Intravenous Therapy (exam 1) Flashcards
What is the purpose of IV therapy?
-maintain and replace fluids
-provide glucose and nutrition
-access to administer meds
-administer blood
-emergency access
how often should you change an IV site?
96 hours or 4 days
what does IID stand for?
intermittent diffusion device
how often should you flush an IID?
q8h to check patency
what should you assess and IV site for?
-infiltration
-swelling
-redness
-tender
-pain
-cool skin
larger number IV = ________ size
smaller
what gauge IV is most common?
20
what gauges (IV) are used for trauma or surgery?
16 and 18
what gauge IV is for rapid or large volume transfusions, trauma, or high risk surgery?
16
what gauge IV is for trauma, surgery, viscous solutions, blood transfusions, and requires a large vein?
18
what gauge IV is for routine infusions and IV access?
20
what gauge IV is for small fragile veins, older adults, and slow infusions?
22
What gauge IV is for slow flow rates, pediatric, and elderly?
24
phenytoin is not compatible with ___?
D5W
what should you check for regarding IV med administration?
-compatibility
-dilution
-rate of administration
-allergies
what is the diffusion ratio for lorazepam?
1:1
how long should a morphine push take?
5 mins
is an adenosine push quick or slow?
quick
what port should be cleaned and used?
port closest to the patient
how mush should be flushed before and after meds?
3-5 ml
should you flush before meds, after, or both?
both
what should never be administered through a TPN or PCA line?
IVP or IVPB meds
what is used for long term therapy or tissue toxic meds such as cardiac or chemo meds?
central venous catheter (central line)
what kind of line can be inserted sterile at the bedside?
PICC line
hoe many ports can a central line have?
1/2/3/4
when can you use a central line for the first time?
after a chest x-ray has been done to confirm placement
where does a PICC line connect
superior vena cava
what can’t be done in an arm with a PICC?
no BP, blood draws, venipunctures
can you draw blood from a PICC?
yes
how much saline should you flush a PICC with?
20 ml
where are implanted ports (Vein) and how to access them?
implanted in superior vena cava and accessed by holding skin
how do you assure placement of an implanted port?
CXR
how do you access an implanted port?
using a non-coring needle (huber needle w/ curve at the end)
steps to access an implanted port?
-prime Huber w/ saline
-hold port and access into rubber stopper
-flush and draw back for blood return
-closed with U100 heparin (keeps port from clotting off)
how much should you flush an imported port with
10 ml (can blow vessel if too small amt)
what should you assure before using an implanted port?
blood return
when using an IV piggyback, the ______ bag hangs the highest
secondary (piggyback)
when using an IV piggyback, the ______ bag hangs lower than the other bag
primary
what should you always check involving IVPB?
compatability
If hanging an IVPB with fluids running…..
-use the secondary tubing
-hang the primary lower using hook
if you hang an IVPB without primary fluids running….
hang the PB alone, but you will lose some fluids in the tubing
steps to prime tubing
-clamp tubing
-spike
-clean
-squeeze 1/3
-open it and let fluid flow to the end
-reclamp
-connect, flush pt.
Pt. comes to ER after car accident, what kind of IV should the nurse start?
-18g peripheral
-22g peripheral
-port-a-cath
-PICC
18g (trauma)
before giving meds IVP via central line which step should be taken?
-apply tourniquet
-hang normal saline bolus
-check blood return
-start peripheral IV
check blood return
what are crystalloids?
clear fluids such as saline
what are colloids?
fluids that cant be seen through (blood, TPN, lipids)
what is tonicity?
when homeostasis serum = other body fluids
what is when the fluid has the same tonicity as other body fluids?
isotonic
what is when fluid shifts out of the blood
hypotonic
what is when fluid is pulled into the vascular system?
hypertonic
what has osmolality close to that of the extracellular fluid and do not cause cells to swell or shrink
isotonic solutions
what are examples of isotonic solutions?
-normal saline
-5% dextrose in water (D5W)
-lactated ringers
what fluids exert less osmotic pressure than ECF
hypotonic (they let fluid in if the pressure is less)
what fluids are used to replace cellular fluid
hypotonic solutions
what are types of hypotonic solutions?
0.45% NaCl (half saline)
what fluids have osmotic pressure greater than ECF
hypertonic (pressure is greater, so they push fluid out)
what fluids are use in hyponatremia and cerebral edema?
hypertonic solutions
what is an example of a hypertonic solution?
3% NaCl (3x amount)
normal sodium level
135-145
normal potassium level
3.5-5
normal chloride level
98-106
normal bicarb level
24-31
normal calcium level
8.8-10.5
normal phosphorus level
2.5-4.5
normal magnesium level
1.8-3.6
what classifies as hyponatremia?
sodium less than 135
what are causes of hyponatremia?
diuretics (pee out sodium)
N/V/D (rid sodium)
overhydration (dilutes sodium)
what are symptoms of hyponatremia?
-N/V
-HA/ SEIZURES!!
-extreme conufsion/psychosis
what classifies as hypernatremia?
sodium greater than 145
what are causes of hypernatremia?
