IV therapy Flashcards
what are some different purposes of IV therapy
-maintenance or replacement of fluids and electrolytes
-provide glucose and nutrition
-access route to administer meds intravenously
-venous access to administer blood products
-venous access for emergencies
are peripheral IVs for short or long term use
short term use
how often should peripheral IVs be changed
change Q96 hours or according to agency’s policy
what does IID stand for
intermittent infusion device
if peripheral IV is capped how often do you flush and assess site
-flush Q8 to check patency
-assess site at least Q8
when talking about IV gauges the larger the number…
the smaller the needle size
which gauge is most common for peripheral IVs
20
what is 16 or 18 gauge large bore used for
trauma/surgery
both require a large vein
what is the smallest gauge we generally use for adults
22
used for fragile veins, older adults, amd slower infusions, can still give blood products
what is 24 gauge used for
slow flow rates, pediatric and elderly
when pushing IV meds, what should you remember to check for?
-allergies
-compatibilities (do the meds get along)
-dilution (some meds need reconstituted/diluted)
-rate of adminstration (slow or fast?)
IVP meds
what port do you clean before pushing the med through it?
the port closest to the patient
clean with alcohol and connect syringe
IVP meds
what port do you clean before pushing the med through it?
the port closest to the patient
clean with alcohol and connect syringe
IVP meds
administer drug at ____ with constant flow
recommended rate
IVP meds
how do you flush a peripheral IV
SAS method (saline, admin, saline)
use 3-5ml
where should you never administer IVP or IVPB meds
TPN or PCA line
when are central venous catheters used
long term therapy or tissue toxic meds
describe central venous catheters
-can be inserted at bedside as a sterile procedure (PICC)
-some are implanted surgically (port)
-single or multiple lumens
-site can be used immediately after insertion
describe a PICC line
-can be inserted by a specially trained nurse
-placement verfiied with chest xray
-follow CVC admin guidelines
describe nursing and nursing assistant care for PICC
- no BP in arm with PICC
- no venipunctures from the arm with the PICC
describe implanted ports
-surgically implanted
-assure initial placement with Xray
-assess site
-access port with noncoring needle
-use CVC admin guidelines
-generally seen with chemotherapy, can be used for years
-when not accessed, low risk for infection
what are the CVC use guidelines
- verify placement prior to initial use (xray)
- assess site
- use 10ml flush and syringe
- assure blood return before asministration
what do you do if blood return is absent prior to administration according to CVC use guidelines
-check clamps/connections
-flush 10ml
-reposition patient/ask pt to cough
-hold therapy
-obtain an order for declotting agent
-confirm proper line placement: xray
IVP meds via central line
remember to check for…
-allergies
-compatibilities
-dilution
-rate of administration
IVP meds via central line
what port do you clean
port closest to patient
IVP meds via central line
do you check for blood return
yeppers
IVP meds via central line
administer drug at ____ with constant flow
recommended rate
IVP meds via central line
describe SAS with central line
-saline, admin, saline
-10ml peripheral flush
-may need heparin in port (sash) (super rare)
IVPB
which infusion is lower
primary
IVPB
which infusion gets hung higher
secondary
describe primary infusion
something running continuously
IVPB
what should you akways check
compatibility
a patient came to the ER after a car accident. what type of IV should the nurse start?
A. 18g peripheral
B. 22g peripheral
C. port-a-cath
D. PICC line
A. 18g
a large bore IV like an 18 would be ideal for a trauma pt. a central line or implanted port are not warrented in this case
before giving an IVP med through a central line which step should the nurse take?
