IV Skills Flashcards
IV infusion pump
Generates the flow of IV fluids by exerting pressure on the tubing or the fluid. Overcomes peripheral resistance.
Types of electronic infusion devices
IV infusion pump, IV controller
Advantages to IV infusion pump
More precise than controllers, accurately deliver the fluid as programmed
Disadvantages to IV infusion pump
Ability to exert pressure and overcome resistance puts IV site at greater risk for infiltration
Purposes of EIDs
Regulate rate and volume of infusions, improves safety and accuracy of fluid and drug administration, not intended to replace the nurse or nurse’s responsibility for monitoring and insuring the flow rate of the therapy
IV controller
Generates flow of IV fluids by gravitational force. Container must be at least 36 inches above venipuncture site to work. Sensor system utilized
Advantages of IV controllers
Reduce the potential to rapid infusion of large amount I solutions because they maintain accurate flow rates
Disadvantages of IV controllers
Cannot detect infiltrations, not often used except in long term care agencies
Equipment prep for EID
- Obtain appropriate tubing that is compatible with the EID
- obtain ordered IV solution
- obtain EID
- prime tubing according to manufacturers instructions
- plug in EID and turn on, clear previous data
- load tubing according to manufacturers guidelines
- set controls to desired infusion rate and volume
- place electronic infusion device on same side as venipuncture
Client Assessment and Teaching Preprocedure EID
- assess patency of IV site. Note complications of phlebitis or infiltration. Presence of these complications necessitates a new IV site
- assess integrity of IV Q1. Change as needed
- teach client about EID alarm system, instruct client not to adjust alarms and call rn if alarm sounds or if pain or swelling occurs at IV site
Initiate/monitor/assess EID
- attach IV tubing to clients IV access device and begin infusion of ordered solution at prescribed rate
- document appropriate information on intake/output flow sheets, IV assessment flow sheets and/or progress notes per agency policy
- assess IV solution and change when container low, container outdated per CDC guidelines (96degrees) or when health care provider orders a different solution
- assess the EID frequently to make sure the solution is infusing properly since these devices can malfunction (check volume infused feature and correlate to ordered rate over specific time span, observe and count actual drops, observe credit of solution an correlate to ordered rate over specific time span), keep EID plugged in at all times except during ambulatory to conserve battery power
- change EID tubing per agency policy
Client Assessment During Procedure EID
- assess IV site Q 1 h, when changing IV bag or rate or prior to administering an intravenous minibag
- assess client response to infusion. Note both therapeutic response and any adverse effects
Troubleshooting EID
when EID alarm sounds immediately pause/stop pump and perform assessment. begin the assessment with the client and proceed systematically in a upward fashion
Systematic Assessment
- Client: IV site, patency, complications, position of extremity
- Assess Tubing: kinks, obstructions, roller clamps/side clamps, air in line, drip chamber correctly filled, placement of tubing within electronic infusion device
- Assess Infusion Device: on/off button, run/hold/pause button, battery power indicator/plugged into outlet, alarm indicator, rate/volume/volume to be infused buttons, drop sensor position
- Assess Solution: Solution credit, height of container (controller only)
What to do in case of Air Detection Alarm
follow systemic assessment looking for air in line. clamp tubing and remove tubing from client’s IV access device and EID. remove air by purging the line. reload electronic infusion device and attach to client’s IV access device
How to prevent Air Detection Alarm
correctly prime IV tuving, set EID at correct volume to be infused
What to do Battery Low Alarm
plug in EID
How to prevent Battery Low Alarm
keep EID plugged in at all times except during ambulation
What to do Pressure or Occlusion Alarm
follow systematic assessment looking for cause of pressure or occlusion
How to prevent Pressure or Occlusion Alarm
maintain patent IV site, open all clamps prior to beginning the infusion, correctly load EID, position client’s extremity to prevent kinking obstruction or disruption of flow
Patient Controlled Analgesia
A method of pain management that allows for self-administration of intravenous analgesics using a computer controlled infusion pump to deliver a predetermined dose of medication within set limits
Purpose of patient controlled analgesia
