IV Therapy Flashcards
Purposes of IV Therapy?
- maintain fluid, electrolyte balance to prevent imbalance
- administer blood and blood products
- administer TPN
- administer prescribed IV meds
- have venous access in emergency situations
Nursing responsibilities of IV Therapy
- assess the need for IV therapy
- assess IV site
- assess/maintain flow rate
- assess pt response to IV
- prevent complications associated
Fluid volume deficit (FVD)
symptoms
- loss of >2.2 lbs in 24hr
- decreased BP
- tachycardia
- slow cap refill
- decreased skin turgor
- thirst
- decreased urine output
- late sign - confusion/restlessness
Fluid volume excess (FVE)
- gain > 2.2 lbs in 24hr
- bounding pulse
- distended neck veins
- crackles in the lungs
- edema (usually in ankles)
What are vascular access devices?
Types?
- catheters, cannulas or infusion ports designed for repeated access to the vascular system
1. Peripheral vascular access device (PVADs)
2. Central vascular access device (CVADs)
a. central venous catheters (CVC)
b. implanted infusion port
c. peripherally inserted central catheter (PICC)
When would you use peripheral vascular access and central vascular access?
Peripheral - short term use
Central - long term use
- medications that are irritating to veins (chemo)
- limited peripheral access or contraindication
- large volume of fluids, or need reliable measurement of fluids delivered
Central Venous Catheter (CVC)
Risk for?
Monitor for?
CVAD - thin flexible catheter that is placed (usually) directly into superior vena cava. Can be inserted through neck, chest or arm
- Risk: infection
- Monitor- pneumothorax, arterial puncture, occlusion, cadiac tamponade
Implanted Infusion Port ?
Benefit?
Used where?
CVAD - access point is buried under the skin. A needle is inserted into port through skin
- Lower risk of infection
- Used in specialized areas - oncology
Peripherally inserted central catheter (PICC)
inserted through a peripheral vein (usually the heart). A long catheter goes all the way to the superior vena cava
IV cannula sizes:
16G, 18G, 20G, 22G, 24G
How do you pick a peripheral site for IV use?
Clean or aseptic technique?
- start at the most distal site possible (if you blow the vein you can move proximal but not below)
- in peds feet is often used, in adults (esp. OA) it shouldn’t be used b/c decreased venous return and increased risk of clots
Aseptic technique - clean site with circular motions for 30 seconds, let dry for 2 mins. Once clean use swab as marker and then insert w/o breaking aseptic principles
How to insert an IV catheter/cannula
angle- 10-30 degrees
- little plastic tube (cannula) over the needle is left behind in site, the needle comes back out
- blood in the flashback chamber indicates your in the vein (but doesn’t always happen
How do you choose an IV cannula size?
- size of pt veins (OA/children- 24 G)
- viscosity of what your infusing and volume (think, large= larger diameter)
- Diagnostic testing may order a size
Changing an IV dressing
- perform hand hygiene and apply gloves
- remove old dressing, careful not to dislodge IV catheter
- assess site
- clean in circular motion, inside out
- inspect
- apply new dressing and tape
IV therapy: OA considerations
- use smaller needles (24-22g)
- choose sites that don’t interfere w/ ADLs
- minimize tourniquet use
- lower angle of insertion
- apply traction to skin while inserting
- use protective device like arm board in necessary
Solute:
Solvent
Solution:
solute - a particle (salt)
solvent - liquid (Water)
solution: solvent + solute
Type of IV fluids
- Crystalloid (solutes cross semi-permeable membranes)
- NaCl, dextrose, lactated ringer’s - Colloids: (large molecules like protein/starch do not cross the semi-permeable membrane, so they increase the volume of extracellular and intravascular fluid)
- blood, plasma protiein, pentastartch - Total parenteral nutrition (TPN): nutritional solution
- Glucose, nutrient, electrolytes
Crystalloid IV Solution types: Isotonic Describe : Effect on cell: uses: Examples of solutions:
-same osmolarity as blood; expands volume without causing fluid to shit in or out of cells
-Constant pressure, cells remain the same
- Uses: volume replacement (vomiting, diarrhea), shock, resuscitation
- Examples:
NS (0.9%)
Dextrose (5% in water- D5W)
Lactate ringer’s (LR)
Crystalloid IV Solutions: Hypotonic solution Cell? Uses? Examples of solutions? Monitor for?
