IV therapy Flashcards
1
Q
What gauge needle do you draw up with
A
18-21G
2
Q
protocol for drawing up material
A
wash hands, clean top of vial
inject air volume equal to volume you want to withdraw
draw up volume
soft recap or hemostat change
3
Q
areas for IM injections
A
deltoid, vastus lateralus, glute max
kids- side of thigh
4
Q
how to do IM injection
A
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
5
Q
how to do sub q
A
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
6
Q
intradermal injection
A
only for sensitivity testing or TB, entrance si 5-10 degrees
7
Q
safe PH range of solutions for IV use
A
5-9
8
Q
comfortable PH range for IV use
A
6.6-7.6
9
Q
osmolarity of isotonic solution
A
250-375
10
Q
risk of phlebitis increases with what
A
increase in osmolarity
11
Q
how to prevent phlebitis
A
slow rate of IV
use large veins
ensure adequate dilution
use buffers like HCL
awareness of catheter placement
12
Q
osmolarity of hypotonic solution
A
<250
13
Q
osmolarity of hypertonic solution
A
> 375
14
Q
what solutions are isotonic
A
0.9% NS, D5W, ringers lactate
15
Q
why are isotonic solutions safe
A
no fluid shift occurs - however hypervolemia may still occur
16
Q
what solutions are hypotonic and concerns with it
A
0.45% NS , can over hydrate cells leading to lysis
17
Q
what solutions are hypertonic and concern with it
A
D10, D28, most vitamins, and minerals
increase volume overload, irritate the vessels, can cause dehydration
max flow rate is 5mL per minute
18
Q
causes of abscess and tx
A
dirty stick, contaminated substance,
administer antibiotics, apply heat, I/D
19
Q
how to avoid broken needle in patient
A
awareness of needle position, inspection before and after
20
Q
hematoma causes and tx
A
damage to vessel
apply firm pressure post injection , use smaller gauge needle in future, pressure bandage
21
Q
what populations are predisposed to hematomas
A
elderly, on blood thinners, IV drug users, connect tissue dz
22
Q
how to address post IV pain
A
movement of limb, contrast, ice
23
Q
Thrombosis
A
slow or stop flow rate
D/C line
Apply ice and pressure to site
24
Q
what increases risk of thrombosis
A
longer infusions, too high or low of PH, high osmolarity
25
infiltration sx and tx
sx, swelling, cold, painful
stop the line, apply light pressure, ice, give apis
26
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
27
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
28
what predisposes to fluid overload
kidney damage, over hydration prior to large volume infusion
29
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
30
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
31
common causes of hypoglycemia
high dose Vit C and EDTA chelation
32
how to antidote hypoglycemia from IV
push 5-50ml of D5W
33
speedshock
place in recumbent position, stop infusion, start NS,
Calcium antidotes Mag and vis versa
34
Rehydration catheter size
largest one available ( smallest number)
35
what solution osmolarity is used for rehydration
isotonic solutions of 375 or lower
36
WHAT SHOULD NEVER BE PUT ALONE INTO A PT
sterile water
37
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
38
osmolarity category of D5W + 0.9% NS
isotonic
39
osmolarity category of 2.5% D5w +0.45% NS
hypertonic
40
osmolarity fo 5% D5W with 0.2% NS
hypertonic
41
osmolarity of electrolyte solutions
isotonic
42
osmolarity of ringers
isotonic
43
what conditions should lactate ringers not be used in
addisons and liver dz
44
antioxidants used in IV
vit C
glutathione
ALA
Poly MVA
selenium/manganese
Ozone
45
what can be used to access a vessel for an IV lasting less than 45minutes
butterly, catheter, whatever
46
what must be used to access a vessel for IV lasting over 45min
catheter
47
how to prep an IV site
cholorhexadine
alcohol x3 then iodine
48
how do you wipe when preparing an access site
clean to dirty , middle out
49
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
50
what is a clean room
has ISO 5-8 air filter, low particulate
ante room
buffer room
laminar flow hood
51
how to set venipuncture
prepare skin
assess vein
set access devise
release tourniquet
secure device
start flow
assess site for infiltration
52
what do catheters decrease
chance for vein damage
53
when are butterflys okay
short infusions, pushes
monitor for vein damage
54
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
55
what are considered central venous access devices
midline catheter
PICC
implanted port device
tunneled device
56
what is the only needle to access an implanted port with
Huber needle
57
