IV Medication Flashcards by Sophie De Feyter

How to calculate drops per minute for
gravity flow devices using the 2 step
method?

Calculate how many mL per hour need to be administered, then multiply that answer by the drop factor and divide by 60 minutes

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what is the formula for the 1 step method to determine the amount of drops per minute?

Amount of fluid multiplied by drop factor

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What are the things that an IV order must contain?

-Solution,
-Rate,
-Route,
-Time Frame

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What supplies are needed to start an IV?

-Gloves
-tape
-dressing (tegaderm)
-drip set,
-gauze,
-tourniquet,
-alcohol prep,
-IV catheter,
-saline flush,
-connector tubing,
-IV
fluid

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When can an IV in the foot be placed on an adult patient?

When there are doctor’s orders for it

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What are important things to review for a patient’s assessment prior to IV insertion?

Physical findings (i.e. mastectomy or
fistula), lab values, age, mobility, skin,
allergies

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What are the 4 parts of an IV catheter?

-Stylet,
-catheter,
-flash chamber,
-safety device

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What are the 5 hand veins?

-digital veins,
-metacarpal veins,
-dorsal veins,
-cephalic veins,
-basilic veins

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What are the characteristics of a good vein?

-Superficial,
-smooth,
-bouncy,
-no pulsation,
-not close to a joint,
-skin is normal

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Why is it important to have a smooth vein when inserting an IV?

Lumpy veins have more valves

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What can hard veins be an indicator of?

Sclerosis

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What are some vein dilation techniques to use when starting an IV?

-Tapping,
-rubbing,
-moist heat,
-gravity,
-fist clenching

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Which hand should you use to anchor a vein?

Non-dominant hand

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How should the bevel of the needle be positioned for insertion?

Bevel should be up

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What are the steps of preparation for IV catheter insertion?

-Prep all supplies,
-identify the patients with 3 identifiers, -position the patient and yourself,
-find vessel,
-use alcohol wipe to prep area,
-position the angiocatheter,
-anchor the vein

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Where should a tourniquet be placed in reference to the IV site?

6 inches above site

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What is the diameter of the swab site that should be wiped with prep before IV
insertion?

Around 3 inches in diameter

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When can a site be touched after prepping the IV site with Chlorhexidine?

NEVER

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What is an indicator that the needle has entered the vessel?

flashback in hub and “flash chamber”

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State 4 techniques that can be used to advance the cannula

-One-step technique,
-pushing cannula off stylet
- “floating” cannula into vein,
-two-handed technique

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What should be on the label of an IV dressing?

-date,
-time,
-initial,
-size of catheter

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What should be done after advancing the IV catheter?

-hold IV catheter steady,
-remove stylet,
-attach T-connector or tubing,
-anchor IV with tape,
-cover IV with transparent dressing, -Label IV dressing,
-Flush IV tubing and catheter

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What needs to be documented following IV insertion?

-time/date of insertion,
-location of site,
-gauge/length/type of catheter,
-Number of attempts & complications, -type of dressing,
-States IV site,
-client response to procedure

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What are indications that IV catheter insertion is unsuccessful?

-loss of blood return,
-severe pain,
-vein puffs up during flushing (infiltrates),
-no blood return

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What may have happened if there is a loss of blood return?

It may have pierced through the vein

What may have happened if the patient is in severe pain following IV insertion?

-The IV may be in surrounding tissue or -it may have pierced a nerve

What may have happened if there is no blood return after inserting an IV?

The needle may have missed the vein

Why should an IV not be placed in a pulsating vessel?

The vessel may be an artery

How many IV attempts can be done before someone else needs to be brought in to start the IV?

What could be the cause of redness, swelling, and warmth at the IV insertion site?

phlebitis

What could be the issue if there is swelling, but it is cool around the IV site?

infiltration

What could be the issue if: -the IV site has no redness, -no swelling, -is dry, -but patient has SOB, -puffy feet, -and palpitations?

Hypervolemia: (aka “fluid overload”) Condition where you have too much fluid volume in your body. It can be caused by several conditions such as heart failure, kidney failure, cirrhosis, or pregnancy.

What could be the issue if the IV site has: -redness, -patient has chills but feels hot -and patient states that he/she feels yucky?

