IV Therapy Flashcards
Intravenous
existing or taking place within, or administered into, a vein or veins.
Bolus
A lot all at once
Fluid overload
More common in the young and elderly
Too much fluid
Isotonic
Same particles on both sides
Action: replaces volume without disrupting intracellular and interstitial volume. ***Expands vascular compartment.
Indications: Used when bleeding out and we want to replace fluids: Vascular dehydration, Hemorrhages, Replaces NaCl, Dilutes hypernatremia (give slowly), PRN patient
Types: NS, Lactated Ringer’s, D5W, 1/4NS
Isotonic Patient: 275-295 mOsm/L
Isotonic Solution: 250-375 mOsm/L
Concerns: Use cautiously in patients who are fluid-overloaded or who would become compromised if vascular volume would increase such as cardiac/renal patients
Hypotonic
Less particles on one side
Action: hydrates cell by pulling h2o into cellular spaces from vascular space. ***Expands intracellular and depletes intravascular
Indications: Therapy of hypertonic dehydration, sometimes used with keto acidosis but we must get their electrolytes and fluid settled before hypotonic therapy
Types: ½ NS, ¼ NS, 33% saline, 2.5% dextrose in water
DO NOT GIVE IF THE PATIENT HAS A BRAIN INJURY: Brains love free water and will absorb it quickly and will lead to brain edema
*can cause cells to burst and can rob blood volume
Hypotonic patient: < 275 mOsm/L
Hypotonic solution: < 250 mOsm/L
Hypertonic
More particles on one side
Action –draws fluid out of intracellular space, leading to increased intracellular volume both in the vascular and interstitial space. ***Expands intravascular and depletes intracellular
ICU only
Indications: Tx of hypotonic dehydration, circulatory collapse, increased fluid shift from interstitial space to vascular space
Types:
10% glucoseICU only, (lungs might get fluid), Check CBG
o 3-5% NSICU only (lungs might get fluid)
o D51/2
o D5NS
o D5 in ringers
Watch: BP, Lung sounds, Sodium levels, Very irritating to the vessels, Infuse very slowly
Hypertonic patient: > 295 mOsm/L
Hypertonic solution: > 375 mOsm/L
Infiltration
Going into the tissue
Secondary medications
Piggyback
Intermittent medication infusion (INT)
Heparin-lock or saline-lock, IV in but no fluid going in
Phlebitis thrombosis
Inflammation of a vein that turns into a clot
Speed shock
Patient goes into shock because of medication going in too fast
Example: Potassium chloride, could kill you because it stops the heart
IV Pump
Forces the fluid into the IV to the pt.
IV controller
Pinches the tubing so that it only lets in a certain amount of med
Macrodrip
Large drops, regular IV tubing
Microdrip
Drops small drops
Women have _______-______% of fluid
50-52%
Babies have ________-________% of fluid
70-80%
What % of fluid is intracellular
40%
What % of fluid is extracellular
20%
What % of fluid is found in your blood vessels?
5%
What % of fluid is found in your interstitial space (CSF, Lymphatic)
15%
What % of fluid is trans cellular?
too small to measure
The __________ senses your level of fluids and electrolytes and controls your thirst and pituitary gland to put out ADH
Hypothalamus
The _______ ________ puts out ADH (antididiuretic Hormone), which tells you not to pee so that you can keep your fluid
Pituitary gland
What are the factors that cause you to produce ADH?
- Stressors
- Drugs (diuretics)
- Smoking
- Cancer
- Steroids (aldosterone)
- Kidneys , Edema, Too much K, Impacts the heart, too much phosphorus, Acidosis
What are the functions of fluids?
o Maintain blood volume
o Helps to regulate temperature (Dehydration=Fever)
o Transports materials to and from cells
o Medium for cell metabolism
o Assists in food digestion thru hydrolysis
o Solvent in which solutes are available for cell function
o Medium for excreting waste
What are the 2 different types of fluids we have in our bodies?
Intracellular
Extracellular: Intravascular, Interstitial, Transcellular
Movement of fluid through capillary walls depends on what?
Hydrostatic pressure: Pressure exerted on the walls of blood vessels
Osmotic pressure: Pressure exerted by the protein in the plasma
The direction of fluid movement depends on what?
the differences of hydrostatic and osmotic pressure
Passive transport
Osmosis: Fluid moves from low solute to high solute
Diffusion: Fluid moves from an area of high solute to low solute
Filtration: Hold on to some particles and let go of others
Active transport
Physiologic pump moves from lower concentrations to one of higher concentration.
Moves against the concentration gradient.
Requires ATP for energy
Against the concentration gradient: Sodium potassium pump maintains the higher concentration of extracellular sodium and intracellular potassium
What are the major cations?
