PIVs, Subcuts and IN Meds

Question 1

What is a PIV?

Answer 1

Peripheral Intravenous (IV)
Vascular access device

Question 2

Where are PIVs commonly placed?

Answer 2

hand
forearm

Question 3

In emergencies where are PIVs placed?

Answer 3

foot
head

Question 4

Which way do hypertonic solutions pull fluid and what is one caution?

Answer 4

pulls fluid from the cells - causes them to shrink - vascular volume increases

Pulmonary edema (especially heart or renal failure patients)

Question 5

What does isotonic solution do for the body and when is it typically used?

Answer 5

increaes fluid volume only
no fluid shifts

vomiting/fluid loss

Question 6

Which way does hypotonic solutions (0.45%) pull and what are they used for?

Answer 6

They pull fluid into the cells
used to help reduce Edema and Third spacing

Question 7

If someone was hypertonic what solution would we give and why?

Answer 7

Give hypotonic to dilute ECF
This causes fluid to go back into the cells

Question 8

What is a subcut line?

Answer 8

a line for subcut medications that are required often so that the patient doesn’t have to keep getting poked

Question 9

What is hypodermoclysis?

Answer 9

administration of fluids through a subcut line
Used when IV access is limited
Used when patient is end of life
Used when patient is at risk for or with mild dehydration
slow rate of infusion b/c subcut is slow absorption

Question 10

What is the max volume of meds administred via subcut at one time?

Answer 10

2 mL + NS flush post med of 0.5mL
total = 2.5 mL

Question 11

When do we flush subcut?

Answer 11

after each use! (each med)

Question 12

how often do we change subcut lines and sites?

Answer 12

Q 5-7 days (check agency policy)
or as indicated by irritation, infection, etc

Question 13

What do we need to label / document with sub cut line?

Answer 13

1. label the line (clear it’s not IV)
2. client chart
3. kardex
   include
   date
   time
   SC line insertion location

Question 14

How often do we monitor sub cut lines?

Answer 14

at least every 8 hours
more often when in use

Question 15

what do we assess with subcut lines?

Answer 15

1. insertion site
2. surrounding skin
3. blood in the tube
4. erythema
5. swelling
6. leaking
7. hardness at site
8. bruising
9. burning
10. pain
11. heat
12. necrosis…. etc.

Question 16

what are 2 options if there are multiple subcut meds but only 1 line?

Answer 16

1. maybe add a second line
2. wait 15-30 min between each med for adequate absorption

Question 17

what is MAD?

Answer 17

Mucosal Atomization Device

Question 18

What must the nasal cavity be like for IN admin?

Answer 18

easily accessible
rich vascular supply for rapid absporption into bloodstream

Question 19

What is the rate of IN med absorption similar to?

Answer 19

IV admin

Question 20

what are the 5 classes of meds commonly given IN?

Answer 20

1. vaccines (live attenuated)
2. antiepileptics
3. opiate analgesics
4. hypoglycemics
5. corticosteroids

Question 21

What is the ideal volume PER NOSTRIL for IN administration?

Answer 21

0.2 to 0.3 mL

Question 22

what is the max dose PER NOSTRIL for IN administration?

Answer 22

0.5 mL

Question 23

what do we do if the dose is more than 0.5 mL?

Answer 23

two separate doses, 5-10 min between

Question 24

What is Phlebitis?

Answer 24

Inflammation of the vein

Question 25

What is thrombophlebitis?

Answer 25

complication of phlebitis
clot formation

Question 26

What is infiltration?

Answer 26

leakage of infusing fluid from a vein into surrounding tissue

Question 27

wht is extravasation?

Answer 27

leakage of vesicant agent into surrounding tissue

Question 28

What is IV ecchyomosis?

Answer 28

bruising @ site

Question 29

what is hematoma?

Answer 29

extravasated blood trapped in the tissues causing a swelling containing blood