facilitates client involvement in pain control, provides individualized pain relief, provides client with a sense of control over the pain, decreases opioid requirements, eliminates need for IM analgesics
Contraindications for patient controlled analgesia
client inability to understand PCA teaching, client with psychomotor deficit who is unable to depress PCA button
Bolus
The amount of medication delivered either as a loading dose or as an additional supplement
Bolus Dose
The amount of medication delivered after PCA started or as an additional supplement
Loading Dose
The amount of medication delivered before starting PCA
Continuous Infusion
The amount of medication continuously delivered to the client each hour
Lockout Interval (Delay Interval, Dose Interval)
The prescribed time interval between PCA injections. This interval is the minimum interval that must pass before another injection is delivered regardless of the number of client attempts. also referred to as time lockout interval which is usually 6-10 minutes for postoperative patients
Max Limit (Dosage Limit)
1 hour or 4 hour limit depending on facility policy. The maximum hourly amount of medication to be delivered in a specific time frame
Total Demands or Attempts
Number of times client pushes PCA button
Injections
Number of completed injections delivered by PCA
Total Drug Delivered or Cumulative Dose
The total amount of medication delivered to the client (continuous, bolus, PCA)
Cone (Concentration)
drug concentration mg/mL of drug loaded in PCA administration set
Extravasation
The leakage of material from a vessel into the surrounding tissue; the escape of vesicant infusate (fluid, medication, or blood products) from the vein into the surrounding tissue
Intravenous Piggyback (IVPB
Common method to administer IV medication concurrently with the primary infusion. It is coupled to the primary infusion line at the first injection port below the back check valve
Indications for intravenous medications
- when medications are too irritating to tissues to be given by other routes
- enter the client’s bloodstream directly by way of a vein, appropriate when rapid effect is required
Advantages of IV medications
direct access to circulatory system, route of administration for medications that irritate the gastric mucosa, route for instant medication action, deliver high medication action, deliver high medication concentrations, instant medication termination if sensitivity or adverse reaction occurs, better control over rate of medication administration
Disadvantages of IV medications
medication interaction because of incompatibilities, speed shock, extravasation of a vesicant medication, chemical phlebitis
Electronic Infusion Device Formula
X mL/ X min TIMES 60 minutes/1hr = mL/hr
Gravity (Manual ) IVPB
X mL/ X min TIMES X drops/mL = X gtts/min
What should an RN teach a patient with PCA?
how to use, report symptoms of itching, N, V, constipation, drowsiness, bladder fullness, TCDB
What should an RN assess in a patient with PCA?
VS, PAIN, LOC, lung sounds
Potential complication of epidural analgesic
high spinal anesthesia can cause loss of respiratory muscle functioning. notify clinican. check MAR for naloxone hydrochloride (Narcan) order for R depression.
What to assess in a patient with an epidural analgesic
ABCs, VS (esp. RR and LOC every hour for first 24 hours and q4h after), pain
Why is catheter placement so important in an epidural analgesic?
accidental migration can lead to accidental puncture of epidural vein. overdose then occurs. c/o ringing in the ears, metallic taste in mouth, sense of impending doom, decreased BP leads to unconsciousness and cardiac arrest. tape down catheter, do not pull on catheter and position safely
Why is it important to asses bowel and bladder functioning in a patient with an epidural analgesic?
medication slows peristalsis in bowels and reduces bladder sensation. check for bladder distention. catheterize per MD order. check bowel elimination status and administer laxative/stool softeners per MD order
What should be reported in a patient with an epidural analgesic?
- resp. depression
- mental status changes
- catheter displacement
- infection at catheter site
- urinary retention
- severe pruritus unrelieved by Benadryl
- N/V despite antimetics
Extravasation
Infiltration. The leakage of material from a vessel into the surrounding tissue; the escape of vesicant infusate (fluid, medication, or blood products) from the vein into the surrounding tissue
Intravenous Piggyback (IVBP)
Common method to administer IV medications concurrently with primary infusion. It is coupled to the primary infusion line at the first injection port below the back check valve.