A. apply tourniquet
B. hang normal saline bolus
C. check for blood return
D. start peripheral IV
C. check for blood return
always check for blood return with central lines as part of checking patency
IV fluids
crystalloids
clear fluids
saline, LR, D5W
IV fluids
colloids
fluids that cannot see through (TPN, blood)
IV fluids
tonicity
homeostasis serum = other body fluids
how similar it is to body composition
IV fluids
isotonic
-same toncity as body fluids
-osmolality close to that of ECF and does not cause cells to swell or shrink
-good for basic hydration and add fluid volume
IV fluids
hypotonic
-fluid shifts out of blood, cells swell
-exert less osmotic pressure than ECF
-used to replace cellular fluid
-used short term, usually for DKA
-mainly seen in ICU
IV fluids
hypertonic
-pull fluid into vasular system, cells shrink
-osmotic pressure greater than that of ECF
-used in hyponatremia and cerebral edema
-usually seen in ICU
name some types of isotonic solutions
-normal saline (0.9% NaCl)
-5% dextrose in water (D5W)
-lactated ringers
name a type of hypotonic solution
0.45% NaCl
name a type of hypertonic solution
3% NaCl
electrolyte values
sodium
135-145
electrolyte values
potassium
3.5-5.0
electrolyte values
chloride
95-105
electrolyte values
bicarb
24-31
electrolyte values
calcium
8.8-10.5
electrolyte values
phosphorus
2.5-4.5
electrolyte values
mag
1.8-3.6
what may cause hyponatremia
sodium <135
-diuretics
-N/V/D
-overhydration
signs and symptoms of hyponatremia
-N/V
-HA/seizures
-dizziness
-muscle cramps/weakness
what may cause hypernatremia
sodium >145
-dehydration
-heatstroke
-burns
signs and symptoms of hypernatremia
-thrist
-fever
-seizures
-muscle twitching
what may cause hypokalemia
potassium <3.5
-diarrhea
-gastric suctioning/vomiting
-diuretics
signs and symptoms of hypokalemia
-weakness/cramps
-constipation
-cardiac dysrhythmias
what may cause hyperkalemia
potassium >5
-kidney disease
-diuretics
-burns
what are some signs and symptoms of hyperkalemia
-weakness
-paresthesias
-cardiac dysrhythmias
what are some potential causes of hypocalcemia
calcium <8.8
-parathyroid disorder
-vit D deficiency
-poor absorption
signs and symptoms of hypocalcemia
-numbness/tingling
-trousseaus and chvostek +
-seizures
potential causes of hypercalcemia
calcium >10.4
-parathyroid disorder
-tumor
-calcium supplements
signs and symptoms of hypercalcemia
-weakness/fractures
-constipation
-hypoactive reflexes
potential causes of hypomagnesemia
mag <1.8
-alcoholism
-diarrhea
-malabsorption
signs and syptoms of hypomagnesemia
-trousseau’s and chvostek’s +
-increased reflexes
-EKG changes
potential causes of hypermagnesemia
mag >3.6
-adrenal insufficiency
-hypothyroidism
signs and symptoms of hypermagnesemia
-flushing
-hypoactive reflexes
-EKG changes
potential causes of hypophosphatemia
phosphorous <2.7
-alcohol use
-low mag
-vomiting/diarrhea
signs and symptoms of hypophosphatemia
-muscle weakness
-confusion
-seizures
potential causes of hyperphosphatemia
phosphorus >4.5
-kidney disease
-dehydration
signs and symptoms of hyperphosphatemia
-N/V
-muscle weakness
-hyperactive reflexes
potential causes of hypochloremia
chloride <96
-vomiting/suction/sweating
-diuretics
-addison disease
signs and symptoms of hypochloremia
-agitation
-muscle cramps
-seizures
potential causes of hyperchloremia
chloride >108
-excessive NaCl infusion
-kidney injury
-dehydration
signs an symptoms of hyperchloremia
-weakness
-edema
-seizures
reviewing your patients morning labs you note a potassium of 5.6. what nursing intervention whould you take?
