IV Therapy Flashcards
What is infusion therapy?
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.
What is infusion therapy used for?
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
What is the role of an infusion nurse?
Infusion nurses often initiate and maintain infusion therapy to reduce complications of therapy.
What should orders for infusion therapy include?
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.
What is the nurses’s responsibility during infusion therapy?
Nurses are responsible for determining that the order is appropriate for the patient and clarifying any questions before administration.
What devices are used for long term infusion therapies?
Peripherally inserted central catheters (PICC), tunneled central catheters, and implanted ports are commonly used for long-term infusion therapy.
What is a vascular access devices (VADs)?
Vascular access devices (VADs) are catheters that are used to deliver fluids, electrolytes, and medications into the intravascular space.
What are some common types of vascular access devices ?
Short peripheral catheters, midline catheters, peripherally inserted central catheters (PICC), nontunneled percutaneous and tunneled central catheters, implanted ports, and hemodialysis catheters
What are VADs used for?
VADs are catheters that are used to deliver fluids, electrolytes, and medications into the intravascular space.
What is the best practice for placement of short peripheral VADs?
Avoiding the small veins in the hands
Arterial therapy is used primarily for?
The administration of chemotherapy agents directly into a tumor site; the liver is the most common arterial site for this purpose
Intraperitoneal therapy is used for?
Antineoplastic agent administration into the peritoneal cavity, especially for ovarian and gastrointestinal tumors that have metastasized into the peritoneum
What is hypodermoclysis?
Subcutaneous therapy of fluids (hypodermoclysis) involves a slow infusion for a short time; the thighs, hips, and abdomen are commonly used sites.
What is the goal of epidural therapies?
PAIN!
What are Intrathecal infusions used for?
Antineoplastic agents used for cancers that cross the blood-brain barrier into the central nervous system
Why do you use IO methods? Who starts them?
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.
How long is an IV if started before they get to the facility?
24 hours
Procedure when accessing a central line?
Aspirate the line for blood return before using then flush the port before infusion / injecting.
What is the SASH method?
Saline, Administer, Saline, Heparin
What precautions do you have to keep in mind when dealing with geri-pts?
Watch the speed of infusion ( icreased risk of FVE), skin tears when d/c’ing IV, lung sounds et overall skin integrity.
Best Nsg practice is to assess an IV site how often?
Every hour
What actions do you take if a pt has a temp >100 and you are to hang blood?
Contact the provider to get instructions
Nsg responsibilities for blood admin?
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
Who has to verify blood products?
Best case is 2 Rn’s
What is the max infusion time of blood?
4 hours
How long do you have to start blood once delivered from the lab?
15 minutes, so have your IV done FIRST!!
Special considerations for blood in geri?
Slower rates, watch for skin tears et integrity of skin
Special considerations for blood in peds?
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
What can the UAP do for you during blood admin?
Pick up blood from bank, take frequent VS, they CAN’T verify bag. It is the Rn’s job to monitor for complications!
What gauge IVs do you use for blood?
At least a 20 gauge or higher for adults, 23 gauge for peds
What do you check for when you get the blood from the bank?
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!
Procedure for hanging blood?
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.
VS procedures after hanging blood?
Vitals are checked q 15 X2, then hourly for the duration of the transfusion.
S/S of febrile reaction?
Acute increase of temp over 2 degrees, chills et shaking
S/S of a hemolytic reaction?
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!!
S/S of an allergic reaction?
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.
S/S of a bacterial reaction?
It can take weeks or months after a blood transfusion to determine that you’ve been infected with a virus, bacterium or parasite.
What do you do if you suspect circulatory overload??
Slow the rate of transfusion and observe closely for pulmonary and peripheral edema. Push a diuretic afterwards.
What do you do if you suspect a reaction?
Stop the infusion immediately, hang new tubing with NS at a keep-vein-open rate. Call physician et notify transfusion services
What is an autologous blood transfusion? Why is it done?
Collection et infusion of pt own blood. It greatly decreases the chances of reactions or infections d/t it being the pts own cells.
If you infuse more than 6-8 units of PRBC you must also admin what?
FFP with every other unit.
Give ___ for every unit of PRBC after 8 units?
Platelets
What supplies are needed for a blood infusion?
Blood, blood admin set with filter, NS 1000mL bag, clean gloves, record of blood admin form, VS equipment
Rate of flow for platelets or plasma?
2-5 mL / min for 5 mins watching for a reaction
Rate of flow for whole blood, RBC or granulocytes?
2 mL / min for 15 minutes to watch for reactions
How long should you stay bedside after starting blood?
15 minutes!! No excuses!!
Symptoms of an immediate adverse reaction are usually manifested during infusion of the initial ___ mL
50mL
Blood can be admin by ____ and ____?
Gravity or pump
Suggested rates for adults are:
PRBCs: ______ mL/hr
Granulocytes: ____ mL/hr
Plasma/Platelets: ____ mL/hr
PRBCs: 100-230 mL/hr
Granulocytes: 75-100 mL/hr
Plasma/Platelets: 200-300 mL/hr
How long should entire platelet product be given?
Within 1 hour, if possible
How long do you monitor pt for reactions?
During the entire infusion et 1 hour post infusion
If pt experiences a reaction while infusing what do you do?
STOP the infusion, maintain a patent line with NS and notify MD ASAP!!!
What do you doc at the end of the infusion?
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
What causes an iron overload reaction?
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.
Delivery of parenteral medications and fluids
Reasons –
Maintain or correct _______________________
Maintain or correct _______________________
Administer ______________________________
Replace _______________________________
Maintain or correct fluid balances
Maintain or correct electrolyte or acid-base imbalances
Administer medications
Replace blood or blood products
Who places IVs? Who is responsible for them?
