IVs Flashcards
three indications for IV
administer fluids, med delivery, and blood administration
three contraindications for IV use
1) . active skin infection site
2) . don’t insert distal to pre-existing thrombophlebitis
3) . avoid LE venipuncture in elderly, ppl w PVD or venous insufficency
potential local complications for IV (2)
thrombosis/thrombophlebitis
OR infection
potential systemic complications for IV (4)
1) . catheter embolization- break of catheter tip if pulled back over needle
2) . septicemia
3) . PE- clot at IV site dislodges
4) . air embolism- flush all lines
how much air is enough to create an air embolism?
5-10ml
two sites of easiest access? IV
dorsal hand and lower aspects of arm
vein choice depends on? (weeds) 7
prescribed therapy, duration of therapy, condition of extremity, patient, condition of vein, size of vein, location of vein
what can you combine with lidocaine to buffer the sting?
bicarb
needle gauge sizes for blood administration vs iv fluids
blood = 16
IV fluids = can be as small as 23
IV insertion procedure (9)
1) . apply tourniquet above elbow
2) . ID best vein (most distal vein that’s good, best palpable, firmness, etc)
3) . release tourniquet
4) . gather supplies
5) . reapply tourniquet
6) . cleanse site with antimicrobial solution
7) . retract skin distal to insertion site
8) . puncture skin looking for flash (slightly pull back on needle and redirect if no flash)
9) advance device 2-3mm further and cannulate
what to do if you get swelling after IV insertion?
turn off infusion and remove IV, apply pressure for 3-5 mins, attempt IV insertion at more proximal site
what are some preferred IV locations for kids?
hand, forearm, upper arm, foot, antecubital fossa
what is a useful type of IV for kids?
butterfly
for geriatric pts, what size cath is best? what do you worry about for small or large veins?
smallest cath
small = fragile and rupture
large = sclerotic
what type of line do you avoid in geriatrics?
LE lines
what to do if phlebitis occurs after IV placement?
remove it! and then pain relief/warm compress
colloids vs crystalloids: weight, pressure, types
colloids: >8000 daltons, high oncotic pressure, albumin/blood products/plasma protein fraction
crystalloids: <8000 daltons, low pressure, D5w/D10W/1/2NS
D5W contents
5% dextrose in water
50g glucose/L H20
170 kcal/L
D10W contents
10% dextrose in water
100g glucose/L H20
340 kcal/L
1/2 NS contents
0.45% NaCl
77 mEq/L Na
77 mEq/L Cl
3% NS contents
513 mEq/L Na
513 mEq/L Cl
NS contents
0.9% NaCl
D5 1/2 NS contents
50 g glucose/L
77 mEq/L Na
77 mEq/L Cl
170 kcal/L
D5LR contents
5% dextrose in lactated ringer's 50 g glucose/L 130 mEq/L Na 110 mEq/L Cl 4 mEq/L K 3 mEq/L Ca 27 mEq/L HCO3 <10 kcal/L
how many fluids do you give for an afebrile 70kg adult?
35 mL x kg x 24 hr
how many fluids do you give an afebrile <70kg adult?
1st 10 kg of body weight: 100mL/kg/d \+ 2nd 10 kg: 50mL/kg/d \+ weight above 20kg: 20mL/kg/d
