IV Therapy Flashcards
1
Q
Large Volumes
A
- Continuous
- Over 3 hours
- Example 100mL/hr
2
Q
Fluid bolus
A
- Patient is dehydrated; has N/V, hypotension
- Short period of time
- Less than 1 hour
3
Q
Meds mixed in large bags of fluids
A
- K+Cl (potassium chloride)
- Vitamins
- TPN
4
Q
IVPB
A
- Small amount of solution (25-100mL)
- Contains a medication that is “piggybacking” onto the main line
- Intermittent
- Aren’t ran continuously
5
Q
IVP
A
- Meds are pushed directly into the vein
- Need to: verify compatibility, know if it needs to be diluted and what to dilute in, how fast to push the meds
- Typically narcotics
- NEVER push K+
6
Q
Vascular Access Devices
A
- Short Peripheral Catheter
- Midline Catheter
- Peripherally Inserted Central Catheter (PICC)
- Nontunneled Percutaneous Central Venous Catheter (CVC)
- Tunneled Catheters
- Implanted Ports
- Hemodialysis Catheters
7
Q
Delegation
A
- UAP/CNA CANNOT administer IV fluids, meds, or blood
- LPN CAN administer IV fluids, IVPB medication
- LPN CANNOT do IVP, or narcotics (PCA)
- IVP medications MUST BE given by RN
- Blood products MUST BE started, initiated, and followed up by a RN
8
Q
Autoguard IV catheter
A
- Yellow is mellow 24g
- Blue is for you 22g
- Pink you seeee 20g
- Green is mean 18g
- The larger the # the smaller the diameter
- 14-16g is very large (surgery, trauma)
- Standard surgery = 18g
- Most therapy is given with 20g
- 22g used when the patient veins cant support a 20g
- 24g-26g used on children and elderly
- Anytime a patient says its tingling, you are in the nerve and need to get the IV out
- Stay away from hand if they have a lot of action
- Move from distal to proximal, may even need to move to other arm
9
Q
AccuVein
A
Used when having a hard time finding a good vein
10
Q
Midline Placement
A
- Basilic Vein (PREFERRED)
- Tip no further than axilla vein
- Used most often without the ultrasound
- Ultrasound allows to go to deeper veins
- Allows for demodulation of fluids
- Mixed solutions
- May be called a mini-stick
11
Q
PICC
A
- Double lumen = 2 ports
- Triple lumen = 3 ports
- Basilic or cephalic
- Placed above the AC
- Sterile dressing needs to be changed every 7 days
- Can be left in for several months
- No BP on that arm
- DO NOT USE until placement is confirmed by x-ray
- Flushed every shift 10cc
- Can infuse TPN
- Can be used to draw blood, need to change the caps with each blood draw
12
Q
CVC Non-tunneled
A
- Greater risk for infection
- Tip is in the superior vena cava (SVC)
- Used for less than 6 weeks
- Don’t typically see at home
- Placement confirmed by x-ray
- Sterile dressing change every 7 days
- Have patient take a deep great and hold when removing
- Will need to apply sterile dressing after CVC is removed
- May be placed in trandelenburg during insertion
- sutured in place
- Can be removed by nursing staff
13
Q
CVC Tunneled
A
- Point of entry is not directly in the vein
- Cuff is coated by antibiotic solution
- Sutured in place
- Cuff gets inflated to help keep it in place
- Used for longer periods of time
- Requires surgery for insertion and removal
- Inserted by physician or advanced practice nurses
14
Q
Complications of CVC
A
- Pneumothorax: air being introduced into the pleural cavity causing the lung to deflate
- Hemothorax: Blood being introduced into the pleural cavity
- Hydrothorax: Fluid and air being introduced into the pleural cavity
- COPD patients are at a higher risk for pneumothorax, hemothorax, and hydrothorax
- Air embolism: bubble of air, acts like a clot/stroke
- Arterial Puncture: hitting the artery
- Catheter migration/dislodgment
- Catheter rupture
- Lumen occlusion: opening of end of cannula is obstructed by clot or web of clot
- Central Line-Related Bloodstream Infections (CLRBI): purulent draining around the site, needs to be d/c & sent down to lab, may need to also culture the site
15
Q
Port a Cath
A
- Must use a Huber needle
- Cancer patients
- Strict sterile technique when accessed
- Can be double lumen or single lumen
- Come in various sizes
- Placed in upper chest wall, possible upper extremity
- Designed to not “core”, designed to slice through and when removed, the material will self-close
16
Q
Huber Needle
A
- 45 degree angle needle
- Needed to access a port a cath
17
Q
Isotonic IV Fluids
A
- Be careful on patients who are at risk for overload (renal & cardiac patients)
- Usually used with burn patients
- No push into or pull out of the cells
- D5W
- NS: should be the only thing used when giving blood products. Need to prime the tubing for blood products with NS
- LR: contains k+
18
Q
Hypotonic IV Fluids
A
- Pushes fluid into the cells
- Puts patients at risk for phlebitis & infiltration
- Moving into the cells & expanding them
- Use cautiously with burns
- 1/2 NS
19
Q
Hypertonic
A
- Pulls fluid out of the cells
- Monitor blood sugar levels
- D5 1/2 NS
- D5 NS
- D10W
20
Q
IV Fluids
A
- Be sure to check the date on the fluids
- Make sure the bag is not leaking
- If it doesn’t look right, don’t hang it
- IV solutions should be changed every 24 hours
21
Q
8 Rights of Medication
A
1) Right time
2) Right patient
3) Right medicine
4) Right dose
5) Right route
6) Right documentation
7) Right effect
8) Right education
22
Q
Before administering drugs
A
- 8 Rights of medication
- Current medications
- Diagnosis = why are they getting this drug?