A. call MD for a tele order
B. place seizure pads on bed
C. hold AM furosemide
D. check for chvostek sign
A. call MD for a tele order
hyperkalemia can lead to fatal heart arrythmias, placing the patient on a monitor would be important in this case
name some different potential complications of IV therapy
-infiltration
-phlebitis
-infection
-occlusion
-fluid overload
-air embolism
what is occlusion
partial blockage of IV access
describe prevention of occlusion
-avoid use of AC for IV start
-use only “compatable” mixtures
-peripheral/central IID sites: use SAS, flush every 8 hours
what is inflitration
-swelling (above IV site)
-cool to touch
-pallor
-tissue has increased firmness
-absence of blood return (not diagnostic)
-pain or discomfort at site
describe prevention of infiltration
-check IV site every hour if infusing
-use stabilization device/proper dressing
-protect IV tubing and site when ambulating patient
-chack patency of access device prior to admin of all meds and fluids
-discontinue IV if any signs of infiltration
-restart the IV at different site
what is extravasation
infiltration with tissue toxic substances
what substances may cause extravasation
-vasopressors (dobutamine, dopamine, epinephrine)
-chemotherapeutic agents (adruamycin, vincristine, bleomycin)
-electrolytes (potassium chloride, calcium chloride, calcium gluconate)
describe prevention and nursing considerations of extravasation
-check IV site at least every hour for signs and symptoms
-stop infusion
-discontinue IV if any signs of infiltration
-restart the IV at different site
-be aware if antidote available
-dilute meds like potassium and calcium
-suggest a central venous catheter
what is phebitis
inflammation of a vein
symptoms of phlebitis
-red streak along vein
-skin is warm, hot along the vein
-vein firm/cord like
-pain
what are some complications of phlebitis
-clots
-infection
name some different types of phlebitis
-mechanical phlebitis
-chemical phlebitis
-post infusion phlebitis
-bacterial phlebitis
describe mechanical phlebitis
-long periods of cannulation, catheter in a flexed area, catheter gauge larger than vein, poorly secured catheter
-usually occurs in AC
describe chemical phlebitis
from an irritating med or solution, rapid infusion rate, med incompatibilities
describe post infusion phlebitis
generally occurs 48-96 hours after infusion has been discontinued
describe bacterial phlebitis
-poor hand hygiene, lack of aseptic, failure to check equipment, or recognize early signs of phlebitis
-often occurs during insertion
describe prevention and nursing considerations of phlebitis
standard IV precautions:
-hand washing
-aseotic technique with new IV
-scrub that hub
-follow agency protocols for tubing/site changes
buffer irritating meds and hypertonic solutions
if phlebitis occurs what do you
-d/c IV and restart
-alert MD
-culture site/device (as ordered/prtocol)
-monitor VS
-document
where are infections more prevalent
central
why do more infections occur with central lines
-poor hand hygiene
-frequent disconnection of tubing
-poor insertion technique
-multi lumens
-frequent dressing changes
-poor hub care
-improper tubing changes
describe syetmic infection from central line infections
-sepsis
-occurs throughout the body
-involves several systems
-organisms/toxins in the blood
-leading cause of deaths in ICU
-CLABSI
describe prevention and nursing considerations for CLABSI
-hand hygiene ** (hand washing, no artificial nails)
-scrub the hub** (15 secs and use disinfecting caps)
-sterility of access/equipment
-know agency policy
-do not use expired solution, tubing, fluids
what is fluid overload
inadvertent administration of excess fluid
increases blood pressure and central venous pressure
signs and symptoms of fluid overload
-moist crackles
-edema
-weight gain
-dyspnea
-rapid/shallow respirations
describe prevention of fluid overload
-use IV pump, monitor IV rate
-check pt every hour (stable adult patient)
-keep I and Os
-monitor vitals, close assessment
-notify MD
what is air embolism
air in circulatory system, very rare
potential causes of air embolism
-during insertion of large bore IV
-accidental removal of large IV
-improper removal of central line
-air given through line
-loose connections
classic signs and symptoms of air embolism
sudden
- difficulty breathing
- chest pain
- muscle or joint pain
- stroke
- mental status change
- low BP
- cyanosis
prevention of air embolism
-prime all tubing
-address all bubbles
-double check flushes and IVP syringes
-proper technique for removing CVC
treatment of air embolism
-stop infusion or disconnect tubing to prevent air entry
-place pt in left side lying trendelenburg (helps prevent air from travelling to right side of heart into pulmonary arteries)
-monitor vitals and pulse ox
you are assessing your patient IV and find it is cool and swollen. what should you do next?
remove IV and restart
cool and swolen would indicate infiltration. simply remove and start a new one
