Intravenous Therapy 2 Flashcards
Intravenous Access
Fluid & electrolyte replacement; Medication; Blood/blood products; Procedural contrasts; Blood specimen; Emergency access; Central vs. Peripheral
central line access more than _____ days
more than 14 days
central line is in
subclavian vena cava -> right atrium -> right ventricle -> out to circulation
central lines can handle
more volumes and more concentrated
tunnel catheters are used for
dialysis
would want central line if
large volumes, chemo, if medication is costic
Central Venous Access Reason for insertion:
Limited peripheral access, Long term therapy, High osmotic or caustic fluids or medications, Frequent blood /blood products, Hemodynamic monitoring, Hemodialysis
Central circulation:
Subclavian, Jugular
Types of central lines:
Non-tunneled, Tunneled, Implanted, Peripherally Inserted Central Catheter (PICC)
Non-tunneled
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
Tunneled
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
Implanted Ports
Long Term; Reservoir under skin; Single or Dual; Non-coring needle (Huber);; subq port, placed during surgery, need special needle to access
What is the difference between tunneled
and non-tunneled?
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.
Peripherally Inserted Central Catheter
PICC
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
Peripheral Venous Access
Short term; Catheter, cannula, butterfly needle
Peripheral Venous Access Uses
Continuous infusion; Keep Vein Open (KVO) or To Keep Open (TKO); Intermittent therapy (INT, Hep-lock)- Needs flush
Peripheral Venous Access can only be used ____ if inserted somewhere else
2 days
Peripheral Venous Access, KVO
running line at slow rate so want vein open, ex. PCA pump
Peripheral IV Nursing Procedures
Insertion, Maintenance, Discontinuation
IV Insertion, Verify Order
have to have order unless emergency
IV Insertion, Equipment:
Catheter gauge 24-14; Kit- tourniquet, dressing, skin prep, tape, label; Tubing- specific to pump; macro & micro; Extension with syringe flush
the larger the number then the
smaller the diameter of the catheter
blood has to be in a diameter of
20 or 18 because the diameter is bigger and blood has particles
flush extension tubing with
saline
if graft/fistula - can’t
can’t insert IV
after inserting an IV check site every
two hours
IV Insertion Site Selection
Hand or arm for adults, Distal & Non-dominant
IV Insertion Site Selection Patient consideration:
Mobility, Vein size & fragility, Previous access- including blood draws, Graft/fistula, Mastectomy, Other equipment
how can you tell if you insert IV into artery
there will be bright red blood, heart beat will shoot off blood with each beat
IV Maintenance Fluid delivery:
Rate/order- Pump & Controllers; Prepare next bag- Set pump & Have available
IV Maintenance Assessment:
At least every 2 hours; Rate, Patency, Site, Volume infused; Pt response
Medication Administration: Primary-
Electrolytes; Flush
Medication Administration: Secondary -
(Piggyback)- Antibiotics, Blood (has to be on own site), Narcotics
Medication Administration: V Push-
Port, Duration, Flush X 2
With IV medication check
Check Compatibility
some IVs have designated sites
heprin, TPA, blood products (have to have own rate on own site)
