IV Therapy and Blood Admin Flashcards by Bianca Helfrich

IV solutions are meds so what do they need

6 RIGHTS and 3 P’s

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What are the two different types of solutions

Depends on PURPOIS
CRYSTALLOIDS, COLLOIDS

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Tell me about crystalloids

TONICITY
HYPO, ISO, HYPER

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Tell me about colloids

Albumin, dextran, blood

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What do hypotonic solutions do

They HAVE LOW concentration so water shifts INTO CELL, CELLS are BIG

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What do hypotonic solutions treat

HYPERnatremia, DEHYDRATION

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What are the risks of hypotonic solutions

Cells BURST, water INTOXINATION, increased ICP, CARDIOVASCULAR collapse

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What are the common hypotonic solutions

0.45 (half normal saline)
0.33

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What does isotonic solutions do

Same tonicity as blood

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What do isotonic solutions treat

Increase VOLUME, replace SODIUM and CHLORIDE

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What is the risk of isotonic solutions

CIRCULATORY overload

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What are the common isontonic solution

D5W, 0.9, lacted ringers (LR)

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Tell me about D5W

Give CARBS, then becomes hypotonic

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What can prolonged use of 0.9 cause

Hypernatremia

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What are the contraindications of 0.9

HEALTH FAILURE, EDEMA, HYPERnatremia

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What most closely resembles blood plasma

Lacted ringers

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What does LR contain

Lots of things NA, K, Ca, CL, lactate

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When are LR used

Surgery, trauma, burns, severe diarrhea, COSTLY

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What are the contraindications of LR

RENAL or LIVER disease

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What do hypertonic solutions do

HAS HIGHER consentration so water moves OUT of CELLS, CELLS SHRINK

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What are the risks of hypertonic solutions

Cellular DEHYDRATION, fluid VOLUME OVERLOAD, IRRITATION at IV site

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What are the common solutions for hypertonic

D5 0.45, D5 0.9, D5 LR, 3%

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What is D5 0.45 used for

HYPOVOLEMIA, mantain fluid BALANCE, POST-OP

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What does D5 0.9 do

Relpace FLUIDS, give CALORIES and Na and Cl

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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

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