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- assess IV solution and change when container low, container outdated per CDC guidelines (96degrees) or when health care provider orders a different solution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
