

>10% concentrations are hypertonic to peripheral veins and MUST BE USED IN

CENTRAL VEINS

Due to the high glucose content, TPN, PN are prime mediums for

bacterial growth!

#1 complication of TPN=

Infection

Complications related to Central Catheter

Pneumothorax with subclavian Air Embolism

Volume in IV tubing only

25-30 cc

Use clamp and one way valve to prevent

air embolism

When given phone consent

2 nurses must be present

Platelets can clump so

lightly shake

cryoprecipitate is given to what type of patients?

septic patients

Reduces swelling/fluid overload. It sucks fluid back to intracellular space

Albumin

During transfusion, a 2 degree raise in temp is

a sign of reaction

A classic reaction to transfusion

hemolysis

Low back pain is a classic sign of

Clumping of blood (hemolysis)

Sometimes protein in donor blood causes

anaphylactic reaction

Clinimix can be given through

peripheral line

If TPN is given during the day,

Lipids are given at night

If TPN is late, hang

D10