IV concepts Flashcards
Delivery of medications in solutions and fluids by parenteral route
____________ _______ most common route
Intravenous (IV) therapy
Maintain fluid balance (or correct)
Maintain electrolyte or acid-base balance (or correct)
Administer medication
Replace blood or blood products
uses for infusion therapy
MOST PEOPLE WILL ALWAYS HAVE A ______ in the hospital
SALINE LOCK
_____________ ________ ____ __________ nurses to initiate and maintain infusion therapy
Teams promote cost savings, patient satisfaction and outcomes
RN generalist inserts peripheral IV lines, and is accountable for all aspects of infusion therapy and delegation of associated tasks
may not have a ___________ if you’re at a small hospital
Specialized team of infusion
team
What are the types of IV solutions (including parenteral nutrition)?
isotonic
hypertonic
hypotonic
What is the normal serum osmolarity of adults?
270 to 300 mOsm/L
___________ = Fluids >300 mOsm/L
Hypertonic
______ = Fluids <270 mOsm/L
Hypotonic
____________ of IV Fluids indicates whether the IV solution will cause shift of fluid into the cell or out of the cell.
Osmolarity
Water does not move into or out of body’s cells
Risk for fluid overload, especially older adults
isotonic infusate
__________ _________ are good for patients who have FVD, or are coming in for surgery and need maintenance IV fluids
isotonic infusate
What are isotonic IV fluids?
lactated ringers -fluid resuscitation -often used for surgery
normal saline (0.9%) -fluid resuscitation -this is the fluid that is used with blood products
what should you do for patients receiving isotonic fluids?
Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion.
Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds.
Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as, decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension.
Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid overload following rapid or over infusion of isotonic IV fluids.
raise HOB so fluids circulate better
if they have edema, elevate the legs
watch if you patient is having more than 80 cc per hour
Elevate the head of the bed at 35 to 45 degrees. Unless contraindicated, position the client in semi-Fowler’s position.
Elevate the patient’s legs. If edema is present, elevate the legs of the patient to promote venous return.
Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume overload. Instruct patients to notify their nurse if they have trouble breathing or notice any swelling.
Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space, patients with hypertension and heart failure should be carefully monitored for signs of fluid overload.
Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion.
Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds.
Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as, decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension.
Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid overload following rapid or over infusion of isotonic IV fluids.
raise HOB so fluids circulate better
if they have edema, elevate the legs
watch if you patient is having more than 80 cc per hour
Elevate the head of the bed at 35 to 45 degrees. Unless contraindicated, position the client in semi-Fowler’s position.
Elevate the patient’s legs. If edema is present, elevate the legs of the patient to promote venous return.
Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume overload. Instruct patients to notify their nurse if they have trouble breathing or notice any swelling.
Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space, patients with hypertension and heart failure should be carefully monitored for signs of fluid overload.
things to watch out for if your patient is receiving isotonic fluids
Decreased concentration of dissolved solutes in intravascular fluids (than in cells)
Water moves into cell
hypotonic infusate
Treat hypernatremia and intracellular dehydration
hypotonic IV fluids
Monitor closely for hypovolemia, hypotension, confusion
considerations for hypotonic fluids
What are the hypotonic fluids?
0.45% sodium chloride
Too much fluid can shift into cells- Can cause _______ ________= life threatening
this occurs with ___________ _______
cerebral edema
hypotonic fluids
document baseline data
do not administer in contraindicated conditions
risk for increased intracranial pressure
watch for FVD -confusion in older adults
warning on excessive infusion
do not administer along with blood products
considerations for patients receiving hypotonic fluids
___________ ___________may exacerbate existing hypovolemia and hypotension causing cardiovascular collapse. Avoid use in patients with liver disease, trauma, or burns.
Hypotonic solutions
Should not be given to patients with risk for IICP as the fluid shift may cause cerebral edema
hypotonic solutions
Monitor for manifestations of fluid volume deficit. Signs and symptoms include confusion in older adults. Instruct patients to inform the nurse if they feel dizzy.
hypotonic solutions
Warning on excessive infusion. Excessive infusion of ______ IV fluids can lead to intravascular fluid depletion, decreased blood pressure, cellular edema, and cell damage
hypotonic
Do not administer along with blood products. Most ______solutions can cause hemolysis of red blood cells especially during rapid infusion of the solution.
hypotonic
Corrects fluid, electrolyte, and acid–base imbalances by moving water out of body’s cells
Parenteral nutrition is example
hypertonic infusate
What are the hypertonic IV fluids?
3% normal saline
Used to treat severe hyponatremia and cerebral edema
hypertonic IV fluids
Monitor closely for hypernatremia and hypervolemia.
hypertonic fluid considerations
IS NOT GIVEN A LOT REALLY
IS NOT GIVEN ON THE MED SURG FLOOR
hypertonic iv fluids
Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion.
for patients receiving hypertonic fluids
Watch for signs of hypervolemia. Since ______ solutions move fluid from the ICF to the ECF, they increase the extracellular fluid volume and increases the risk for hypervolemia. Look for signs of swelling in arms, legs, face, shortness of breath, high blood pressure, and discomfort in the body (e.g., headache, cramping).
hypertonic
Monitor and observe the patient during administration. ______solutions should be administered only in high acuity areas with constant nursing surveillance for potential complications.
