Module 4 Flashcards
what are the signs & symptoms or tourniquet retention
transient pain, edema, parenthesis, leak @ site, may slow rate or may infiltrate, compartment syndrome
what are the signs & symptoms of misconnection
Pain, fever, chest pain, dyspnea, anaphylaxis, cardiopulmonary crest, seizure, altered mental status, sepsis, coagulopathies. Varies a lot could be insidious or abrupt
what are the signs and symptoms of phlebitis
pain, swell, tender, local or streaking erythema, venous cording
what are the sings and symptoms of air embolism
dynode, cough, wheeze, chest/ shoulder pain, agitation, sense of doom, tachypnea, tachycardia, hypotension, stroke type findings, harsh systolic murmur
signs and symptoms of device fragmentation embolization
palpitations, arrhythmias, chest pain, SOB, cough, swell, pain, confusion, hypotension, inability to flush or aspirate blood
signs and symptoms cathater associated venous thrombosis
mostly asymptomatic, pain edema, venous engorgment, difficulty moving shoulder or neck or chest - PE symptoms
signs and symptoms of infiltration
inadvertent admin of nonvesicant solution into SC tissues
Pain, burn @ incision & along Vascular, edema, colonies, blanching, leak & local parenthesis AVOID PRESSURe
signs and symptoms of extravasation
blister, slough, necrosis
signs and symptoms of infection
local induration, erythema, tender, drainage, systemic. rare but if its attributed to phlebitis then remove.
who is most at risk for tourniquet retention
those who are at risk are those who cannot communicate symptoms
what are the contributing factors to tourniquet retention
Obesity, decreased pain perception, impaired communication, distracted provider, short tourniquet or poor visibility
how to prevent tourniquet retention
- long/bright
- don’t roll up sleeve/ place over clothes
- keep visible
how to recover from tourniquet retention
remove, assess, inform provider, document, report, inform family
what is the risk factors for misconnection
OVERCOMPATIBILITY -transition/transfer reconnection -low recognition of of risk poor lighting / don't want to disturb proximity overcompatility
what is the most common complication
phlebitis
when may phlebitis occur
up to 48 hours after removal
where is the worst place you could put a PICC
antecubital fossa
how often should you change SPC
72-96 hours
what are risk factors for phlebitis
-Increased age, female, fragile, bad veins, malignant neoplasm, bad pacmenet/mgmt/assess, hand for spa or antecubital fossa for PICC, leg diameter, poorly secured, over 72-96 hours or what material was infused
how should you recover from the phlebitis
- remove
- assess
- notify provider
- culture tip
- report
- disclose
Air embolism
uncommon but highly lethal - no safe volume
LETHAL = 50ml (or 3-5ml per kg) up to 20ml if rapid
the lungs can filter 0.35ml/kg/min
what are the risk factors for air embolism
hypovolemia asymptomatic patent foramen oval misconnection dismiss air in the line suboptimal removal/insert inserting above the heart
how to prevent air embolism
don’t leave unprimed tubing out
clamp when puncturing
occlusive dressing
what is the recovery for air embolism
stop tx left tredndelenberg or left lateral decubitus O2 100% face mask aspirate air contact physician, report, disclose
what increases the risk of fragment embolization
1) Pico between clavicle & 1st rib
2) Baddly secured
3) Improper storage
4) power injection
how to prevent fragmentation embolization
don’t remove PICC agains resistance
limit scissors, don’t repair
how to recover from fragmentation embolization
keep device
chest Xray
report
disclose
what are the purposes of IV’s
Parenteral nutrition, blood monitoring, fluid, drugs, testing
EXPLAIN ISOTONIC SOLN
-Same osmolarity as body fluid (250-375 mOsm/L)
-Increased risk fluid overload in renal or cardiac disease
-use because fluid is decreased (hemorrhage, diarrhea, vom)
= fluid resuscitation
-initially will stay intravascular
-no movement into or out of ICF compartment
-FOR INTRAVASCULAR DEHYDRATION
-Ex. NSm LR, D5W
EXPLAIN HYPERTONIC SOLN
- shrink cells
- soln pull fluid out of cells into extracellular b/c soln has more solute than cell does
- INDICATIONS: hyponatremic (sodium leaves with fluid) or cerebral edema or intravascular dehydration with intracellular or interstitial overload
- out of ICF & interstitial compartment into intravascular
- osmolarity >375
- irritating to vein increases risk of HF & pulmonary edema
- Examples: D5NS D5 1/2 NS, D5LR, D10W
Explain hypotonic SOLN
- exacerbates hypotension
- pull fluid into the cell (Swell)
- for intracellular dehydration
- <250mosml
- fluid shift into ICF & interstitial
- 1/2 NS or 2.5DW or o.33 saline
when should you use a CVAD
-high or low ph
osmolarity 900+
parental nutrition
vesicants
what is the steel needle winged butteryfly
- one time for push or phlebotomy
- osmolairty <900
what is the short over the needle cath
7.5 cm or less than 3 inchest
continuous or intermittent
short term
what is the midline cath for
7.5-20cm
-continous or intermittent
-1-4 weeks
<900mosml
IV gauge 14-18
Trauma, surgery, rapid blood transfusion or fluid
IV gauge 20
Continous or intermittent blood transfusion in adults
22-24 gauge IV
continuous or intermittent all ages or blood transfusion in kids & elders
Symptoms of fluid volume deficit
decreased urine output, dry mucuous membrane, decreased cap refill, disparity in central vs. peri pulses, tachycardia, hypotension, shock
symtoms in fluid excess
dyspnea, edema, crackles, increased urine output,
*otify provider, adjust infusion rate, type of fluid
what to do for chemical phlebitis
heat, elevate, slow infusion, think about removal
what to do about mechanical phlebitis
heat, elevate, monitor 1-2 days about removal
what to do for bacterial phlebitis or hematoma
remove, remove
Explain phlebitis scale
1= erythema with or without pain 2= pain, erythema with out without edema 3= pain with erythema & or edema. Streak & cod 4= same as 3, a cord larger than 2.5 cm & purulent drainage
Explain visual infusion phlebitis scale
1= pain or red 2= pain red or swell 3= pain along cannula, induration 4= same as 3 & palpable venous cord 5) same as 4 but also pyrexia
how often check IV & pump
once an hr
explain paediatric maintenance fluid
100ml/kg for first 10kg
50 ml for next 10 kg
20ml/kg kg for the rest
signs of deficient fluid
hypotensive with increased HR lost more than 1 kg in a day decreased output inelastic skin thirst, weak, dry
explain when you would use a PICC
LT or vein irritant (1-4 weeks)
limited or poor veins
need large volume
Infiltration scale
1= blanched, 1 inch edema, cool with or without pain
2= above + 2.54- 15.2 cm edema
3= Increased translucent >15.cm edema, pain & numbness
4=blanches, translucent, leaky, tight, discoloured, bruised, sloweelen, deep pit, impaired circulation ,moderarte to severe pain, infiltrate of blood or vesicant
