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ASN 210 > IV Therapy > Flashcards

IV Therapy Flashcards

1
Q

What is infusion therapy?

A

Infusion therapy is the delivery of medications in solution and fluids by parenteral (piercing of skin or mucous membranes) route through a wide variety of catheter types and locations using multiple procedures.

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2
Q

What is infusion therapy used for?

A

Maintaining or correcting fluid and electrolyte balance, correcting acid-base imbalance, achieving optimum nutrition, maintaining homeostasis, infusing blood or blood products, and treating or preventing illnesses with medications

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3
Q

What is the role of an infusion nurse?

A

Infusion nurses often initiate and maintain infusion therapy to reduce complications of therapy.

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4
Q

What should orders for infusion therapy include?

A

The specific type of fluid, rate of administration written in milliliters per hour, or the total amount of fluid and the total number of hours for infusion, drugs, and the specific dose to be added to the solution, such as electrolytes or vitamins.

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5
Q

What is the nurses’s responsibility during infusion therapy?

A

Nurses are responsible for determining that the order is appropriate for the patient and clarifying any questions before administration.

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6
Q

What devices are used for long term infusion therapies?

A

Peripherally inserted central catheters (PICC), tunneled central catheters, and implanted ports are commonly used for long-term infusion therapy.

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7
Q

What is a vascular access devices (VADs)?

A

Vascular access devices (VADs) are catheters that are used to deliver fluids, electrolytes, and medications into the intravascular space.

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8
Q

What are some common types of vascular access devices ?

A

Short peripheral catheters, midline catheters, peripherally inserted central catheters (PICC), nontunneled percutaneous and tunneled central catheters, implanted ports, and hemodialysis catheters

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9
Q

What are VADs used for?

A

VADs are catheters that are used to deliver fluids, electrolytes, and medications into the intravascular space.

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10
Q

What is the best practice for placement of short peripheral VADs?

A

Avoiding the small veins in the hands

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11
Q

Arterial therapy is used primarily for?

A

The administration of chemotherapy agents directly into a tumor site; the liver is the most common arterial site for this purpose

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12
Q

Intraperitoneal therapy is used for?

A

Antineoplastic agent administration into the peritoneal cavity, especially for ovarian and gastrointestinal tumors that have metastasized into the peritoneum

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13
Q

What is hypodermoclysis?

A

Subcutaneous therapy of fluids (hypodermoclysis) involves a slow infusion for a short time; the thighs, hips, and abdomen are commonly used sites.

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14
Q

What is the goal of epidural therapies?

A

PAIN!

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15
Q

What are Intrathecal infusions used for?

A

Antineoplastic agents used for cancers that cross the blood-brain barrier into the central nervous system

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16
Q

Why do you use IO methods? Who starts them?

A

Intraosseous therapy allows fluids and medications to be absorbed by the rich vascular network of the long bones; it is used for both children and adults, particularly in emergency situations. Paramedics or EMS will start them in the field.

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17
Q

How long is an IV if started before they get to the facility?

A

24 hours

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18
Q

Procedure when accessing a central line?

A

Aspirate the line for blood return before using then flush the port before infusion / injecting.

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19
Q

What is the SASH method?

A

Saline, Administer, Saline, Heparin

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20
Q

What precautions do you have to keep in mind when dealing with geri-pts?

A

Watch the speed of infusion ( icreased risk of FVE), skin tears when d/c’ing IV, lung sounds et overall skin integrity.

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21
Q

Best Nsg practice is to assess an IV site how often?

A

Every hour

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22
Q

What actions do you take if a pt has a temp >100 and you are to hang blood?

A

Contact the provider to get instructions

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23
Q

Nsg responsibilities for blood admin?

A

Signed consent, baseline VS (plus temp), Check Dr order for type, amount et rate of admin, size of IV to be used, Hx of prior infusions et reactions, Religeous considerations, compatability of blood to pt

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24
Q

Who has to verify blood products?

A

Best case is 2 Rn’s

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25
Q

What is the max infusion time of blood?

A

4 hours

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26
Q

How long do you have to start blood once delivered from the lab?

A

15 minutes, so have your IV done FIRST!!

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27
Q

Special considerations for blood in geri?

