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Interventions > Peripheral Venous Access & IV Therapy Concepts > Flashcards

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
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2
Q

Iv solution that is used to maintain normal blood plasma

A

-dextrose(sugar) or saline (salt) diluted in water for injection (solvent)

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3
Q

osmolarity

A

-concentration of solution expressed as total number of solute particles per liter

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4
Q

how is blood concentration describes

A

-millOsmols per Liter

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5
Q

how are IV solutions classified

A
  • isotonic: same osmolarity as blood
  • hypotonic: lower osmolarity than blood
  • hypertonic: higher osmolarity than blood
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6
Q

what is normal blood osmolarity

A

280-320 mOsm/L

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7
Q

reasons why medication are given through IV therapy

A

-absorption into blood stream is immediate

-

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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
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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

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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

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11
Q

what to do why IV order

A
  • check most recent/current order

- renewed every 24hrs at minimum

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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
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13
Q

parts of solution bag

A

-port: tubing insertion and additives

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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
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15
Q

types of peripheral IV catheter needles

A
  • over the needle catheters
  • winged catheter (butterfly)
  • OSHA mandated safety needles
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16
Q

winged catheter

A
  • reduced risk of contamination
  • improves stability
  • excellent with difficult views
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17
Q

OSHA mandated safety needles

A
  • active: user activated

- passive: automatic retraction

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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
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19
Q

primary lines

A

-continous primary infusion
-bolus of fluid
-may have intermittent secondary infusions
-pump or gravity infusion
additives are run slowly

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20
Q

how is potassium delivered

A
  • dangerous to run quickly

- runs slow

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21
Q

intermittent Venous Access devices (saline locks)

A
  • for intermittent infusion
  • extension of tubing
  • flushing
  • usually used of IV antibiotics and noncontiguous meds
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22
Q

why do IVAD have extension tubing

A

-infection control

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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
Q

peripheral site selection considerations

A

-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
Q

when to use upper vs lower extremities for PIV?

A

adults: upper extremities not lower

- pediatics: can do scalp and lower extremeties

27
Q

contraindications for peripheral site selection

A
  • mastectomy
  • arm with lymph node dissection
  • arm wi artery venous fistula
28
Q

why do distal in periperhal site selection

A

if vein blows, you have sites further up

29
Q

what are areas to avoid in peripheral site selection

A
  • ventral surface and lateral surface of wrist for 4-5 inches: nerve damage
  • burns, infections in extremity
  • AV fistula/ catheters for dialysis
30
Q

why not use legs in as peripheral access in adults

A

-stagnation of circulation causes risk of thromboembolism

31
Q

what factors make it harder for site selection

A

-obesity, IV drug use, multiple chronic disease

32
Q

site selection for children

A
  • scalp
  • foot
  • finger
33
Q

common sites of PIV, gauges

A
  • metacarpal: 20-24 g, avoid antibiotics, chemotherapy, potassium
  • cephalic: 16-22 gauge
  • basilic: 16-22 gauge
34
Q

process of venipuncture

A
  • comfortable positive
  • dilate vien
  • cleanse with chlorhexidine and allow to dry
  • stabilize vien
  • bevel up
  • 10-15 degree angle
  • maybe use of anesthetics
35
Q

how to dilate the vein

A
  • pump fist with hand lower than hear
  • stroke downward
  • friction from cleansing
36
Q

chlorhexidine swab

A
  • 2%
  • press applicator against skin and apply for 30 seconds
  • do not wipe or blot: air dry
  • allow to complete dry
37
Q

monitoring site and infusion

A
  • monitor q1hr: 6R, tolerance of fluid volume, complications
  • dressing integrity: transparent semipermeable membrane dressing: tegaderm
  • intake and output
38
Q

infection control

A
  • 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
Q

complications: infiltration

A
  • leakage of IV fluid into surrounding tissue

- cool to touch, pale, edema, leaking, pain

40
Q

treatment for infiltration

A
  • 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
Q

complication:extravastion

A

-leakage of vesicant into surrounding tissue

42
Q

vesicant

A

any medication that can cause blistering serve tissue injury or tissue necrosis

  • chemotherapuetic agent: vinca alkaloids
  • catecholamines: dopamines, epinephrine, norepinephrine
43
Q

extravasation treatment

A
  • 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
Q

complication: phlebitis

A
  • inflammation of the vein due to mechanical trauma from needle or catheter or chemical trauma from a solution
  • red, warm, edema, pain
45
Q

risk factors for phlebitis

A
  • mechanical irritation
  • chemical irrigation
  • contamination
46
Q

treatment of phlebitis

A
  • 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
Q

systemic complication ofIv therapy:fluid overload

A
  • dyspnea
  • increase BP
  • increased Hr
  • increased RR
  • crackles
  • jugular vien distention
  • edema
48
Q

systemic complication of IV therapy: speed shock

A
  • IV runs too fast
  • dizziness
  • chest tightness
  • flushed
  • pounding headache
  • chills
  • back pain
  • dyspnea
  • apprehension
49
Q

systemic complication of IV therapy: sepsis

A
  • red
  • tender
  • fever
  • malaise
  • VS changes
50
Q

systemic complication of IV therapy: air embolism

A
  • 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
Q

assessment: initial contact

A
  • 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
Q

assessment: baseline informaion

A
  • vs
  • edema status: peripheral/ central pulmonary
  • lung sounds: crackles
  • heart sounds: murmur or increase HR
  • quality of pulses
53
Q

assessment: hourly

A
  • rate
  • amount infused
  • site complications
54
Q

nursing diagnosis

A
  • 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
Q

plan/ implementation

A
  • 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
Q

documenting IV intaking

A
  • 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
Q

evaluation

A
  • patient IV remain patent
  • patient does not experience complications
  • complications recognized early

Interventions (8 decks)

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