IV Fundamentals Flashcards by Delia Archer

What is the main goal of IV therapy? And what is it used for?

Maintain & regain fluid electrolyte balance
And
Medium for delivery of meds

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-reflect location where embolism lodges
-pain proximal to IV insertion site
-shortness of breath, cyanosis, tachycardia
-other signs of shock
These can cause what systemic reaction to IV therapy?

IV Catheter Embolism

Study Tip: causes a clot in the blood vessel which is why tachycardia results to try to mechanically push the clot. Cyanosis occurs due to decreased oxygenation r/t the clot. SOB occurs as well because an embolism is a blood clot that floats freely in the blood stream. The blood clot can travel to the lungs, where they can cause difficultly breathing.

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3% sodium chloride
10% dextrose in water
These examples describes what type of IV solution?

Hypertonic Solution

Osmolarity:
1030 mOsm/L
(500 mOsm/L)

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Consists of electrolytes, Na+, Cl-, K+, Ca and lactate.

Lactated Ringer’s

Study Tip: the liver metabolizes lactate to form bicarbonate to help correct acidosis

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-can cause cell to rupture, hemolysis
-this is a risk when using this solution
These examples describes what type of IV solution?

Hypotonic Solution

Study Tip: when you put a hypotonic solution in blood which is isotonic you dilute the blood which leaves the interstitial and cells with a higher concentration of Solutes. This pulls the excess fluid into of the cells causing them to swell and burst or rupture.

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-Shortness of breath
-intake greater than output
-Increase Bp, pulse, respiratory rate
-Crackles in lungs on auscultation
-Extremity edema
This assessment shows that your patient has what systemic reaction to IV therapy?

Fluid Overload/Circulatory Overload

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dextrose 5% & 0.45% sodium chloride

What is this IV solution called?

D5 ½ NS

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0.45% NaCl
D5W IV
These examples describes what type of IV solution?

Hypotonic Solution

Osmolarity;
154 mOsm/L
D5W is Isotonic in the IV bag and Hypotonic in the Bloodstream

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-mechanical: excessively large IV catheter
-chemical: infusion of irritating solutions
-bacterial
These can cause what local reaction to IV therapy?

Phlebitis

Study Tip:
Phlebitis is often caused by an traumatic injury to a vein such as too large gauge of needle being used on too small of a blood vessel.
Phlebitis can also result from certain medications (ex. K+) that can irritate the veins.

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Vesicant medication leaks outside infiltrated IV

These can cause what local reaction to IV therapy?

Extravasation

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How do you calculate drip rates for Manual IV’s?

Volume (mL) x drop factor (gtt/mL) / Time (min) = IV flow rate gtt/min

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0.9% sodium chloride
Lactated Ringer’s
These examples describes what type of IV solution?

Isotonic Solution

Osmolarity:
308 mOsm/L
(273 mOsm/L)

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What are the four standard drop factors?

10 gtt/mL: macrodrop
15 gtt/mL: macrodrop
20 gtt/mL: macrodrop
60 gtt/mL: microdrop

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What are 3 common localized reactions to using IV therapy?

Phlebitis (mechanical, chemical, bacterial)
Infiltration
Extravasation

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0.45% sodium chloride

What is this IV solution called?

½ normal saline

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Varying tissue damage, pallor, swelling, pain

This assessment shows that your patient has what local reaction to IV therapy?

Extravasation

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-osmolarity greater than 350 mOsm/L
-if osmolarity is greater than 500, administer through central lines
These examples describes what type of IV solution?

Hypertonic Solution

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When administering an intermittent IV Bolus

*IV piggyback is usually dosed at _______ compared to the ______ primary solution.

50-250 mL

500-1000 mL

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-IV meds administered too quickly
-Toxic effects related to med being infused
These can cause what systemic reaction to IV therapy?

Speed Shock

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Facility policy/can leave in for treatment of meds
Antidote medication
This treatment is used for what local reaction to IV therapy?

Extravasation

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Use caution if client is at risk for fluid volume overload.

This example describes what type of IV solution?

Hypertonic Solution

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0.9% NaCl
0.9% sodium chloride
Preferred solution when administering blood products to prevent hemolysis of RBC’s
This is what commonly used IV solution?

