IV therapy Flashcards
What gauge needle do you draw up with
18-21G
protocol for drawing up material
wash hands, clean top of vial
inject air volume equal to volume you want to withdraw
draw up volume
soft recap or hemostat change
areas for IM injections
deltoid, vastus lateralus, glute max
kids- side of thigh
how to do IM injection
wash hands
glove
clean area
place injecting needle on syringe
remove cap
stabilize pt skin, and dart hold syringe
90 degree entrance of skin , stop 1/2 cm form hub
pull back to ensure not in vessel
inject
withdraw needle, place cotton ball over site
dispose of needle
bandage pt
how to do sub q
wash hands, glove, clean area, place needle on syringe
remove cap
pinch up pt skin
enter 30 degrees stop 1/2 cm form hub pull back then inject
intradermal injection
only for sensitivity testing or TB, entrance si 5-10 degrees
safe PH range of solutions for IV use
5-9
comfortable PH range for IV use
6.6-7.6
osmolarity of isotonic solution
250-375
risk of phlebitis increases with what
increase in osmolarity
how to prevent phlebitis
slow rate of IV
use large veins
ensure adequate dilution
use buffers like HCL
awareness of catheter placement
osmolarity of hypotonic solution
<250
osmolarity of hypertonic solution
> 375
what solutions are isotonic
0.9% NS, D5W, ringers lactate
why are isotonic solutions safe
no fluid shift occurs - however hypervolemia may still occur
what solutions are hypotonic and concerns with it
0.45% NS , can over hydrate cells leading to lysis
what solutions are hypertonic and concern with it
D10, D28, most vitamins, and minerals
increase volume overload, irritate the vessels, can cause dehydration
max flow rate is 5mL per minute
causes of abscess and tx
dirty stick, contaminated substance,
administer antibiotics, apply heat, I/D
how to avoid broken needle in patient
awareness of needle position, inspection before and after
hematoma causes and tx
damage to vessel
apply firm pressure post injection , use smaller gauge needle in future, pressure bandage
what populations are predisposed to hematomas
elderly, on blood thinners, IV drug users, connect tissue dz
how to address post IV pain
movement of limb, contrast, ice
Thrombosis
slow or stop flow rate
D/C line
Apply ice and pressure to site
what increases risk of thrombosis
longer infusions, too high or low of PH, high osmolarity
infiltration sx and tx
sx, swelling, cold, painful
stop the line, apply light pressure, ice, give apis
venous spasms sx and tx
pain at the site that travels up the arm
slow the drip rate, warm the solution, flush the line, check PH, heat arm, check position of line
sx of fluid overload and what to do
Edema, HTN, SOB, crackles in lungs
slow infusion, heat limbs, give oxygen
call 911 - needs diuretic tx
what predisposes to fluid overload
kidney damage, over hydration prior to large volume infusion
common interactions
Calcium channel blockers with EDTA, Magnesium- causes HEART BLOCK
rawolfia and reserpine with magnesiu, calcium, or EDTA- causes irreversible hypotension
beta blockers with magnesium - stops response
how to treat syncope
place in recumbent position
smelling salts
cover with blanket
watch for reentry seizure and reassure
continue infusion if needed and able
common causes of hypoglycemia
high dose Vit C and EDTA chelation
how to antidote hypoglycemia from IV
push 5-50ml of D5W
speedshock
place in recumbent position, stop infusion, start NS,
Calcium antidotes Mag and vis versa
Rehydration catheter size
largest one available ( smallest number)
what solution osmolarity is used for rehydration
isotonic solutions of 375 or lower
WHAT SHOULD NEVER BE PUT ALONE INTO A PT
sterile water
what volume of fluid repleats for 1 day of loss and how quickly can it be infused
1500-2000ml infuse 125ml per hr up to 1,000ml and recheck
osmolarity category of D5W + 0.9% NS
isotonic