A

Slower rates, watch for skin tears et integrity of skin

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28
Q

Special considerations for blood in peds?

A

Watch very closely, they are unable to verbalize reactions. Watch your VS very closely. Be vigilant for an emergency et stay with them for the first hour

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29
Q

What can the UAP do for you during blood admin?

A

Pick up blood from bank, take frequent VS, they CAN’T verify bag. It is the Rn’s job to monitor for complications!

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30
Q

What gauge IVs do you use for blood?

A

At least a 20 gauge or higher for adults, 23 gauge for peds

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31
Q

What do you check for when you get the blood from the bank?

A

Verify Dr order, check ID of bag to pt, verify all bag info with another Rn, check expiration date. EXAMINE BLOOD FOR ABNORMAL COLOR, CLOTTING, GAS BUBBLES OR EXTRENEOUS MATERIALS!

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32
Q

Procedure for hanging blood?

A

Nurse #1 holds the blood, nurse #2 holds the paper tags. Nurse #1 asks patient to confirm their identity, then reads the donor #, unit #, BB-id #, and expiration date from the bag of blood. Nurse #2 verifies that the stated info matches that on the paper tags.

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33
Q

VS procedures after hanging blood?

A

Vitals are checked q 15 X2, then hourly for the duration of the transfusion.

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34
Q

S/S of febrile reaction?

A

Acute increase of temp over 2 degrees, chills et shaking

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35
Q

S/S of a hemolytic reaction?

A

Breathlessness
Tachycardia
Hypertension followed by hypotension
Chest or loin pain

Subsequently, the patient might develop:
Disseminated intravascular coagulation (DIC)
Circulatory and respiratory failure
Renal failure
THIS IS A MEDICAL EMERGENCY!!
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36
Q

S/S of an allergic reaction?

A

Allergic reactions can present as an urticarial rash (hives) or a mild pyrexia (fever)
This can also develop into edema around the eyes or larynx and cause dyspnea.
Full anaphylaxis is uncommon.

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37
Q

S/S of a bacterial reaction?

A

It can take weeks or months after a blood transfusion to determine that you’ve been infected with a virus, bacterium or parasite.

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38
Q

What do you do if you suspect circulatory overload??

A

Slow the rate of transfusion and observe closely for pulmonary and peripheral edema. Push a diuretic afterwards.

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39
Q

What do you do if you suspect a reaction?

A

Stop the infusion immediately, hang new tubing with NS at a keep-vein-open rate. Call physician et notify transfusion services

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40
Q

What is an autologous blood transfusion? Why is it done?

A

Collection et infusion of pt own blood. It greatly decreases the chances of reactions or infections d/t it being the pts own cells.

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41
Q

If you infuse more than 6-8 units of PRBC you must also admin what?

A

FFP with every other unit.

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42
Q

Give ___ for every unit of PRBC after 8 units?

A

Platelets

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43
Q

What supplies are needed for a blood infusion?

A

Blood, blood admin set with filter, NS 1000mL bag, clean gloves, record of blood admin form, VS equipment

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44
Q

Rate of flow for platelets or plasma?

A

2-5 mL / min for 5 mins watching for a reaction

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45
Q

Rate of flow for whole blood, RBC or granulocytes?

A

2 mL / min for 15 minutes to watch for reactions

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46
Q

How long should you stay bedside after starting blood?

A

15 minutes!! No excuses!!

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47
Q

Symptoms of an immediate adverse reaction are usually manifested during infusion of the initial ___ mL

A

50mL

48
Q

Blood can be admin by ____ and ____?

A

Gravity or pump

49
Q

Suggested rates for adults are:
PRBCs: ______ mL/hr
Granulocytes: ____ mL/hr
Plasma/Platelets: ____ mL/hr

A

PRBCs: 100-230 mL/hr
Granulocytes: 75-100 mL/hr
Plasma/Platelets: 200-300 mL/hr

50
Q

How long should entire platelet product be given?

A

Within 1 hour, if possible

51
Q

How long do you monitor pt for reactions?

A

During the entire infusion et 1 hour post infusion

52
Q

If pt experiences a reaction while infusing what do you do?

A

STOP the infusion, maintain a patent line with NS and notify MD ASAP!!!

