IV therapy fluid Flashcards
Where is most fluid located?
Inside the cells
What is diffusion?
Movement of particles from high concentration to low concentration
What is osmosis?
The movement of water through a semipermeable membrane
Low particle concentration -> high particle concentration
What is osmotic pressure?
The pressure exerted on a semipermeable membrane by osmosis
Pressure necessary to create equilibrium
What is filtration?
Movement of fluid and small particles due to hydrostatic pressure
Where does filtration happen?
Kidney/capillary level
What is active transport?
Movement of particles from an area of LOW concentration to an area of HIGH concentration
Requires ATP
What are the 2 types of solutions?
Crystalloid
Colloid
What is a crystalloid solution?
Clear solution
Isotonic fluids
Hypotonic fluids
Hypertonic fluids
What is a colloid solution?
Proteins/starch
Blood products
Parenteral nutrition
When do you use an isotonic fluid?
Low BP
When do you use a hypotonic solution?
When cells needs fluid and are dehydrated
When do you use a hypertonic solution?
In people with edema
To pull fluid from cells into vasculature
What is insensible fluid loss?
Losing fluid that cannot be measured (sweating during a hot day - diaphoresis, respiration)
What is sensible fluid loss?
Fluid loss that can be measured
When is 3% fluid usually used?
For brain swelling because the swelling has no where to go
How do you treat a dehydrated pt?
Give 0.9% NS to increase fluids, THEN hypotonic
What is fluid osmolality?
The number of dissolved particles per unit of water
We refer to solutions in relation to plasma
What is a hypotonic solution?
Less concentrated (more dilute) than plasma
What is a hypertonic solution?
More concentrated than plasma
What is IV therapy?
Infusion of a fluid into a vein to prevent or to treat fluid or electrolyte imbalance or to deliver medications, nutrition, or blood products
What are types of venous access devices?
Peripheral insertion devices Midline infusion devices Peripheral inserted central venous access devices Tunneled central venous access devices Implanted vascular access devices
What is a peripheral insertion device?
Over-the-needle intravenous catheters
Winged infusion or small vein needles
What are advantages of a peripheral insertion device?
Choice of sites
Ease of insertion and removal
Decreased infection rates
What are disadvantages of a peripheral insertion device?
Short term (72 hours)
Infiltration/phlebitis
Inability for hyperosmolar solutions
Inability to draw blood
What is infiltration?
When the catheter is dislodged from the vessel and you have fluid leaking into the tissue
What are symptoms of infiltration?
Cool to touch, swelling, discomfort and no blood return
What is phlebitis?
Inflammation of the vessel
What are symptoms of phlebitis?
Pain, warmth, redness at site, edema
Can you draw blood off of peripheral IVs?
No
What is a midline infusion device?
Similar to a PICC line
What are advantages of a midline infusion device?
Ease of insertion and removal
Intermediate use
Decreased infection rates
TPN and blood draws
What are disadvantages of a midline infusion device?
Infiltration/phlebitis/air embolism more common than peripheral line
Why is an air embolism more common in midline infusion devices?
It’s a wider bore - concern for air getting inside the catheter
Where are midline infusion devices usually placed?
Basilic, cephalic, or brachial veins 3-8 inches
How long are midline infusion devices usually good for?
6-8 weeks
What is a peripheral inserted central venous access device?
A PICC line
Considered a central line because it feeds into the heart even though it’s peripheral
What are advantages of a peripheral inserted central venous access device?
Ease of insertion and removal
Long term & home use
Decreased infection rates
May infuse all solutions and blood draws
What are disadvantages of a peripheral inserted central venous access device?
High thrombosis rate
Small Diameter
Higher malposition risk
CLAB/CRBSI
How long is a a peripheral inserted central venous access device good for?
1 year
What veins could a a peripheral inserted central venous access device be put into?
Basilic, cephalic, or brachial veins (end near right atrium)
What is an implanted vascular access device?
Port
Central line
When are implanted vascular access devices used?
Oncology or people with long term autoimmune disease that requires lots of medication over time
What are advantages of implanted vascular access devices?
Long term & home use
No external catheter
Low maintenance, swim/shower/bath, cosmetic
Decreased infection rates than tunneled
What are disadvantages of implanted vascular access devices?
Surgical insertion and removal
Need to access - port is under skin
What is a central venous access device?
Central line
Can have a triple-lumen catheter
What are advantages of central venous access devices?
Ease of insertion and removal
Intermediate term
May infuse all solutions and blood draws
*TPN line has to remain specifically for that
What are disadvantages of central venous access devices?
CLAB/CRBSI
What are guidelines for peripheral site selection?
Determine type and duration of therapy
Inspect the patient’s veins
Place a tourniquet 4 to 6 inches above venipuncture site
Lower extremity below the level of the heart.
Ask the patient to open and close fist several times
Warm soaks x 5 minutes before venipuncture: vasodilates selected vessel
Where is the best place to put an IV?
Antecubital because the veins are big there
What factors affect flow rate?
Height of the solution container Position of the extremity Tubing obstruction Position of the IV access IV patency
What are nursing functions in IV therapy?
Initiating Maintaining Assessing Discontinuing Administering
How does the nurse initiate IV therapy?
Preparing the patient Selecting the site Preparing the site Performing the venipuncture Securing the venipuncture device
How does the nurse maintain IV therapy?
Monitoring and documentation
Dressing changes (72 hours)
Changing IV solutions and tubing
Intermittent flushing of an infusion lock
Disconnect as little as possible to decrease risk for infection
How does the nurse assess for complications in IV therapy?
Check for: Infiltration Phlebitis Infection Fluid overload Air embolism Pneumothorax (think in relation to central lines) Catheter breakage or damage
What are S&S of infected IV site?
Local - redness, warmth, purple to drainage
Systemic - fever, wbc, chills, malaise
How does the nurse discontinue IV therapy?
When all ordered fluids have infused or when complications develop
Inspect the integrity of the catheter after removal
How does the nurse administer IV therapy?
IVP Intermittent infusion Continuous infusion PCA Epidural analgesia
How does IV therapy change through the lifespan?
Newborn and infant
- Veins are tiny and difficult to locate and cannulate
- IVs normally put in scalp because you can see the veins better
Toddler and preschooler
- Avoid areas over joints - children’s increased activity level
School-age child or adolescent
- Fear of invasive procedures
Adult or older adult
- Requires special care because of age-related changes in the skin and vessels
- Vessels become more fragile
- “Rolling”
