Peripheral Venous Access & IV Therapy Concepts Flashcards
1
Q
reasons for IV therapy
A
- maintain daily fluid/electrolyte balance
- replace build.electrolyte losses
- correct fluid/electrolyte imbalance
- provide access to venous system for med administration
2
Q
Iv solution that is used to maintain normal blood plasma
A
-dextrose(sugar) or saline (salt) diluted in water for injection (solvent)
3
Q
osmolarity
A
-concentration of solution expressed as total number of solute particles per liter
4
Q
how is blood concentration describes
A
-millOsmols per Liter
5
Q
how are IV solutions classified
A
- isotonic: same osmolarity as blood
- hypotonic: lower osmolarity than blood
- hypertonic: higher osmolarity than blood
6
Q
what is normal blood osmolarity
A
280-320 mOsm/L
7
Q
reasons why medication are given through IV therapy
A
-absorption into blood stream is immediate
-
8
Q
peripheral IV: facts
A
- most common type of IV
- short term therapy
- goes into superficial views of the hand and forearm
- Iv fluid, medication, blood products instilled
9
Q
pump infusion
A
given with control using automated pump that can calculate the amount of time and rate you would like to administer medication
10
Q
gravity infusion
A
usually given over longer period of time
-less exact than automate pump
relied on nurse to make sure its set properly
11
Q
what to do why IV order
A
- check most recent/current order
- renewed every 24hrs at minimum
12
Q
parts of a correct IV order
A
- written by legally authorized HCP
- date and time order was written
- signature of authorized HCP
- type of solution and/or additive
- amount of solution to be given (volume)
- over what time or rate of continuous infusion
13
Q
parts of solution bag
A
-port: tubing insertion and additives
14
Q
parts of tubing
A
- spike
- drip chamber
- backflow check valve
- port
- clamps: roller regulate flow and slide stop flow
- luer lock
- end interred into IVAD/catheter hub
15
Q
types of peripheral IV catheter needles
A
- over the needle catheters
- winged catheter (butterfly)
- OSHA mandated safety needles
16
Q
winged catheter
A
- reduced risk of contamination
- improves stability
- excellent with difficult views
17
Q
OSHA mandated safety needles
A
- active: user activated
- passive: automatic retraction
18
Q
universal color codes gauges
A
- magma(14): trauma
- gray (16) major surgery, volume volume infusions, unstable patients
- greem(18): love volume infusions, multiple/rapid transfusions
- pink (20): medications, hydration, transfusion
- blue (22): small view, common for short term access, and usually can’t administer blood
- yellow (24): fragile small veins, pedi population, last resort for adults
19
Q
primary lines
A
-continous primary infusion
-bolus of fluid
-may have intermittent secondary infusions
-pump or gravity infusion
additives are run slowly
20
Q
how is potassium delivered
A
- dangerous to run quickly
- runs slow
21
Q
intermittent Venous Access devices (saline locks)
A
- for intermittent infusion
- extension of tubing
- flushing
- usually used of IV antibiotics and noncontiguous meds
22
Q
why do IVAD have extension tubing
A
-infection control
23
Q
flushing guidelines
A
- 2-3mL saline q 12hrs with use
- pulsatile method
- positive pressure method
24
Q
what is the positive pressure method?
A
-hold fluid pressure on the IV and doesn’t allow for back flow of blood or fluids
25
peripheral site selection considerations
-choose smallest gauge: view must support gauge
-PIV not for: total parenteral nutrition (TPN), pH less than 5 or greater than 9 and osmolarity greater than 6000 mOsm/L
-upper vs lower extremities
-duration of therapy
-limb
-start as distal as possible
areas to avoid
-contraindications
-no used for routine blood draws
-site selection in children
26
when to use upper vs lower extremities for PIV?