53
Q

What do you doc at the end of the infusion?

A

Date/time of initiation and completion of each unit transfused
Type of blood infused
Initial and subsequent VS
Presence or absence of transfusion reactions – actions taken
State of client after transfusion
Current IV fluids infusing, if any

54
Q

What causes an iron overload reaction?

A

Multiple transfusions result in an increased serum ferritin.

> 1,000mg per liter, the iron infiltrates organs such as the liver, heart and kidneys, which can lead to organ failure or even be fatal.

55
Q

Delivery of parenteral medications and fluids
Reasons –
Maintain or correct _______________________
Maintain or correct _______________________
Administer ______________________________
Replace _______________________________

A

Maintain or correct fluid balances
Maintain or correct electrolyte or acid-base imbalances
Administer medications
Replace blood or blood products

56
Q

Who places IVs? Who is responsible for them?

A

Depends on which type of IV it is. RNs are taught to insert PIVs. EMTs and paramedics also put in PIVs and Ios. LPNs can place PIVs as well.
Although others may start the IV and may monitor the infusion, the RN is ultimately responsible for the care, maintenance and infusion of the IV!

57
Q

Isotonic- _________ Risk factor?
Hypertonic- __________
Hypotonic- ___________

A

Isotonic- It stays in the blood. They are volume expanders. What becomes a risk factor? Fluid overload.
Hypertonic- picture big fat swollen cells and hypertonic fluid is pulling the fluid out, helping them shrink down.
Hypotonic- picture tiny shrunken, dehydrated cells that are thirsty for water! Hypotonic fixes thirsty cells.

58
Q

What is a peripheral IV line? Placed where? How long?

A

Short peripheral caths, mid-line caths. Placed in the arm or hands. In place for < 6 days.

59
Q

Sizes of PIV?

A

3/4 - 1 1/4 inch, 26-14 gauge

60
Q

Veins used for PIVs?

A

Basilic, cephalic or median veins

61
Q

PIV’s must be changed every ___ hours.

A

96

62
Q

Pre-hospital Iv’s must be changed within ____ hours of admission to the hospital.

A

24

63
Q

Patients should only be stuck a max of 5 times, with ______________per nurse.

A

2 sticks

64
Q

Assess site at minimum q ___ hours; for continuous infusion, check site q _____.

A

8; 2 hours

65
Q

__________ at least q 12 hours.

Assess dressing q ___________.

A

Flush; shift

66
Q

Change dressing q ___hours. Site and tubing should be changed q ____hours too.

A

96; 96

67
Q

Do not place a PIVs…

A

Try not to use the hands, lower extremities of older pts
Do not use the wrist of adults!!!
On the same side as a woman’s mastectomy, axillary lymph node dissection, lymphedema
Paralysis of upper extremity
Dialysis graft or fistula
In a vein that feels hard or cord-like
Veins on palm side should be avoided

68
Q

Rules for IV push meds….

A

Administered only by an RN et for medications requiring administration over 1 minute or longer

69
Q

Medication should be diluted according to _____________________________.
Ensure ___________________ with IV in progress.

A

Your drug book; compatability

70
Q

Indications of IV push meds…

A 
Quick response desired
Loading dose needed
Limits number of IM injections
Avoid incompatibility problems
Deliver meds if unable to take by mouth or IM
71
Q

All about Mid-line Caths….

A

3-8 inches long, 3-5 Fr.
May be single or double lumen
Inserted in vein, usually in antecubital fossa
Tip stays in upper arm, not beyond venous network in axillary vein ( the armpit)
Used for therapies from 1-4 wks

72
Q

Usually the _____ vein is preferred over the _______ vein because of its ______ diameter and straighter path.

A

Usually the basillic vein is preferred over the cephalic vein because of its larger diameter and straighter path.

73
Q

Midline catheters are good for?

A

Midline catheters are good for patients with poor vein integrity or patients on blood thinners who can’t tolerate multiple IV sticks without bruising.

74
Q

______ technique is used to insert medline caths?

A

STERILE

75
Q

Midline caths should not be used to infuse ______. Why??

A

Not to be used for vesicants d/t the insertion site being so deep you can’t tell if infiltration has happened until there is massive tissue damages.