osmolarity category of 2.5% D5w +0.45% NS
hypertonic
osmolarity fo 5% D5W with 0.2% NS
hypertonic
osmolarity of electrolyte solutions
isotonic
osmolarity of ringers
isotonic
what conditions should lactate ringers not be used in
addisons and liver dz
antioxidants used in IV
vit C
glutathione
ALA
Poly MVA
selenium/manganese
Ozone
what can be used to access a vessel for an IV lasting less than 45minutes
butterly, catheter, whatever
what must be used to access a vessel for IV lasting over 45min
catheter
how to prep an IV site
cholorhexadine
alcohol x3 then iodine
how do you wipe when preparing an access site
clean to dirty , middle out
how to minimize infection in IV
monitor exp date of materials
look for contamination or sedimentation in vials
ensure use of filter tips when possible
never reuse anything
be aware of your location in relation to cannulas and needles
what is a clean room
has ISO 5-8 air filter, low particulate
ante room
buffer room
laminar flow hood
how to set venipuncture
prepare skin
assess vein
set access devise
release tourniquet
secure device
start flow
assess site for infiltration
what do catheters decrease
chance for vein damage
when are butterflys okay
short infusions, pushes
monitor for vein damage
How to set IV catheter
clean site
assess vein
Have line preset
traction and insert catheter/needle as whole
watch for flash, if seen advance 1mm further
retract guide needle part way
remove torniquet
occlude vessel and remove guide needle/ dispose
attach line
start drip
observe insertion site
what are considered central venous access devices
midline catheter
PICC
implanted port device
tunneled device
what is the only needle to access an implanted port with
Huber needle
all implanted ports are access with what kind of site prep
sterile
what line is never used for anything but blood draw on a multi lumen device
THE RED LINE
when do you flush ports and PICCA lines
before and after use
how to assess for medication safety if question in PT treatment
dont use
run interdermal test
premedicate patient to negate IgE effect
sign of thrombosis
slow or stopped flow rate
texture of a vein that has experienced phlebitis
ropy texture , sclerosis
Line flushing how to do it
use saline, slow flush through port with IV stopped, no smaller syringe than 10cc
if putting procaine or lidocaine into push how to administer
1-2% drug in 9cc NS, push slowly
how much air does it take to kill a human if entering the vessel with IV
10-60CC
how to treat suspected air embolism
place in left lateral decubitus position, give O2 as lungs are block, monitor vitals, ensure EMS is called to transport
how to address a catheter embolism
save the rest of the catheter
apply pressure proximal to the site or torniquet it
imaging at ER to locate
if in metabolic acidosis what should be given
bicarbonate 50ml
if in metabolic alkalosis what should be given
administer NaCl and normalize potassium
Signs and treatment for respiratory acidosis
tachycardia, diaphoresis, HA
treat with ox and improving ventilation
signs and treatment for respiratory alkalosis
anxiety, hyperventilation, dizzy, paresthesia’s
Treat with bag breathing, sedatives, visualization
DRIP RATE
drops/minute divided by ( #mL / drop) = mL/min times 60 = mL per hour
what is the molarity of 3% and 5% sodium chloride
hypertonic
what are saline infusions used for
if hypotonic- base solution for additives
isotonic- volume stabilization
hypertonic or isotonic- raise sodium and chloride levels
what is D5w or 5% dextrose used for
rehydration
solution base for antibiotics
labile blood sugar control
what is the osmolarity and function of D10, D20,D50
all are hypertonic forms of dextrose in water
they lower potassium and increase glucose in the body
what is sterile water used for
carrying solution only - MUST HAVE ADDITIVES
what are electrolyte solutions used for
