IV theory

Question 1

Hypotonic solution

Answer 1

Lower solute in the solution than the cell causing water to go into the cells (NS, LR)
Cytolysis

Question 2

Hypertonic solution

Answer 2

Higher solute in the solution causing water to leave the cell (Mannitol)
Plasmolysis

Question 3

Isotonic solution

Answer 3

Equal inside and outside the cell

Question 4

Crystalloids

Answer 4

Dissolved salts and sugars creates crystalloids.
Contains no proteins
Stays in intravascular space shortly before diffusing across capillary walls into tissue

Question 5

Colloids

Answer 5

Contains large molecules like protein
Doesn’t pass through capillary membrane as fast

Question 6

Micro sets

Answer 6

Always 60 gtts/ml
Delivers meds over a long period of time
Assists in precise measurement of medications
Controls amount of fluid and fluid overload in certain patients

Question 7

Macro sets

Answer 7

10, 15, 20 gtts/ml
Most common utilized admin sets
effective for TKVO and large fluid admin (bolus)

Question 8

Local complication- Infiltration causes

Answer 8

Causes: dislodgement of the catheter from the vein, puncture of distal wall, leakage of solution/medications into surrounding tissue, poorly secured IV, poor vein/ site, irritating solution/med that inflames intimate of vein, improper cannula size, high delivery rate/ pressure of solution/meds

Question 9

Infiltration S&S

Answer 9

coolness of skin around IV site, swelling at IV site with/without pain, sluggish/absent flow rate, infusion continues to infuse when pressure is applied to vein above tip of cannula, no back flow of blood into IV tubing when clamp is open and solution lowered below IV site

Question 10

Infiltration treatment

Answer 10

discontinue IV, confirm catheter is intact, restart IV away from site, ice pack if needed, document incident

Question 11

IV complication- Hematoma

Answer 11

Blood collects outside the vessel after catheter passes through the vein
S&S: redness, tenderness, pain, swelling
Treatment: after catheter is removed, make sure it is intact, apply light direct pressure to site, cover and document the condition

Question 12

IV complication- Phlebitis

Answer 12

Inflammation of the vein caused by injury to the vessel wall
S&S: pain, swelling, redness, tenderness
Treatment: use of an appropriate size catheter to cannulate vein

Question 13

IV complications- Local infection

Answer 13

Infection present at/ around Iv site after IV initiation (3-4 days after IV)
S&S: redness, foul discharge/ odour at site
Treatment: upon IV canulation ensure clean site, sterile tubing/ catheter, proper PPE precautions

Question 14

Air embolism (systemic complication)

Answer 14

Caused by air entering blood stream via catheter tubing during insertion, tubing is disconnected to replace solutions, or new extension tubing

Question 15

Air embolism S&S

Answer 15

hypotension, cyanosis, weak/ rapid pulse, loss of consciousness

Question 16

Air embolism management

Answer 16

close tubing, turn pt on left side with head down, check tubing for leaks, administer high concentration O2, notify medical direction

Question 17

Bolus vs TKVO

Answer 17

Bolus: IV fluid in as fast as possible, hypotensive
TKVO: 30-60cc/h (>12 years) or 15cc/h (2-12 years)

Question 18

Mechanical complications

Answer 18

changes in position of needle, height of solution, amount of solution, position of pt (kinked tubes), disconnected tubes, plugged air vents and/or plugged needles/ cannula

Question 19

Catheter sizes

Answer 19

Orange- 14g
Grey- 16g
Green- 18g
Pink- 20g
Blue- 22g
Yellow- 24g

Question 20

ACR documentation

Answer 20

Time of insertion, number of attempts (individually documented), size/type of catheter, vein selected,
description of site and infusing abilities, medic info (number and initial), any type of reaction, if discontinued time and condition of catheter

Question 21

IV line maintenance standard BLS- general directive

Answer 21

1. to keep the vein open to maintain IV patency for a pt<12 if 15ml/hr and >12 is 30-60ml/hr for any isotonic/ crystalloid solutions
2. an IV for fluid replacement with a max flow rate infused up to 2ml/kg/hr to max flow rate of 200ml/hr, thiamine/ multivitamin preparations, drugs within certification level, or potassium chloride for pts >18 to a max of 10mEq in a. 250ml bag

Question 22

IV line maintenance standard BLS- use of escorts

Answer 22

unless within level of certification a escort may be used if a pt needs an IV for blood/ blood product admin, potassium chloride <18 years old pt, medication, requiring electronic monitoring or pressurized IV fluid infuser/ pump/ central venous line, or for a neonate/ paediatric pat <2 years of age.

Question 23

IV line maintenance standard BLS- procedure (pre-transport)

Answer 23

confirm physicians written order with sending facility staff, determine IV solution/ flow rate/ catheter gauge/ catheter length/ cannulation site, note condition of Iv site prior to transport, amount of fluid remaining in bag, amount of fluid required to complete transport time and obtain more fluid, and document all pre-transport IV information on ACR

Question 24

IV line maintenance standard BLS- procedure (during transport)

Answer 24

monitor/maintain IV at prescribed rate (change bag as required), discontinue IV if dislodged/ interstitial and remove catheter with aseptic technique, and confirm condition of catheter if removed

Question 25

IV line maintenance standard BLS-guideline

Answer 25

the IV bag should be changed when approx. 150mls of solution remaining

Question 26

IV and fluid therapy medical directive- indications

Answer 26

actual or potential need for IV medication or fluid therapy

Question 27

IV and fluid therapy medical directive- conditions

Answer 27

IV cannulation:
age- >2 years
LOA, HR, RR, SBP, other- N/A

0.9% NaCl fluid bolus:
LOA, HR, RR, other- N/A
SBP- normotension

Question 28

IV and fluid therapy medical directive- contraindications

Answer 28

IV cannulation:
suspected fracture proximal to the access site

0.9% NaCl fluid bolus:
fluid overload

Question 29

IV and fluid therapy medical directive- IV cannulation (0.9% IV maintenance)

Answer 29

Age: >2-<12 years
Route: IV
Infusion: 15ml/hr

Age: >12 years
Route: IV
Infusion: 30-60 ml/hr

Question 30

IV and fluid therapy medical directive- 0.9% fluid bolus

Answer 30

Age: >2- <12 years
Route: IV
Infusion: 20ml/kg
Reassess every: 100ml
Max volume: 2000ml

Age: >12 years
Route: IV
Infusion: 20ml/kg
Reassess every: 250ml
Max volume: 2000m

Question 31

IV and fluid therapy med directive auxiliary indications

Answer 31

actual or potential need for IV medication or fluid therapy

Question 32

IV and fluid therapy med directive auxiliary conditions

Answer 32

age >2 years, SBP hypotensive

Question 33

IV and fluid therapy med directive auxiliary contraindications

Answer 33

fluid overload

Question 34

IV and fluid therapy med directive auxiliary treatment- NaCl 0.9% maintenance infusion

Answer 34

> 2-<12 years: infusion 15ml/hr

> 12 years: 30-60ml/hr

Question 35

IV and fluid therapy med directive auxiliary NaCl 0.9% fluid bolus

Answer 35

> 2-<12 years: 20ml/kg, reassess every 100ml, max volume 2000ml

> 12 years: 20ml/kg, reassess every 250ml, max volume 2000ml