76
Q

Types of PIVs?

A

Short PIVs

Mid line catheters

77
Q

Types of central lines?

A 
PICC lines
Nontunneled percutaneous 
Tunneled 
Ports
Hemodialysis catheters
78
Q

Tip of central lines is placed where?

A

Superior vena cava (SVC)

79
Q

How must placement be verified before infusion?

A

X-ray, don’t use until confirmed!!

80
Q

Do not run ___ through central line unless it’s placed in the ___.

A

TPN; SVC

81
Q

What does a pt have to refrain from is a central line is placed?

A

ACTIVE RIGOROUS ACTIVITIES (running)

82
Q

Don’t use anything smaller than a ____ syringe?

A

10mL

83
Q

_______ if catheter enters R ventricle.

A

Arrhythmias

84
Q

Flush _____ & ________ med infusion, and after blood draws

A

before; after

85
Q

Scrub the hub for ______ seconds

A

15-30

86
Q

Inject NS vigorously with _______

Clamp tubing _____ removing _____ from hub

A

Inject NS vigorously with pulsating flush (push-pause technique)
Clamp tubing before removing syringe from hub

87
Q

Peripherally Inserted Central Catheter (PICC) –

Placed in _______ or middle of upper arm and is _____ inches long

A

Placed in antecubital fossa or middle of upper arm and is 18-29 inches long

88
Q

PICC lines:
Tip resides in _____________
________________________to be sure tip is in place before infusion

A

Superior vena cava (SVC); Verify with a CXR

89
Q

How many lumens are on a PICC?

A

1-3 lumens

90
Q

Dressings changed when integrity is compromised or at least q ______

A

7 days

91
Q

Do not infuse ____ into a PICC?

A

Blood products

92
Q

Why are PICC lines preferred for long term Tx?

A

Lower complication rate, arms are free of lines so there is less change for complications

93
Q

______ does not occur, as with central venous catheters

A

Pneumothorax

94
Q

Indications for a PICC line?

A

Infuse all types of therapy
Lengthy courses of antibiotics, chemotherapy agents, parenteral nutrition,
Can be in place for months or years
Infusing blood through PICC requires infusion pump

95
Q

Compliactions of a PICC line?

A

Complications: infection, phlebitis, thrombophlebitis

96
Q

What do you need to draw blood from a PICC line?

A

To draw blood from a PICC, you need a physician order. Then you draw back 10 mL of waste, then what you need for the lab.

97
Q

Nontunneled Percutaneous Central Catheters –
Inserted by physician, sterile technique
_____________________________in upper chest or internal jugular veins
Tip resides in _________, confirmed by chest x-ray
May be single lumen or have up to 5 lumens
Used for short term therapy (7days)
Pt placed in ___________________ for placement
Increased risk of cross-contamination with tracheostomy (CR-BSI)

A

Subclavian vein; Trendelenberg

98
Q

Nontunneled Percutaneous Central Catheters have 3 lumens. What can you do with each: Proximal, Medial, Distal?

A

Proximal: Blood sample, Medications, Blood administration.

Medial: TPN, Medications

Distal: Blood administration, High volume fluids, Viscous fluids, Medications, CVP monitoring

99
Q

4 types of tunneled lines?

A

Broviac, Hickman, Groshong, Leonard

100
Q

Why is a tunneled cath the right pick?

A

Mechanical barrier to microorganisms, anchors the catheter in place (cuff has ATB on it)
Surgical technique for insertion
Long-term therapy ( months, years, lifetime)
Chosen when PICC not a good choice
Must be flushed daily at minimum. Assess dressing q shift, change at minimum q 7 days. May draw blood with MD order.
Another option for oncology pts

101
Q

Hickman and Broviac Catheters
Hickman – ________used in adults
Broviac - Used in ______
Flushed with ____ mL of Heparin 10 units/mL per lumen after each use or daily

A

larger diameter; peds and small adults; 2.5mL

102
Q

Groshong Catheters
Closed end with ________
Pressure sensitive valve restricts ____ of blood and air embolisms
Eliminates need for _____ no need to clamp because a closed system
10cc NS flushing required only every ____ days when not in use and after each use