all implanted ports are access with what kind of site prep
sterile
58
what line is never used for anything but blood draw on a multi lumen device
THE RED LINE
59
when do you flush ports and PICCA lines
before and after use
60
how to assess for medication safety if question in PT treatment
dont use
run interdermal test
premedicate patient to negate IgE effect
61
sign of thrombosis
slow or stopped flow rate
62
texture of a vein that has experienced phlebitis
ropy texture , sclerosis
63
Line flushing how to do it
use saline, slow flush through port with IV stopped, no smaller syringe than 10cc
64
if putting procaine or lidocaine into push how to administer
1-2% drug in 9cc NS, push slowly
65
how much air does it take to kill a human if entering the vessel with IV
10-60CC
66
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
67
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
68
if in metabolic acidosis what should be given
bicarbonate 50ml
69
if in metabolic alkalosis what should be given
administer NaCl and normalize potassium
70
Signs and treatment for respiratory acidosis
tachycardia, diaphoresis, HA
treat with ox and improving ventilation
71
signs and treatment for respiratory alkalosis
anxiety, hyperventilation, dizzy, paresthesia's
Treat with bag breathing, sedatives, visualization
72
DRIP RATE
drops/minute divided by ( #mL / drop) = mL/min times 60 = mL per hour
73
what is the molarity of 3% and 5% sodium chloride
hypertonic
74
what are saline infusions used for
if hypotonic- base solution for additives
isotonic- volume stabilization
hypertonic or isotonic- raise sodium and chloride levels
75
what is D5w or 5% dextrose used for
rehydration
solution base for antibiotics
labile blood sugar control
76
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
77
what is sterile water used for
carrying solution only - MUST HAVE ADDITIVES
78
what are electrolyte solutions used for
Isotonic, for volume depletion or dehydration
DOUBLE CHECK INTERACTIONS IF ADDING ANYTHING TO IT
79
Ringers lactate
rehydration, acidosis of most kinds
DO not use in addisons or hepatic disease
80
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
81
what disease cause concern for potential fluid overload
kidney disease
CHF
liver failure
hypertonic infusions
rapid high volume administrations
82
what solutions are hydrating and which are dehydrating
isotonic = hydrating
hypertonic=dehydrating
83
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
84
volume of NS or ringers to address hyponatremia
<125mEq/L
85
How quickly can you lower sodium levels in hypernatremia
15mEq/L in 8hrs
86
what can you use to lower sodium levels
D5W, half normal saline, or NS
87
what causes alkalosis
volume depletion, thiazide diuretics, acute infection
presents as: tetany, hypertonic reflexes, decreased respiration
88
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
89
excess or high phosphate
restrict dietary intake or give calcium
90
when is calcium needed in IV
chelation, hypocalcemia, high dose vitamin C
91
hyperparathyroid causes what shift in phosphorous and calcium
phosphorous goes down
calcium goes up
92
what can too low of calcium lead to
laryngospasm
prolonged QT interval
93
what causes low calcium
hypoparathyroid
magnesium
vit D deficiency
diarrhea
infection
trauma
burns
94
how to check calcium deficit
tap cheek- chovestek sign positive if facial twitch
trousseaus sign- bp cuff on arm
95
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
96
WHAT should never be mixed with calcium in a syringe due to precipitation
bicarb
97
how to treat hypercalcemia
saline diuresis with NS and oral fluids
give furosemide to act as diuretic
2 nasal sprays calcitonin
phosphate salts
98
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
99
Low magnesium
causes by potassium wasting diuretics, laxatives, poor absorption, fluid loss, alcohol abuse
SX: muscle weakness, insomnia, tremor, tetany, seizures
100
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
101
how fast can you give a Mag push
1.5ml/min
102
after what dose is potassium and calcium added to a mag solution
3 grams
103
what do we never do with potassium
give as push or add to hanging IV bag
104
when is zinc used
immune therapies
oxidative therapies
cancer
eye
infectious formulas
1-25mg or up to 100mg
105
when is chromium added
immune formulas
blood sugar management
eye problems
20-200mcg
106
selenium
immune and antioxidant formulas
400-1600mcg
107
manganese dose and use
CT repair, repletion
0.1-1mg
108
molybdenum dose and use
bipolar
repletion
sulfite toxicity
25-250mcg
