Test 1

Question 1

What is Intravenous
 Cannulation

Answer 1

Placement of a catheter into a vein for the administration of blood, fluids, or medications directly into the circulatory system or to obtain venous blood specimens for laboratory determinations.

Question 2

Objectives of IV Therapy

Answer 2

• maintain or replace blood volume
• restore acid-base balance
• provide a route for medication administration

Question 3

Epidermis

Answer 3

• forms the protective covering of dermis
• varies in thickness and varies with age
• thinnest area on inner surface of limbs
• dorsum of the skin in the hand of elderly pts cannot always handle venipuncture

Question 4

The Dermis

Answer 4

• highly vascular and sensitive
• contains many capillaries and thousands of nerve fibres
• venipuncture can cause great pain in some area and very little in other’s

Question 5

Tunica intima of blood vessel

Answer 5

• inner layer
• semi-elastic
• smooth surface allowing blood cells to slide more easily

Question 6

Tunica media of blood vessel

Answer 6

• muscle
• vasoontricts and vasodilators in response to hormones, temperature and trauma

Question 6

Tunica external of blood vessel

Answer 6

• outer layer
• connective tissue that holds the vein in place

Question 7

Veins vs arteries

Answer 7

• structurally similar with very subtle differences
• veins: less muscular, less shape, contain valves to control blood flow. rely on blood being collected to trapped to dissent otherwise they should flatten easily. tend to be more shallow and more visible. use milking action of the muscles to help move blood (rely on muscle pump to encourage flow)

Question 8

Good Vein for IV

Answer 8

• fairly straight
• easily accessible
• well fixed, not rolling
• springy when palpated

Question 9

Bad Vein for IV

Answer 9

• sclerotic (rigid, hard)
• near joints
• close to a palpable arterial pulse
• near injured areas
• near oedematous extremities
• in an extremity with circulation problems

Question 10

Indications for IV Therapy

Answer 10

1. important addition in treatment of cardiac treatment, hypoglycemia, seizures, shock
2. hypovolemic pt: usually need at least two IV lines with large-bore catheters
3. intravenous medication: administered into bloodstream
4. precautionary measures: in stable pts whose deterioration is anticipated
5. IV administration of CM

Question 11

Contraindications for IV Therapy

Answer 11

• sclerotic veins
• burned extremities
• avoid if possible: previous IV infiltration/extravasation, injured/infected extremity, arteriovenous fistula, phlebitis

Question 12

Solutions

Answer 12

• a liquid preparation of one or more soluble chemical substances usually dissolved in water
• All intravenous solutions are composed of ions and water

Question 13

Crystalloid

Answer 13

• solutions that pass through semipermiable membranes, most common
• NS 0.9%, D5W (5% dextrose in water), Lactated Ringers (RL) Lactate + Calcium, potassium, sodium & chloride in water

Question 14

Colloid

Answer 14

protein-laden plasma expanders that do not pass semipermeable membranes, rather they draw water in

Question 15

Intracellular

Answer 15

-within the cells
- ICF intracellular fluid

Question 16

Extracellular

Answer 16

• within the blood vessels and between the cells (interstitial)
• ECF: extracellular fluid

Question 17

IV Gauge Sizes

Answer 17

• 10, 12, 14: Cardiac arrest, hypovolemic trauma
• 16, 18: Shock, severe respiratory/cardiac, blood products
• 18 (common size): diabetics, seizures, OD’s, Blood, D50W
• 20, 22: TKVO (to keep vein open) for meds, maintenance therapy
• 22,24,Butterfly: infants, toddlers, elderly

Question 18

Localized Hematoma

Answer 18

• Discolouration of the skin
• Discomfort and potential swelling
• Subcutaneous hematoma is the most common complication
• Can lead to thrombophlebitis or infection

Question 18

Localized Pain

Answer 18

• Body’s way of saying something’s wrong
• Some discomfort is normal (1-3/10)
• Sensory adaptation – natural process that reduces pain/discomfort levels
• Severe pain should warrant discontinuation

Question 19

Localized Extravasation

Answer 19

• Form of infiltration that start as escaping fluid into surrounding tissues
• Infiltrate of toxic substances (contrast, chemotherapy medications)
• Symptoms are: redness, pain, burning sensation or itching
• Stop the infusion immediately and notify the physician

Question 19

Localized Infiltration

Answer 19

• The IV has perforated the vein, leaking solution into the interstitial spaces
• Swelling, blanching, coldness initially
• Stop the IV, remove the catheter, and apply pressure dressing

Question 20

Localized Phlebitis

Answer 20

• The IV catheter or the solution is irritating the vein.
• Gravol, Demerol, chemotherapy, etc
• Type I (allergic) or Type IV (contact dermatitis) hypersensitivity reactions
• Observe, watch for systemic reactions, and if need be, discontinue if too painful

Question 21

Localized Thrombus

Answer 21

• The development of a clot at or near the end of the catheter, limiting flow of the IV and potentially causing embolism
• Caused by lack of forward motion for prolonged time (kinked tubing, bag not high enough, IV placement site in a flexed joint)
• Redness, swelling, limited flow, pain
• Seen more commonly in long term, indwelling, poorly monitored or cleaned sites
• Discontinue, remove catheter, apply pressure dressing, allow healing.

Question 22

Localized Infection

Answer 22

• Common causative agents
• Staphylococcus, Fungus
• Redness, swelling, itching, pain, heat
• Discontinue, document, and recommend physician consultation

Question 23

Systemic Pyrogenic

Answer 23

• Infection that has become systemic (system wide, septicemia)
  Site, or fluid type (common with blood infusion)
• Fever, chills, nausea, vomiting, malaise
  -Discontinue IV, report to physician

Question 24

Systemic Embolism

Answer 24

• Catheter shear: incorrect insertion technique leads to plastic embolism
• Air: allowing too much air in IV tubing, or opening the IV site for too long provides air bubble to enter vein
• Thromboembolism: poorly maintained site allows buildup of thrombus that breaks loose causing embolism

Question 25

Systemic Pulmonary Embolism

Answer 25

• Sudden onset of pain
• Dyspnea
• Oxygen saturation levels drop
• Cardiac output diminishes to “shock” state
• Rapidly fatal
• Seek physician advice immediately and discontinue IV site.

Question 26

Systemic Pulmonary Edema

Answer 26

• IV flow rate set too high, goes unmonitored, allows over accumulation of fluids.
• Dyspnea, coarse crackles, productive pink tinged, frothy sputum, orthopnea.
• Decrease IV flow rate (TKVO), seek physician advice.

Question 27

Good IV start

Answer 27

• Great flow when IV is “opened up”
• Zero infiltration, pain, swelling
• Flashback chamber readily clears of blood when running IV fluids
• Medications or saline push are easily administered with little or no resistance.

Question 28

Bad IV start

Answer 28

• NO flow when opened
• Pain, swelling, hematoma at site
• Flashback chamber full of blood when trying to run IV fluids
• Drip Chamber remains inactive

Question 29

Care of the Patient with an IV in Place

Answer 29

• Assess the infusion site every 30 minutes to make sure contrast has not infiltrated
• The IV pole should be 18 to 24 inches above the injection site
• IV drugs act quickly so the technologist must be alert to reactions