IV Flashcards
Nursing interventions for infiltration?
Take it out Apply warmth Elevate Measure amount of edema Document
If a patients IV site is cool, pale and swollen what complication has occurred?
Infiltration
-when the IV cannula has broken through or dislodged itself from the vein and the IV fluid is now leaking into surrounding tissue
A pt has an IV insitu and is receiving therapy, how often should the nurse assess patient?
Every 1 hr
Nursing interventions for phlebitis?
Check to see what is infusing Turn it off -alert RN because all of med is possibly now not infused Cool compress Repositioning Frequent assessment -spread of inflammation -signs of thrombus -any drainage?
A patient is receiving PRBC. The nurse tells the patient to report what immediately?
Feeling strange or different SOB Nausea Itchy Pain Headache Feeling warm or chills Leaking at site
What should nurse always assess before patient receives blood?
Consent
Baseline vitals, LOO, LOC
Dose, type of blood to be infused
Where should you send a blood bag and equipment to if your patient has a transfusion reaction?
Transfusion hospital services
Blood bank
Common IV complications?
Hematoma -occurs when there is leakage of blood from vessel into surrounding tissue Phlebitis/thrombophlebitis Infiltration/extravasation Local infection Nerve injury -pricking of a nerve during insertion Venous spasm -spasm on vein Septicemia Air embolism
What is extravasation?
Leaking of IV medications into space/tissue around infusion sites
A patients IV site appears to be reddened, warm, painful with slight edema.
What is this a sign of most likely?
Phlebitis
-inflammation of the vein
What can cause I local infection around IV site?
Poor aseptic technique during initiation -poor skin prep, contaminated cannula Contaminated blood Air contaminations Pt might have already been septic
Factors to be considered when choosing a vein for venipuncture?
Vein condition -presence of valves, thrombosis Duration of infusion Type of infusion Pt preference Presence of pre-existing conditions -stroke, fistula Age Skill level Anticipated surgery?
Considerations when choosing a cannulation device?
Condition of vein
Type of therapy
Fast/high volumes need large
Age
Things to document after insertion of a peripheral IV catheter?
Gauge of cannula Location Number of attempts If you were unsuccessful -how many times? Type of dressing Type of solution Client response Any teaching
What is IV fluid therapy?
Used when clients are unable to take food and fluids orally
Supply’s fluids directly into the vascular fluid compartment and replaces electrolyte losses
Isotonic solutions?
Same osmolarity as body fluids
-remains in vascular compartment
Ex. 0.9% NaCl, NS, lactated ringers
What is D5W?
Defined as isotonic but becomes hypotonic when dextrose is metabolized in plasma and then supplies only water
Hypotonic solutions??
Lower concentrations than body fluids
Used to provide water and treat dehydration
Ex. 0.45% NaCl, 0.33% NaCl
Fluid moves into cells and makes them bigger
Hypertonic solutions?
Greater than normal body fluids
- draw fluid out of intracellular and interstitial compartments into vascular compartment
- expands vascular volume
Ex. D5NS, D5LR
Make cells small d/t fluid escaping from cells
Why do we not insert IV into an artery?
Not easy to visualize externally
Generally in deep tissue and often protected by muscle
Characteristic of veins?
Thin walled vessels with valves Do not pulsate Usually above muscle and tissue Potential to collapse Easier to visualize externally
Why does venipuncture pose a risk for thrombus formation?
Because it damages the tunica intima
-build up of platelets=potential for thrombus
Upper vs lower extremity veins?
Upper:
-located on dorsal and central surface
Lower:
-should be avoided d/t the potential of embolism and thrombophlebitis
Considerations for peripheral intravenous?
Client consent Purpose Duration Location Vein condition
(Short term use)
What type of vein do hypertonic solutions need?
Require large veins with adequate blood flow to dilute solution
-as well as medications that can irritate vein, rapid infusions, PRBCs,
What should you palpate for to determine if vein is good?
Spongy Straight No pulse Long Full Rebounds easy
How to decide on catheter selection?
Smallest gauge and length appropriate for prescribed therapy/usage
Duration of therapy
IV insertion prep of patient?
Inform client Prepare client Assess site potential Organize equipment Prepare site -chlorahexadine
Catheter sizes for PIV?
24-22g-neonates, elderly, fragile veins
20g- most adults for general therapy
18g- blood products, surgery, general IV
16-14g- trauma, life threatening, major surgery
Patient education for IV?
Limitations on movement or mobility
Notify nurse if site becomes problematic
Routine assessments by nurses necessary
Central venous catheter?
Long term therapy or receiving therapy damaging to vessels
ex. Chemo
Usually inserted into subclavian or jugular vein, with distal tip of catheter resting in superior vena cava
-allow for movement, but greater risk of complications, thrombosis and infection
Peripherally inserted central catheter?
Inserted in the basilic or cephalic vein just above or below the antecubital space
-rests in lower portion of vena cava
Used for long term IV therapy
Why do we flush a IV catheter?
Minimizes risk of infection
Ensures patency
Calculating drop rate?
Total infusion volume x drop factor
Divided by
Total time in minutes
Review orders for IV meds?
What time of med Dosage Route Frequency or time Special considerations
Follow rights of med admin
Advantages in IV drug admin?
Provides several options for med delivery
-bolus, continuous, intermittent
Rapid absorption
Prolonged action
Meds that are irritating can be given with less discomfort
Patient can avoid multiple injections
Disadvantages to IV med admin?
Cannot take it back or slow it Requires extra training Antidote must be available Risk of rapid dose infusion Risk of complications -extravasation, chemical phlebitis, fluid overload
Drug stability and compatibility?
Refers to the length of time that a drug retains its original properties and characteristics
Factors that affect stability?
pH Number of additives Dilution Time Light exposure Temperature Type of container
What is IV bolus rate determined by?
Determined by the amount of medication they can be given per min
Research prep for medication?
Recommended rate of admin Recommended concentration Time frame of stability Correct diluent Necessary assessment
What are IV meds?
Meds administered through IV that enter bloodstream directly by vein
- good when rapid effect desired or when meds are to irritating
- avoids discomfort
Adding meds to IV?
Injection port
Tandem
-attached to line of IV in secondary port
Piggy back
IV push? (Bolus)
Admin of an undiluted directly into circulation
-used in emergency or when med cannot be diluted
Signs and symptoms of fluid overload?
Dyspnea Rapid/laboured breathing Cough Crackles in lungs Bounding pulse
Monitoring of IV?
Maintain prescribed rate, prevent complications
- ensuring correct solution
- flow rate
- ensure patency of tuning
- inspection of insertion site
- assess for bleeding
- providing instructions
- document
Why change tubing?
Maintain sterility, maintain flow (patency), prevent infection.
Why do we discontinue IV?
Therapy is complete
IV site needs to be changed
Chemical vs therapeutic vs physical incompatibility?
Chemical:
-changed on a molecular level
Therapeutic:
-undesirable effects in pt
Physical:
-causes visual changes in med
A patient is NPO d/t bowel obstruction what type of IV solution should be given to this patient?
Short term: isotonic solutions
- no calories
- replaces fluid
Long term: hypertonic solutions
-calories
Interosseous infusion?
Directly into the bone marrow
-non collapsible entry point into venous system
Intraperitoneal infusion?
Delivery of fluids/drugs directly into the abdominal cavity
Venipuncture sites?
In adults veins in arm and hand commonly used
- start distally to work up
- larger veins preferred over small veins in hand
In infants scalp and foot commonly used