IV infection

What does extravasation refer to?

The leakage of injected drugs from blood vessels causing damage to the surrounding tissues

Signs and Symptoms of extravasation? (3)

-pain, -stinging or burning sensations, -edema around the intravenous (IV) injection site

What action should be taken with an IV site that is not WNL?

Discontinue the IV and relocate

Why might IV insertion/IV therapy be needed?

-antibiotic administration, -hydration, -med administration

What is compatibility when referring to medications?

The chemical stability of two or more medications when administered together

What are the 3 types of incompatibility?

-Physical, -chemical, -therapeutic

What does a med look like if it has a physical incompatibility?

Precipitation/hazy

What happens if there is a chemical incompatibility?

Drug decomposition

What happens when there is a therapeutic incompatibility?

Undesirable pharmacologic activities

Why is it important to learn how to calculate IV flow rates manually?

In case of IV pump malfunctions or IV pumps are not available

Why are IV drip factors important?

-Important when working with IV line; -helps telling us the rate that a medication will be administered into the patient

Macrodrip?

Big drops: -60 gtt/mL Is used to infuse large volumes or to infuse fluids quickly

Microdrip?

Small drops: - Need to check package ~ 10 gtt/LI, 15 gtt/mL, or 20 gtt/mL Typically used to deliver precise amounts of medication in small drops to children and infants

How do you calculate Gravity IV Drip Rates?

(Number of mL to infuse/ Number of minutes) × Tubing drop factor (gtt on bag) = gtts/minute

How do you calculate IV Drips for Infusion Pumps?

Total number of mL ordered/ Number of hours to run = Rate in mL/hour

How do you determine how many Hours an IV will run?

Num of mL ordered/Num mL per hour = Number of hours to run

What is the Drip rate?

How fast a medication is going in (infusing) gtt/min (gtt = drops) *it’s always a whole number

What is the Drop factor?

The size of the tubing *The number of drops it takes to make up 1 ml using the particular tubing gtt/ml

How do you find the Drip rate ?

Drop factor X flow rate

What is MICRO tubing?

Micro = less than 100 *usually only 60gtt per ml

What are the exceptions when using micro tubing?

-giving blood -Viscous fluid *you must use MACRO tubing!!

What is MACRO tubing?

When the flow rate is 100 or more: 3 sizes: 10, 15 20 gtt/ml

What determines the tubing size?

The flow rate

What is the formula for drops per minute?

mL/min X drop factor

State IV Medication advantages

-Direct access to circulatory system -instant action -Instant drug action and drug termination -Rapid treatment -Better control of rate -Great for those with Gl tract limitations -Good for meds that irritate gastric mucosa

State IV Medication disadvantages/ complications

-Reconstitution errors: recommeded volume of diluent -Venous Spasm -Drug incompatibilities -Impaired drug absorption -Speed Shock -Chemical phlebitis -Extravasation of vesicants -Air embolism

What are the IV Cannulations sites to avoid?

-Legs, ankles, and feet -Sclerosed or thrombosed veins -Veins that are knotted or tortuous -Veins below an infiltrated site or areas of phlebitis -Areas of inflammation, disease, bruising, or breakdown -Veins of surgically compromised or injured extremities -Dominant hands (if possible) and extremities with AV shunts for dialysis

What does IV Cannulations and Phlebotomy heavily relies on?

feel/touch not sight

Where do IV Cannulations start ?

Low and work proximally - inner wrist is sensitive - AC is last option!

IV Therapy: -Where? -Length? -Absorption?

-Within the vein (peripheral or central) -short to long term -Fastest delivery method

State IV Therapy Advantages

-replace fluid -transfuse blood -deliver meds -correct electrolyte imbalances

State IV Therapy Disadvantages

-adverse reactions -incompatible -infections (local or systemic): -damage -fluid overload -overdose -hinderance (annoying) -potentiate/worsen electrolyte imbalances

What is the FORMULA FOR CALCULATING DROPS PER MINUTE (gtts/min):

Drops per minute (gtts/min)= (Total infusion volume × drop factor)/ total time of infusion in minutes

What is the FORMULA FOR INFUSION TIME (IN HOURS)?

infusion time (hour) = total volume to infuse(mL) / millilitres per hour being infused(mI/hour)