- Low osmotic pressure
- fluid moves into cells, causing them to enlarge (swell)
- Uses: cellular dehydration
- examples:
0. 45% NS
0. 225% NS - Monitor: hypovolemia, hypotension
Crystalloid IV Solution: Hypertonic
Higher solute concentration, pulls fluid out of cells, causing cells to shrink
- Uses: cerebral edema, sever hyponatremia
-Examples:
Dextrose 10% in water D10W
3-5% NaCl/NS
D50.45%NaCl
D5LR
IV tubing types
Macrodrip - 10 to 15 ggt/mL
Microdrip - 60 ggt/mL
Buretrols
volume control device. (50-100mL)
Chamber is filled with smaller volume than IV bag, sits under IV bag. reduces risk of increaed volume being used
How do you regulate IV flow rate?
Risk of going to fast? slow?
- Manual regulation using roller clamp (count drops for 1 min)
- Electronic infusion device
too fast- risk fluid overload
too slow- deprive pt of needed fluid,can clot easily
Factors that influence IV Flow rate
- patency of IV catheter
- patency of tubing
- height of solution (faster-higher, slower-lower)
- restrictive IV dressing
- position of extremity
- infiltration
IV troubleshoot: if IV is not working
- check site for infiltration
- check for kinks
- reposition arm
- lower bag below arm to check for blood return
- raise IV pole
- check slide clamp and roller clamp are open
IV troubleshooting: removing air
- remove by closing clamp, stretching the tube and strumming like guitar strings. Bubbles will flow upwards towards a port , where it can be sucked out with a syringe. (above backflow chamber it can go into bag)
- when priming, flip port upside down and fill before letting the fluid continue down the tube
How do you change an IV bag?
- change when about 50 mLs remaining
- assess IV site
- ensure drip chamber is 1/2-1/3 full
- perform hand hygiene
- clamp IV to stop flow
- remove old bag
- spike and hang new bag
- check for air in tubing, and remove
- ensure drop chamber is 1/2-1/3 full
- regulate flow
Complications of IV therapy
- infiltration
- extravastion
- phlebitis
- infection
- bleeding/bruising
- fluid overload
- air embolism
Infiltration: what is it
characterized by?
intervention?
IV fluid enters the subcutaneous space CHARACTERIZED BY - swelling - pallor and coolness - pain (sometimes) - change in IV flow rate - leaking at IV site INTERVENTION: - discontinue IV - raise affected extremity to promote venous return - apply warm, moist compression for 20 mins
Extravastion: what is it?
characterized by?
intervention?
- vesicant med/fluid enters subcutanous space (question if vesican med is going into peripheral access) CHARACTERIZED BY: - burning/pain at site - swelling - coolness - blistering/sloughing of skin - change in IV flow - leaking from IV site INTERVENTION: - discontinue IV - notify physician - elevate extremity - apply cool or warm compress depending on manufacturer
Phlebitis: what is it?
charactized?
interventions?
- inflammation of the vein (may be certain types of catheter materials, meds) CHARACTERIZED: - pain - edema - redness (may travel with veins) - warm - can result in blood clots in emboli INTERVENTION: - stop infusion, take out - apply warm, moist compress - new line must be started in diff. vein
IV infection:
Characterized by?
intervention?
characterized:
- redness and possible discharge at IV site
- elevated temp
Intervention:
- stop infusion and notify physician
- remove the device and culture the site/catheter is ordered
- monitor vitals
IV complications - Air embolism
what is it?
characterized?
interventions?
- presence of air in the vascular system that travels into the right ventricle, and/or pulmonary circulation CHARACTERIZED: - SOB - cough - neck/shoulder pain - anxiety/feeling of doom - lightheadedness - hypotension - increased HR INTERVENTION: - occlude source of air entry (if known) - trendelenburg position (if tolerated) - oxygen - vital signs - notify physician
Risk factors of bleeding/brusing with IV therapy and interventions
risk factors - pts receiving heparin - pts with bleeding disorder interventions - apply pressure dressing at site
Fluid overload IV - how does it happen?