Indications for IV meds
- when medications are too irritating to tissues to be given by other routes
- enter the client’s blood stream directly by way of a vein, appropriate when rapid effect is required
Advantages of IV meds
- direct access to the circulatory system
- route of administration for medications that irritate the gastric mucosa
- route for instant medication action
- deliver high medication concentraions
- instant medication termination if sensitivity or adverse reaction occurs
- better control over rate of medication administration
Disadvantages of IV meds
- medication interaction because of incompatibilities
- speed shock
- extravasation of a vesicant medication
- chemical phlebitis
Parenteral Meds Supplied in Powered Form
The powder cannot be removed from the sealed vials. You must add sterile water or saline to the vial and dissolve the powder to form a solution. You then inject the liquid volume of a prepared solution that contains the proper amount of the medication
Reconstitution
The technique of adding a solvent to a powdered medication to prepare it for administration
Back Priming
Clear tubing of air by opening clamp, temporarily placing secondary IV medication bag lower than the primary IV solution bag and allowing primary solution to flow retrograde into secondary tubing *if the medication is not compatible, back prime into old secondary bag to remove residual medication from secondary line. make sure you back prime all medication.
How much solution does a secondary line hold?
19.4 mL
Which injection port chamber do you attach a piggyback?
Primary Y tubing site port. The use of injection port closest to the drip chamber of primary IV line allows piggyback to infuse while stopping the flow of primary IV line through backcheck valve.
How do you adjust the flow on the secondary medication?
using the roller clamp on the primary tubing
When should you disconnect flush syringe and cleanse the device cap with a new alcohol swab?
Before connecting IV tubing
How do you direct the fluid in a tube with a stopcock?
The stopcock handle is always over the close port.
Intravenous Push Medication
The injection of a medication diluted in less than 50 mL of diluent directly into an existing IV access device close to its insertion site
If the IV push medication is not compatible with other IV solutions/medications that the client is receiving at the same time, what would the RN do?
Sterile normal saline flush before and after administering the medication
What should you assess after giving an IV Push?
anaphylactic reaction, chemical phlebitis and inflitration
Central Venous Catheters
Used for treatment in which medications or fluids are infused directly into a major vein; used in emergencies, when a client’s peripheral veins are inaccessible, or when a client needs infusion of a large volume of fluid, multiple infusion therapies, or long-term venous access. central venous catheter is inserted with its tip in the superior vena cava, inferior vena cava, or right atrium of the heart
Signs of Clot formation in a catheter
difficulty flushing, sluggish infusion, absence/sluggish blood return, extravasation
Signs of extravasation
burning, swelling around insertion site
Intravenous Push Medication
The injection of a medication diluted in less than 50 mL of diluent directly into an existing IV access device close to its insertion site
If the IV push medication is not compatible with other IV solutions/medications that the client is receiving at the same time, what would the RN do?
Sterile normal saline flush before and after administering the medication
What should you assess after giving an IV Push?
anaphylactic reaction, chemical phlebitis and inflitration
Central Venous Catheters
Used for treatment in which medications or fluids are infused directly into a major vein; used in emergencies, when a client’s peripheral veins are inaccessible, or when a client needs infusion of a large volume of fluid, multiple infusion therapies, or long-term venous access. central venous catheter is inserted with its tip in the superior vena cava, inferior vena cava, or right atrium of the heart
Signs of Clot formation in a catheter
difficulty flushing, sluggish infusion, absence/sluggish blood return, extravasation
Signs of extravasation
burning, swelling around insertion site
SASH
Saline, Administer Med, Saline, Heparin
What is special about Groshong?
SAS NO HEPARIN
Peripheral IV Length/Gauge/Duration
18-22 gauge, 1.5 to 2 in over the needle catheter, 96 hours
Can a peripheral IV be used for blood draws?
NO
Peripheral IV Flushing
1-3 mL sterile normal saline every shift and after use
Peripheral Valve Changes
Entire catheter changed every 96 hours
Peripheral Dressing Change
Dressing change with new site only
When is a central line used?
