Intravenous Therapy 2

Question 1

Intravenous Access

Answer 1

Fluid & electrolyte replacement; Medication; Blood/blood products; Procedural contrasts; Blood specimen; Emergency access; Central vs. Peripheral

Question 2

central line access more than _____ days

Answer 2

more than 14 days

Question 3

central line is in

Answer 3

subclavian vena cava -> right atrium -> right ventricle -> out to circulation

Question 4

central lines can handle

Answer 4

more volumes and more concentrated

Question 5

tunnel catheters are used for

Answer 5

dialysis

Question 6

would want central line if

Answer 6

large volumes, chemo, if medication is costic

Question 7

Central Venous Access Reason for insertion:

Answer 7

Limited peripheral access, Long term therapy, High osmotic or caustic fluids or medications, Frequent blood /blood products, Hemodynamic monitoring, Hemodialysis

Question 8

Central circulation:

Answer 8

Subclavian, Jugular

Question 9

Types of central lines:

Answer 9

Non-tunneled, Tunneled, Implanted, Peripherally Inserted Central Catheter (PICC)

Question 10

Non-tunneled

Answer 10

Short term; Directly in large vein- Subclavian, Jugular; Bedside insertion; Terms- C VL, Subclavian, Triple Lumen;; has wings that have to be sutured in place

Question 11

Tunneled

Answer 11

Long term; Insert chest & tunnel under skin; Surgical insertion; Types- Hickman, Broviac, Groshong (Depends on tip);; see no wings so not sutured, have cuff that goes under skin and once skin heels holds it in place, inserted off floor and in special environment

Question 12

Implanted Ports

Answer 12

Long Term; Reservoir under skin; Single or Dual; Non-coring needle (Huber);; subq port, placed during surgery, need special needle to access

Question 13

What is the difference between tunneled

and non-tunneled?

Answer 13

A Hickman® or Broviac®are both examples of tunneled catheters. They are placed in the OR or in interventional radiology . Nurses do not remove these; When you look at a tunneled catheter, it doesn’t have the “wings” that are used for sutures. Also, you can feel a bump a inch or two away from where the catheter comes out. This is the cuff, a piece of material that grows into the tissue to keep microbes out.

Question 14

Peripherally Inserted Central Catheter

PICC

Answer 14

Long term; Ante-cubital or above; Bedside insertion; RN-special training;; for 14 days, use chest xray to look at proper location, can be in superior vena cava or subclavian

Question 15

Peripheral Venous Access

Answer 15

Short term; Catheter, cannula, butterfly needle

Question 16

Peripheral Venous Access Uses

Answer 16

Continuous infusion; Keep Vein Open (KVO) or To Keep Open (TKO); Intermittent therapy (INT, Hep-lock)- Needs flush

Question 17

Peripheral Venous Access can only be used ____ if inserted somewhere else

Answer 17

2 days

Question 18

Peripheral Venous Access, KVO

Answer 18

running line at slow rate so want vein open, ex. PCA pump

Question 19

Peripheral IV Nursing Procedures

Answer 19

Insertion, Maintenance, Discontinuation

Question 20

IV Insertion, Verify Order

Answer 20

have to have order unless emergency

Question 21

IV Insertion, Equipment:

Answer 21

Catheter gauge 24-14; Kit- tourniquet, dressing, skin prep, tape, label; Tubing- specific to pump; macro & micro; Extension with syringe flush

Question 22

the larger the number then the

Answer 22

smaller the diameter of the catheter

Question 23

blood has to be in a diameter of

Answer 23

20 or 18 because the diameter is bigger and blood has particles

Question 24

flush extension tubing with

Answer 24

saline

Question 25

if graft/fistula - can’t

Answer 25

can’t insert IV

Question 26

after inserting an IV check site every

Answer 26

two hours

Question 27

IV Insertion Site Selection

Answer 27

Hand or arm for adults, Distal & Non-dominant

Question 28

IV Insertion Site Selection Patient consideration:

Answer 28

Mobility, Vein size & fragility, Previous access- including blood draws, Graft/fistula, Mastectomy, Other equipment

Question 29

how can you tell if you insert IV into artery

Answer 29

there will be bright red blood, heart beat will shoot off blood with each beat

Question 30

IV Maintenance Fluid delivery:

Answer 30

Rate/order- Pump & Controllers; Prepare next bag- Set pump & Have available

Question 31

IV Maintenance Assessment:

Answer 31

At least every 2 hours; Rate, Patency, Site, Volume infused; Pt response

Question 32

Medication Administration: Primary-

Answer 32

Electrolytes; Flush

Question 33

Medication Administration: Secondary -

Answer 33

(Piggyback)- Antibiotics, Blood (has to be on own site), Narcotics

Question 34

Medication Administration: V Push-

Answer 34

Port, Duration, Flush X 2

Question 35

With IV medication check

Answer 35

Check Compatibility

Question 36

some IVs have designated sites

Answer 36

heprin, TPA, blood products (have to have own rate on own site)