A

Pressure sensitive 2 way valve; backflow; Heparin; 7 days

103
Q

Changing a CV dressing-
Wash hands – place pt in comfortable position
Apply ____ for you and patient or turn pts head away
Clean gloves – remove old dressing
Inspect site
Don sterile gloves – clean skin outward from insertion site in a ______ or _____ manner
Redress with ______ dressing or 4x4 securely taped
Label dressing – date, time, & ______

A

Mask; circular or friction rub; transparent; initial

104
Q

Implanted Ports (VAP – Vascular Access Port)
Placed in ___ pocket, surgically created, catheter is in the vein
Upper chest or __________
Single or double lumen
Accessed by using a _____ needle - Huber
Chest access can ____________________
High risk for needle stick by ____
Flushed after each use/ _________________________

A

SQ; subclavian or internal jugular; noncoring, tolerate over 2000 sticks; nurse; at least once a month

HIGH RISK FOR NEEDLE STICKS TO NURSE!!

105
Q 
Accessing Implanted Ports –
\_\_\_\_\_\_ a Physician’s order to access
Any credentialed \_\_\_ can access port
Central line dressing change kit
10 ml \_\_\_\_ syringe 
10 ml syringe with 5 ml \_\_\_\_\_
\_\_\_\_\_\_\_ needle with extension tubing
A

DO NOT NEED; Rn, NS; Heparin; Noncoring

106
Q 
Implanted Ports –
Regular port or Power port –
Can withstand pressure of \_\_\_\_\_\_\_\_\_
Verify that is power port by \_\_\_ methods
Check pt chart
Palpate top to identify \_\_\_ bumps on \_\_\_\_\_
Palpate sides of port for \_\_\_\_\_\_ shape
Identification card or ID bracelet
A

injections in radiology; 2; 3; septum; triangular

107
Q 
Power Port -	
After using \_\_\_ identifiers – access with \_\_\_\_\_\_\_ noncoring needle
Removal of powerloc-
Secure base with \_\_\_ fingers
Grasp \_\_\_\_\_ and pull up till hear \_\_\_\_\_
Dispose in \_\_\_\_\_\_\_
\_\_\_\_\_\_\_ and care as for regular port
A

2; powerloc; 2, wings; click; sharps container; flushing

108
Q 
Dialysis Catheter –
Very \_\_\_\_\_ lumens
Tunneled or \_\_\_\_\_\_\_\_\_
Problems – \_\_\_\_\_\_, vein thrombosis
DO NOT use for \_\_\_\_\_\_ of fluids
Flushed with \_\_\_\_\_\_\_
A

large; nontunneled; CR-BSI; administration; Heparin

109
Q

What is CR-BSI?

A

catheter related blood stream infection

110
Q

Who gets to play with dialysis ports?

A

DIALYSIS NURSES ONLY!!

111
Q

Document document document!
Date/time of IV insertion
Name of people involved with the insertion
Make sure consent is signed
______________________________________________
How the procedure went
______________________________________________
Confirmation of placement
If any patient ______ was completed

A

Vein, type of IV used, size of cath;
Type of Dsg et securement method;
Education

112
Q 
At least once a shift:
The type of IV, 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_-
When it was last changed, 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Describe the insertion site
How much of the line is \_\_\_\_\_\_ ( ie. 8 cm external)
A

Condition of dsg;
when it was lasted flushed;
Patency of the line;
External

113
Q

Why would you use hypodermoclysis?

A

Subcutaneous infusion is given to palliative care patients who can’t tolerate oral meds, but IM injections are too painful and vascular access is not possible or too difficult.

114
Q

Hypodermoclysis

A

process of giving isotonic fluids to a patient via the subcutaneous tissue

115
Q

Hyaluronidase _____ may be mixed with infusion fluid to improve the _________

A

150 units; absorption

116
Q

What do you do if you can’t draw back from a central line?

A

If you can’t draw back, have patient cough, change position, or move their arm. You can also try to flush the line.

117
Q

How do you flush a central line after drawing blood?

A

Pulsatile flush with 20 ml of NS vigorously after drawing blood, followed by 5 mL of heparin 100 units/mL

ASN 210 (3 decks)

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