Isotonic, for volume depletion or dehydration
DOUBLE CHECK INTERACTIONS IF ADDING ANYTHING TO IT
Ringers lactate
rehydration, acidosis of most kinds
DO not use in addisons or hepatic disease
what is in a lactated ringer
sodium chloride
sodium lactate
anhydrous
potassium chloride
calcium chloride
hydrochloric acid or sodium hydroxide for PH
is Isotonic and ph of 6.6
what disease cause concern for potential fluid overload
kidney disease
CHF
liver failure
hypertonic infusions
rapid high volume administrations
what solutions are hydrating and which are dehydrating
isotonic = hydrating
hypertonic=dehydrating
what is the osmolarity of half normal saline and is it safe to infuse alone
hypotonic, and yes its safe though at 154mosm it is the lowest one usually its just a base
volume of NS or ringers to address hyponatremia
<125mEq/L
How quickly can you lower sodium levels in hypernatremia
15mEq/L in 8hrs
what can you use to lower sodium levels
D5W, half normal saline, or NS
what causes alkalosis
volume depletion, thiazide diuretics, acute infection
presents as: tetany, hypertonic reflexes, decreased respiration
what causes acidosis or high cl and how does it present
causes: head trauma, excess ACTH, severe dehydration
sx: drowsiness, weakness, lethargy, tremor, dysrhythmias, SOB, tachypnea, hyperventilation
excess or high phosphate
restrict dietary intake or give calcium
when is calcium needed in IV
chelation, hypocalcemia, high dose vitamin C
hyperparathyroid causes what shift in phosphorous and calcium
phosphorous goes down
calcium goes up
what can too low of calcium lead to
laryngospasm
prolonged QT interval
what causes low calcium
hypoparathyroid
magnesium
vit D deficiency
diarrhea
infection
trauma
burns
how to check calcium deficit
tap cheek- chovestek sign positive if facial twitch
trousseaus sign- bp cuff on arm
how to treat hypocalcemia
10cc calcium gluconate in 20cc sterile water or D5W with slow push ) NOT GLUCONATE IN SHELLFISH ALLERGY )
alternative is Ca chloride - IV only though
WHAT should never be mixed with calcium in a syringe due to precipitation
bicarb
how to treat hypercalcemia
saline diuresis with NS and oral fluids
give furosemide to act as diuretic
2 nasal sprays calcitonin
phosphate salts
magnesium dose , use, precautions
1-6 grams in 1/2-1 L bag
sulfate more absorbable
chloride form worsens HTN and CHF
Uses: lower arrhythmias,
CAN CAUSE HEART BLOCK if mixed with CA channel blockers
Low magnesium
causes by potassium wasting diuretics, laxatives, poor absorption, fluid loss, alcohol abuse
SX: muscle weakness, insomnia, tremor, tetany, seizures
Hyper magnesium and how to treat
SX: lethargy, low BP, slow pulse, flushing, decreased DTR, heart block, death
Tx: cal gluconate 10% 1 to 10cc IV
how fast can you give a Mag push
1.5ml/min
after what dose is potassium and calcium added to a mag solution
3 grams
what do we never do with potassium
give as push or add to hanging IV bag
when is zinc used
immune therapies
oxidative therapies
cancer
eye
infectious formulas
1-25mg or up to 100mg
when is chromium added
immune formulas
blood sugar management
eye problems
20-200mcg
selenium
immune and antioxidant formulas
400-1600mcg
manganese dose and use
CT repair, repletion
0.1-1mg
molybdenum dose and use
bipolar
repletion
sulfite toxicity
25-250mcg
B complex
must be protected form light
most contain B1, 2,6,5,3
Increases enzyme activity
boosts energy
supports glycolysis
1-5cc
when are multivitamin mixtures used
nutrient depleted patients
B 1- thiamine depleted by what
loop diuretics
digitalis
B3, niacinamide
supports serotonin pathways
B5, dexpanthenol
for adrenal support
fatigue, allergies
100-2000mg
B6 pyridoxine
Commonly causes nausea, slow infusion eat during
uses:
interstitial diuretic
amino acid metabolism
CAD
50-200mg
B12
for megaloblastic anemia
homocystiene reduction
neuropathies
asthma
Signs of MTHFR problem
