IV Therapy (SL) Flashcards
Do IV medications require doctor’s orders?
YES
What is the purpose of IV therapy? (SLB)
- To supply electrolytes, fluids, glucose, vitamins, medications = restores acid-base balance
- To establish lifeline for rapidly needed medications
- Restore volumes of blood components
Types of Solutions based on concentration (IHH)
Isotonic: D5W, LRS, ,SS
Hypertonic: .45%
Hypotonic: .33%
Types of Solutions based on purpose (NEAAE)
Nutrient Electrolyte Alkalizing Acidifying Blood Volume Expander
What is the formula for flow rate in ml/hr?
total infusion volume / total infusion time
What is the formula for flow rate in gtts/min?
(total infusion volume x drop factor) / (total infusion time x minutes)
Factors affecting flow rate (PPHIS)
Position of arm: bend = slow Patency of tubing Height of bottle: higher = faster Infiltration Size of catheter to vein
Identify the four vein sites on the back of the hand (TSVB)
Tributaries of cephalic vein
Superficial dorsal vein
Venous arch
Basilic vein
Vein access sites for infants (SF)
Scalp
Top of foot
IV Locations (4, BFEF)
Back of hand
Forearm
Elbow / antecubital
Top of foot
What principle do we follow in choosing iv location to preserve veins of px?
Distal-proximal, non-dominant hand first
The selected vein must be (PSNL)
Easily palpable
Soft
Naturally splinted by bone
Large enough to accomodate catheter
Blood transfusions require G_/G_ because they have ___ bores or diameters
18/20
Large
What happens to the veins of patients undergoing chemotherapy?
They shrink and become brittle
Give at least 3 things that we need to assess in patients for IV therapy
Duration of IVT Size of cannula Skin Type of Solution LOC Activity Age (pedia/geria = hard) Dominant Arm
When preparing to initiate iV meds, we must check (ECHOA)
Expiry date Clarity of solution Holes in bottle Doctor's orders: type, amount, infusion rate Additional meds to be infused
What are the two types of catheter?
Intravenous
Butterfly
Match the gauge number to its corresponding color:
- 18G
- 20G
- 22G
- 24G
- 26G
A. Purple B. Yellow C. Pink D. Green E. Blue
1D 2C 3E 4B 5A
Green-Pink-Blue-Yellow-Purple (GPiBYPu)
The ____ the gauge number, the ___ the bore/diameter (they are ___ proportional)
Smaller
Bigger/wider/larger
Inversely
Match the gauge number to its corresponding use:
- 18/20G
- 22G
- 24G
A. Pediatric patients
B. Blood transfusion or operating room
C. Adults, normal meds
- B
- C
- A
Used to direct the flow of fluid through an infusion system while allowing multiple tubings to be connected.
Three-way stopcock
How to know which end of a stopcock is closed?
Kalbo = closed
What is the format of an IV tag?
UPPER LEFT:
Name of px
Room#
MIDDLE:
Name of IV Fluid
Infusion Rate
BOTTOM LEFT:
Date
Nurse:
BOTTOM RIGHT:
Time
What are the six rights? (PMDTRD)
Right Patient Medication Dose Time Route Documentation
What is the drop factor for
Microset?
Macroset?
Micro: 60 mcgtts/min, usually for pediatric px
Macro: 10/15/20 gtts/min
As nurses, we must refer to a drug reference for ___ and ___
Incompatibilities
Side effects
The patient must be informed on (PRA)
Procedure
Reason
Arm preference
Give at least 3 clinical factors that will be affected by IV administration
Urine output VS Distended neck veins Breath sounds Capillary refill Skin turgor Edema Weight Mucous membranes Thirst LOC Scheduled surgeries/procedures Laboratory data Allergies
3 Patient Identifiers
Full Name
Birthday
Bracelet
What are the signs and symptoms of complication in IV administration? (ERPEBI)
Edema Redness Phlebitis/inflammation Extravasation/leak Bleeding Infection
(T/F) we do not need to perform hand washing prior to opening tubing set
FALSE, we need to wash our hands to maintain aseptic technique
Once the tubing set has been opened, we have to keep the tube ___ and the ___ covered
Coiled
Spike
Why do we need to place the roller clamp “OFF” and 1-2 inches below drip chamber
To prevent leakage
More accuracy in regulation
Where do we hold when we are going to spike the bottle with our DOMINANT hand?
On the wing
What motion are we supposed to do when spiking the IV bottle?
Twisting
Roller clamp
UP: ___
DOWN: ___
Open
Closed
What are the 3 ways we remove bubbles from the IV tubing?
STRETCH-KINK
ASPIRATE
KIDNEY BASIN
Stretch tube or kink and flick and adjust roller clamp if needed
Using 5-10 cc syringe and aspirate air through Y-port
Disconnecting iv tubing and letting fluid flow into kidney basin
(T/F) If the patient has a stopcock, it is okay to keep the port that is not going to be used open.
