IV therapy use advantage & disadvantage Flashcards
IV cannulation tips and tricks:
start low (distal veins) and work proximally, caution with fragile skin, avoid inner wrist, antecubital is the LAST option, take your time
sites to avoid for IV cannulation:
-legs, ankles, & feet
-sclerosed or thrombosed veins
-veins that are knotted or tortuous
-veins below an infiltrated site or areas of phlebitis
-areas of inflammation, disease, bruising, or breakdown
-veins of surgically compromised or injured extremities
-dominant hands (if possible) and extremities with AV shunts
considerations for selecting a vein:
condition, reason for the IV, what solution or meds will be used
vein evaluation:
palpate (best palpated when engorged) & suitable veins should be round, firm, & elastic
selection of catheter size: 14g or 16g
great for trauma or surgery when needing rapid infusions
selection of catheter size: 18g
good for patients going into surgery, receiving blood or caustic meds
selection of catheter size: 20g or 22g
most common size for adult patients
selection of catheter size: 24 g
most common for pediatric patients, can use for adults with small or fragile veins
methods of administration: intermittent
medications on scheduled dose daily or several times per day (ex: vancomycin 750 mg/250mL @ 250 mL/hr Q12 hours)
methods of administration: continuous
IV solutions continuously (ex: NS @ 100 mL/hr)
methods of administration: bolus
specified amount of solution to be administered in a specific time frame (through IV pump or syringe - often quickly administered)
(ex: 10 mL of drug A to be admixed with 100 mL of NS and infused over 30 min)
methods of administration: push
specified amount of medication to be administered in a specific time frame (through IV syringe ONLY)
(ex: 20 mg pantoprazole IVP over 2 min)
IVs that are being used intermittently are commonly referred to as an “____”
“I N T”
continuous has fluids continuously infusing, can be used for _____, ______ ______, or both depending on the Pt’s needs
hydration, electrolyte replacement
IV bolus can be administered via a(n) ___ ____ OR with a _____
IV bag; syringe
an IV push is only administered via a _____ and pushed in via the _____
syringe; plunger
nurse’s responsibilities for IV therapy:
assess IV site for any irritation/or infection, patency, adverse reactions, teach the patient, and restart any questionable peripheral sites
where do you apply the tourniquet for IV therapy?
approx. 4-6 inches above insertion site
IV medication advantages:
direct access to circulatory system -> instant drug action and drug termination, rapid treatment, better control of rate, great for those with GI tract limitations, good for meds that irritate gastric mucosa
IV medication disadvantages and complications:
reconstitution errors, venous spasms, drug incompatibilities, impaired drug absorption, speed shock, chemical phlebitis, extravascular of vesicants, air embolism
air embolism:
air enters the central veins
air embolism: causes
solutions runs dry, air in tubing, loose connections, improper removal of CVAD, poor technique with dressing or tubing changes
air embolism: S&S
dyspnea, tachypnea, lightheadedness, palpitations, drop in BP, weakness, cyanosis, and expiratory wheezes
air embolism: intervention
call for help, position patient in trendelenburg on THEIR LEFT SIDE, administer oxygen, monitor VS, and have emergency equipment ready
complications of IV therapy: fluid overload
too much fluid overloads the circulatory system
complications of IV therapy: infection
localized or
systemic
complications of IV therapy: phlebitis
irritation to vein; mechanical or chemical
complications of IV therapy: infiltration
fluid seeps into tissue
complications of IV therapy: extravasation
infiltration of any caustic medication into tissue
chemical phlebitis:
inflammation of a vein associated with chemical irritation
causes of chemical phlebitis:
too rapid of infusion, presence of particulate matter in solution, improper dilution or reconstitution when preparing meds, and administration of irritating meds
prevention of chemical phlebitis:
use an in-line filter for meds that do not reconstitute completely, increase volume of dilution, CVAD or larger peripheral veins for IV site, slow the rate of infusion, and restart any questionable IVs
infiltration:
fluid leak into tissue around the vein
infiltration S&S:
does not irritate the tissue, pain or burning at IV site, skin tightness at site, blanching/coolness of skin, and dependent edema
infiltration: interventions
stop infusion, remove IV line, place a new IV line, continue to monitor infiltrated site and call physician if needed
extravasation:
infiltration of a vesicant drug
S&S of extravasation
pain or burning at IV site, skin tightness at site, blanching/coolness of skin, and dependent edema
____ are the safest for administration of vesicant drugs
CVADs
extravasation: prevention
dilute meds as recommended, avoid use of high-pressure pumps, assess & monitor IV site, teach pt what to report
venous spasm:
sudden, brief, tightening of muscle cells inside the vein
causes of venous spasm:
viscous solutions, too rapid administration, cold or irritating solutions
symptoms of venous spasm:
sharp pain at the IV site, pain radiating up the arm with the IV site
prevention techniques of venous spasm:
dilute meds as recommended, admin solutions and meds at room temperature, admin at recommended rate, restart questionable IVs, and consider a warm compress during infusion
IV push preparation example:
HCP ordered: ceftriaxone 1 gm IV daily
Pharmacy dispenses: 1 gm vial of ceftriaxone to be reconstituted in 10 mL sterile water
the nurse uses a sterile syringe with a blunt fill needle to access sterile vials
IV push administration:
follow 7 rights, verify pt allergy/status, scan pt’s arm band, scan med vial and verify with eMAR (3rd check), HH & don clean gloves, remove alcohol permeated cap from IV lumen –> clean needle-less connector access with alcohol pad for 15 seconds
IV push administration continued once you get ready to administer with syringe to catheter:
-purge air from a sterile saline flush -> attach syringe -> flush lumen & catheter with 9 mL -> remove syringe
-clean needle-less connector access -> attach medication syringe -> administer med at recommended rate -> remove syringe
-clean needle-less connector access -> attach post saline flush syringe -> flush slowly for the first 2-3 mL then vigorously for total of 9 mL
-remove flush syringe -> clamp lumen -> attach new alcohol permeated cap
figuring drops per minute for gravity infusion:
total volume x drop factor/ time in minutes = gtts/minute
mL x gtts / min = gtts/min
use ____ ____ included with the tubing delivery system to control the rate of administration
roller clamp
IV gravity preparation:
activate vial & reconstitute the medication first -> insert and prime primary tubing to administer via gravity flow (prep of med can be done in med room or the pt room)
clamp tubing, remove protection cover from the “set” site on med bag -> remove protective cover from spike and aseptically insert the spike into the “set” site of the bag, squeeze and fill the chamber 1/3 to 1/2 full
slowly open the roller clamp and prime tubing to end port (leaving the protective cover on the tubing end)
your primary fluid will be your _____,_____, or _____ solution; primary fluid is also called “___ __ ___” on the IV pump
isotonic, hypertonic, or hypotonic solution; guardrail IV fluids
“_____ ______” programming are for your medication (abx, pain meds, etc.)
guardrail drugs
avoid using ____ ____ on the IV pump because the smart pump can’t help with parameters of infusion.
“basic infusion”