109
B complex
must be protected form light
most contain B1, 2,6,5,3
Increases enzyme activity
boosts energy
supports glycolysis
1-5cc
110
when are multivitamin mixtures used
nutrient depleted patients
111
B 1- thiamine depleted by what
loop diuretics
digitalis
112
B3, niacinamide
supports serotonin pathways
113
B5, dexpanthenol
for adrenal support
fatigue, allergies
100-2000mg
114
B6 pyridoxine
Commonly causes nausea, slow infusion eat during
uses:
interstitial diuretic
amino acid metabolism
CAD
50-200mg
115
B12
for megaloblastic anemia
homocystiene reduction
neuropathies
asthma
116
Signs of MTHFR problem
developmental delay
motor abnormality
gait abnormality
seizures
psychiatric manifestations
homocystinuria
premature death
117
folic acid
ADD VERY FIRST OR VERY LAST TO PREVENT PRECIPITATION
1-20mg
118
what should always be tested for before giving a high dose vitamin C infusion
G6PD deficiency
RBC
CBC
119
at what dose is Vitamin C antioxidant
lower doses 10g or less
supports immune function helps maintain glutathione
120
at what dose is vitamin C pro oxidant
high dose >50g
for chronic infections
cancer treatment
121
side effects of high dose vitamin C
shivering , palpitations, HTN
122
how does Vitamin C impact blood sugar
false elevation that tricks the glucometer
123
what is carnitine used for
mitochondrial functional deficits
200-600mg
124
Arginine uses and dose
asthma
ED
angina
HTN
1-20g
125
Glycine contraindication
bipolar
126
what is MIC used for
lipotrophic compound of methionine, inositol, choline to support the liver
2-10cc
127
NAC
push or IV
supports glutathione
mycolytic
500-6000mg
128
Glutathione uses
asthma, allergy, infection
neurodegeneration
detox
give alone or in normal saline
129
histadine
rheumatoid arthritis
130
where should amino acid mixtures be stored
dark place
131
what % amino acid in a mixture should not be exceeded
2.5%
132
adverse effects of over dosed amino acids
hyperglycemia
increased liver test
metabolic acidosis
flushing
allergic reactions
133
is DMSO lipid or water soluble , other precautions
lipid soluble
glass bottles only
add just prior to infusion
for pain and neurodegeneration
134
MSM solubility, use, and dose
water soluble
detox, pain, soft tissue repair
10g
135
PTC or phosphatidylcholine
helps with concentration, and cognitive support , liver damage and NASH
infuse slow
NEVER ADD ANYTHING TO IT- infuse alone IN d5w
136
ALA
INFUSE ALONE
must be filtered either before or during IV
single dose vials
detox and healing of liver
may feel hot flush
137
Hydrogen peroxide
dont give with vitamin C
infuse slowly
do G6pd WORK UP PRIOR
se: ACHES, FEVER, CHILLS, anxiety, fatigue, vasculitis, flu symptoms
138
hydrochloric acid
Slow push
never with any infection that can't drain .
give through IV port with immune formulae
139
only IV form of vitamin D
calcitriol
140
what is the protocol with calcitriol
infuse ALONE in D5w solution
141
WHAT THREE ITEMS must you change the line or flush it prior to administering anything else
ALA, PTC, Vit-D
142
IV penicillin G
5mil U in 100CC NS or D5W
run over 30min
following dow 2.5milU every 4 hours
143
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
144
oxacillin
slow push 1 g in 10cc over 10min
follow with 1 g every 4 hours
145
clindamycin
never faster than 300mg over 15min
follow with 900mg every 8 hours
146
doxycycline
200mg in 500cc of NS or D5W
run over 4 hours
follow 100-200mg daily
147
erythromycin
250mg per hour max rate
no mixing of meds
follow 500mg every 6 hours
148
vancomycin
1g over 1 hr max dose
follow 1 g every 12 hours
149
Iron
GIVE ALONE
never give dexferrum form iv AS ANAPHYLAXIS OCCURS
1-1.5hr minimum
100cc NS minimum
iron sucrose safest form
150
fat soluble vitamins
A,D,E,K and biotin and are available in water soluble forms
151
vitamin A
IM only - otherwise anaphylaxis
never in pregnancy, liver dz, liver cancer
152
vitamin K
give subq
protect from light
dilute with NS, D5W, or D5NS
se: muscle cramping , abdominal pain
153
glycyrrhizic acid
for liver diz, viral support, elevated liver enzymes
never in HTN, cushings
154
sillibinin
slow infusion
D5W or NS
anti viral, anti cancer, liver support
can cause hot flush, SOB, rash
155
artemesinin
anti cancer, anti lyme, anti viral
156
curcumin
liver support, anti inflammatory
157
Use of single dose vials
discard after one use
okay for 4 hours in hood
max punctures 2
158
use of multidose tube
28 days max from open date
3 punctures max or dispensing pin used
159
how many things can you put in a syringe
3
160
how many things can you put in a bag
3
