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NCLEX-RN® > NCLEX-RN (1) Fundamentals > Intravenous Therapy > Flashcards

Intravenous Therapy Flashcards

Review the types of IV fluids, how to put an IV in, and complications.

1
Q

What is intravenous therapy (IV therapy)?

A

It is giving fluids and other nutrients through a vein.

It is given to clients who can’t take fluids orally or when there is dehydration.

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2
Q

What are the steps to insert an IV?

The nurse is using a translumination device to locate the veins.

A
  1. Select site
  2. Clean the site with disinfectant solution
  3. Apply tourniquet
  4. Insert needle
  5. Check indicator of blood return
  6. Advance catheter
  7. Pull stylette back slightly, advance catheter into vein
  8. Release tourniquet
  9. Apply gentle pressure over the vein at the catheter tip and remove the metal stylette
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3
Q

What is the difference between a peripheral IV site and a central line?

A
  • Peripheral IV site: a short IV that goes into a vein into the arm.
  • Central line: an IV that also goes into a vein but is threaded much further in so that the tip of the catheter site is closer to the heart for quicker administration.
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4
Q

What are the 3 types of IV solutions?

A
  1. hypotonic
  2. isotonic
  3. hypertonic
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5
Q

What is a hypotonic solution and what are some examples?

A

Hypotonic solutions are “more watery”. There is a lower concentration of solutes compared to body fluids.

Examples: 0.45% saline, 1/2 normal saline, D2.5W, 0.33%NS

When given, HypOtonic fluids will first go into the vascular space then will shift “Out of the vessels” and into the cells to replace cellular fluid.

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6
Q

In what situations is a hypotonic solution given?

A
  1. Fluid replacement for those with nausea/vomiting, burns or hemorrhage for a client who has cardiac or renal disease
  2. Hypernatremia
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7
Q

Why is a hypotonic solution given for fluid replacement for clients with cardiac or renal disease?

A

Clients with cardiac or renal disease cannot handle extra fluids too quickly.

A hypotonic solution prevents the client from receiving fluids too quickly because it goes into the vascular space and then leaves quickly to go into the cells.

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8
Q

Why is a hypotonic solution given to clients with hypernatremia?

A

Because it will dilute the sodium in the blood.

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9
Q

What is an isotonic solution and what are some examples?

A

Isotonic solutions have the same concentration of solutes as body fluids.

Examples: 0.9% NS, Lactated Ringers or LR, D5W, D5 1/4 NS

When given, iSotonic fluids will first go right into the vascular space and then “Stay in the vessels” to treat dehydration.

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10
Q

In what situations is an isotonic solution given?

A

It is fluid replacement for those with nausea/vomiting, burns or hemorrhage.

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11
Q

Who should NOT receive isotonic solutions?

A

Clients with renal or cardiac disease.

The kidneys and heart cannot handle the extra fluid. It will cause fluid volume overload.

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12
Q

What is a complication of administering too much isotonic solution?

A

It can cause fluid volume overload and increased blood pressure.

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13
Q

What is a hypertonic solution and what are some examples?

A

Hypertonic solutions have an increased concentration of solutes as compared to body fluids.

Examples: D10W, 3%NS, 5%NS, D5LR, D5NS, TPN, albumin

When given, fluids will first go into the vascular space and then pull fluids from the 3rd space to go back into the vessels.

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14
Q

In what situations is a hypertonic solution given?

A

When a client has too much fluid in the 3rd space such as severe edema, burns or ascites.

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15
Q

What is a complication of administering too much hypertonic solution?

A

It can cause severe fluid volume overload.

This client is usually in an ICU with frequent monitoring of blood pressure, heart rate, and central venous pressure.

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16
Q

What substances are in D5W and D10W?

A

Glucose

  • D5W: 5% dextrose and water
  • D10W: 10% dextrose and water

Dextrose is a type of sugar.

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17
Q

Which type of client should typically NOT receive D5W or D10W?

A

Clients with diabetes because the blood sugar is already elevated.