Hypertonic
Verify order. Prescription for ___________ _________ should state the specific hypertonic fluid to be infused, the total volume to be infused, the infusion rate and the length of time to continue the infusion.
hypertonic solutions
Assess health history. Patients with kidney or heart disease and those who are dehydrated should not receive ______IV fluids. These solutions can affect renal filtration mechanisms and can easily cause hypervolemia to patients with renal or heart problems.
hypertonic
Prevent fluid overload. Ensure that administration of ______ fluids does not precipitate fluid volume excess or overload.
Do not administer peripherally. ______solutions can cause irritation and damage to the blood vessel and should be administered through a central vascular access device inserted into a central vein.
hypertonic
Monitor blood glucose closely. Rapid infusion of __________ __________ solutions can cause _________. Use with caution for patients with diabetes mellitus.
hypertonic dextrose
hyperglycemia
0.9% Normal Saline (0.9% NaCl)
isotonic solution
Fluid resuscitation for hemorrhaging, severe vomiting, diarrhea, GI suctioning losses, wound drainage, mild hyponatremia, or blood transfusions.
NS
Monitor closely for hypervolemia, especially with heart failure or renal failure.
NS
Fluid resuscitation, GI tract fluid losses, burns, traumas, or metabolic acidosis. Often used during surgery.
Lactated Ringer’s Solution (LR)
Should not be used if serum pH is greater than 7.5 because it will worsen alkalosis. May elevate potassium levels if used with renal failure.
Lactated Ringer’s Solution (LR)
DON’T CAUSE SHIFTS BETWEEN CELLS AND OUTSIDE FLUID
isotonic solutions
0.45% Sodium Chloride (0.45% NaCl)
5% Dextrose in Water (D5W)
hypotonic solutions
Used to treat intracellular dehydration and hypernatremia and to provide fluid for renal excretion of solutes.
0.56$ sodium chloride
Monitor closely for hypovolemia, hypotension, or confusion due to fluid shifting into the intracellular space, which can be life-threatening. Avoid use in patients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema.
0.45% sodium chloride
Provides free water to promote renal excretion of solutes and treat hypernatremia, as well as some dextrose supplementation.
5% dextrose in water
Monitor closely for hypovolemia, hypotension, or confusion due to fluid shifting out of the intravascular space, which can be life-threatening. Avoid use in patients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema.
5% dextrose in water
3% Sodium Chloride (3% NaCl)
hypertonic solution
Used to treat severe hyponatremia and cerebral edema
3% sodium chloride
Monitor closely for hypervolemia, hypernatremia, and associated respiratory distress. Do not use it with patients experiencing heart failure, renal failure, or conditions caused by cellular dehydration because it will worsen these conditions.
3% sodium chloride
Which type of solution is given in the ICU?
3% sodium chloride
What are the most common IV fluids?
isotonic
What are the three most common IV complications?
Infiltration
Phlebitis
Hematoma
What does this picture indicate?
hematoma
Nicking the vein during an unsuccessful insertion
Incomplete insertion of the needle into the lumen of the vessel
Tourniquet above a previous attempt site
Unskilled clinician
Lack of pressure over site of discontinued catheter * Large cannula
hematoma
With ______ IV attempts, apply
direct pressure and elevate extremity until bleeding stops
unsuccessful
IV fluid leaks into the tissue around the vein.
infiltration
Swelling at or around IV site
Pain/burning
Numbness/tingling
Blanching
IV won’t flow
infiltration
What are s/s of ilfiltration?
Swelling at or around IV site
Pain/burning
Numbness/tingling
Blanching
IV won’t flow
What does this picture indicate? (you dont need to know the grades)
infiltration
In order to treat IV ______, the site will be elevated to reduce swelling. Also, a warm or cold compress may be applied for thirty minutes every two or three hours to reduce swelling.
PALE, COOL TO TOUCH, SHINNY
FIRST THING YOU DO IS STOP THE IV
infiltration
The IV site is pale, cool to touch, and shinny. What may be occurring with the patency of the IV? What is your first intervention?
Infiltration
stop the IV
What does this picture indicate?
extravasation
It is also due to infiltration of fluid/medication leaving the vein but it causes irritation/tissue damage.
extravasation
Often occurs with chemo/vesicants. Those medications are often given through a central rather than a peripheral IV for that reason.F
SEE THIS WITH CHEMO DRUGS A LOT
IF THERE IS COBAND ON THE IV YOU NEED TO TAKE IT OFF AND ASSESS SEVERAL TIMES A SHIFT TO MAKE SURE THE SITE IS ALRIGHT
extravasation
Inflammation of the vein
Mechanical- IV not secured properly; too large IV in vein
Chemical- due to irritating IV fluids
Bacterial- contamination of IV catheter during insertion of IV
Erythema at insertion site which can extend or cause a red streak
phlebitis
What does this picture indicate?
phlebitis
t/f: phlebitis will be red and painfull?
true
What are the procedures for phlebitis?
remove catheter
culture cannula is infection suspected
apply warm moist compress
provide comfort measures
phlebitis
Fluids
Type of fluid
Rate of administration in mL/hr (or total amount of fluid and hours for infusion)
Drugs and dose to be added
Drugs (in IV fluids)
Drug name
Specific dose and route
Frequency of administration
Time(s) of administration
Length of time for infusion (number of doses/days)
Purpose
Prescribing Infusion Therapy
What is this picture?
portable vein transilluminator for superficial veins
What does CRBSI stand for?
catheter related blood stream infection
What are some causes of CRBSI?
contaminated infusate
Contamination of catheter hub
skin organisms (need to cleanse area really well)
contamination of device prior to insertion