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!
Isotonic- _________ Risk factor?
Hypertonic- __________
Hypotonic- ___________
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.
What is a peripheral IV line? Placed where? How long?
Short peripheral caths, mid-line caths. Placed in the arm or hands. In place for < 6 days.
Sizes of PIV?
3/4 - 1 1/4 inch, 26-14 gauge
Veins used for PIVs?
Basilic, cephalic or median veins
PIV’s must be changed every ___ hours.
96
Pre-hospital Iv’s must be changed within ____ hours of admission to the hospital.
24
Patients should only be stuck a max of 5 times, with ______________per nurse.
2 sticks
Assess site at minimum q ___ hours; for continuous infusion, check site q _____.
8; 2 hours
__________ at least q 12 hours.
Assess dressing q ___________.
Flush; shift
Change dressing q ___hours. Site and tubing should be changed q ____hours too.
96; 96
Do not place a PIVs…
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
Rules for IV push meds….
Administered only by an RN et for medications requiring administration over 1 minute or longer
Medication should be diluted according to _____________________________.
Ensure ___________________ with IV in progress.
Your drug book; compatability
Indications of IV push meds…
Quick response desired Loading dose needed Limits number of IM injections Avoid incompatibility problems Deliver meds if unable to take by mouth or IM
All about Mid-line Caths….
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
Usually the _____ vein is preferred over the _______ vein because of its ______ diameter and straighter path.
Usually the basillic vein is preferred over the cephalic vein because of its larger diameter and straighter path.
Midline catheters are good for?
Midline catheters are good for patients with poor vein integrity or patients on blood thinners who can’t tolerate multiple IV sticks without bruising.
______ technique is used to insert medline caths?
STERILE
Midline caths should not be used to infuse ______. Why??
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.
Types of PIVs?
Short PIVs
Mid line catheters
Types of central lines?
PICC lines Nontunneled percutaneous Tunneled Ports Hemodialysis catheters
Tip of central lines is placed where?
Superior vena cava (SVC)
How must placement be verified before infusion?
X-ray, don’t use until confirmed!!
Do not run ___ through central line unless it’s placed in the ___.
TPN; SVC
What does a pt have to refrain from is a central line is placed?
ACTIVE RIGOROUS ACTIVITIES (running)
Don’t use anything smaller than a ____ syringe?
10mL
_______ if catheter enters R ventricle.
Arrhythmias
Flush _____ & ________ med infusion, and after blood draws
before; after
Scrub the hub for ______ seconds
15-30
Inject NS vigorously with _______
Clamp tubing _____ removing _____ from hub
Inject NS vigorously with pulsating flush (push-pause technique)
Clamp tubing before removing syringe from hub
Peripherally Inserted Central Catheter (PICC) –
Placed in _______ or middle of upper arm and is _____ inches long
Placed in antecubital fossa or middle of upper arm and is 18-29 inches long
PICC lines:
Tip resides in _____________
________________________to be sure tip is in place before infusion
Superior vena cava (SVC); Verify with a CXR
How many lumens are on a PICC?
1-3 lumens
Dressings changed when integrity is compromised or at least q ______
7 days
Do not infuse ____ into a PICC?
Blood products
Why are PICC lines preferred for long term Tx?
Lower complication rate, arms are free of lines so there is less change for complications
______ does not occur, as with central venous catheters
Pneumothorax
Indications for a PICC line?
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
Compliactions of a PICC line?
Complications: infection, phlebitis, thrombophlebitis
What do you need to draw blood from a PICC line?
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.
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)
Subclavian vein; Trendelenberg
Nontunneled Percutaneous Central Catheters have 3 lumens. What can you do with each: Proximal, Medial, Distal?
Proximal: Blood sample, Medications, Blood administration.
Medial: TPN, Medications
Distal: Blood administration, High volume fluids, Viscous fluids, Medications, CVP monitoring
4 types of tunneled lines?
Broviac, Hickman, Groshong, Leonard
Why is a tunneled cath the right pick?
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
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
larger diameter; peds and small adults; 2.5mL
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
Pressure sensitive 2 way valve; backflow; Heparin; 7 days
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, & ______
Mask; circular or friction rub; transparent; initial
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/ _________________________
SQ; subclavian or internal jugular; noncoring, tolerate over 2000 sticks; nurse; at least once a month
HIGH RISK FOR NEEDLE STICKS TO NURSE!!
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
DO NOT NEED; Rn, NS; Heparin; Noncoring
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
injections in radiology; 2; 3; septum; triangular
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
2; powerloc; 2, wings; click; sharps container; flushing
Dialysis Catheter – Very \_\_\_\_\_ lumens Tunneled or \_\_\_\_\_\_\_\_\_ Problems – \_\_\_\_\_\_, vein thrombosis DO NOT use for \_\_\_\_\_\_ of fluids Flushed with \_\_\_\_\_\_\_
large; nontunneled; CR-BSI; administration; Heparin
What is CR-BSI?
catheter related blood stream infection
Who gets to play with dialysis ports?
DIALYSIS NURSES ONLY!!
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
Vein, type of IV used, size of cath;
Type of Dsg et securement method;
Education
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)
Condition of dsg;
when it was lasted flushed;
Patency of the line;
External
Why would you use hypodermoclysis?
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.
Hypodermoclysis
process of giving isotonic fluids to a patient via the subcutaneous tissue
Hyaluronidase _____ may be mixed with infusion fluid to improve the _________
150 units; absorption
What do you do if you can’t draw back from a central line?
If you can’t draw back, have patient cough, change position, or move their arm. You can also try to flush the line.
How do you flush a central line after drawing blood?
Pulsatile flush with 20 ml of NS vigorously after drawing blood, followed by 5 mL of heparin 100 units/mL