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18
Q

What substances are in lactated Ringer’s (LR)?

A

Sodium, potassium, calcium, and water.

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19
Q

Which clients is Lactated Ringer’s NOT given to because of electrolyte overload?

A

Clients with acute kidney injury or chronic kidney disease because their potassium is already elevated.

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20
Q

What are IV gauges?

A

They are the size of the diameter of the needle.

It is sometimes called a lumen or cannula.

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21
Q

Complete the sentence:

The ______the IV gauge number the _______the diameter.

A

smaller, larger

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22
Q

What IV gauge would be used for rapid fluid administration or blood products?

A

18 or 19 gauge lumen

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23
Q

What IV gauge would be used for fat emulsion (lipids)?

A

20 or 21 gauge lumen

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24
Q

What IV gauge would be used for standard IV fluids or IV meds?

A
  • 22 or 24 gauge lumen
  • 25 gauge lumen for very small veins
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25
**Label the parts of IV tubing:** * drip chamber * extension hook * flow control clamp * piggyback set * piggyback Y-port * primary set * secondary Y-port * slide clamp * spike
26
What does it mean to **"prime the tubing"?**
To make sure the **tubing has fluid in it** before it is connected to the client's IV access and started.
27
What is an **IV piggyback** or **secondary tubing?**
An IV medicine that **goes through the IV tubing** that is hung above the main bag of IV fluids.
28
What is the **purpose** of an IV filter?
To **catch and prevent larger molecules** from entering the client's veins.
29
What is an **IV pump?**
A machine where the IV tubing is placed to **control the amount** of fluids a client gets without having to calculate and count drips.
30
What is a **normal IV fluid rate** for a typical client?
100-125 ml/hour
31
What is an **IV compatibility check?**
The check confirms that what will be **administered through the IV is compatible** with the main bag of fluids that is already running through the IV.
32
**Why** is IV tubing flushed before and after giving an IV medication or solution?
**To prevent a reaction** from two incompatible fluids in the IV tubing.
33
What is **keep vein open (KVO)** for?
To keep the IV fluids going through the client's **IV at a very slow rate** for future use. ## Footnote The IV pump is set at 20 mL/hour.
34
**Label** the common veins for IV insertion on the inner arm: * accessory cephalic vein * basilic vein * cephalic vein * median cubital vein * median vein of forearm
35
**Label** the common veins for IV insertion on the dorsal surface of the hand: * basilic vein * cephalic vein * dorsal venous arch
36
What areas should be **avoided** for IV venipuncture?
1. Edematous extremity 2. An arm that is weak, traumatized or paralyzed 3. The arm that is on the same side as a mastectomy 4. An arm that has an AV fistula or shunt for dialysis 5. A skin area that is infected
37
How **many** milliliters of normal saline should be used to flush an IV site before and after using it and before the start of a shift?
1-2 mL of normal saline
38
**Why** are small veins not used for IV insertion?
Because the IV medication or fluid is too harsh on the vein and can cause **trauma**.
39
**Why** are IVs **NOT** usually placed in the inner elbow?
Because it's too easy for the IV to get **dislodged.**
40
How should an IV be **anchored/secured?**
By looping the tubing and securing with **tape.**
41
What can be **used** for an IV with restless or active clients when there is a risk of the IV coming out?
Use an **armboard or splint** with a restless/active client to secure the IV.
42
How **often** should an IV cannula be removed and restarted in another vein?
**Every 72-96 hours** to prevent infection.
43
What is an **air embolism?** | (Immediate Complication)
It's when **air goes into the client's IV**.
44
How is an air embolism **prevented** from occurring?
By **priming the tubing with IV fluids** before using it. ## Footnote Always monitor the tubing for air bubbles.
45