- In emergencies or when a patient a peripheral veins are inaccessible
- when a patient requires infusion of large volume of fluid, multiple infusions, long term venous therapy
Benefits of central IV line
- access to central veins
- rapid infusion
- draw blood
- measure CVP
- reduce venipuncture
- reduced risk of vein irritation
- administer multiple incompatible medications
Risks of central IV
- pneumothorax
- sepsis
- thrombus formation
- perforation
- increase time, skill, $
- risk of air embolus
When do you flush with heparin with a central IV?
q8h to every day
What do you flush a central IV with?
Heparinized saline and/or saline filled with 10 mL
Valve changes central IV
Use strict asepsis risk of embolus
Dressing change central IV
Sterile technique, scrub with chlorhexadine
Removal of central IV line
MD and picc by qualified nurse
What must all central line have prior to use?
Must have positive confirmed placement by X-ray prior to use… Tip of catheter in superior vena cava or subclavian
Groshong
Do not put heparin
Pneumothorax Symtoms
- chest pain
- dyspnea/tachypnea
- cyanosis
- decreased or absent BS
Pneumothorax Cause
- lung puncture during insertion
- vessel puncture
- lymph puncture
- infiltration
Pneumothorax TNI
- notify MD
- assess BS and VS
- anticipate catheter removal
- administer O2
- prepare for chest tube insertion
- document
Pneumothorax prevention
- positioning during insertion
- assess for infiltration
- ensure immobilization of client during insertion
- minimize activity after insertion
Air Embolus Symptoms
- chest pain
- resp. distress
- weak pulse
- hypotension
Thrombosis Symptoms
unilateral edema, erythema at or along insertion site, fever
Local Infection Symptoms
redness, warmth, tenderness, swelling, exudate, local rash, fever, chills, malaise
Systemic Infection Symptoms
fever, positive blood cultures, chills, tachycardia, increase WBC, tachypnea, N, V, s/s of shock, malaise
Air Embolus Cause
- entry of air into circulatory system during insertion or tubing change
- inadvertent opening/cutting or breaking of catheter
Air Embolus TNI
clamp catheter immediately, turn to left with head in down position, administer O2, call MD, document
Air Embolus Prevention
-purge air from tubing, use filters, use air detectors on electronic infusion device, use luer locked or taped connections
Thrombosis Cause
formation of a fibrin or blood cloth on the catheter
Thrombosis Prevention
maintain flow through cath, positive pressure technique, dilute irritating solutions
Thrombosis TNIs
notify MD, anticipate cath removal, anticoagulants, warm, moist heat, don’t use CVC, document, anticipate fibrinolytic agent per MD order (clot dissolver)
Local Infection Cause
failure to maintain asepsis during insertion on routine care, immunosuppression
Local Infection TNI
check T, culture drainage from site, redress aseptically, possible antibiotics, anticipate cath removal, document
Local Infection Prevention
strict asepsis, cath insertion, dressing change, disinfection of cath hub and needleless access device, hand hygiene, if no longer needed discuss D/C with MD, teach client
Systemic Infection Cause
occurs for same reason as local infection but spreads systemically, more freq in immunocompromised clients, contaminated infusate
Systemic Infection TNIs
draw cultures, CV support, antipyretics, antibiotics, culture tip if cath removed, check VS, document
Systemic Infection Prevention
check infusate, use sterile technique, keep system close, teach asepsis
Fluids won’t infuse cause/Tni
Mechanical Occlusion, Pinch-Off Syndrome
- examine IV setup for kinked tubing, closed clamps, an empty infusion bag, and readjustment of the IV delivery system
- reposition the patient, raise arm on access side or turn head
- have patient cough
Unable to draw blood due to possible clot formation cause/TNIs
Portal reservoir occlusion
- gentle aspiration may dislodge the occlusive material
- obtain MD order to flush line with ordered declotting solution
Catheter Breaks Cause/TNIs
Inadvertent opening or cutting or breaking of catheter
- clamp cath immediately
- contact MD
- assess for air embolus
What should you tech a client for central line devices?
