Intravenous Therapy Flashcards
To Start an IV you must have
A provider’s order with type, kind, and rate of solution
Type of nurse that inserts and manages IV’s the best
ICU nurses
Nurses must know these to start an IV
Type of solution
Desired effect
Possible complications
Patient’s condition
Reason for IV
Inserting needle or catheter into a vein using sterile technique
Venipuncture
IV insertion site:
Extremities: hands, arms, feet, legs
Peripheral
IV insertion site:
Subclavian or internal jugular veins
Central
This IV is entered towards the IVC for chemo or potassium because they are caustic to veins
Central
IVC
Inferior Vena Cava
Fluids should be what temp?
Room temp and site dressed with sterile dressing
What peripheral site is not recommended for adults? Why?
The foot because of possible circulation problems
Use the _______ gauge cannula that can deliver the prescribed therapy at the desired rate
smallest
Use _______ gauge cannula for rapid infusion of IV fluids, viscous medications, or blood components
18–20 gauge
Use _________gauge shorter cannula (e.g., 3/4-inch) cannula for older adults and pediatric patients.
22–24 gauge
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
Macro tubing:
10,15,20 gtts/minute
Micro tubing
60gtts/min
IV fluid closest to ECF osmolality
Isotonic
IV fluid used expand EC volume (plasma)in fluid loss, dehydration & hypernatremia
Isotonic
IV fluid that does not provide nutrition-only 200 calories per liter!!
Isotonic
D5W
Dextrose 5% in water: no sodium! If used for long time can deplete sodium…
IV fluid that if used for long time can deplete sodium…
D5W
Types of Isotonic fluids
D5W, Lactated Ringers, and NS
NS –
0.9% Saline (normal)
IV fluid that is a good ECF expander but is not completely like ECF because only has Na & Cl
NS
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?
NS
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
