IV Therapy Flashcards
Vascular access
Cannulation of a peripheral extremity vein.
Intraosseous access for infusion
Assembling your equipment
Gather and prepare equipment, sterilize equipment, two ports (injection port, access port)
Choosing a solution
Identify the needs of the patient (critical, stable, fluid replacement, medications), usually limited to 2 isotonic crystalloids (normal saline, LR solution)
Choosing an administration set
Piercing spike, drip sets (60gtts=1mL, 10gtts=1mL)
3 C’s and an E
Expiry date, solution clarity, solution colour, solution concentration
Parts of IV solution containers
Fluid amount (mL), expiration date, fluid type, med admin port, admin set port
Most appropriate vein
Avoid valves, avoid rolling veins
Criteria for finding a vein
Straightest, firm, round, springy when palpated.
Avoid, joints, edematous extremities, extremities with a dialysis fistula, extremities on side of mastectomy, areas of overlying cellulitis
Why can large protruding arm veins be deceiving?
Often roll from side to side
Why would you start attempting distally and work proximally?
Distal site ruptures or infiltrates
Criteria for choosing an IV cannula
Purpose of the IV, age of the patient, location for the IV, available vessels for venipuncture
Needle types
Over-the needle cannulas, butterfly cannulas, through-the-needle cannulas
Syringe and needles
Prepackaged in colour-coded packs with a needle, plunger, body or barrel, flange and tip, hypodermic needle lengths vary from 1-5cm, gauge refers to the diameter, smaller the number larger the diameter
Needle gauges, what they’re for?
14-16g: aggressive fluid resuscitation (orange, grey)
18g: fluid resuscitation (green)
20g: medication administration (pink)
22g: medication administration (blue)
Contaminated stick
When you puncture the skin with the same cannula used to cannulate the vein
Preparing supplies
IV solution, IV drop set, IV needle, tourniquet, tape (2-3 pieces, 1-1.5in), OP site, antimicrobial swabs, sterile 4x4s, sharps containers, PPE (eye shields, gloves)
Catheter shear
Keep the beveled side of the cannula up. Do not extend catheter over the end of the needle
Prepping the IV site
Alcohol or iodine swab; apply gentle downward or lateral traction, clean the site in a circular motion; small to large circles
Insertion angle of the IV cannula
20-30 degrees , once there is flash, drop angle down to 15 degrees
How will you know if your cannula is in the vein?
Flash of blood in the flash chamber
Securing the line
Secure Op site (tegaderm) over coloured IV catheter but not over the IV tubing or lock, tape the area
Changing an IV bag
Do not allow an IV fluid bag to become completely depleted, always ensure some fluid is left in the drip chamber and tubing
Steps of changing an IV bag
Stop the flow of fluid, prepare the new IV bag, insert the piercing spike, ensure that the drip chamber is appropriately filled
Steps for discontinuing the IV line
Shut off the flow, peel back the tape toward the IV site, stabilize the cannula while you loosen the tape, do not remove the IV tubing, place a 10x10 cm piece of gauze over the site, gently pull the cannula and the IV line.
Factors affecting IV flow rates; perform the following checks
Check the IV fluid, check the administration set, height of the IV bag (must be hung high), check the type of cannula used, check the tourniquet (do not leave it on after completing the IV)
Potential complications of IV therapy
Infiltration, thrombophlebitis, occlusion, vein irritation, hematoma, nerve/tendon/ligament damage, arterial puncture
Infiltration
The escape of fluid; IV passes through the vein, cannula enters the tissue surrounding the vein
Signs and symptoms; Edema at venipuncture site, pt complains of pain at venipuncture site