adults: upper extremities not lower
| - pediatics: can do scalp and lower extremeties
27
contraindications for peripheral site selection
- mastectomy
- arm with lymph node dissection
- arm wi artery venous fistula
28
why do distal in periperhal site selection
if vein blows, you have sites further up
29
what are areas to avoid in peripheral site selection
- ventral surface and lateral surface of wrist for 4-5 inches: nerve damage
- burns, infections in extremity
- AV fistula/ catheters for dialysis
30
why not use legs in as peripheral access in adults
-stagnation of circulation causes risk of thromboembolism
31
what factors make it harder for site selection
-obesity, IV drug use, multiple chronic disease
32
site selection for children
- scalp
- foot
- finger
33
common sites of PIV, gauges
- metacarpal: 20-24 g, avoid antibiotics, chemotherapy, potassium
- cephalic: 16-22 gauge
- basilic: 16-22 gauge
34
process of venipuncture
- comfortable positive
- dilate vien
- cleanse with chlorhexidine and allow to dry
- stabilize vien
- bevel up
- 10-15 degree angle
- maybe use of anesthetics
35
how to dilate the vein
- pump fist with hand lower than hear
- stroke downward
- friction from cleansing
36
chlorhexidine swab
- 2%
- press applicator against skin and apply for 30 seconds
- do not wipe or blot: air dry
- allow to complete dry
37
monitoring site and infusion
- monitor q1hr: 6R, tolerance of fluid volume, complications
- dressing integrity: transparent semipermeable membrane dressing: tegaderm
- intake and output
38
infection control
- perform hand hygiene before and after handling IV system
- change IV site q72-96 hours
- change primary tubing q96
- change secondary tubing q24
- use aseptic technique
- change fluid q24
- change dressing q24
- discontinue Iv once clinically indicated
- avoid writing on IV bags
- wipe all port with antiseptic swab before using
39
complications: infiltration
- leakage of IV fluid into surrounding tissue
| - cool to touch, pale, edema, leaking, pain
40
treatment for infiltration
- warm compress for normal or alkaline ph (8,9)
- cool compresses for acidic pH (5,6)
- elevate extremity
- remove catheter, restart somewhere else
- document infiltration and treatment
41
complication:extravastion
-leakage of vesicant into surrounding tissue
42
vesicant
any medication that can cause blistering serve tissue injury or tissue necrosis
- chemotherapuetic agent: vinca alkaloids
- catecholamines: dopamines, epinephrine, norepinephrine
43
extravasation treatment
- stop infusion
- attach surging to IV catheter and aspirate med
- elevate extremity
- notify MD
- call pharmacy for antidote
- apply ice for 15-20 min for 24 hours for all meds expect heat for vinca alkaloids and catecholamines
- documentation: medical record, incident report
44
complication: phlebitis
- inflammation of the vein due to mechanical trauma from needle or catheter or chemical trauma from a solution
- red, warm, edema, pain
45
risk factors for phlebitis
- mechanical irritation
- chemical irrigation
- contamination
46
treatment of phlebitis
- remove catheter: restart elsewhere
- warm compress
- document phlebitis and treatment
- monitor site for healing vs infection or tissue damage
- do not rub is thrombus is suspected
47
systemic complication ofIv therapy:fluid overload
- dyspnea
- increase BP
- increased Hr
- increased RR
- crackles
- jugular vien distention
- edema
48
systemic complication of IV therapy: speed shock
- IV runs too fast
- dizziness
- chest tightness
- flushed
- pounding headache
- chills
- back pain
- dyspnea
- apprehension
49
systemic complication of IV therapy: sepsis
- red
- tender
- fever
- malaise
- VS changes
50
systemic complication of IV therapy: air embolism
- break of Iv system above heart level allow air into the circulatory system as a bolus: pinch off catheter
- respiratory distress
- HR increase
- BP decrease
- cyanosis
- change in LOC
51
assessment: initial contact
- solution: correct as written
- remaining volume in bag
- presence of time tape
- IV site: complications
- drip chamber: too full or too empty
- gravity drip: dripping at correct gtt/min
- electronic infusion device: mL/hour agree with order
- roller clamp: out of patient reach
52
assessment: baseline informaion
- vs
- edema status: peripheral/ central pulmonary
- lung sounds: crackles
- heart sounds: murmur or increase HR
- quality of pulses
53
assessment: hourly
- rate
- amount infused
- site complications
54
nursing diagnosis
- impaired comfort
- acute pain
- deficient fluid volume
- risk for imbalanced fluid volume
- risk for infection
- deficient knowledge
- impaired skin integrity
- self care deficit
- potential complication: med therapy adverse effects
55
plan/ implementation
- reconcile differences found in assessment
- documentIV intake per agency policyL when hanging bag and end of shift
- flush IV if not running well
- discontinue IV and arrange for restart
- provide first aid for complication
- change dressing prn
56
documenting IV intaking
- when hanging new bag: state amount, and type of solution, time hung, mouth of solution infused from old bag since las measured
- at end of shift: indicate how much solution left in bag
57
evaluation
- patient IV remain patent
- patient does not experience complications
- complications recognized early
