Lab 1: IV Infusions Flashcards
list 5 reasons why an IV infusion might be ordered
- NPO (ex. for surgery)
- replace losses (ex. NVD)
- diabetes insipidus
- blood loss (ex. trauma, surgery)
- insensible losses (ex. burns)
what are 2 types of IV fluid therapy
- maintenance therapy = water & electrolytes
- replacement fluid therapy –> hypernatremia, adding K
what is parental nutrition
- IV feeding
- delivers nutritonal formula that contains nutrients such as glucose, salts, amino acids, lipids, and added vitamins & dietary minerals
what are 2 types of parental nutrition
- partial
2. total
what is partial parental nutrition
- supplies only part of daily nutritional requirements
- supplements oral intake
what is total parental nutrition
- supplies all daily nutrient requirements
where can total parental nutrition be used? what is required for it?
- can be used at home or at hospital
- v concentrated & can cause thrombosis of peripheral veins = requires a central venous catheter
what are the 3 types of IV solution
- hypotonic
- isotonic
- hypertonic
what are 3 types of isotonic solutions
- 0.9% NS
- lactated ringer
- D5W
what is the action of NS and LR (4)
- no fluid shift
- vascular (blood vessel) expansion
- replace fluid loss
- electrolyte replacement
what are indications for NS (5)
- shock
- resuscitation
- blood transfusions
- hyponatremia
- DKA
what is a risk associated w 0.9 NS
- fluid overload
who should you use caution in with 0.9% NS (4)
- HTN
- HF
- edema
- hypernatremia
what are indications for LR (5)
- dehydration
- burns
- GI tract fluid losses
- acute blood loss
- hypovolemia
what are 2 risks associated w LR
- hyperkalemia
- fluid overload
who should you use caution in with LR (2)
- liver disease
- cardiac pts
why should you use caution in someone w liver disease r/t LR
- liver cannot metabolize lactate
what are the indications for D5W (dextrose in water) (4)
- fluid loss
- dehydration
- hypernatremia
- hyperkalemia
what is a risk associated w D5W
- vein irritation
who should you use caution in with D5W (3)
- increased ICP pts (head injury pts)
- renal pts
- cardiac pts
how does D5W change once it enters the body
- once inside the body, it becomes metabolized & becomes hypotonic
who do isotonic solutions do
- remain in the vasculature = expand blood vessel volume
who do hypotonic solutions do (3)
- shift fluid into cells
- treats cell dehydration
- provides free water
who does D5W do
- shifts fluid into cells
- hydrates cells
what are 2 types of hypotonic solution
- 0.45% NaCl (1/2 NS)
- 0.33% NaCl (1/3 NS)
what are the indications for hypotonic solution (4)
- hypertonic fluid imbalance
- improve renal fnxn
- fluid loss
- cellular dehydration
what are risks associated w hypotonic solutions (5)
- hypotension
- increased peripheral edema
- increased ICP
- hyponatremia
- IV site phlebitis and infiltration
who should you use caution in with hypotonic solution (4)
- stroke
- head trauma pts
- increased ICP pts
- severe burn pts
what is the action of hypertonic solution (2)
- shifts fluid into vessels
- causes cells to shrink
what are 5 types of hypertonic solution
- D5LR
- D5NS
- D51/2NS
- 3 % NaCl
- 5% NaCl
what are indications for D5LR (7)
- electrolyte replacement
- dehydration
- burns
- GI tract fluid losses
- acute blood loss
- nutrition(provide cals)
- hypovolemia
what are risks associated w D5LR (5)
- fluid overload
- pulm edema
- hyperglycemia
- hyperkalemia
- IV site phlebitis and infiltration
who should you use caution w D5LR (3)
- DKA
- cardiac pts
- renal pts
what are indications for D5NS (3)
- fluid loss
- hyponatremia
- nutrition
what are risks associated w D5NS (4)
- fluid overload
- pulm edema
- hyperglycemia
- IV site phlebitis and infiltration
who should you use caution in w D5NS (3)
- DKA
- cardiac pts
- renal pts
what are indications for D5 .45 NS (3)
- post-op
- nutrition
- rehydration
what are risks associated w D5 .45 NS (4)
- fluid overload
- pulm edema
- hyperglycemia
- IV site phlebitis and infiltration
who should you use caution in w D5 .45 NS (3)
- DKA
- cardiac pts
- renal pts
what should you make sure to check before giving IV fluids (2)
- verify physicians order
- right reason?
