IV Therapy and Blood Admin Flashcards
IV solutions are meds so what do they need
6 RIGHTS and 3 P’s
What are the two different types of solutions
Depends on PURPOIS
CRYSTALLOIDS, COLLOIDS
Tell me about crystalloids
TONICITY
HYPO, ISO, HYPER
Tell me about colloids
Albumin, dextran, blood
What do hypotonic solutions do
They HAVE LOW concentration so water shifts INTO CELL, CELLS are BIG
What do hypotonic solutions treat
HYPERnatremia, DEHYDRATION
What are the risks of hypotonic solutions
Cells BURST, water INTOXINATION, increased ICP, CARDIOVASCULAR collapse
What are the common hypotonic solutions
0.45 (half normal saline)
0.33
What does isotonic solutions do
Same tonicity as blood
What do isotonic solutions treat
Increase VOLUME, replace SODIUM and CHLORIDE
What is the risk of isotonic solutions
CIRCULATORY overload
What are the common isontonic solution
D5W, 0.9, lacted ringers (LR)
Tell me about D5W
Give CARBS, then becomes hypotonic
What can prolonged use of 0.9 cause
Hypernatremia
What are the contraindications of 0.9
HEALTH FAILURE, EDEMA, HYPERnatremia
What most closely resembles blood plasma
Lacted ringers
What does LR contain
Lots of things NA, K, Ca, CL, lactate
When are LR used
Surgery, trauma, burns, severe diarrhea, COSTLY
What are the contraindications of LR
RENAL or LIVER disease
What do hypertonic solutions do
HAS HIGHER consentration so water moves OUT of CELLS, CELLS SHRINK
What are the risks of hypertonic solutions
Cellular DEHYDRATION, fluid VOLUME OVERLOAD, IRRITATION at IV site
What are the common solutions for hypertonic
D5 0.45, D5 0.9, D5 LR, 3%
What is D5 0.45 used for
HYPOVOLEMIA, mantain fluid BALANCE, POST-OP
What does D5 0.9 do
Relpace FLUIDS, give CALORIES and Na and Cl
What can prolonged use of D5 0.9 do
HYPERnatremia
What are the contraindications of D5 0.9
CARDIAC or RENAL FAILURE
What does D5 LR do
LR and adds calories
What does 3% treat
SEVERE HYPOnatremia with close MONITORING
What are colloid solutions
Plasma EXPANDERS
What are plasma expanders
Plasma or starch that can NOT pass throught the membrane
What are colloid solutions used for
VOLUME, ONCONTIC pressure, RAISE BP, SHOCK, BURNS, SURGERY, TRAUMA, SEPSIS
Why are colloid solutions good
Establish equilibrium without LARGE amount of fluid
What are the common colloid solutions
Albumin, dextran, plasmanate, hetastarch, blood
What is IV access used for
To GIVE and TAKE
What are the critical thinking checkpoints for IV access
AGE, DIAGNOSIS, HISTORY, VEINS, PURPOSE of IV
What is peripheral access
IV, SHORT term
What is central venous access
CENTRAL LINE, LONG-term, CAUSTIC infusions
Where do adults get IV’s
Hands and arms
Where do children get IV’s
Scalp and feet
Where do you try your first IV
Distal
What areas to avoid IV’s
Wrist and elbows, it will obstruct it
What are reasons for limb alert
Injury, dialysis, masectomy
What are the PIV catheters
OVer-the-needle (angiocath)
Winged infusion needle (butterfly)
Midline
What are butterflys used for
NEEDLE STAYS in, short-term, children and older
What is a midline
Long cath that does NOT go to heart, up to 2 weeks
Where does CVAD’s go
Goes to SVC
Who care central lines put in by
DOCTOR, STERILE, INFORMED CONSENT
What are the uses of CVAD’s
RAPID infusion, DILUTION of IRRITATING solutions, DRAW blood form it, PRESSURE
What type of lumens do CVAD lumen have
Multiple in different locations to admin two incompatible solutions, DEDICATED lumen for TPN
What do CVAD require
ASSESSMENT, FLUSHING, STERILE dressing
What are the four types of CVAD’s
NON/TUNNELED, PICC, PORT
Tell me what non-tunneled CVAD
SKIN to VEIN (NECK) Extensive IV therapy, CAUSTIC
What are the risks of a non-tunneled CVAD
CLABSI, pneumothorax, PE
What is tunneled CVAD used for
Lifelong/long therapy (TPN, chemo, dialysis)
What is the dacron cuff
The subQ tissue holds the dacron cuff in place
What is the benefits of PICCs