- type of central venous access device, purpose, length of catheter or port that will be inserted, signs and symptoms to report, such as increased temperature, discomfort, pain and difficult breathing, site care of PICC, CVTC, or implanted port
- emergency measures for clamping the cath if it breaks
- flushing protocol
- access line for administering medication, TPN, or fluids
Purpose of Parenteral Nutrition
Parenteral nutrition is a nutritional product that provides a partial or complete source of nourishment for clients who are unable to ingest or utilize suggicient calories and nutrients to sustain metabolic function
Total Parenteral Nutrition/Central Parenteral Nutrition
high alert medications, delivery of nutrients through a central line, provides total 24 hour calorie and nutrient needs in sufficient quantity to promote tissue growth and repair, long term use, home parenteral nutrition is life saving option for clients who needs it, 20-70% dextrose solution, promotes tissues synthesis, wound healing, normal metabolic function, bowel rest and healing, greater than 20% dextrose solution as calorie source, use for large caloric and nutrient needs, can provide full protein and calorie amounts, restores nitrogen balance, essential vitamins, electrolytes, minerals, builds tissue, heals wounds
Disadvantages
metabolic complications:
- glucose intolerance
- electrolyte imbalances
-risk pneumothorax or hemothorax with central line insertion
Peripheral Parenteral Nutrition
delivery of nutrients through a short cannula inserted into a peripheral vein, provides supplemental calories and protein, short term use that maintains the client’s nutrition level, used if central venous cath placement is contraindicated, fat is primary calorie source, 10% of lower dextrose solution, no insertion and maintenance of central catheter, delivers less hypertonic solutions than cantral venous parenteral nutrition, reduces chance of metabolic complications, increases caloric source, along with fat emulsion, supplemental nutrition will not increase patient weight but helps maintain it
Disadvantages
- cannot be used in nutritionally depleted patients
- cannot be used in volume restrict patients
- may cause phlebitis
Parenteral Nutrition In-Line Filter
a filter in the fluid pathway between the IV tubing and the venipuncture device. The micron filter contains a membrane that removes bacteria and particulate/particles and air from entering the client’s vein. Filters are used with total nutritional preparations and lipids
Parenteral Delivery Methods
continuous delivery or cyclic delivery
Continuous Delivery
In parenteral nutrition, delivery of an infusion over a 24 hour period
Cyclic Delivery
In parenteral nutrition, delivery of the entire solution overnight, also used to wean a client from total parenteral nutrition. during the last 30 to 60 minutes of cycling, the rate of administration is gradually cut to allow the pancreas to adjust to the glucose load.
What is important to check with a client on TPN?
BLOOD GLUCOSE
What should be done to prepare the TPN before infusing?
The infusion should be warmed at room temp for 30 minutes because chilled solution can cause discomfort, hypothermia, venous spasm, venous constriction
When should TPN be changed?
every 24 hours
May you add medications to a bag of parenteral nutrition?
NO
What should you do if parenteral nutrition is abruptly stopped?
Hang D10W at the same rate to prevent rebound hypoglycemia
Venipuncture
The act of entering a vein. The procedure is performed to withdraw a blood sample (phlebotomy) or to administer fluids, blood products, or medications
No venipunctures/IVs in…?
AV fistula arm, PICC line arm, stroke arm, mastectomy arm
When should you assess IV site after venipuncture?