What are the **signs and symptoms** of an air embolism? | (Immediate Complication)
Due to **decreased oxygen:** * tachycardia * chest pain and dyspnea * hypotension * cyanosis * decreased LOC
46
What are the **interventions** if an air embolism is suspected? | (Immediate Complication)
Turn the client on the left side with the head of the bed in the **Trendelenburg position** to trap the air embolism in the right atrium.
47
What is a **catheter embolism?** | (Immediate Complication)
It's when the **catheter tip breaks off from the client's IV** and goes into the bloodstream.
48
How is a catheter embolism **prevented** from occurring?
**Remove the catheter slowly** to prevent breaking. ## Footnote After IV removal, always inspect the tip to assure it hasn't broken off.
49
What are the **signs and** **symptoms** of a catheter embolism? | (Immediate Complication)
Du to **decreased oxygen**: * decreased BP * pain along the vein * weak, rapid pulse * cyanosis of nail beds * loss of consciousness
50
What are the **interventions** if a catheter embolism is suspected? | (Immediate Complication)
* **place a tourniquet** as proximal as possible to the IV site on the affected limb * **prepare for x-ray and surgery** to remove catheter.
51
What is **IV circulatory overload?** | (Immediate Complication)
When IV fluids are administered too rapidly. ## Footnote It is especially harmful in clients with renal, heart or liver failure.
52
How is IV circulatory overload **prevented** from occurring?
By using IV fluids **cautiously in clients with fluid retention problems** such as kidney disease, cardiac disease, and liver disease: * assess for fluid volume overload at least every 2 hours * make sure the correct amount of fluids is going in the IV
53
What are the **signs and** **symptoms** of circulatory overload? | (Immediate Complication)
Due to fluids backing up into the vascular space and lungs: * increased BP * JVD * tachypnea * dyspnea * moist cough and crackles
54
What are the **interventions** if IV circulatory overload from IV fluids is suspected? | (Immediate Complication)
* **stop the fluids** or put at KVO rate * elevate the HOB * apply oxygen * anticipate chest x-ray and diuretics
55
What is **IV electrolyte overload?** | (Immediate Complication)
When electrolytes are received too quickly causing **electrolyte imbalances.** ## Footnote The most dangerous electrolyte is potassium which can cause dysrhythmias.
56
What are the **signs and symptoms** of electrolyte overload? | (Immediate Complication)
Occur because **electrolytes control cell and muscle function:** * Calcium and Magnesium imbalances: can cause seizures, coma or dysrhythmias * Potassium imbalances can cause dysrhythmias * Sodium imbalances can cause a coma
57
What are the **interventions** if electrolyte overload from IV fluids is suspected? | (Immediate Complication)
**Stop the fluids** and call the HCP.
58
Why is **infection** a potential complication of IV therapy?
Because an **IV cannula pierces the skin** allowing bacteria to enter.
59
Is **IV insertion** a sterile or non-sterile procedure?
It's a **sterile procedure**, yet clean gloves are worn for insertion. ## Footnote Don't touch the skin where the IV needle enters the skin.
60
How is infection from an IV **prevented?**
* **change IV tubing** and site at least every 96 hours * **change IV dressing** if soiled * **label the IV bag** and tubing with date and time * **change fluids** at least every 24 hours
61
What are the **steps** taken if a client does get a possible infection from an IV site?
1. **Remove IV** and place in sterile container for culture 2. Get **blood cultures** 3. **Restart IV** in opposite arm
62
What is **IV infiltration?**
When IV fluid **seeped out of the vein** and into the tissue. ## Footnote It is usually caused by the IV moving and getting dislodged.
63
How is IV infiltration **prevented?**
* Avoid IVs over areas that bend (inner elbow) * Use an armboard for active clients
64
What are the **interventions** if infiltration has occurred?
* **remove the IV immediately** * elevate arm * depending on what the fluid was the HCP may order cold or warm compresses
65
What is **phlebitis** and **thrombophlebitis?**
* **phlebitis:** inflammation of the vein usually caused by an IV med or infection * **thrombophlebitis:** blood clot
66
How are phlebitis and thrombophlebitis **prevented?**