♣ Sodium ♣ Potassium ♣ Calcium ♣ Magnesium ♣ Hydrogen ions
What is sensible loss?
Urination and bowel movements
What is insensible loss?
- Skin= 500mL/day (Temperature?)
- Bowels= 100-200mL/day (diarrhea? C.Diff?)
- Lungs= 300-500mL/day (Hyperventilates?)
Altogether, we lost between 500-1,000mL per day through insensible loss
First spacing
Normal distribution of fluids within the body
Second spacing
Abnormal accumulation in interstitial tissue
Easily exchanges with extracellular fluid
Example: on your feet all day, lay down and swelling goes away
Third spacing
Fluid accumulation in body not easily exchanged with ECF
Examples: fluid in the lungs, severe burn, peritonitis, fistula. Pancreatitis, bowel extension, OR exposure (extensive)
S/S: Hypovolemia
Treat:
• Slowly administer fluids to avoid hypervolemia
• Look at electrolytes and urine concentration
• Replace electrolytes and fluid if need be
• Look for protein in the blood stream (Low protein- edemitis)
Gerontology considerations
Reduced homeostatic mechanisms (Cardiac, renal, respiratory)
o Decreased body fluid percentage
o Medication use
o Hormone: decrease in ADH
o Dehydrated more easily
o Lost subcut tissue
o Dry skin
o Do not feel thirsty as often as younger individuals
o *Should be weighed everyday (Best way to measure fluid balance)
o *Will collect fluid in lungs faster than younger pateints, which leads to pulmonary edema
o *Do not depend on tenting to tell you if the patient is older
Fluid volume deficit (FVD)
Medical diagnosis: Hypovolemia
Definition: Losing fluid and electrolytes in the same proportion
***Different from dehydration: losing fluids only
Can be recovered by administering NS or Ringer’s Lactate
If hemorrhage: administer NS
Causes: • Vomiting • Diarrhea • GI suctioning • Sweating • Decreased intake • Inability to gain access to fluid
Risk factors: • Diabetes insipidus • Adrenal insufficiency • Osmotic diuresis • Hemorrhage • Coma • Third space shifts
S/S • Rapid weight loss • Decreased skin turgor • Oliguria • Concentratied urine • Postural hypotension • Rapid and weak pulse • Increased temperature • Cool and clammy skin due to vasoconstriction
*PC: hypovolemic shock
Fluid volume excess (FVE)
Medical diagnosis: hypervolemia
Definition: Fluid overload or diminished omeostatic mechanisms
Risk factors:
• Heart failure
• Renal failure
• Chirrhosis of the liver
S/S • Edema • Distended neck veins • Abnormal lung sounds (wheezing) • Tachycardia • Increased BP • Pulse pressure • CVP • Increased weight • Increased UO • SOB • Wheezing
Treatment:
• Directed at the cause
• Restriction of fluids and sodium
• Administration of diuretics
*PC: pulmonary edema, HTN, electrolyte imbalance, hypoxemia, respiratory alkalosis
IV therapy for maintenance
Mainly for those who are NPO and/or stressed
Give: 1500 mL fluid/sq meter of body surface
Should include: glucose, sodium, potassium and water
• Supplies calories
• Spares protein
• Minimizes ketone formation (Helps put the patient into ketosis)
IV therapy for replacement
Given when the body cannot maintain requirements
Usually d/c in 48 hours
Check renal function before administration
Given for: • Diarrhea • GI surgery • N&V • Loss of electrolytes • Wound infection
IV therapy for restoration
Used for restoration on ongoing basis - greater than 48 hours
Given for:
• Burns
• Wound draining
• Fistula draining
Similar to replacement except you need
- Strict I & O
- Daily labs
- Type of fluid depends of type lost
What is the minimum urine output/hour
30mL/hour
Midline vascular access device
Peripheral
3-8” long
Can stay in 6 days – 4 weeks without causing a problem
Peripherally Inserted Central Venous Cather (PICC)
Peripheral
Specially trained nurses can insert them
***Remove in slow short pulls
o Don’t put pressure on the needle until you see blood because there could be a clot.
Given in the Basilic vein most often
• Sometimes given in the cephalic vein or subclavian vein
Can’t us turnicut so put in Trendelenburg
Ends in the superior vena cava of the heart
Central Venous Catheter (CVC)
Short term non-tunneled
• 10 days
• Placed in the jugular or subclavian
Long term tunneled • ***Must be removed by doctor • Hickman • Broviac • Groshong • Implanted port (Portacath)
Given for: Long term therapy, TPN, Glucose therapy, Chemo, Kidney failure
Crystalloids
Hypotonic, Isotonic, and Hypertonic solutions
Solutes are totally dissolved and can freely move in and out of membranes.