NS (Normal Saline)

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-Lightheadedness
-Chest pain/discomfort, palpitations, rapid pulse
-shock, cardiac arrest
This assessment shows that your patient has what systemic reaction to IV therapy?

Speed Shock

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*isotonic in bag
*dextrose metabolizes quickly
-leaves only water (hypotonic)
These examples describes what type of IV solution?

D5W

Study Tip: The solution is isotonic in the bag because of the dextrose but the sugar (dextrose) metabolizes rapidly in the blood stream which leaves only water (NS) when it gets administered which causes the blood to become hypotonic almost immediately. So D5W is actually HYPOTONIC.

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Stop IV, remove cannula, elevate extremity, cold compress | This treatment is used for what local reaction to IV therapy?

Infiltration

-smaller volume of solution -IV PiggyBack This example describes what type of IV therapy?

Intermittent IV Bolus

-Infusion @ a higher rate than the client can tolerate -occurs commonly in older adults, infants, children, and heart failure These can cause what systemic reaction to IV therapy?

Fluid Overload/Circulatory Overload

-Slow infusion rate of IV fluids -Elevate head of bed -Administer oxygen -Notify provider for diuretic -Document findings This treatment is used for what systemic reaction to IV therapy?

Fluid Overload/Circulatory Overload Study Tip: infuse IV at a slow rate so that the body can naturally adapt to the change in tonicity without being forced fluids. Elevate head of bed to decrease fluid being retained in the lungs or pericardium???. Give oxygen to maintain oxygenation and perfusion. Ask provider for diuretic to help excrete excess fluid.

What are the three advantages to using IV therapy?

Rapid onset of therapeutic effects of medication. Precise control of medication dose via infusion device. Reduced discomfort and irritation.

-shearing off portion of IV catheter -catheter damaged during insertion -excessive force These can cause what systemic reaction to IV therapy?

IV Catheter Embolism Study Tip: why?

This is the most common treatment for acidosis. | This is what commonly used IV solution?

LR (Lactated Ringer's)

-use to treat dehydration inside cells -move water to cells These examples describes what type of IV solution?

Hypotonic Solution Study Tip: hypotonic solution increases fluid volume but decreases concentration of Solutes. This means that the higher concentration of Solutes is in the interstitial and the cells so the water is pulled into the cells and the interstitial which treats dehydration by hydrating the cells.

-Stop medication being infused -Replace IV tubing; infuse 0.9% NaCl 30 mL/hr -Notify provider -Anticipate administering epinephrine This treatment is used for what systemic reaction to IV therapy?

Mild to Moderate Allergic Reaction Study Tip: Epinephrine combats allergic reaction physiological effects.

Use electronic infusion pump or other control device to prevent what local reaction to IV therapy?

Speed Shock

-use for volume expansion of vascular system -can cause fluid overload These examples describes what type of IV solution?

Isotonic Solution Study Tip: Isotonic solutions stay within the blood vessel because they are the same tonicity. Can cause fluid overload if given too rapidly because it would cause hypervolemia???

-remove IV catheter, inspect for damage to tip -apply a tourniquet above insertion site -notify provider -anticipate obtaining an x-ray This treatment is used for what systemic reaction to IV therapy?

IV Catheter Embolism Study Tip: Why would you get an x-Ray? Place tourniquet to prevent embolism from traveling to the heart or brain.

What are 4 common systemic reactions to using IV therapy?

speed shock fluid overload catheter embolism allergy/anaphylaxis

-Bronchospasm, wheezing, shortness of breath -Severe hypotension, tachycardia -Respiratory/cardiac arrest These can cause what systemic reaction to IV therapy?

Severe Allergic Reaction

dextrose 5% in Lactated Ringers | What is this IV solution called?

D5LR

5% dextrose in water 5 g dextrose 100 mL water =1 L 1L of this IV solution provides 170 calories This is what commonly used IV solution?

D5W

-When inserting an IV catheter, never re-insert the needle into the IV cannula after removing it. Inspect catheters for damage prior to insertion. When removing an IV catheter, check to make sure the catheter is intact before discarding it. This should be implemented to prevent what systemic reaction to IV therapy?

IV Catheter Embolism Study Tip: Caused by catheter damage upon insertion. So this would help you avoid damaging the catheter if you reinsert the needle into the cannula you could damage it.

dextrose 5% in 0.9% sodium chloride | What is this IV solution called?

D5 NS

Name the three types of IV solutions?

