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Fundamentals Clinical > IV Management > Flashcards

IV Management Flashcards

1
Q

Why might a patient need an IV?

A
  • Med administration = faster absorption
  • IV fluid admin = treat fluid/electrolyte imbalance
  • Blood transfusion
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2
Q

IV catheter gauges

A

14-30G

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3
Q

What type of patient will have a peripheral IV?

A

Inpatient clients that will be there for a shorter amount of time

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4
Q

What type of patient will have a CVAD?

A
  • More serious inpatient clients who will be there for a long time
  • outpatients may have implanted ports
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5
Q

Sites for peripheral IVs

A
  • Hand
  • Forearm
  • Upper arm
  • Foot
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6
Q

Sites for CVADs

A
  • Picc line - Long catheter inserted into a peripheral vein and into a larger vein
  • Tunneled CVAD - Thin tube placed under the skin into the vein for long-term access (usually in neck)
  • Non-Tunneled CVAD - Inserted into large vein in your neck, chest, or groin for short period of time
  • Port - Port is placed beneath the skin in chest, arm, abdomen; help people who need frequent IV meds or blood draws; easy access to vein
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7
Q

What equipment do you need to start an IV?

A
  • IV catheter
  • IV start kit (tourniquet, prep solution, tape, gauze, securement device)
  • Administration set - IV tubing
  • Extension tubing (J-loop)
  • Saline flush
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8
Q
  1. What gauge is used for geriatrics & neonates?
  2. What gauge is commonly used for adults?
  3. What gauge is commonly used for trauma, surgery, rapid infusion, & transfusions?
A
  1. 22-24G
  2. 20-22G
  3. 16-18G
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9
Q

Steps to prep an IV (6 steps)

A
  1. Prep supplies
  2. Attach end cap to extension tubing if needed
  3. Flush extension tubing
  4. Select vein
  5. Apply tourniquet 3-4” above site
  6. Cleanse the site
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10
Q

Steps to insert an IV (11 steps)

A
  1. Hold skin taut, needle bevel up, 30 degree angle
  2. Follow course of vein
  3. Blood will flashback into chamber once in the vein
  4. Lower angle of catheter
  5. Advance catheter
  6. Release tourniquet
  7. Hold pressure on vein above IV
  8. Active needle safety
  9. Quickly attach extension tubing
  10. Flush
  11. Secure dressing and label
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11
Q

Factors affecting gravity infusion

A
  • Height of solution: Higher = faster infusion
  • Patient position
  • BP: Higher BP = more force required to infuse
  • Gauge of catheter: Bigger = faster infusion
  • Condition of catheter/tubing : Occlusion, dislodged from vein
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12
Q

Infusion Pump Considerations

A
  • Program to correct flow rate
  • Alarms may sound for: Infusion complete, air in line, resistance to flow (occlusion)
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13
Q

What are piggyback infusions used for?

A

Antibiotics or smaller meds

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14
Q

What should you label your lines with?

A
  • Date/time, your initials when priming tubing
  • Med being admin
  • “High alert” labels as needed
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15
Q

Safety tips for IVs

A
  • Ensure compatibility between IV solutions/meds
  • Ensure correct infusion rates
  • Closely monitor patient for reactions
  • Check tubing & solutions for expiration
  • Flush IV site at least once a shift if not in use
  • Frequently monitor IV site Q4H
  • When discontinuing, make sure catheter tip is still in tact
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16
Q

When should you change IV solutions?

A

When they’re nearly empty

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17
Q

When should you change administration sets for….
1. Continuous infusions
2. Intermittent infusions
3. Parenteral nutrition
4. Blood

A
  1. Vary depending on facility (72-96hrs)
  2. Q24H
  3. Q24H
  4. Q4H
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18
Q

When should you change IV dressings…..
1. Transparent
2. Gauze
3. Tunneled/implanted CVC

A
  1. Q5-7 days
  2. Q2 days
  3. Once a week
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19
Q

When an IV is not in use you should….

