Test 1 Flashcards
1
Q
What is Intravenous Cannulation
A
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.
2
Q
Objectives of IV Therapy
A
- maintain or replace blood volume
- restore acid-base balance
- provide a route for medication administration
3
Q
Epidermis
A
- 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
4
Q
The Dermis
A
- 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
5
Q
Tunica intima of blood vessel
A
- inner layer
- semi-elastic
- smooth surface allowing blood cells to slide more easily
6
Q
Tunica media of blood vessel
A
- muscle
- vasoontricts and vasodilators in response to hormones, temperature and trauma
6
Q
Tunica external of blood vessel
A
- outer layer
- connective tissue that holds the vein in place
7
Q
Veins vs arteries
A
- 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)
8
Q
Good Vein for IV
A
- fairly straight
- easily accessible
- well fixed, not rolling
- springy when palpated
9
Q
Bad Vein for IV
A
- sclerotic (rigid, hard)
- near joints
- close to a palpable arterial pulse
- near injured areas
- near oedematous extremities
- in an extremity with circulation problems
10
Q
Indications for IV Therapy
A
- important addition in treatment of cardiac treatment, hypoglycemia, seizures, shock
- hypovolemic pt: usually need at least two IV lines with large-bore catheters
- intravenous medication: administered into bloodstream
- precautionary measures: in stable pts whose deterioration is anticipated
- IV administration of CM
11
Q
Contraindications for IV Therapy
A
- sclerotic veins
- burned extremities
- avoid if possible: previous IV infiltration/extravasation, injured/infected extremity, arteriovenous fistula, phlebitis
12
Q
Solutions
A
- a liquid preparation of one or more soluble chemical substances usually dissolved in water
- All intravenous solutions are composed of ions and water
13
Q
Crystalloid
A
- 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
14
Q
Colloid
A
protein-laden plasma expanders that do not pass semipermeable membranes, rather they draw water in
15
Q
Intracellular
A
-within the cells
- ICF intracellular fluid
16
Q
Extracellular
A
- within the blood vessels and between the cells (interstitial)
- ECF: extracellular fluid
17
Q
IV Gauge Sizes
A
- 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
18
Q
Localized Hematoma
A
- Discolouration of the skin
- Discomfort and potential swelling
- Subcutaneous hematoma is the most common complication
- Can lead to thrombophlebitis or infection
18
Q
Localized Pain
A
- 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
19
Q
Localized Extravasation
A
- 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
19
Q
Localized Infiltration
A
- 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
20
Q
Localized Phlebitis
A
- 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
21
Q
Localized Thrombus
A
- 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.
22
Q
Localized Infection
A
- Common causative agents
- Staphylococcus, Fungus
- Redness, swelling, itching, pain, heat
- Discontinue, document, and recommend physician consultation
23
Q
Systemic Pyrogenic
A
- 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
24
Q
Systemic Embolism
A
- 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
25
Q
Systemic Pulmonary Embolism
A
- 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.
26
Q
Systemic Pulmonary Edema
A
- 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.
27
Q
Good IV start
A
- 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.
28
Q
Bad IV start
A
- NO flow when opened
- Pain, swelling, hematoma at site
- Flashback chamber full of blood when trying to run IV fluids
- Drip Chamber remains inactive
29
Q
Care of the Patient with an IV in Place
A
- 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