-dehydration
-heat stroke
-burns
signs/symptoms of hypernatremia
-thirst
-fever
-seizures
-hyperactive muscles/twitching
value for hypokalemia
less than 3.5
causes of hypokalemia?
diarrhea
gastric suction/vomit
diuretics
s/sx of hypokalemia
weakness/cramps
constipation
dysrhythmias
what kind of dysrhythmias are associated with hypokalemia?
tachy/PVCs (premature ventricular contraction can lead to v-tach)
value for hyperkalemia
greater than 5
causes of hyperkalemia
kidney disease
diuretics (spirinolactone)
burns
s/sx of hyperkalemia
weakness
paresthesia
dysrhythmias
what dysrhythmias are associated with hyperkalemia?
brady/wide QRS
what classifies as hypocalcemia?
less than 8.8
what causes hypocalcrmia?
-parathyroid disorder
-vit. D deficiency
-poor absorption
s/sx of hypocalcemia
-numb/tingle
-Trousseaus (toes) and Chovstek (rigid muscle in cheek)
-seizures
what classifies as hypercalcemia?
greater than 10.4
what causes hypercalcemia?
parathyroid disorder
-tumor
-calcium supplemets
s/sx of hypercalcemia
weakness/fractures
constipation
weak reflexes
what classifies hypomagnesemia
less than 1.8
what causes hypomagnesemia?
alcoholism
diarrhea
malabsorption
s/sx of hypomagnesemia
-trousseaus and chvostek (and seizures)
increased reflexes
EKG chamges
what classifies hypermagnesemia?
greater than 2.6
what causes hypermagnesemia?
adrenal insufficiency (addison’s disease)
hypothyroidism
s/sx of hypermagnesemia
flushimg
weak reflexes
EKG changes
what classifies hypophosphatemia?
less than 2.7
what causes hypophosphatemia?
alcohol use
low magnesium
Vomit/diarrhea
s/sx of hypophosphatemia
muscle weakness
confusion
seizures
what classifies hyperphosphatemia?
greater than 4.5
causes of hyperphosphatemia?
kidney disease
dehydration
s/sx of hyperphosphatemia
N/V
muscle weakness
low reflexes
what classifies hypochloremia?
less than 96
causes of hypochloremia?
-vomit/suction/sweat
-diuretics
-addison’s disease (adrenal insuff.)
s/sx of hypochloremia
agitation
muscle cramps
seizures
what classifies hyperchloremia
greater than 108
what causes hyperchloremia
excessive NaCl infusion
kidney injury
dehydration
s/sx of hyperchloremia
weakness
edema
seizures
when reviewing labs, pt. potassium is 5.6 what intervention should you take?
-call MD for tele order
-place seizure pads on bed
-hold AM furosemide
-check Chvostek sign
tele order (leads to arrythmias)
what complication is when fluid leaks from the vessel to the tissue?
infiltration
what complication is inflammation of the vein?
phlebitis
what IV complication is from not washing hands and improper insertion?
infection
what IV complication is a blockage from a bent arm, clot, or clamp?
occlusion
what is a partial block of IV access
occlusion
what iv site should be avoided because of bending and eating
AC
how often should an IV be flushed
q8h
what does an IV infiltration look like?
-cool to touch
-pallor
-firm/tender
-absence of blood return
-pain
how often should an IV site be checked while fluids are going?
once an hour (more if toxic substance)
__________ IV is there are any signs of infiltration
discontinue
what is an infiltration with toxic tissue substances (several electrolytes)
extravasation
which vasopressors can cause extravasation?
-dobutamine
-dopamine
-epinephrine
what chemotherapeutic agents can cause extravasation?
adriamycin, vincristine, bleomycin
what kind of agents can cause extravasation?
vasopressors and chemotherapeutic agents, and electrolytes
what electrolytes can cause extravasation?
potassium chloride
calcium chloride
calcium gluconate
what is a common antidote for extravasation?
phentolamine
what are symptoms of phlebitis?
red streak along vein
warm skin, hot
vein firm and cord-like
pain
complication from phlebitis
clots and infection
what type of phlebitis is from long times of cannulation, catheter in flexed area, catheter larger than vein, poorly secured catheter
mechanical phlebitis (we did it)
what type of phlebitis is from an irritating med or solution, rapid infusion, or med incompatibilities
chemical phlebitis
what kind of phlebitis occurs 49-96 hours after infusion has been discontinued?
post infusion phlebitis
what type of phlebitis is from poor hand hygeine, lack of asepsis, failure to check, or recognize phlebitis? often occurs during insertion
bacterial phlebitis
what kind of infection…
-occurs throughout body
-involves several systems
-organisms/toxins in blood
-leading cause of death in ICUs
systemic (sepsis)
what is CLABSI
central line acquires bloodstream infection
fluid overload ______ blood pressure and central venous pressure
increases
s/sx of fluid overload
moist crackles, edema, weight gain, dyspnea, rapid/shallow resps
how to prevent fluid overload?
use IV pump and monitor rate
check pt. every hour
i&o
vitals, assessment
what is air in the circulatory system?
air embolism
what are potential causes of air emboli?
-insertion of large bore IV
-accidental removal of large IV
-improper removal of central line
s/sx of air embolism
difiiculty breathing!!!
CP, muscle/joint pain, mental status change, stroke, low BP, cyanosis
how to prevent air emboli?
prime all tubing
address all bubbles
double check flushes
proper technique removing CVC (lay flat)
treatment of air emboli
stop & disconnect
left side-lying Trendelenburg
VS and pulse ox
assess IV = cool and swollen, what do you do?
-administer antidote
-call MD for antibiotic
-remove IV and restart
-call MD for central line
remove IV and restart
