Vol.1-Ch.14 "IV Acess and Medicine Admin" Flashcards
What 5 things should you record when giving a Pt meds?
Document:
- drug given
- dose
- time
- route
- patient’s response
6 Rights = ?
- right drug
- right Pt
- right dose
- right time
- right route
- right documention
Before moving Pt from ambulance account for all?
Ensure all sharps accounted for before removing patient from ambulance
Enteral medications:
placed?
Dont’s?
Advantages?
Place under tongue with gloved fingers
Not swallowed, spit out, or rinsed
Advantages: accessibility, rapid onset
Buccal enteral meds (ex. glucose) are placed?
In pocket between cheek and teeth
Intralingual injections are placed where?
with what gauge and size needle?
Injected into underside of tongue
25-gauge, 5/8-inch needle
5 different injection routes?
Injection routes:
- intradermal (ID)
- subcutaneous (Sub-Q)
- intramuscular (IM)
- intravenous (IV)
- intraosseus
Steps in order of intramuscular injection
Prep; prepare correct medication dose; select injection site; cleanse site with alcohol wipe using circular motion from center out; allow to dry
Spread skin at site; hold skin taut, insert needle at 90-degree angle with quick, darting motion
Pull back plunger slightly, check for blood; if blood present, remove needle; if no blood, inject medication with slow, continuous motion, withdraw needle; massage area; apply pressure with gauze if bleeding, apply bandage if needed; observe patient; properly dispose sharps; document
asepsis means?
environment free of all forms of life
what speed are transdermal meds absorbed? what are some common ones?
they are absorbed slowly.
commonly nitro, hormones, and analgesics
Mucous membrane routes include? (4)
are these fast or slowly absorbed?
moderate to fast absorption
- sublingual
- buccal
- ocular
- nasal
When using nebulizer how much saline do you combine your med with?
At what liters per minute should you set the O2?
3-5ml
5-8 liters per minute
Types of pulmonary med admin? (3)
Nebulizer
Metered dose inhaler
Endotracheal Tube
Elixirs VS Emulsions VS Suspensions VS Syrups
Elixirs = liquids combines with alcohol or places in a sweetened fluid.
Emulsions = meds combined with a fat or oil emulsifier
suspensions = a liquid that contains small particles of solid medication
Syrups = A concentration solution of sugar in water or another liquid to which a med is added.
Enteral Medication Admin Routes? (3)
Oral
Gastric Tube
Rectal
Parenteral routes include?
syringes and needles (hypodermic needle)
Main two components of a syringe?
plunger and barrel
6 types of parenteral packaging
- glass ampules
- single and multidose vials
- nonconstituted medication vials
- nebulizer vials
- prefilled syringes
- intravenous medication fluids
Intradermal injetions: (dermal is just below epidermis which is the upper most layer) (dermal is shallow layer)
needle size? injection angle? bevel up or down? Rub or no rub site after and why? Pinch skin or pull taught? absorption slow or fast?
- 25 to 27 gauge ; 3/8th to 1 inch long
- 10-15 degree angle
- bevel up
- do not rub site after because it promotes systemic absorption and negates localized effect
- skin gets pulled taught (you don’t pinch because your going so shallow)
- slow absorption
Subcutaneous injections: (aiming for subcutaneous tissue, which is just below the dermis, which is just below the epidermis)
needle size? injection angle? bevel up or down? rub or no rub site after? pinch skin or pull taught? absorption slow or fast?
- 24 to 26 gauge ; 3/8th to 1 inch long
- 45 degree
- bevel up
- you can rub if needed to promote systemic absorption (you can also draw an extra .1mL of air and get it on the plunger side in order to push meds in a little further and reduce chances or med or blood leakage)
- pinch a 1 inch fold of skin
- slow absorption
When injecting and you draw in before pushing meds, and blood is present what do you do?
Start over with NEW needle
after preparing your equipment and checking medication what is the next step? what is the step after that?
your 3rd step is to draw the medication into syringe or needle ; the 4 step following is to clense the injection site
(starting at intended injection site and moving outward to push any germs away from site)
Preferred intradermal injection sites are?
Typical amount of mL of medicine given is?
- forearm and upper back
- typically less than 1mL
(useful for allergy testing or TB testing)
Preferred subcutaneous injection sites are?
Typical amount of mL of medicine given is?
- anywhere you can easily pinch skin ; upper arms, thighs, and sometimes abdomen
- typically less than 1mL
Intramuscular injections:
needle size? injection angle? bevel up or down? pinch skin or pull taught? absorption slow, moderate, or fast?
- 21 to 23 gauge hypodermic ; 3/8 to 1 inch
- 90 degree angle
- bevel up
- pull skin taught
- moderate absorption
Recommended injection sites for intramuscular?
how many mL can go in each site?
- deltoid (up to 2mL)
- dorsal gluteal (5mL) (must miss the sciatic nerve!)