- Comorbities = multiple disease process, will this interfere with the additional diseases
- Lab values
- Drug levels: Normal drug levels for that specific medication (coumadin, K+, etc.
- CBC Values: What’s their blood count? Is this going to affect something? RBC, WBC, Platelets
- CMP Values: complete metabolic panel
23
Q
IVPB
A
- 25mL to 250mL IV bag
- Short tubing
- Connects to the upper “Y-Port”
- Primary infusion or intermittent
- Hung higher than the primary infusion
- Primary infusion can be placed on hold while IVPB is infusing
24
Q
Complications of IV therapy (Local)
A
Local = right there in a small area, right at the site
- Cellulitis
- Phlebitis
- Infiltration/Extravasation
- Hematoma
- Ecchymosis
- Site infection
- Nerve damage
25
Q
Cellulitis
A
- Inflammation of the cells or surrounding tissue of the site
- Inflammation of subcutaneous connective tissue
S&S:
- Swollen
- Redness
- Warm to touch
- Pain
- Edema
- Induration
- Red streaking
- Fever (systemic)
- Chills (subjective)
- Rigor - see them shaking (objective)
- Malaise - general feeling of not feeling well
To avoid Cellulitis:
- Avoid lower extremities
- NEVER use the lower extremity of a diabetic patient
- Use surgical aseptic technique
- Rotate sites every 72 hours
Treatment:
- Discontinue the infusion and remove the catheter
- Elevate the extremity
- Apply warm compresses 3-4 times/day
- Obtain a specimen for culture at the site & prepare the catheter for culture if drainage is present
- Administer: antibiotics, analgesics, antipyretics
26
Q
Phlebitis
A
Inflammation of the vein from mechanical or chemical (medication) trauma
S&S:
- Throbbing, burning, or pain at the site
- Increased skin temp
- Erythema
- Red line up the arm with a palpable band at the IV site
- Swollen
- Fibrin can be activated
- Can start a thrombus
Cause:
- Catheter too large for the vein size
- Veins become inflamed by irritating or vesicant solutions or medications (typically phenergan, K+)
Treatment:
- Promptly discontinue the infusion and remove the catheter
- Elevate the extremity
- Apply warm compresses 3-4 times/day
- Restart the infusion proximal to the site or in another extremity
- Culture the site and catheter if drainage is present
27
Q
Infiltration
A
- Fluid is leaking out of the vein and into the interstitial spaces
- Escape of fluids or drugs into the subcutaneous tissue
S&S:
- Cool to touch around the site
- Swollen
- Pale, pallor, white - may bruise after awhile
- Induration: elevated area
- Firm
- Pain
- Burning
- Necrosis of the tissue
- Damp dressing
Causes:
- Catheter unsecured
- Incorrect catheter size
- Vesicants
Treatment:
- Stop the infusion and remove catheter
- Elevate the extremity
- Encourage active range of motion
- Apply warm or cold compress
- Restart the infusion proximal to the site or in another extremity
28
Q
Extravasation
A
- When an IV catheter becomes dislodged & meds infuse into the tissues
- Pain
- Stinging
- Burning
- Swelling
- Redness at the site
29
Q
Hematoma
A
Blood leaking out
Hema = Heat; apply heat to area
30
Q
Ecchymosis
A
- Pin point rash
- May be seen along area of IV or tourniquet placed
- Bruising
31
Q
Site infection
A
Change site
32
Q
Systemic
A
Body wide, through the whole system
33
Q
Air embolism
A
- When d/c line or IV
- Air is in the tubing
34
Q
Catheter embolism
A
- Part of it breaks off
35
Q
Circulatory overload
A
- Body has too much fluid and can’t handle it
36
Q
MUST
A
- Monitor the site every 2 hours
- Flush the IV every shift
37
Q
Fluid Volume Overload Signs and Symptoms
A
- Weight gain: CHF patients must be weighed daily
- Elevated BP
- Increased HR
- Increased respirations
- Distended neck veins
- Decreased electrolyte levels
- Generalized edema
- Decreased HCT
- Decreased BUN
- Bounding pulse
38
Q
Fluid Volume Deficit Signs and Symptoms
A
- Weight loss
- Decreased salivation
- Decreased output
- Dry, cracked lips
- Poor skin turgor (check near clavicle for peds & elderly)
- Increased HCT
- Increased BUN
- Thready (light) pulse