FALSE, if not needed = keep closed to prevent leaks when connecting another line/tubing
How do we prevent snagging of the iv tubing?
We create a loose loop and tape it to the patient’s catheter
When do we change iv fluids?
When only 50 ml is left in the bottle
How do we shake medications?
A. Shake up and down
B. Roll/invert
B. shaking up and down can cause bubbles to form
Every _ days, IV insertion site is changed
7
IV tubings are to be changed every _ days/ _ hrs
3 days / 72 hrs
Max is 1 week, case to case basis
(T/F) When a patient is ordered for IV discontinuation, we just disconnect the tubing from the catheter
TRUE. removal of insertion site requires another order (usually when px is going home already)
How do we change gown on a patient with iv?
Start on side that is not connected to the IV
Let old and new gown pass through arm and IV tubings
Volume metric controlled chamber is also known as?
Soluset
What is a soluset for? what is its regulation?
Piggyback medications (antibiotics) or pediatric pxs
Microdrops
How do we prime a soluset?
PNSS, fill chamber with 30cc
It is usually used to increase the RBC, hemoglobin, or
hematocrit levels
Packed RBC
Used when patient is bleeding or lacks this component
Fresh Frozen Plasma
For patients with thrombocytopenia (low)
Platelets
What makes a BT set different from regular IV tubings? what is its regulation?
A blood transfusion set has a filter
10 gtts/ml
A phlebotomist will get blood and
Type and Cross-match
What do nurses need to double check prior to blood transfusion? (CTWMRV)
Crossmatching results Tag on blood bag (px and donor name) Weigh bag to know how much cc Pre-BT medications If px needs to go to restroom Baseline VS
For the first 15 minutes of BT, the regulation should be _ ml/min or _ gtts/min
After 15 mins, we get _ and regulate as desired in DO
2 ml/min or 20 gtts/min
VS
During the first 15 mins of BT, the nurse should assess for the ff reactions (DILT)
Difficulty breathing
Itching
Low back pain
Increasing temp
How do we dispose of blood bags?
Remove needle Roll with BT set Wrap with paper Write px name, room#, time and date infused Return to blood bank
For BT, what IV fluid is compatible?
Only PNSS
Every when do we get VS during BT? (5)
Baseline (before transfu) First 15 mins After 30 mins Every hour during BT An hour after BT finished
How long should blood be transfused?
4-6 hours only
Crackles during BT indicates?
circulatory overload or congestion
To avoid spoilage when transfusing blood for pediatric px, request blood bank to
Divide the blood already
What should we do if px has reaction to BT?
Immediately stop transfusion (turn stopcock if have)
Flush mainline with PNSS
Inform doctor
Types of reactions to BT
Anaphylactic shock
Wheezes
Chest pain
Cardiac arrest
Non hemolytic or not r/t destruction of RBC (headache, muscle pain)
Acute Hemolytic (renal failure, DIC, jaundice)
> 10 bags of BT
Dysrhythmia/low BP
Iron overload
Hypocalcemia
For platelets, since it is a __ infusion, we use a special infusion set without a filter and nurse stay at bedside
fast
Total Parenteral Nutrition is also known as ___ and it is used when a px will be on NPO for more than _ days
Central Nutrition
3
What gauge number is used for TPN? Why?
G20 (used for TPB ALONE)
TPN is thick/viscous
Since TPN usually has high dextrose content, doctor may order ___
Capillary Blood Glucose (CBG) q4h
If concentration is : fat emulsion, we have to change IV tubings every _ hrs because ____
3:1
24 hrs
Good environment for bacterial growth
TPN regulation for first hr:
after:
40-60 ml/hr
desired
still depends on hospital policy
Once opened, a bag of TPN is good for how long?
24 hrs whether fully consumed or not
Where do we place tourniquet for IV access selection?
Above antecubital fossa or 4-6 inches above proposed site
To protect fragile skin during tourniquet use, we can
Place over light clothing
Avoid using too tightly
Can also use BP cuff
How do we assess for vein condition? (3)
DEPENDENT-PALPATE-STROKE/CLOTH
Place extremity in dependent position or press down
Palpate, should feel soft and bouncy
Stroke vein proximal-distal or use warm washcloth = distention
How do we clean insertion site (3)?
Vertically
Horizontally
Spiral, circling outwards
How do we insert ONC or winged needle (venipuncture)?
Gently stretch skin w/thumb
10-30 degrees
BEVEL UP
Wait for backflow
ONC stands for?
Over-the-Needle Catheter
How do we regulate IV fluids? (RCCEED)
Review doctor’s orders
Calculate
Count for 1 min
Assess for excess fluid, dehydration, electrolyte imbalance
What do we d if drip chamber is too full? (3, PIS)
Pinch iv tube below it
Invert bottle
Squeeze and release drip chamber
What are the signs of phlebitis with a grade of 4? (PRSD)
Pain
redness
swelling
purulent drainage
What are the signs of infiltration with a grade of 4? (BBEP) What do we do if these are present?