Isotonic Hypotonic Hypertonic

What is the definition of osmolarity?

Concentration of dissolved particles (solute) within solution (solvent)

This is measured in milliosmoles per liter (mOsm/L)?

Osmolarity

-osmolarity of 200-350 mOsm/L -similar to extracellular fluid These examples describes what type of IV solution?

Isotonic Solution

-stop infusion, remove IV catheter, change vein -warm compress -document using a phlebitis scale, monitor site This treatment is used for what local reaction to IV therapy?

Phlebitis Study Tip: Do not use ice packs instead of warm compress because it will constrict the blood vessels more and this will cause more of the vessels surface area to come in contact with the irritating medication causing more irritation.

-Hypersensitivity to medication | These can cause what systemic reaction to IV therapy?

Mild, Moderate and Severe Allergic Reaction

-Stop medication -Change IV to isotonic solution -Notify provider -Treat effects -monitor vital signs --Document the occurrence-- This treatment is used for what systemic reaction to IV therapy?

Speed Shock

Generalized urticaria, hives, itching | These can cause what systemic reaction to IV therapy?

Mild to Moderate Allergic Reaction

Pallor, swelling, pain | This assessment shows that your patient has what local reaction to IV therapy?

Infiltration

*0.45% NaCl (154 mOsm/L) *D5W IV These examples describes what type of IV solution?

Hypotonic Solution Study Tip: These are considered hypotonic because the osmolality is less that 200 mOsm/L. D5W is labeled at Isotonic in the IV bag by the pharmacist but when it is administered to the patient and inside the blood stream it becomes Hypotonic.

*solution to administer IV medications *causes a increase in blood glucose These examples describes what type of IV solution?

D5W Study Tip: Dextrose and Glucose are the same thing. They are both sugars!

*call rapid response team * initiate oxygen therapy *elevate head of bed *stop medication infusion *replace IV tubing; infuse 0.9% NaCl 30 mL/hr *anticipate administering epinephrine diphenhydramine *perform emergency measures as necessary This treatment is used for what systemic reaction to IV therapy?

Severe Allergic Reaction

-osmolarity less than 200 mOsm/L -lower osmolality than extracellular fluids These examples describes what type of IV solution?

Hypotonic Solution

*0.9% sodium chloride (308 mOsm/L) *Lactated Ringer’s (273 mOsm/L) These examples describes what type of IV solution?

Isotonic Solution Study Tip: These are considered isotonic solutions because the osmolality is between 200-350 mOsm/L which is the same as blood.

-pulls fluid into vascular space -use if client is dehydrated These examples describes what type of IV solution?

Hypertonic Solution Study Tip: Hypertonic solutions have a high concentration of Solutes so when placed into the blood which is isotonic it increases the concentration of Solutes in the blood stream to be a higher concentration than in the interstitial and cells. This pulls fluid from the interstitial and the cells into the blood vessel or intravascular space. This treats dehydration by increasing blood volume.

dextrose 10% in water | What is this IV solution called?

D10W

What patients are at HIGH RISK for fluid volume overload?

heart/renal failure older adults children

-3% sodium chloride (1030 mOsm/L) -10% dextrose in water (500 mOsm/L) These examples describes what type of IV solution?

Hypertonic Solution Study Tip: This solution is hypertonic because the solute concentration is over 300 mOsm/L.

Use w/gravity, electronic IV pumps | What type of tubing would you implement for this treatment?

Primary Tubing

-D5 Lactated Ringers -D5 0.9% sodium chloride These examples describe what type of IV solution?

Hypertonic Solution

-When admin. IV bolus meds; always administer over @ least 1 min -Check drug references for meds that may require slower admin. -Dilute IV bolus meds app & admin. Intermittent IV bolus @ recommended rate This should be implemented to prevent what local reaction to IV therapy?

Speed Shock

__________ IV solutions are less concentrated than normal body fluids, so they move fluid from veins into the cells & interstitial spaces.

Hypotonic

Used for continuous infusion | What type of tubing would you implement for this treatment?

Primary Tubing

What is the definition of Intermittent IV Bolus?

???

Mark tubing w/date, time of use, initials | What type of tubing would you implement for this treatment?

Primary Tubing and Secondary Tubing

__________ IV solutions are the same concentration as normal body fluid so there is no change in normal fluid movement & the IV solution remains in the intravascular space.