what are important things to do when giving K+ (which is a high risk med) (2)
- need a 2 nurse check
- recheck any time you change the rate
what effect does hypervolemia have on the cardio system (3)
- increased BP
- tachycardia
- irregular HR
what effect does hypervolemia have on the resp. system (3)
- crackles
- SOB
- pulmonary congestion
what effect would hypervolemia have on body comp/ on observation of the pts body (3)
- peripheral edema (dependent, pitting)
- weight gain
- distended neck vein
what effect would hypervolemia have on the GI system (2)
- anorexia
- NV
what effect would hypervolemia have on the neuro system (4)
- headache
- changes in LOC
- confusion
- seizures
what should you do if someone is experiencing signs of hypervolemia (4)
- alert MD
- assess
- give O2
- frequent monitoring
what med could you give for hypervolemia
- lasix (slow infusion
what effect would hypovolemia have on the cardiac system (4)
- tachycardia
- low BP
- thready pulse
- low CO
what effect would hypovolemia have on the GI/urinary system (4)
- low urine output
- anorexia
- NV
- thirst
what effect would hypovolemia have on the resp system (2)
- rapid breathing
- shallow resp.
what effect would hypovolemia have on the neuro system (5)
- restlessness
- anxiety
- lethargy
- confusion
- behavioral changes
what effect would hypovolemia have on the skin (4)
- decreased skin turgor
- pale
- clammy
- cool
what should you do if someone is experiencing hypovolemia
- assess
- alert MD
- may need fluids
- O2
- identify cause
- frequent monitoring
how often should you change the tubing on a primary infusion
- every 96 hr
how often should you change the IV bag on a primary infusion
- every 24 hr
what are potential IV complications (7)
- infection
- phlebitis
- infiltration
- extravasation
- circulatory overload
- thrombophlebitis
- hematoma
what are signs of infection at the IV site (5)
- red
- warmth
- swelling
- pain
- purulent drainage
what should you do if you suspect/there is infection at the IV site (3)
- d/c the IV line
- express drainage is present
- send catheter tip for culture
what is important to prevent infection at the IV site
- use aseptic technique when initiating & managing an IV line
what is phlebitis
- inflammation of the vein
what are 3 categories of causes of phlebitis
- mechanical
- chemical
- bacterial
what could cause mechanical phlebitis (3)
- movement of cannula
- poor blood flow around cannula
- unskilled venipuncture
what could cause chemical phlebitis (3)
- low pH
- high osmolality
- drugs (concentrated)
what could cause bacterial phlebitis (3)
- poor technique
- contaminated solution or equipment
- endogenous
what are S&S of phlebitis (5)
- pain
- redness
- warmth
- edema
- vein hard, red, and cord like (streaking)
what is Tx of phlebitis (3)
- d/c IV
- warm moist compress for 20 min, qid
- restart infusion in opposite limb if possible
what is important ti prevent phlebitis
- monitor the IV site every hr for redness and tenderness
what is infiltration
- leakage of IV solution or medication (non-vesicant) into the extravascular tissue
what causes infiltration
- Iv catheter dislodged & fluid infuses into tissue
S&S of infiltration (6)
- edema
- pallor
- decreased skin temp around site –> cold, clammy skin
- pain
- blanching
- burning
what is Tx of infiltration (3)
- d/c line
- elevate the extremitity
- apply warm compress at site to absorb fluid
what is extravasation
- leakage of a vesicant (irritating agent that causes blistering)
what can cause extravasation(3)
- peripheral catheter erodes thru vessel wall
- increased venous pressure + leakage around original venipuncture site
- needle pulls out of vein
what are symptoms of extravasation (6)
- pain
- stinging
- burning
- swelling
- redness at site
- tissue sloughing
what is treatment for extravasation (4)