Blanched skin
bruising
pitting edema
pain
DISCONTINUE
If there are signs of infiltration or phlebitis, we (EW20)
Elevate
wrap in warm towel for 20 mins
Flow rate for the ff lipids:
- 10% emulsion
- 20% emulsion
- lipids only
- lipids in PPN solution
A. 24 hrs
B. 4 hrs
C. 6-12 hrs
D. 6 hrs
1B
2D
3C
4A
How long do we apply pressure when removing catheter
2-3 minutes or
5-10 minutes if w/hx of coagulopathy
What material is not necessary when preparing to start IVF?
A. Arm Splint
B. Mask
C. IV Infusion Set
D. Alcohol swab
B
Which of the following is the initial action of the nurse prior to starting an IV infusion?
A. Perform hand hygiene
B. Open sterile packages
C. Verify patient’s identity
D. Prepare needed articles
A.
When securing the hub of the IV cannula to the skin, it is very important to:
A. Ensure that the cannula is taped to the tubing or saline/heparin lock device
B. Ensure that the tape does not cover the insertion site
C. Ensure that the extremity is completely immobilized
D. Ensure that the patient is unable to see the insertion site
B
(T/F) It is not necessary to wear gloves when discontinuing an IV since there is no risk of exposure to blood or body fluids.
FALSE (removal of cannula)
Which of the following actions are correct when caring for a patient who is on parenteral infusion?
- Review patient’s nutritional history
- Assess lung sounds for presence of crackles
- Assess the patient’s serum triglyceride level
- Monitor VS every 10 mins for the first 30 mins after initiation
ALL
Used intravenous infusion tubing must be discarded properly. What color of the garbage bin must it be discarded?
yellow
When should IV dressings be changed?
Every 48 hrs / 2 days
Within __ mins of release of blood from blood bank, we have to administer this
30
What is osmolality?
Amt of dissolved particles in a fluid
Which iv site is prone to infection?
Top of foot
After we wipe the dressing w/an alcohol swab and remove them ____, we have to support the iV catheter to prevent ____
one by one/layer by layer
sudden removal
When should pre-BT medications be given?
Before getting blood from the blood bank
Where can we insert the line for BT?
Y-port + tape to main line
Stopcock cleaned with alcohol swab
Why do we need to return blood bags to the blood bank for disposal?
Blood banks keep it in case a px develops a late reaction, cause can be traced
(T/F) It is ok to choose an IV site that may interfere with ADL’s since px can learn to cope with this.
FALSE, we can choose other sites
(T/F) When dressing an iv site, we should cover the connection of the tubing and catheter hub
FALSE, it should be kept visible to check for blockage
Do we still need to prime the IV tubing if we will use an infusion pump?
Yes, then we connect it to the catheter and set the pump to the desired ml/hr
When adding piggyback medications to a NEW container, we should always check for ____
Compatibility
Before injecting medications in the port, we should always ____
Wipe port w/alcohol swab
When adding piggyback medications to an EXISTING container, what do we need to check? (APTR)
Enough amount of solution to dilute medication
Pause IVT/pump
Turn bottle to prevent administration of bolus (high conc) medication
Reestablish primary infusion after piggyback meds (restarts after naubos na PB)
What does MAR stand for?
Medication Administration Record
When hanging a piggyback medication, it should be placed ____ the primary fluid bag
ABOVE
higher = faster
After infusion of piggyback medications, we can ____ or ___ the bag and tubing for ____
discard or leave
for next piggyback meds
Identify the steps in administering IV Bolus through EXISTING LINE (DSWAIP)
Dilute Use stopcock Wipe port Aspirate for backflow Inject w/watch Pinch main line when pushing
Identify the steps in administering IV Bolus through SALINE LOCK (WS/AARPS)
Wipe port Inject saline + expel air Aspirate If resistance occurs, stop and discontinue Push within recommended time Inject second saline
What should we check for in a 3-in-1 TPN soln? WHat should we do to troubleshoot this problem?
Fat separation
agitate the bag for fat droplets of 1-2 cm
What is the initial infusion rate for TPN?
40-60 ml/hr
Guidelines for TPN infusion (DBIAI)
Different line for IV meds Do not use same port for blood sample/CVP Do not interrupt TPN Follow asepsis Assess for lipid intolerance
What are signs of intolerance to fat emulsion? (TTCHNP)
Increased triglycerides Increased temp Chills Headache Nausea + vomiting Chest pain
IF TPN bottle is refrigerated, what should we do?
Let bottle come to room temp for 30 mins
1 gtts = _ mcgtts
1 ml/hr = 1 ___
1 gtts = 4 mcgtts
1 ml/hr = 1 mcgtts/min
Righty =
Lefty =
righty tighty
lefty loosey
Aftercare post-IVT includes (CFYGHD)
Check if catheter is complete
Throw excess fluid in TOILET
Throw iv catheter, tubings, and bottle in YELLOW trashcan
Remove gloves + handwash
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