Possible complications?
Treatment?
- occurs when fluid is given at a higher rate or in a larger volume than the body can aborb or excrete
COMPLICATIONS: - hypertension, heart failure, pulmonary edema
TX depends on severity
Advantages and disadvantages of IV route
advantage: rapid response, effective absorption, accurate titration, IV drug delivery can be stopped immediately if adverse reaction
disadvantage: immediate adverse reaction, long term use damage to vessel walls, incompatibilities (physical/pharmaceutical, chemical, therapeutic)
What steps to take when administering IV medication
- check IV site first
- follow 10 rights of med, and use 3 MAR checks
- observe closely for S/S of adverse reactions
Infusion methods of IV meds
- continuous infusion (drips constantly)
- direct injection (IV push or bolus) - goes directly in w/o being dilated
- Piggy-back, mini-bag infusion (primary IV line or intermittent infusion by injecting via saline or heparin locks)
- volume-control (buretrols); PCA (patient-controlled analgesia); syringe pumps
IV med Infusion method: continuous infusion
Explain what is it.
how do you prepare it?
medication mixed into large volume of IV fluid. may be pre-mixed, or added by the RN
if mixing med:
- use aseptic technique (scrub port, inject meds into bag using syringe)
- mix well
- label
IV med infusion method: direct injection (IV push or IV bolus)
injecting a concentrated dose of medication directly into the patients systemic circulation, either:
a. directly into vein (no IV line)
b. through an existing infusion line
- -> emergency, ICU
IV med infusion method: piggy-back or mini-bag infusion
piggy back: a secondary medication set that goes through the primary IV, or a saline/heparin lock
- hangs above primary IV, delivered via gravity or pump. the main line stops infusing while piggy back is, then continues once it runs out at whatever rate piggy back was set to. Roller clamp on the primary line sets drip rate on secondary line
- saline/heparin locks are access to the vein without IV bag attached
saline or heparin locks (intermittent infusion devices)
advantages
disadvantages
provide access to vascular system without having, without an IV bag attached
ADVANTAGES - freedom for client, cost savings, convenience for nurse, minimal amount of fluid for pt
DISADVANTAGES - has to be flushed after each use, can clot easily if blood backs up
Types of saline locks
all needless devices
- pre-pierced septum/blunt cannula (hard piece of plastic pierces)
- Luer-activated device (LAD) - screws on
- valve technology - positive pressure caps (caps redirect a small amount of fluid into the internal cathetr tip when the tubing or syringe is disconnected to prevent blood reflux into lumen (mostly in CVAD, but PAD in children)
Flushing saline locks
solution?
size of syringe?
amount for PVAD and CVAD?
solution: 0.9% NS
Size of syringe - 10 mL diameter, but in 3,5 or 10 mL (to reduce PSI)
PVAD - 3.5 mL
CVAD - 10-20 mL
IV Flushing Method
Check patency?
How often?
S-A-S
Saline - administer med- saline
- check patency first by drawing back blood, but you don’t always get it. just push it in slowly an ask for feedback (will hurt if blowing vein or not right place)
- how often flush: every time you give meds, according to policy
IV therapy: turbulent flushing techniques
push-pause- should always be done for CVAD, may as well do for PVAD. scrubs the inside of the line to prevent buildup in device.
IV therapy: positive pressure locking technique
Why?
How?
positive pressure prevents blood reflex from the vein into the lumen of the VAD, preventing buildup, clots and occlusion.
How? maintain a forward motion on the syringe plunger as the syringe is removed from the access/injection site, slide the clamp on the extension tubing closed while injecting the last bit of fluid
How do you discontinue a peripheral IV?
- an order is required for discontinuing fluids/meds
- close all clamps
- remove tape and site dressing, stabilize catheter while doing so
- apply light pressure and withdrawal catheter, keep hub parallel to skin
- apply pressure for 2-3 mins
- cover site with gauze/bandage
- inspect catheter tip for intactness