Takes 3-4X of these to do the same job as Colloids (expanders)
Ringer’s lactate=most balanced solution
• If pt. is allergic to lactose, don’t give lactate
• There is a plain solution for these patients
*Look for kidney failure because potassium is added to many solutions
Expanders (Colloids)
Solutes don’t dissolve
Need more osmotic pressure
Hypertonic
Can be substitutes for blood transfusions
Types
• Albumin: Plasma protein, 500 mL of blood, Low albumin=edema, High protein=weight loss
• Dextran: 20-40mL/minute, Given for hypovolemia, Substitute for blood transfusion
• Hespan: Heta-starch, Not a blood product, LESS TOXIC THAN THE OTHERS, Substitute for blood transfusion
• Mannitol: EXPANDER USED FOR BRAIN INJURY. It does not cause the brain to swell
*Medications should not be given with or added to these solutions
PC: ALWAYS OVERLOAD
What is the formula for patient osmolarity?
(2 x Na) + (glucose÷18) +(BUN ÷2.8)
What is the formula for Mean Arterial Pressure (MAP)?
Diastole+Diastole+Systole/3
*should be above 60!
Discontinuing an IV
Gloves
Wait until you see blood and then put pressure
Observe catheter for problems
- If part of the catheter is gone, put turnicut on and call physician
Removal of Central Lines
- Per agency policy
- ***Patient in Trendelenburg
- ***Have patient bear down so blood will come out to prevent air from going in
- Inspect the integrity of the catheter
- Document
- Take precautions to prevent air embolus and catheter breakage
What type of solution are blood products compatible with?
NS ONLY!
What should you do if the patient has a reaction to a blood transfusion?
stop the blood immediately, take all of the blood and saline administered with blood away
keep the IV in with the piggy-backed saline.
Intrinsic infection
An infection that was already in the patient prior to care.
Extrinsic infection
An infection that we caused through care
How often should tubing be changed?
72 hours
How often should bags be changed?
24 hours
How often should the IV site be changed?
72 hours
How can we implement infection control?
- Wash hands before doing anything with the site
- Good skin prep and technique with start
- Change tubing/bags/site at proper times
- Label all above - If no label consider expired
- Inspect and palpate site daily, change if necessary
- Dressing are to be left intact until catheter is removed or it becomes damp, loose, soiled
- Wear gloves for dressing changes if needed
- Universal precautions
- Care with flushes, needless systems, additives
Site assessment: o Redness o Swelling o Tenderness o Coolness o Warmth o Inflitration- pain, coolness, pallor o Phlebitis- pain, redness, warmth, red streak
Monitor: o Length of time hanging o Tubing o Flow rates o Pumps o Dressing o Site o Patient response o Documentation o Write down patient name and flow rate on the bag so that everyone knows
Infiltration
Local PC
- Skin is cool and tight
- Take IV out
- Place warm compress
- Graded from 0-4
Phlebitis
Local PC
- Red, warm, swelling, red streak
- Take IV out
- Place either cold or warm compress
- Inform physician and possibly infection control
Thrombophlebitis
Local PC
• Edema, tender, vein feels like a cord
Hematoma
Local PC
- Bruise and swelling, burning pain, discolored
- Take IV out
- Apply pressure
- Elevate
- Ice
Spasms
Local PC
• IV too fast or the solution is cold (blood)
Extravasation
Local PC
- Infiltration of medicine
- Burning
- Try to suck it back out with a syringe
- Notify, take a picture, elevate, warm or cold compress, incident report, sometimes they even have to have surgery
Overload
Systemic PC
S/S: Restless, Headache, High pulse, Gain >2 pounds in one day, Cough, fluid in the lungs, Edema, Hypoxia, O2 Sat<90 , Wide difference between I&O
Treat: Report, Give diuretics, Keep HOB up, Daily weight, I&O monitoring, Do not take IV out, Turn down to keep the vein open, Keep patient warm
Air embolism
Systemic PC
S/S: Palpitations, Confused, Coma, SOB, Tachycardia, Murmurs, Shock
Treat: Call for help, Clamp the line, **Trendelenburg on left side to prevent it from moving into the lungs, **Oxygen, Vasopressors, Fluids, Could go into cardiac arrest
Infection/Septicemia
Systemic PC
- Chills
- Fever
- Tachycardia
- N&V
- Pain
- Elevated white count
- Could go into septic shock
Speed shock
Systemic PC
- Med too fast
- Could go into cardiac arrest
Catheter embolism
Systemic PC
Apply tourniquet and notify provider
Catheter occlusion
Systemic PC
Find a specialist immediately
