IV access Flashcards
What does peripheral IV catheter deliver to?
Examples? (2)
Delivers to small veins in peripheral circulation such as on your hand
Examples
- PIVC (peripheral IV catheter)
- Cannula
What does central venous catheters deliver to?
Examples?
Delivery to large central veins feeding right atrium
Examples
- CVCs (central venous catheters)
(non-tunneled, tunneled, implated)
- PICC (peripherally inserted central catheter)
What are the various insertion points of central venous access sites? (4)
Internal jugular vein
Subclavian vein
Arm vein
Femoral fein
Non-tunneled CVC
Insertion?
Infection risk?
Duration?
Insertion
- directly inserted into central area
- most inconvenient (cannot shower)
Infection risk
- Highest
Duration:
- Used for <2 weeks, usually when emergency access is required
Tunneled “hickman/groshing/broviac”
Insertion?
Infection risk?
Duration?
Insertion
- Travels under skin in plastic tubing before inserting into vein
- can be hidden
Infection risk?
- Middle
Duration
- Used for months to years
Implant
Insertion?
Infection risk?
Duration?
Insertion?
- A small reservoir (port) is connected to a catheter that enters a central vein.
- surgical
Infection risk?
- Lowest
Duration?
- months to years
Explain how an IV insertion complication can present?
- Pain, bleeding, hematoma
- CVCs can also have hemothorax, pneumothorax
How does dislodgment complication look like
more risky with CVC, migration risk
Lead to dysrhythmia
How does an embolism complication look like?
Air into the blood or piece of catheter into the blood
How does an occlusion look like in IV complication (3)
Fibrin flap
Intraluminal
Fibrin sheath
Fibrin flap
- sucked back over opening during aspiration of blood
Intraluminal
- develops when blood is present in catheter lumen
Fibrin Sheath
- Can cover all or part of opening
How does the Phlebitis IV complication look like? Which type of catheter does it occur in
This is inflammation of peripheral vessels causing pain and redness
Only in PIVC because they’re close to the surface so you can actually see the swelling, it may happen in CVC’s but you wouldn’t know because it’s deep
How does infiltration IV complication look like?
What does it cause? (4)
hen drugs or fluids enter surrounding tissue WITHOUT causing damage
a. Due to damaged vessel walls
b. Causes edema, erythema, pain, skin may appear cool or taut
What does Extravasion complication look like?
What does it cause?
when drugs or fluids enter surrounding tissue CAUSING harm
a. Due to damaged vessel walls
Causes edema, erythema, pain, skin may appear cool or taut AND burning/stinging, blisters
How is occlusion complication managed?
Lipid/precipitate
Basic or acidic or ethanol solution
Thrombosis:
- alteplase dwell x 30 min to 2 hours
How is phlebitis/infection managed (3)
- Catheter removal +/- reinsiertion at different site
- Topical or systemic NSAID if mod-severe
- Antimicrobial therapy, if needed
How is extravasation complication managed
- Stop infusion immediately, do not flush, attempt aspiration of fluid
- Administer antidote
- Elevate limb
- Apply cold or heat
Which complication is most likely to be seen more often with a PIVC and a CVC
Phlebitis
How is a direct IV dose delivered?
When is it used?
Risks (3)
Medication delivered via syringe through shortest mount of tubing over seconds - minutes
When is it used?
- Quick onset
Risks
- Speed shock or infusion reaction
- No ability to correct medication error
- increased risk of phlebitis due to drug concentration
How is a continuous infusion delivered?
Risks (2)
Medication delivered continuously at prescribed rate via gravity or pump
Risks
- drug can lose stability and sterility with long hang times
- may result in administration of large fluid volumes
How is an intermittent infusion delivered
Pros (3)
Cons (2)
Medication delivered via low volume mini-bag over at least 15 minutes
Pros
- Easy to stop
- Nurse can “set it and forget it”
- less risk of speed shock
Cons
- increased cost/waste
- onset is slow/long
How is a piggyback infusion delivered?
Occurs when you need a continuous AND intermittent infusion
Piggyback is attached to the primary infusion line - The piggyback bag is placed higher than the primary one and the pump.
- gravity helps the secondary medication flow first
If the primary infusion is something essential like norepinephrine, piggyback would not work
What does drug incompatibility depend on (4)
- pH
- Temperature
- Contact time
- Concentrations
Differentiate between the types of monitoring level for drugs
Basic
Intermediate
Advanced
Full monitoring
Intensive monitoring
Basic
- efficacy of drugs
Intermediate
- vital signs qhour
Advanced
- more frequent checking of vital signs
Full monitoring
- remote continuous ECG
Intensive monitoring
- Invasive hemodynamic and advanced resp support
- ICU, ER
What are advantages of IV meds (4)
- Fast-acting effect
- Reliable concentration for bioavailabality
- Easy to titrate to response
- Minimal discomfort