* Avoid small veins * Don't put IV on the inner elbow * Use an armboard
67
What are the **interventions** if phlebitis occurs?
* **Stop IV med** that is causing problem and remove it * Notify HCP * Start an IV in the opposite arm * Give antibiotics if from infection * Warm/moist compresses to dilate vein and promote circulation
68
What is **extravasation** and a **vesicant?**
**Extravasation:** tissue damage usually caused by a very harsh IV fluid or IV meds seeping into the surrounding tissues. **Vesicant:** the substance that causes extravasation.
69
What are the **interventions** if extravasation has occurred?
**Remove the IV**, notify the HCP.
70
What is a **central venous access device** (CVAD)? ## Footnote Also known as a **central venous catheter**, **central venous line** or **central line**.
An **IV catheter that goes right into a very large vein** so larger amounts of fluids and medications can be given or it's used for measuring central venous pressure. ## Footnote It is for long term use.
71
What are the **common sites** for a CVAD?
* internal jugular vein * subclavian (chest) * femoral vein (groin) * veins in the arms (called PICC lines)
72
What is a major **complication** that can occur if the CVAD is not inserted in the correct place? | (Immediate Complication)
The CVAD catheter can puncture the pleural space and cause a **pneumothorax** (collapsed lung).
73
How is placement of a CVAD **verified?**
X-ray
74
What are the **3 main types** of CVADs?
1. Central venous catheter or Peripherally inserted central line (PICC line) 2. Tunneled central venous device 3. Implantable port
75
What **type** of CVAD is this?
Implanted port CVAD
76
What **type** of CVAD is this?
Peripherally inserted central catheter
77
What **position** should the client be in for central insertion, tubing changes, and line removal for a CVAD?
Trendelenburg and bearing down/Valsalva maneuver. ## Footnote This position is to increase pressure in the central veins while the IV system is open. An air embolism can occur if not done.
78
How are blood clots **prevented** with CVADs?
Always flush with **heparin or normal saline** to prevent blood clots from forming on the tip of the catheter.
79
Why should the tubing always be **clamped** for a CVAD?
To prevent **air embolisms**.
80
How often should the **tubing be replaced** for a CVAD or any IV?
Replace the tubing **every 24 hours**. ## Footnote This is to prevent infections from old tubing.
81
What is used to **clean the insertion site** of a central line?
**Chlorhexadine** and cover with a sterile dressing.
82
What is **worn** by both the nurse and client during a sterile dressing change of a central line?
A mask.
83
What **medication** is given through the central line if a there is a suspected blood clot stuck to the tip of the tubing?
**Alteplase**, a thrombolytic. ## Footnote Alteplase will dissolve the clot so the central line can be used.
84
What are the **steps** for getting a blood culture through a central line?
1. Turn infusions off for at least 1 minute 2. Clean the cap with alcohol 3. Use proximal lumen (the biggest lumen) 4. Get first blood sample and send to lab 5. Clean cap again with alcohol 6. Flush with 10 mL of normal saline ## Footnote **Don't** flush with normal saline before getting the blood sample.
85
What are the **steps** for getting a blood lab sample through a central line?
1. Turn infusions off for at least 1 minute 2. Clean the cap with alcohol 3. Use proximal lumen (the biggest lumen) 4. Flush with 5-10 mL of normal saline 5. Aspirate 5 mL and discard 6. Clean cap again with alcohol 7. Withdraw blood into speciman tubes 8. Clean cap again with alcohol 9. Flush with 10 mL of normal saline
86
What is an **epidural catheter?**
An **IV catheter placed in the epidural space** for the administration of pain meds.
87
Why is a skeleton or spine abnormality a **contraindication** for an epidural catheter?
**Skeleton or spine abnormalities:** unable to get the catheter into the correct area
88
Why are bleeding disorders or use of anticoagulants a **contraindication** for an epidural catheter?
**Bleeding disorders or use of anticoagulants with epidural catheter:** insertion can cause bleeding that is difficult to control.

NCLEX-RN (1) Fundamentals (17 decks)

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