developmental delay
motor abnormality
gait abnormality
seizures
psychiatric manifestations
homocystinuria
premature death
folic acid
ADD VERY FIRST OR VERY LAST TO PREVENT PRECIPITATION
1-20mg
what should always be tested for before giving a high dose vitamin C infusion
G6PD deficiency
RBC
CBC
at what dose is Vitamin C antioxidant
lower doses 10g or less
supports immune function helps maintain glutathione
at what dose is vitamin C pro oxidant
high dose >50g
for chronic infections
cancer treatment
side effects of high dose vitamin C
shivering , palpitations, HTN
how does Vitamin C impact blood sugar
false elevation that tricks the glucometer
what is carnitine used for
mitochondrial functional deficits
200-600mg
Arginine uses and dose
asthma
ED
angina
HTN
1-20g
Glycine contraindication
bipolar
what is MIC used for
lipotrophic compound of methionine, inositol, choline to support the liver
2-10cc
NAC
push or IV
supports glutathione
mycolytic
500-6000mg
Glutathione uses
asthma, allergy, infection
neurodegeneration
detox
give alone or in normal saline
histadine
rheumatoid arthritis
where should amino acid mixtures be stored
dark place
what % amino acid in a mixture should not be exceeded
2.5%
adverse effects of over dosed amino acids
hyperglycemia
increased liver test
metabolic acidosis
flushing
allergic reactions
is DMSO lipid or water soluble , other precautions
lipid soluble
glass bottles only
add just prior to infusion
for pain and neurodegeneration
MSM solubility, use, and dose
water soluble
detox, pain, soft tissue repair
10g
PTC or phosphatidylcholine
helps with concentration, and cognitive support , liver damage and NASH
infuse slow
NEVER ADD ANYTHING TO IT- infuse alone IN d5w
ALA
INFUSE ALONE
must be filtered either before or during IV
single dose vials
detox and healing of liver
may feel hot flush
Hydrogen peroxide
dont give with vitamin C
infuse slowly
do G6pd WORK UP PRIOR
se: ACHES, FEVER, CHILLS, anxiety, fatigue, vasculitis, flu symptoms
hydrochloric acid
Slow push
never with any infection that can’t drain .
give through IV port with immune formulae
only IV form of vitamin D
calcitriol
what is the protocol with calcitriol
infuse ALONE in D5w solution
WHAT THREE ITEMS must you change the line or flush it prior to administering anything else
ALA, PTC, Vit-D
IV penicillin G
5mil U in 100CC NS or D5W
run over 30min
following dow 2.5milU every 4 hours
Ampicillin IV
ALWAYS IN NS never D5w DUE TO DEGREDATION
2 grams in 100cc NS
over 30min
no faster than 125mg/min
follow with 1g every 4hr
oxacillin
slow push 1 g in 10cc over 10min
follow with 1 g every 4 hours
clindamycin
never faster than 300mg over 15min
follow with 900mg every 8 hours
doxycycline
200mg in 500cc of NS or D5W
run over 4 hours
follow 100-200mg daily
erythromycin
250mg per hour max rate
no mixing of meds
follow 500mg every 6 hours
vancomycin
1g over 1 hr max dose
follow 1 g every 12 hours
Iron
GIVE ALONE
never give dexferrum form iv AS ANAPHYLAXIS OCCURS
1-1.5hr minimum
100cc NS minimum
iron sucrose safest form
fat soluble vitamins
A,D,E,K and biotin and are available in water soluble forms
vitamin A
IM only - otherwise anaphylaxis
never in pregnancy, liver dz, liver cancer
vitamin K
give subq
protect from light
dilute with NS, D5W, or D5NS
se: muscle cramping , abdominal pain
glycyrrhizic acid
for liver diz, viral support, elevated liver enzymes
never in HTN, cushings
sillibinin
slow infusion
D5W or NS
anti viral, anti cancer, liver support
can cause hot flush, SOB, rash
artemesinin
anti cancer, anti lyme, anti viral
curcumin
liver support, anti inflammatory
Use of single dose vials
discard after one use
okay for 4 hours in hood
max punctures 2
use of multidose tube
28 days max from open date
3 punctures max or dispensing pin used
how many things can you put in a syringe
3
how many things can you put in a bag
3