A
  1. Disconnect IV tubing from extension tubing
  2. Place sterile injection cap on the end of tubing
  3. Clamp extension tubing
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20
Q

When continuing and IV that was previously locked you should…

A
  1. Inspect IV site
  2. Unclamp extension tubing
  3. Scrub extension tubing hub with alcohol wipe
  4. Flush IV to ensure patency
  5. Connect IV admin tubing and begin infusing
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21
Q

Preventing IV med complications

A
  • Assess patient & IV site before, during, after giving med
  • Determine compatibility of drug with IV fluid
  • Use sterile technique
  • Admin med slowly (use correct push rate)
  • Observe patient carefully for signs of adverse reaction
  • Have antidote on hand if needed/available
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22
Q

What do you do in case of a serious allergic reaction?

A
  • Support patient airway
  • Deliver O2
  • Admin med antidote to reduce reaction
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23
Q

Vesicant Solution

A

Solution that causes the formation of blisters, tissue sloughing, & necrosis

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24
Q

Hematoma

A

Localized mass of blood outside the blood vessel

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25
Q

Cause of hematoma

A
  • Nicked vein
  • Discontinue IV w/out holding pressure
  • Tourniquet too tight over previously attempted site
  • Poke through the vein
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26
Q

Signs & symptoms of hematoma

A
  • Ecchymosis (discoloration of skin from bleeding underneath)
  • Localized mass
  • Discomfort
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27
Q

Nursing response to hematoma

A
  • Gentle venipuncture technique
  • Apply pressure when discontinuing IV
  • Ice
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28
Q

Infiltration

A

Seepage of non-vesicant solution or med into surrounding tissues

29
Q

Causes of infiltration

A
  • IV catheter dislodges or tip penetrates vessel wall
30
Q

Signs/symptoms of infiltration

A
  • Slow/stopped flow of IV
  • Swelling, tender, pallor, hard, cool at site
  • Burning sensation
31
Q

Nursing response to infiltration

A
  • Stop infusion immediately
  • Restart IV in a different vein: Higher in the arm or in a different extremity
  • Elevate to promote absorption of excess fluid
32
Q

Extravasation

A

Seepage of vesicant solution or med into surrounding tissues

33
Q

Causes of extravasation

A
  • IV catheter dislodges or tip penetrates vessel wall
34
Q

Signs/symptoms of extravasation

A
  • Slow/stopped flow of infusion
  • Swelling, tender, hard, cool
  • Burning sensation/blanching
  • Blistering (late sign)
  • Serious cases: necrosis of dermis
35
Q

Nursing response to extravasation

A
  • Stop infusion immediately
  • Administer antidote
  • Apply cold compress
  • Elevate
36
Q

Phlebitis

A

Inflammation of a vein

37
Q

Causes of phlebitis

A
  • Mechanical irritation: trauma to vessel, compression of the line, patient movement, low flow rate
  • Infusion of solutions that are irritating to vessel: Dextrose, potassium chloride, antibiotics, vitamin C
  • Sepsis
38
Q

Signs/symptoms of phlebitis

A
  • Red, painful, warm
  • Local swelling, palpable cord along vein
  • Sluggish infusion rate
  • Elevated temp
39
Q

Nursing response to phlebitis

A
  • Discontinue IV, start in new location
  • Apply cold compress if warm/tender, then later warm compress
  • Assess for circulatory impairment
  • Consult PCP if streaking or erythema along vein w/ palpable cord
40
Q

Thrombophlebitis

A

Thrombosis (blood clot) & inflammation

41
Q

Causes of thrombophlebitis

A
  • Use of veins in legs for IV
  • Use of hypertonic/highly acidic solution
  • Untreated phlebitis
42
Q

Signs/symptoms of thrombophlebitis

A
  • Sluggish flow rate
  • Edema
  • Tender, warm, erythema
  • Cord-like veins
43
Q

Nursing response to thrombophlebitis

A
  • Discontinue IV, start in a new area
  • Use all new equipment
  • Apply warm/moist compress
  • Consult PCP
44
Q

Local Infection

A

Microbial contamination of the cannula of IV site

45
Q

Causes of local infection

A
  • Using poor technique when inserting IV
  • Leaving catheter in place for longer than 96 hours
  • Direct contamination
46
Q