Isotonic

IV catheter slips out of vein, fluid leaks from previous IV puncture site These can cause what local reaction to IV therapy?

Infiltration

-Change IV site every 3-4 days -Always use correct size IV catheter for client’s vein -Secure IV catheter & tubing carefully to prevent irritation of site -Use scrupulous aseptic technique -Cover IV site w/clear dressing to allow for frequent monitoring & prevent contamination w/micro-organism -Change dressing if it becomes wet or dislodged This should be implemented to prevent what local reaction IV therapy?

Phlebitis

-Used for Central IV/PICC line-very irritating to veins | This example describes what type of IV solution?

Hypertonic Solution

__________ IV solutions are more concentrated than normal body fluids, so they pull fluid from other compartments back into the veins

Hypertonic

IV tubing can be _________ and __________.

Primary & Secondary

-hang primary bag lower than secondary to allow the infusion -the primary infusion stops while secondary is infusing This example describes what type of IV therapy?

Intermittent IV Bolus

Define Tandem Administration?

When the primary & secondary bags are infusing @ the same time it’s called tandem administration.

-both bags @ the same level -bags infuse @ the same time These examples describes what type of IV therapy?

Tandem Administration

MINI-INFUSION PUMP | “Syringe pump”

-SEE PICTURE ON ATI

What should be documented on the label of intermittent IV infusions?

- client’s name - med generic name - pt dose - med brand name - client’s DOB - client’s medication record # and barcode - expiration date & pharmacist’s initials - infusion rate * look at the medication label on ATI

-existing IV line w/syringe -IV primary must be compatible w/med you are administering These examples describes what type of IV therapy?

Intermittent IV Bolus

Steps: 1. Flush w/0.9% saline 2. Administer meds 3. Flush w/0.9% saline *pinch the tubing above the port so the medication will go into the pt and not up the tubing This example describes what type of IV therapy?

Saline Lock which is an example of an Intermittent IV Bolus

-attach below primary set -holds up to 150 mL of solution This example describes what type of IV therapy?

Volume Controlled Administration Sets

-carefully control volume -used to administer IV meds to infants, children & older adults These examples describes what type of IV therapy?

Volume Controlled Administration Sets

Name the 6 most common additives to primary IV solutions?

1. Potassium chloride 2. magnesium sulfate 3. oxytocin 4. heparin 5. regular insulin 6. ranitidine

-has own secondary IV tubing -place solution on IV pole w/secondary tubing -insert secondary tubing into port below roller clamp This example describes what type of IV therapy?

Intermittent IV Bolus

When is a large volume IV Bolus used?

usually for 1 time prescription

IV med mixed w/50-250 mL of solution given over an hour. | This example describes what type of IV therapy?

Intermittent IV bolus infusion

CONTINUOUS IV INFUSION FLOW RATE

***SEE EXAMPLE ON ATI**

What 2 complications can occur if an IV infusion rate is too fast?

Fluid overload | Electrolyte imbalances

What complication can occur if an IV infusion rate is too slow?

Delay in recovery

Electronic IV infusion pumps are measured at what rate?

mL/hr

-two bags regulated by separate roller clamps -use secondary port near IV catheter during this type of IV therapy These examples describes what type of IV therapy?

Tandem Administration

-Contains internal detectors (alarms) -Flow rates of whole # per hour This example describes what type of IV therapy?

Electronic IV Infusion devices

What 5 types of patients would you most commonly use an Electronic IV infusion pump?

``` Pediatric Renal disease Cardiac disease Receiving IV medications Need strict control of volume infusion ```

What is the math equation for electronic infusion devices?

Volume (mL)/Time (hr) = IV flow rate mL/hr

How are manual IV rates measured?

gtt/min

What is a Drip Chamber w/roller clamp?

See ati

The drop factor is?

gtt/mL === # of drops per min

What is the difference between macrodrip and microdrip?

***SEE VIDEO ON ATI***

Small amount of medication either concentrated or diluted and injected over a short time 1-2 mins This example describes what type of IV therapy?

IV Bolus Medication

-redness, swelling, discomfort @ site -redness, heat, firmness along vein This assessment shows that your patient has what local reaction to IV therapy?

Phlebitis

Lactated Ringers is used to correct what fluid and electrolyte imbalance?

Acidosis