Medsurg Exam 1: IV Therapy Flashcards
Patient perspectives and roles
Unpleasant, painful, invasion of space
Patient cant eat or drink
Pre operative, post operative, alterations in mental status, severe physical illness, protracted nausea and or vomiting or both
What is the role of the Nurse in IV Therapy
Need to elicit confidence, if you do not succeed go get someone else
What do you need to check and monitor for IV medications?
Need to monitor the site and what is needed
Correct solution and the integrity of the solution
clarify/ not expired/ no precipitates
Correct infusion rate
Pump functioning properly
Maintain patency of saline locks
Rapid Action of Specific Medications (need it FAST)
Medications that need to administered fast?
Electrolyte imbalances = potassium correction, sodium correction, magnesium, calcium
Cardiac medications
Medications for pain and nausea
When would IV therapy be used for rehydration?
Extreme alterations of sodium balance
Heat exhaustion/ heat stroke
Burn injuries
Profound metabolic acidosis
When would you use IV therapy in cases of life threatening conditions?
Acute and overwhelming illness: diabetic ketoacidosis, heat stroke, spesis, any variety of other illness/conditions or exacerbations of the same
Vasoactive drips =
IV push critical medications
The only game in town = CroFab Antivenom
Vasoactive drips
Vasoactive drips = aka pressors: dopamine, dobutamine, levophed, epinephrine, nipride
When would we use IV therapy to deliver blood?
Profound anemia
Hemorrhage / hemorrhagic shock = packed RBC/ FFP/ Platelets
Clotting abnormalities = liver diseases/ hemophilia
I
MPORTANT = IV size is important for these patients
18 gauge angiocath at least for transfusion of blood and blood products in an adult
When you need ensuring delivery of the medication ?
Antibiotics
Sepsis
Insulin: IV drip or IVP for diabetic ketoacidosis: versus SQ administration for unusual administration
Anticoagulants and thrombolytics: Heparin, TPA, streptokinase
Chemotherapeutic agents that are IV
What are other reasons we would use an IV (Misc.)?
IV access for = Patients comfort (IM vs. IV), rapid delivery of medication, nurses convenience
Emergency department placements, prehospital
Critical care units
Going to the OR
For the What if… especially with a cardiac patient
What is the goal of IV therapy ultimately?
Fluid and electrolyte balance, Nutrition status (central lines and PICC lines), Maintain homeostasis via blood and blood product administration, treat numerous conditions with medications
What are the 3 steps that are included in a proper IV order?
Specific type of fluid to be administered
Rate of administration must be specific (ml/hr)
TKO and KVO is not considered an appropriate IV rate
What does it mean when medications are added to an IVF?
Admixture in the IV it has to be specific (example D5 ½ NS with KCl 40 mEq/l @ 125ml/hr)
IVPB Medications do not consistently list the amount that a drug is mixed in
Ancef 1 gm IV q 8 hours (usually in 50 ml)
Levaquin 750 mg IV daily (usually in 100 ml)
Vancomycin 1 gm IV every 12 hours (often in 250 ml)
What are the biggest issues with IV infusion of drugs?
Not all infusions are appropriate for peripheral venous infusions (pH less than 5 or greater than 9 require infusion through a central line)
Proper dilution of medications
Compatibility issues
Rate of insulin? Require a pump? Comfort? Require a cardiac monitor (Dilantin)?
Normal blood serum osmolality
290 mOsm/Liter
Osmo close to blood is called
Isotonic
Over 350 mOsm/L is called
Hypertonic
Under 250 mOsm/L is called
Hypotonic
4 Types of IV infusions
Volume controlled continuous infusions IVPB also known as Piggyback infusions How does it work? IV bolus infusions Blood and blood product infusions: Require a speciality tubing
Special Populations
For inpatients = watch serum electrolytes
Ederly patients: less is better, careful with skin
GI losses
Trauma patients: boluses
Burn Patients: volume being infused will be based on the patients percentage burn
Head injuries: infuse less, approx ⅔ of a normal maintenance rate
Insensible losses
those we cannot track
VADs
Vascular Access Devices
Devices
What is a peripheral catheter? Insertion site? Size Range? Placement? Pt. History?
Inserted: superficial veins of the hand, forearm
Creative placements are seen when patients lack skin to be pricked (drug abusers)
Size Range
¾ inch to 2 inches 26 gauge to 14 gauge (may be much larger)
Large number of gauge = smaller bore (diameter)
Larger - more irritating
Distal Placement
Patients history: Mastectomy patients, dialysis patients, infants and children
What is a midline catheter? Insertion site? Size Range? Placement? Pt. History?
6-8 inches long
Antecubital fossa placement
Useful for longer term therapy
PICC (Peripherally inserted central catheter) line
Treated as a central line
Who gets these types of catheters?
Who places these catheters?
Tunneled Central Catheters
Placed by a physician or NP, have a rough cuff which rests under subcutaneous tissue that forms granulation tissue around same
Distal edge rest in SVC
Physical barrier from microorganism entry
Multiple varieties: Broviac, Hickman, Leonard
Implanted Ports
Usually placed in upper chest wall
Require non coring huber needle to access same
Chronically ill patients
May use EMLA cream if protocol
Central Lines
Placed by MD or NPs
Rests with distal tip in SVC
At risk for sepsis
Not your first choice for an IV (but think back to why a pH of the drug may require you to use the central line)
Dialysis Catheters
DO NOT TOUCH THESE
Intraosseous lines
Trauma and children
Intraperitoneal infusions
Often chemotx
Hypodermoclysis
Subcutaneous infusions
Intraspinal infusion
Analgesia, anesthesia
Intra-arterial infusions
Some chemotx
TPN vs. PPN
PPN patient = unable to eat less than 14 days
PPN infused via a large bore special peripheral line
TPN and PPN combine amino acid solutions with fat emulsions to provide require nutrients
TPN
Requires a central line
Is hyperosmotic
Solution is ordered daily and mixed daily based on patients current lab values
Mixed under laminar flow hood
Daily labs: electrolytes and
CBC
Accuchecks
Scrupulous IV site care: TPN IV tubing change daily
Must be filtered: Patient at risk of fluid shifting, risk of sepsis
Complications of IV Therapy
11
Alteration of fluid status Phlebitis = inflammation of the vein Thrombosis/Thrombophlebitis Infiltration Ecchymosis and Hematoma Infection: Localize and sepsis Allergic rxn Vasospasm Nerve Damage Extravasation of injurious substances or medications into tissues = tissue necrosis and sloughing Central Line association and complications