39
Q
Hematoma
A
- Collection of blood
- Blood leaking out
- Subcutaneous hematoma: most common complication
- Can be a starting point for other complications: thrombophlebitis and infection
- Greater than 10mm
40
Q
Hematoma Signs & Symptoms
A
- Discoloration of the skin
- Site swelling and discomfort
- Inability to advance the cannula all the way into the vein during insertion
- Resistance to positive pressure during the lock flushing procedure
41
Q
Hematoma Causes
A
- Nicking the vein
- D/C the IV without applying adequate pressure
- Applying the tourniquet too tightly above a previously attempted venipuncture site
- Leaving the tourniquet on too long
42
Q
Hematoma Treatment
A
- Applying pressure after IV catheter removal
- Use warm compress and elevation after the bleeding stops
- Hema = heat; apply heat
43
Q
Colloid solutions
A
- Packed Red Blood Cells (PRBCs)
- Platelets
- Fresh Frozen Plasma
- Albumin
- Cryoprecipitate
- Must be 18g or 20g - if too small, will damage or rupture the RBCs and that would then excrete K+ into the system and cause K+ overload
44
Q
RN responsibility before blood infusion
A
- Verify consent
- Verify with another RN
- Name and blood bank number
- ABO and Rh type of patient
- ABO and Rh type of donor
- Expiration time
- Unique facility identifier
- Lot number
- EDUCATE on procedure/adverse reaction symptoms
- Vital signs prior to start infusion
- Complete the blood transfer w/in 4 hours of removal from refrigeration
- Exam blood for discoloration or cloudiness
45
Q
Blood products FAQs
A
- Blood products can only be given with NS
- Jehovas witness do not accept any blood - need to be aware of religious preferences. If religion doesn’t allow blood transfusions, MUST get a consent form
- Plasma and serum are the same thing and that is what the RBCs are floating in
- Albumin given to pull fluid back into the peripheral spaces
46
Q
Adverse reactions ACTIONS
A
1) STOP the transfusion
2) Check VS
3) Infuse NS
4) Notify MD
5) DO NOT dispose of blood
6) Document
47
Q
Adverse reaction signs with transfusions
A
- Dyspnea
- Wheezing
- Cyanosis
- Chest tightness
- Hypotension
- Flank pain
- Anxiety/restlessness
- Headache
- Tachycardia
- Chills
- Fever
- Flushing
- Itching
- N/V
- “Impending Doom”
- Laryngeal edema
48
Q
RN responsibility during infusion
A
- Use proper tubing
- Administer blood products using NS
- Remain w/patient for at least the FIRST 15 MIN
- EDUCATE on adverse reactions symptoms
- Infuse product at ordered rate
- Monitor VS
- Document
49
Q
Rn responsibility after infusion
A
- Dispose of bag and tubing properly in RED bag
- Place RED hazard bag in proper bin
- Document
- Educate
- Watch for post-transfusion complications
50
Q
Transfusion-associated graft-versus-host-disease
TA-GVHD
A
- Occurs in immunosuppressed/immunocompetent patients (diabetes, cancer, HIV)
- Manifestations usually occur w/in 1-2 weeks after transfusion
- Thrombocytopenia (low platelet count)
- Anorexia
- N/V
- Chronic hepatitis
- Weight loss
- Recurrent infection
51
Q
Autologous Blood Transfusion
A
- Collection and transfusion of ones own blood
- Usually done before a surgery
- Eliminates compatibility problems
- Fresh packed RBCs can be stored for 40 days
- Rare types of blood may be frozen for 10 years
52
Q
Complications
A
- Transfusion reaction
- circulatory overload (elevation in bp due to increased blood volume, blood was given too fast. Can cause heart failure and pulmonary edema-excess fluid in the lungs); can give IV lasix
- Septicemia (infection of the blood, blood poisoning) by bacteria or toxins
- Iron overload - delayed complication that has received several transfusions or a patient with low platelets (thrombocytopenia)
- Disease transmission - Hep C: will start to see symptoms w/in 4-6 weeks
- Hyperkalemia: stored blood might lyse=break in the bag and then be transfused causing hyperkylemia
- Citrate toxicity - due to preservative placed in the blood as a coagulant (primarily a result of hypocalcemia)
- Hypocalcemia