- stop infusion (d/c IV)
- may aspirate drug
- ice/cool compress
- antidote
what is a thombophlebitis
- complication of phlebitis
- clot formation at cannula tip/wall of vein
what are S&S of thrombophlebitis (4)
- painful
- swelling
- edema of extremity
- sluggish/stopped IV flow
what is treatment of thrombophlebitis
- d/c & restart in opposite limb if possible
- warm compress qid, 20 min
what is a hematoma
- blood trapped in the tissues causing a swelling containing blood
what can cause a hematoma r/t IV infusion (3)
- not enough pressure post IV removal/poke
- vein punctured thru ventral wall at time of veni puncture
- leakage of blood from needle displacement
what is treatment for a hematoma (4)
- elevate
- ice
- pressure
- monitor for continue bleeding/deficits
- remove venipuncture device
what is circulatory overload
- systemic complciation of IV infusion
- causes excess fluid in circulatory system
what are characteristics of circulatory overload
- dyspnea
- edema
- hypertension
- moist breath sounds on auscultation
what are possible causes of circ. overload (3)
- miscalculation of fluid requirements
- flow rate too rapid
- roller clamp loosened
Tx for circulatory overload
- raise HOB
- O2 & meds per order
what is important for prevention of circulatory overload
- use pump controller
- recheck calculations
- monitor infusions frequently
what can cause thrombophlebitis
- injury to endothelial cells of vein wall = platelets stick & thrombus forms
what are signs of a hematoma (3)
- tenderness at venipuncture site
- bruising around site
- inability to advance or flush line
what is a potential systemic complication of IV infusions
- air embolism
what are signs of an air embolism
- unequal breath sounds
- resp. distress
- weak pulse
- increased CVP
- decreased BP
- loss of consciousness
when changing an IV solution, how far in advance should you have the next solution preppared and accessible? why?
- at least 1 hr
- reduces risk of clot formation in vein caused by an empty IV bag
when changing an IV solution, when should you prepare to change the solution? why?
- when less than 50 mL of fluid remains
- or when a new solution is ordered
- prevents air from entering the tubing and veing from clotting d/t lack of flow
how full should the drip chamber be when changing an IV solution? why?
- at least half full
- provides fluid to vein while bag is changed
what can be done to remove large portions of air in IV tubing
- swab injection port below the air w alcohol & let dry
- connect syringe to port and aspirate the air into the syringe
when should IV tubing be changed? (4)
- every 96 hr
- puncture of tubing
- contamination of tubing
- occlusions in existing tubing after influsion of packed red blood cells, albumin, whole blood, etc
how long should you apply pressure to the site after removing the IV catheter
- 2-3 min
- or until no further bleeding is noted
what is important to do at all times while changing a peripheral IV dressing
- stabilize the catheter
how full should the drip chamber be during an IV infusion
1/3 to 1/2 full
how high should the IV bag be above the IV site
- 90 cm
how often should a PIV dressing be changed
- gauze dressing q2days
- transparent semipermeable dressing = 5-7 days
- if gauze is underneath TSM = every 2 days
- if wet, soiled, or loosened = change immediately
what is the minimal rate for KVO
- approx 10-15 mL/hr
how often should an IV infusion be assessed
- every hour
proper infusion rate, infusion site, etc.
how often should primary intermittent tubing be changed
every 24 hr
when should IV solutions be changed
- when new order
- when less than 50 mL in bag
what should you label an IV dressing with
- time and date of dressing change
- time and date of insertion
- gauge and length of catheter
- nurse’s initials