Decreased complication risks
Who have ports
Oncology, hematology
What type of needle is used for a port
Huber
What type has the lowest incidence of CLABSI’s
PORTs
How often are ports assessed
Every MONTH
What are some CVAD care tips
Alcohol-impregnated CAPS, check PATENCY, CLAMP line when not in use
Do you still need to manually disinfect alcohol before using the line
YES
Tell me about heparin use with CVADs
Used to prevent blood clot but only in the line so make sure you pull the line before put anything is
When can yo udiscontinue CVAD
Written ORDER
Can nurses take out ports or tunneled CVAD
NO
What do you need to do at the beginning of each shift for IV’s
Correct MED and DOSE, SITE, DRESSING, DATE
What do you need to do at each hour
MED, DOSE, SITE
Tubing:
PIV
CVAD
24-72 hours
24 hours
Dressing change:
PIV
CVAD
PRN, aseptic
If gauze: 48 hours
No guaze: 5-7 days
What to document for IVs
Start and stop, volume (IO), safety guardrails (in brain)
What are the high risk meds
Heparin, insulin, PCA pain pumps
What are the complications of IV therapy
INHECTION, OCCLUSION, PHLEBITIS, INFKILTRATION,EXTRAVASATION (serious)
What are the signs of occlusion
Infusion is SLOW, with RESISTANCE
What to do if there is occlusion
KINKS or arm POSITIONI”NG
Occlusion:
PIV
CVAD
Discontinue SITE, RESTART ELSEWHERE
Notify PROVIDER
What is phlebitis
INFLAMMATION from poor INSERTION, MOVING of catheter, IRRITATING sollution
How to prevent phlebitis
DILUTION, STABLIZE site, GAUGE
What to do if there is phlebitis
STOP fluids, NOTIFY, ELEVATE, WARM compress
What is infiltration
Solution and/or nonvesicant med goes into tissue
What are the signs infiltration
COOLness, FIRMness, BLANCHING
What is the prevention of infiltration
Avoid FLEXION, ASSESS, PATENCY
What to do if there is infiltration
STOP, REMOVE PIV, ASSESS for extravasation
What is extravasation
SERIOUS, infusion of VESICANT med into tissues
What is a vesicant med
Result in blisters and tissue death
What can extravasation lead to
PERMANENT tissue damage
What is the late sign of extravasation
Blisters
How to prevent extravasation
KNOW VASICANTS, SLOW infusion, LARGE vein, CVAD
What to do if there is extravasation
STOP, PULL back med, NOTIFY, ANTIDOTE, MARKER, NO PRESSURE
What is the antidote for extravasation
DAM
Why do crystalloids not solve hemorrhage or anemia
They only restore fluids and electrolytes not blood compentents
What do vlood components do
TRANSPORT, PRESSURE, ?INFECT?ION, CLOTTING
What is needed for blood administration
INFORMED consent, COMPATIBILITY
What do you need to assess from before blood transfussion
ALLERGIES, REACTION, IV, do NOT use if CLOTTED, VITALS (BEFORE)
What are TWO nurses checking before blood transfussion
NAME, DOB, TYPE, ID, EXPERATION
What is the most common reason for transfusion reaction
Bad identification
What are the components of the blood transfusion
Y like line with SALEINE and BLOOD, new TUBING for each unit
Tell me about the first 15 mins of blood transfusion
STAY, MONITOR for reaction, VITALS at 15 mins
What to do if there is no reaction in 15 mins
Increase infusion rate
What is the time frame for blood infusion
Competely infused within 4 hours
What are you going to do when it’s complete
VITAL signs
What are you docimenting for blood transfusion
VS, start and stop, type, tolerance, events and interventions
What are the transfusion reactions
Allergic, febrile, hemolytic
Tell me about an allergic reaction
common, hypersensitivity to PLASMA
What to do if your pt has a severe allergic reaction
STOP and NOTIFY, ANTIHISTAMINE
Why does a febrile reaction happen
Reaction to WBC
What are the signs of a rebrile reaction
2 degree increase, can happen AFTER transfusion
What are the symptoms of the rebril reaction
Chills, tachy, anxiety, HA
What do you do if your pt is known for febrile reaction
Use leukocyte-reduced components