- vastus lateralis (5mL)
- rectus femoris (5mL)
Advantages and disadvantages to peripheral venous access?
Advantage:
easy to see / access
easy to do while performing other procedures
Disadvantaged:
they collapse easy in hypovolemia or circulatory failure
peds and geris can be delicate and hard to cannulate
When trying different venous access points where should you start trying and in what direction should you move?
Start trying distally then move proximally as needed
Advantages and disadvantages of central venous access?
Advantage:
good for reuse in hospital setting
they don’t collapse easy
disadvantages:
they require xray to confirm placement
cannot be used with other procedures like CPR
they risk things like air embolism, rupture, etc
Which type of access is not one that paramedics will use but may run into in transports between hospitals?
Central Venous Access
What is a PICC and when is it usually used?
Its a Peripherally Inserted Central Catheter; typically used in children with long hospital stayed; it is a long thin tube that is inserted in a peripheral venous access but threads to a central vein (we wont be inserting these)
What is a Colloid and what are 4 common ones?
Colloidal solutions contain large proteins that cannot pass through the capillary membrane. They help maintain vascular volume (not usually given in prehospital care)
- Plasma protein fraction
- albumin (each gram given can retain 18mL of H2O in blood)
- dextran
- hetastarch
What is are Crystalloids?
3 types of concentrations?
Crystalloids are the primary out of hospital care IV solutions given, they are a combo of electrolytes and water.
(solutions measured by “tonicity”)
Isotonic solutions: Equal tonicity to blood plasma
Hypertonic solutions: Have higher solute concentration (makes fluids move out of cells)
Hypotonic solution: Have lower solute concentration (makes fluids move into cells)
To make sense of fluid motion remember that water is going to move towards whichever side has more solute (like salt and water) (to hyper is like pooring in salt to soak up water while hypo is like pooring in a bunch of water into salt pockets.
3 Most commonly used IV fluids and what are they?
- Lactated Ringer’s (Hartman’s Solution) - Isotonic solution containing sodium chloride, potassium, chloride, calcium chloride, and sodium lactate in water. (isotonic electrolyte solution)
- Normal saline solution - Isotonic electrolyte solution with 0.9% sodium chloride in water.
- 5% dextrose in water (D5W) - hypotonic glucose solution used to keep a vein patent and to supply calories needed for cellular metabolism.
Should you ever warm or cool IV fluids?
Yes you can warm or cool IV bags to lower or raise PT body temp; either a fridge or heater can be used or the trucks heater/ac
What is the most desirable fluid for replacement?
Whole blood; it is seldom used in ambulance though because it is a precious commodity and usually saved for mass casualty incidents or helo-air care
3 pieces to IV packaging? (bags)
- label
- medication administration port
- administration port
Parts of macro and micro drip tubing and brief description: (8)
- spike (sharp plastic piece that pierces the IV admin port)
- Drip chamber (clear, squeezable chamber usually 3/4 full that allows you to see the drip rate)
- Drop former (plastic piece that comes through the top of the drip chamber and is either very narrow or a little wider depending on micro or macro)
- Tubing
- Clamp (is able to immediately stop flow, also prevents air entering when bag is changed or backflow of fluids/meds)
- flow regulator (allows for constant flow monitoring; rolled toward bag increases drip flow, towards pt decreases drip rate)
- medication injection port (port that allows for hypodermic needle to inject meds into ; some models dont need hyperdermic needle)
- Needle adapter (rigid plastic device designed to fit into the hub of an intravenous cannula)
3 basic types of IV cannulas:
- Over-the-needle catheter (IV catheter or cannula)
- Hollow-needle catheter
- Plastic catheter insert through a hollow needle
Micro VS Macro drip rate per 1mL
When would you want to use them?
Microdrip = 60 drops per 1mL Macrodrip = 10 drops mer 1mL
Micro is good for when you need to watch how much fluid you give your pT
Macro is good for fluid replacement in situations like shock, or hypotension
Over-the-needle catheter is also called the?
4 parts include?
IV catheter or cannula and it is a semi flexible catheter enclosing a sharp metal stylet; hollow; beveled
- metal stylet (needle)
- flashback chamber (lets you see blood enter when you’ve entered the vein, confirms placement)
- Teflon catheter (slides over the metal stylet into a successfully punctured vein
- Hub (on back of teflon catheter, recieves the needle adapter of the admin tubing once removed from the metal stylet.
For peripheral venous access which IV cannula is preffered? why?
over-the-needle catheter is preferred because it is easier to place and anchor; permits freer movement.
Which IV cannula is better for children or Pts with smaller/delicate veins?
Hollow Needle Catheter
Hollow Needle Catheter is also called? Describe it?
Winged or Butterfly Catheters (because they have wings for guidance); they do not have a teflon tube and instead just use the stylet and secure it
Catheter inserted through the needle is also called what? Desribe it.
