iv fluids and eq Flashcards
iv fluids
- –Replace or maintain fluids and electrolytes.
- –Rapidly administer medications, especially those that can’t be given orally because the gastrointestinal tract can’t absorb them.
- -Provide parenteral nutrition directly into the circulation.
fluid container
IV fluid containers range from 50 mL to 3,000 mL (3 L).
iv solution components
- Sodium chloride (NaCl) –common table salt, used in various concentrations as a fluid and electrolyte replenisher, isotonic vehicle, irrigating solution, and enema.
- Glucose (dextrose)—glucose available in various solutions for IV administration. It is prescribed for the treatment of calorie deficit, for hypoglycemia, and in solution for fluid deficit.
- Water
- Electrolytes
common iv abbreviation
5% dextrose and lactated Ringer’s solution — D5LR
5% dextrose and sodium chloride —D5NS
5% dextrose and 0.45% sodium chloride—D5 1/2 NS
5% dextrose and 0.2% sodium chloride —D5 1/4 NS
5% dextrose and water – D5W
2.5% dextrose and 0.9% sodium chloride —D2.5NS
Lactated Ringer’s solution or Ringer’s lactate — LR or RL
- 9% sodium chloride —NS
- 45% sodium chloride— 1/2 NS
osmolarity
the osmotic pressure of a solution expressed in osmoles or milliosmoles per liter of the solution.
What are the reasons for a prescriber ordering a medication using the IV route?
- rapid admin time
- increased absorb rate
- replace fluids and electrolytes
- avoid GI tract
What information is known about the IV solution when the label reads D5W?
- contains dextrose
- it is in 5% concentration
- water is base solution
Match each abbreviation with its meaning.
Normal saline — NS
Lactated Ringer’s solution —LR
5% dextrose and 0.45% sodium chloride — D5 ½ NS
Dextrose 5% and lactated Ringer’s solution —D5LR
iv sites
3 common:
peripheral line-
central line-
peripherally inserted central line (PICC)
peripheral lines
A peripheral line uses a vein in the arm or hand as the infusion site. In an infant, a peripheral line uses a scalp vein for infusion. If none of these sites are accessible, a peripheral line may use a lower extremity site for venous access.
central lines
A central line uses a special catheter to access the subclavian, jugular, or other large vein. Then the catheter is threaded through that vein into the right atrium of the heart.
PICC line
A PICC line uses a peripheral vein to access a central vein. Starting in the arm, the PICC line is inserted in the antecubital vein and then advanced into the superior vena cava.
types of tubing
basic primary
primary
secondary
basic primary tubing
Use basic primary tubing (basic administration set) to continuously infuse a solution with no piggyback or to administer a solution at specific times when a continuous infusion isn’t needed.
This type of tubing doesn’t have a back-check valve.
primary tubing
Use primary tubing for continuous infusions or for the primary infusion when a patient also needs an intermittent infusion of a piggyback (secondary) solution.
If a piggyback solution is needed, attach it to the primary tubing through the port right below the back-check valve.
This tubing has a back-check valve and several Y-sites (entry points for secondary sets or ports for IV push medications).
secondary tubing
Use secondary tubing to enter primary tubing right below the back-check valve.
When infusing a piggyback (secondary) solution, raise the piggyback solution and lower the primary solution so that the piggyback solution infuses first.
This tubing is shorter than primary tubing.
tubing components
Spike, which may be vented, unvented, or universal (usable with plastic or glass containers)
Drip chamber, which has a drop orifice that is macro size (to deliver large drops) or micro size (to deliver small drops)
Clamp, which is used to stop or start the infusion and regulate the flow rate
What type of tubing incorporates several Y-sites?
primary tubing
The selection of different types of IV tubing is based on which factor(s)?
blood products
med specifications
use electronic infusion device
Saline and Heparin Locks
Plan to use an intermittent venous access device (medlock, saline lock, or heplock) to administer IV medication intermittently or access a vein in an emergency. To keep the line free of clots and other blockages, irrigate (flush) it as indicated with sterile saline solution or the anticoagulant heparin. Use the type and amount of flush solution required by the facility.
flushing access line
Use heparin (a potent anticoagulant even in diluted form), which often comes in prefilled syringes, for unused ports of PICC or central lines.