Signs/symptoms of local infection

A
  • Redness, swelling
  • Exudate
  • Elevated temp
47
Q

Nerve Injury

A

Nerve is inadvertently injured during venipuncture or compressed

48
Q

Causes of nerve injury

A
  • Using veins on inner surface of wrist and forearm
  • Not anchoring the vein for puncture
  • Using a large needle
  • Advancing needle across instead of with the vein
  • Probing “excessive redirection of needle within the vein)
  • Inserting too deeply and through the back wall of the vein
  • Too many venipuncture attempts
  • Infiltration/extravasation
  • Tourniquet too tight/left on too long
49
Q

Signs/symptoms of nerve injury

A

Direct Injury: Sharp acute pain at the site or up and down arm
- Pins and needles or electric shock sensation
- Pain, numbness, tingling in fingers
- Pain that persists after needle is removed

Compression Injury: Pain & tingling typically appear 24-96 hours after venipuncture

50
Q

Nursing response to nerve injury

A
  • Stop procedure & withdraw catheter
  • Apply pressure to prevent hematoma
  • Report to supervisor & provider
  • Do not start new IV in the affected arm
  • Treat infiltration if it occurs
  • Fasciotomy is usual treatment
51
Q

Fasciotomy

A

Incisions around the area to let blood or fluid seep out

52
Q

How many venipuncture attemps should you make before moving to a new site?

A

2

53
Q

Septicemia

A

The presence of microorganisms or their toxic products in the circulatory system

54
Q

Causes of septicemia

A
  • Break in aseptic technique
  • Contaminated IV solution
55
Q

Signs/symptoms of septicemia

A
  • Fluctuating fever
  • Chills
  • Tachycardia
  • Confusion
  • Hypotension
  • Altered mental status
  • Elevated WBC count
56
Q

Nursing response to septicemia

A
  • Discontinue IV infusion immediately
  • Consult PCP
  • Treatment often involves antibiotics, fluids, & meds to support vital signs
57
Q

Fluid Overload

A

Too much fluid volume in the body

58
Q

Causes of fluid overload

A
  • Infusing excessive amounts of IV fluids
  • Admin fluids too rapidly
59
Q

Signs/symptoms of fluid overload

A
  • Weight gain
  • Edema
  • Hypertension
  • Shortness of breath
  • Crackles in lungs
  • Distended neck veins
60
Q

Nursing response to fluid overload

A
  • Slow IV flow rate
  • Place client in a high-Fowler position
  • Monitor vital signs
  • Admin oxygen, if needed
  • If severe, diuretics may be ordered
61
Q

Air Embolus

A

Rare complication involving the introduction of air into the vascular system

62
Q

Causes of an air embolus

A
  • Loose connections
  • Adding a new IV bag to a line that has run dry w/out clearing the line of air
  • Air in tubing cassette of infusion pump
63
Q

Signs/symptoms of air embolus

A
  • Palpitations
  • Chest pain
  • Light-headedness
  • Dyspnea
  • Cough
  • Hypotension
  • Tachycardia
  • Sudden change in mental status
64
Q

Nursing response to air embolus

A
  • Call for help
  • Place client in Trendelenburg position on the left side
  • Admin oxygen
  • Have emergency equipment available
65
Q

Catheter Embolus

A

A piece of the catheter breaks off and travels through the vascular system

66
Q

Causes of a catheter embolus

A
  • Reinserting the catheter used in an unsuccessful insertion
  • Removing & reinserting a stylet causing shearing of the catheter
  • Placing the catheter in a joint flexion
67
Q

Signs/symptoms of catheter embolus

A
  • Sharp, sudden pain at IV site
  • Jagged catheter end on removal
  • Dyspnea
  • Chest pain
  • Tachycardia
  • Hypotension
68
Q

Nursing response to catheter embolus

A
  • Apply a tourniquet above the site
  • Notify the provider & radiologist
  • Start a new IV
  • Prepare the patient for radiographic examination

Fundamentals Clinical (3 decks)

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