30 minutes after venipuncture and every hour after that
Anemia
Hemoglobin level less than 8g/dL
Apheresis
A procedure in which blood is temporarily withdraw, one or more components are selectively removed and the remainder is reinfused into the donor
Leukopenia
WBC count below 5000/mL
Neutropenia
Diminished number of neutrophils in the blood
Thrombocytopenia
Platelet count below 100,000/mL
Homologous
Collected from a volunteer donor for transfusion to another individual
Autologous
collected from the client for a planned transfusion - donated prior to elective surgical procedure
Autotransfusion
Collection and reinfusion of blood lost during surgery and immediately after surgery
Purpose of Blood Transfusion
Restore and maintain blood volume, Improve O2 carrying capacity, Replace deficient clotting factors and improve coagulation
Whole Blood Purpose
Replace blood volume due to massive hemorrhage 2 hour trauma, surgery
Whole Blood TNI
requires T & C, may infuse rapidly in emergencies
Packed Red Blood Cells Purpose
Restore O2 carrying capacity, correct anemia
Packed Red Blood Cells TNI
requires T & C, usual rate of infusion is between 2-4 hours
Platelets Purpose
Replace deficiency of platelets (thrombocytopenia) to prevent bleeding
Platelets TNI
T & C preferred, administer as rapidly as pt. can tolerate
Fresh Frozen Plasma or Cryoprecipitate Purpose
Provide clotting factors
Fresh Frozen Plasma or Cryoprecipitate TNI
T required, C per agency policy, call blood bank to thaw FFP 1/2 hour before transfusion
Type and Crossmatch Purpose
Establish the compatibility of donor and recipient blood. Typing identifies a person’s blood type (A, B, O, AB) and Rh blood group (+/-). Crossmatching identifies minor antigens
Type and Crossmatch TNI
Assure that test has been ordered/obtained to reduce likelihood of a transfusion reaction
Hemolytic Reaction Cause
Infusion of ABO incompatible blood
Hemolytic Reaction Assessment
fever, chills, backache, headache, dyspnea, chest pain, hypotension, bleeding, renal failure
Hemolytic Reaction Prevention
check/verify/inspect patient ID, blood bag, blood component tag
Allergic Reaction Cause
sensitivity to plasma proteins
Allergic Reaction Asessement
flushing, itching, urticaria, wheezing
Allergic Reaction Prevention
if hx of allergic rx, premedicate with diphenhydramine
Febrile Reaction Cause
sensitization to donor’s WBCs, platelets, or plasma proteins
Febrile Reaction Assessment
fever, chills, warm/flushed skin, headache, anxiety, muscle pain
Febrile Reaction Prevention
premedicate with antipyretic (acetaminophen) if previous history of febrile rx
Bacterial/Septic Reaction Cause
contaminated blood administered
Bacterial/Septic Reaction Assessment
high fever, chills, vomiting, diarrhea
Bacterial/Septic Reaction Prevention
hang product within 30 minutes of obtaining from blood bank. tranfuse unit within 4 hours. observe for any discoloration or clumping. return unit to blood bank before infusion if problems arise
Risk for Injury (Transfusion Reaction) Outcome
Exhibits no signs or symptoms of a transfusion reaction during infusion of blood component
Risk for Injury (Transfusion Reaction) Key Assessment Data
- premedicate with acetaminophen and/or diphenhydramine prior to transfusion, if ordered, due to previous reaction
- stay with client for 1st 15 minutes of transfusion, assess and obtain VS q15 mins X 4
- continue to assess and obtain VS q30 mins
What to do if transfusion reaction is suspected at any time
- STOP TRANSFUSION
- keep vein open with 0.9% NS (new IV administration set)
- assess patient and support abc
- notify MD
- treat symptoms per MD order
What type of tubing is used for blood transfusions?
Special Y-type blood tubing. It contains a special filter required to remove debris and clots.
What size cath to establish patent IV site for blood transfusion?
18g or larger cath prevents damage to PRBCs
How long do you have to hang blood after it has been obtained from the blood bank?
30 minutes
What to do for infiltration
discontinue the IV, apply warm compresses, elevate extremity, check circulatory status of limb, restart IV above infiltration site
Benadryl generic name
Diphenhydramine
Classification of Benadryl (diphenhydramine)
antihistamine
Use of Benadryl (diphenhydramine)
prophylactic measure to prevent an allergic reaction during a blood transfusion in clients known to be at high risk for this type of reaction
Action of Benadryl (diphenhydramine)
blocks the effects of histamine
Side effects of Benadryl (diphenhydramine)
dizziness, drowsiness, urinary retention, hematologic toxicities
Nursing Implications Benadryl (diphenhydramine)
give IV undiluted, 25 mg/min. Be alert for urinary retention. Provide for safety and security. Use cautiously in patients with increased intraocular pressure, renal disease, prostatic hypertrophy.
