IV theory Flashcards
Hypotonic solution
Lower solute in the solution than the cell causing water to go into the cells (NS, LR)
Cytolysis
Hypertonic solution
Higher solute in the solution causing water to leave the cell (Mannitol)
Plasmolysis
Isotonic solution
Equal inside and outside the cell
Crystalloids
Dissolved salts and sugars creates crystalloids.
Contains no proteins
Stays in intravascular space shortly before diffusing across capillary walls into tissue
Colloids
Contains large molecules like protein
Doesn’t pass through capillary membrane as fast
Micro sets
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
Macro sets
10, 15, 20 gtts/ml
Most common utilized admin sets
effective for TKVO and large fluid admin (bolus)
Local complication- Infiltration causes
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
Infiltration S&S
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
Infiltration treatment
discontinue IV, confirm catheter is intact, restart IV away from site, ice pack if needed, document incident
IV complication- Hematoma
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
IV complication- Phlebitis
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
IV complications- Local infection
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
Air embolism (systemic complication)
Caused by air entering blood stream via catheter tubing during insertion, tubing is disconnected to replace solutions, or new extension tubing
Air embolism S&S
hypotension, cyanosis, weak/ rapid pulse, loss of consciousness
Air embolism management
close tubing, turn pt on left side with head down, check tubing for leaks, administer high concentration O2, notify medical direction
Bolus vs TKVO
Bolus: IV fluid in as fast as possible, hypotensive
TKVO: 30-60cc/h (>12 years) or 15cc/h (2-12 years)
Mechanical complications
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
Catheter sizes
Orange- 14g
Grey- 16g
Green- 18g
Pink- 20g
Blue- 22g
Yellow- 24g
ACR documentation
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
IV line maintenance standard BLS- general directive
- 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
- 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
IV line maintenance standard BLS- use of escorts
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.
IV line maintenance standard BLS- procedure (pre-transport)
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
IV line maintenance standard BLS- procedure (during transport)
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
IV line maintenance standard BLS-guideline
the IV bag should be changed when approx. 150mls of solution remaining
IV and fluid therapy medical directive- indications
actual or potential need for IV medication or fluid therapy
IV and fluid therapy medical directive- conditions
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
IV and fluid therapy medical directive- contraindications
IV cannulation:
suspected fracture proximal to the access site
0.9% NaCl fluid bolus:
fluid overload
IV and fluid therapy medical directive- IV cannulation (0.9% IV maintenance)
Age: >2-<12 years
Route: IV
Infusion: 15ml/hr
Age: >12 years
Route: IV
Infusion: 30-60 ml/hr
IV and fluid therapy medical directive- 0.9% fluid bolus
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
IV and fluid therapy med directive auxiliary indications
actual or potential need for IV medication or fluid therapy
IV and fluid therapy med directive auxiliary conditions
age >2 years, SBP hypotensive
IV and fluid therapy med directive auxiliary contraindications
fluid overload
IV and fluid therapy med directive auxiliary treatment- NaCl 0.9% maintenance infusion
> 2-<12 years: infusion 15ml/hr
> 12 years: 30-60ml/hr
IV and fluid therapy med directive auxiliary NaCl 0.9% fluid bolus
> 2-<12 years: 20ml/kg, reassess every 100ml, max volume 2000ml
> 12 years: 20ml/kg, reassess every 250ml, max volume 2000ml