Use normal saline solution for subsequent flushes. As required by facility procedure, use 1 to 3 mL for each flush.
During medication therapy via an intermittent venous access device, flush the device before and after administering the medication. As a memory aid, use the mnemonic preferred by a facility, such as:
S I S, which stands for saline, IV medication, saline
S A S, which stands for saline, administer medication, saline
precautions iv flush
When flushing an intermittent venous access device, use a 10-mL syringe to minimize pressure on the vein. Use of a smaller syringe:
Creates higher pressure in the IV device
Can damage the vein
Can harm the patient
Remember to slide the lock clamp during the last milliliter of flush solution to ensure a lock by creating positive pressure. This prevents blood from backing up into the tubing.
When would an intermittent venous access device be used?
- giving intermittent meds
- during emergency
gravity infusion systems
The nurse can regulate the flow of IV solutions with:
A gravity infusion system
A mechanical infusion system
An electronic infusion system
Gravity infusion requires a sufficient gradient between the pressure in the peripheral vein and in the IV container (based on its height).
- The IV solution flows from the container to the peripheral vein.
- The closer the IV container is to the patient’s heart, the slower the infusion flows.
- The higher the container is in relation to the heart, the faster the infusion flows.
The nurse controls the infusion rate by adjusting the clamp or using a flow regulator, such as the Dial-a-Flow system. The gravity infusion system is a less accurate way to regulate the IV flow because it is based on the:
- Position of the patient’s arm
- Container height
- Catheter type
- Position of the catheter in the vein
mechanical infusion systems
Two types of mechanical infusion systems are the elastomeric pump and a spring-loaded syringe.
The elastomeric pump regulates the flow rate using atmospheric pressure and a flow-restricting device at the distal tip of the tubing. The pump is commonly used by home care patients. Depending on the medication order, it can be set to infuse a solution for more than 30 minutes to several days.
The spring-loaded syringe fits in a container that holds a coiled spring with a disk on each side. As the spring returns to its relaxed form, it pulls the disks together. This causes the fluid container to collapse, which makes the solution infuse.
electronic infusion
Electronic infusion systems accurately deliver a programmed volume of IV solution over a specified time period. To deliver an infusion at a set rate, an electronic infusion device applies controlled pressure. One disadvantage of electronic infusion systems is that each device requires a particular type of tubing or cassette.
“smart pumps” use customized software that contains the minimum and maximum safe infusion rates for various medications. These pumps also have mechanical safety alarms that sound when:
Air is in the line.
The line is occluded.
The infusion is complete.
The battery is low.
The door is open.
Common volumetric electronic infusion systems include:
Single-channel, which accepts a single IV line
Multiple-channel, which accepts one to four separate IV lines
Syringe
Ambulatory
Patient-controlled analgesia, which is a special pump with locking ability to prevent medication theft
Which factors influence gravity flow regulation of an IV?
catheter type
container height
pt arm position
fluid components
In which setting is an elastomeric pump most commonly used?
home care
What are the types of electronic infusion devices?
ambulatory pump
single-channel pump
pt controlled analgesia pump
Which components are commonly found in most IV fluids?
water
glucose
electrolytes
sodium chloride
What information on the prescriber’s order is used to set up an electronic pump for an infusion?
flow rate
volume to be infused
What tubing is indicated for a patient who is only receiving routine IV fluids?
basic primary tubing
What is common to all types of IV tubing?
drip chamber
Which component of IV tubing stops or starts the infusion and adjusts the IV flow rate?
roller clamp
Why is a syringe smaller than 10 mL not recommended for flushing the peripheral and central venous access devices?
vein damage
pt inury
increased pressure damages device
Heparin is used therapeutically as what type of medication?
anticoagulant