AKA - intracatheter
It is a Tephlon catheter that is inserted through a large metal stylet used in the hospital setting to implement central lines (we will not use these)
What are the different uses for a 22 gauge, 20 gauge, and (18/16/14) gauge?
- 22 gauge (small) is good for fragile veins (old and young)
- 20 gauge (medium) is good for average adult that does not need fluid replacement
- 18/16/14 gauges are used to increase volumes or viscous meds.
Blood can only be given by what gauge or larger?
16 gauge or larger
On what side of the intended injection site do you place the venous constricting bang? What is maximum amount of time you should leave the band on for?
On the proximal side of injection side (to stop venous return and engorge veins); it should be left on no longer than 2 minutes
What might you want to do after injection of IV catheter but before connecting an IV tube?
Take a venous blood sample
8 steps of Peripheral Intravenous access?
- Place constricting band
- Cleanse venipuncture site
- Insert IV cannula into vein
- Withdrawl any blood samples needed
- Connect IV tuing
- Turn on the IV and check flow
- Secure Site
- Label intravenous solution bag
Steps to prepare the IV bag before IV injection and tubing connection? (5)
- Examine IV fluid for clarity and exp date
- Spike the IV bag
- Squeeze fluid into drip chamber to fill line
- Open clamp/flow regulator and flush solution through tubing to remove any air bubbles
- Shut down flow regulator and replace cap over the needle adaptor (remember if contamination occurs this must be restarted with new equipment)
What should be placed on the label that goes onto the IV bag?
- Date and time initiated
- Person initiating the IV access
All 12 steps in order of Intravenous access in the hand, arm, leg: (step 6 is insert IV cannula, try to remember what comes before and after)
- Confirm indication of type of IV access needed/ gather needed equipment
- Prepare all needed equipment (including IV bag)
- Select Venipuncture site
- Place constricting bang
- Cleanse venipuncture site
- Insert IV cannula into vein
- Slide catheter over needle into vein
- Obtain venous blood sample
- attache the admin tubing to cannula
- Cover catheter and puncture site with adhesive
- Label IV bag
- Continually monitor Pt
When inserting an IV should you pinch or pull skin taught?
Bevel?
Angle?
- pull skin taught to stabilize the vein and keep it from rolling
- Bevel up
- Insert at 10 to 30 degree angle
(continue until you feel the “pop” of entering the vein and blood go into the flashback chamber)
When inserting a catheter, how far past the needle end should you insert it?
0.5cm
After you insert the catheter with the stylet still in, how do you take the stylet out?
Once catheter is inserted, tamponade (press down slightly) at the catheter tip to prevent blood from flowing from the catheter and or air from entering into the circulatory system as you remove the stylet.
When you need to continue IV therapy, at what mL do you start to prepare a new bag?
When your current bag gets around 50mL you can prep the new bag
What is an intravenous bolus?
involves injecting the circulatory system with a concentrated dose of medication through the medication admin port of an established IV
Intravenous infusion is also called what? what is it?
AKA “Piggybacking”
Deliver a steady, continual dose of medication through an existing IV line
If IV infusion is premixed, what should you check the label for? (4)
(if its not premixed you should put this info on the bag label you put on)
- Name of med
- Total dosage in weight mixed in bag
- Concentration (weight per single mL)
- Expiration date
(if its not premixed you should put this info on the bag label you put on)
what is a herapin lock?
A herapin lock is a peripheral IV port that does not use a bag of fluid. It is for Pts that need the occasional bolus but not a continuous flow of fluids or meds
What should be injected into a herapin lock following meds and why?
After meds inject sterile saline to fill the port and keep it open
3 types of venous access devices?
Placed into what kind of veins and why?
- Tunnel
- Medication port
- Peripherally inserted central catheter (PICC)
placed into large veins because they clot less easily and can remain in place for a long period of time
Electromechanical infusion pumps are?
devices that permit precise delivery of fluid and or medication through electronic regulation
2 types of electromechanical infusion pumps?
- infusion controllers : gravity flow devices that regulate the fluids passage through the pump
- Infusion pumps : deliver fluids and meds under positive pressure.
Obtaining blood samples:
purpose?
safety precautions?
Purpose:
- Baseline evaluation
Safety precautions:
- Label tube with patient name, date, time, your initials - Tape sample to bag, give to ER receiving party
what steps should you take when you have a reaction giving an IV? (7)
- Immediately discontinue blood infusion
- Open primary IV line
- Rapidly infuse normal saline
- High-flow oxygen
- Continually monitor patient for changes
- Contact medical direction for orders
- Save blood bag, tubing, must be returned to lab for analysis
Sites for intraosseous infusion sites: (4)
- proximal tibia (most commonly used) (medial and inferior to the anterior tibial tuberosity) - medial malleolus of the distal tibia - humeral head - sternum
the tibia is comprised of?(3)
where do you insert an IO?
- the middle diaphysis and the two epiphyses at the ends
- locate the tibial tuberosity and move 1-2 fingers blow and find the flat expanse medial to the anterior tibial crest
