Week 1 & 2 IV infusion therapy Flashcards
What are the 5 reasons people need IV infusion?
- can’t drink/eat - NPO
- cuz they’re N &V - replace fluid
- Diabetes insipidus - peeing it out like a B
- Blood loss - hypovolemic
- losing it through skin- burns- insensible losses
What does Maitenence fluid therapy do?
give water or electrolytes that would normally be taken in but can’t/aren’t
What does replacement fluid therapy do?
replace losses due to hypernatremia and add K+
Who is hypotonic fluid for and why?
- dry mucous membranes (dry cells)
- Hypertension
b/c it causes fluid to move out of the Vascular system and into the cells. Lowers BP and hydrates cells
who is hypertonic fluids for and why?
- low BP
- Edema
b/c it draws water out of intracellular and interstitial space into the vascular system
Who is isotonic solutions for?
- hypovolemia
- replace fluids in vascular system
What IV fluid do we NOT give to infants or people with any head injury and why?
D5W (Dextrose in water)
can cause cerebral edema because the sugars get broken down in the body and then it becomes hypotonic. Fluid will be drawn out of the vascular system and into the interstital/intracellular spaces
what are the 3 isotonic fluids?
- 0.9% NaCl normal saline (NS)
- LR (Lactated ringer)
- D5W 5% (dextrose in water)
What are 2 hypertonic solutions
- D5NS, D51/2NS (dextrose 5% in NS or 1/2NS)
- D5LR, 3% or 5% sodium chloride (Dextrose 5% in Lactated ringer - can be 3% or 5% NaCl
what are 2 hypotonic solutions
- 0.45% NaCl (1/2 NS)
- 0.33% NaCl (1/3 normal saline)
Which isotonic solutions do not provide fluid shift and which do?
no shift: 0.9 NS, LR
yes shift: DSW
what are the 3 things that Isotonic 0.9% NS and LR do in the body?
- fill up vascular system (BP)
- Replace fluid loss
- replace electrolytes
what 1 thing does isotonic D5W do in the body?
- Shifts fluid into cells and hydrates them
What are the 5 indications of isotonic 0.9% NS and why?
- shock - hypovolemia
- Resuscitation - BP/hypovolemia
- blood transfusions
- Hyponatremia - because they contain 0.9% NaCl/100mL or 9g in 1L
- DKA - restore blood volume and sodium initially
What are the 5 indications of LR (more similar to blood plasma & less NaCl)
- Dehydration -
- Burns-
- GI tract fluid losses
- acute blood loss
- Hypovolemia
What are the 4 indications for isotonic D5W? (becomes hypotonic in body)
- Fluid loss
- Dehydration
- Hypernatremia- to much sodium in blood stream
- Hyperkalemia- too much potassium in blood stream
What 1 thing does 1/2 NS and 1/3 NS do in the body?
shifts fluids into cells and hydrates them
what are the 4 indications for 1/2 NS or 1/3 NS ?
- Hypertonic fluid imbalance
- Improve renal function
- Fluid loss - replace
- Cellular dehydration
What are the 7 indications of D5LR (Dextrose 5 %, lactated ringer)
- electrolyte replacement
- Dehydration
- Burns
- GI tract fluid loses
- Acute blood loss
- Hypovolemia
- Nutrition (calories b/c sugar)
what are the 3 indications for D5 0.9NS (Dextrose 5% in 0.9% NaCl normal saline) ?
- Fluid loss
- Hyponatremia
- Nutrition (calories)
What are the 3 indications for D5 0.45NS (Dextrose 5%, half NaCl normal saline) and their risks?
- Post-op
- Nutrition (calories)
- Rehydration - = fluid overload, pulmonary edema,
what is one risk that is different for D5LR from D5.9NS and D5.45NS and why?
hyperkalemia b/c lactated ringer has potassium in it
What can D5LR replace that D5.9NS and D5.45NS can’t?
electrolytes
What solution is used for acute blood loss?
D5LR
What is a risk with any D5 IV solution?
hyperglycemia
What are the main 4 risks of hypertonic fluids?
- Fluid overload
- Pulmonary edema
- hyperglycemia
- Iv sites phlebitis and infiltration
Which fluid is typically indicated for Post-op and why?
D5 .45NS
Dextrose (calories)
Rehydration of vascular system b/c fluid drawn in
Which 3 dx should caution be used with Hypertonic solutions and why?
- DKA - already high BS
- Cardiac patients - fluid overload/pulmonary edema (arythmias with D5LR)
- Renal (kidney) issues - fluid overload & glucose excretion issues
What is the main risk of 0.9NS and why?
Fluid overload
b/c you’re just filling the vascular system
What are the 2 main risks of LR and why?
- Fluid overload b/c you’re filling the vascular system
- Hyperkalemia b/c potassium in LR
Which solution causes vein irritation?
D5W
what are the dx that caution should be taken when giving 0.9 NS and why?
- HTN, HF, Edema - fluid overload
- Hypernatremia - b/c it has NaCl in it
what are the dx that should not have LR and why?
- Liver disease - can’t metabolize the lactate
- cardiac patients - fluid overload + hyperkalemia
what are the dx that should not have D5W and why?
- increased ICP (hypotonic in the body and can increase fluid in brain/body)
- renal patients - edema
- cardiac patients - edema
What are the risks with hypotonic fluids and why?
- Hypotension - fluid out of vascular system and into cells
- increase peripheral edema - fluid into extracellular spaces
- increase ICP - fluid out of vascular system
- hyponatremia -
- IV site phlebitis- foreign object in skin
what dx should caution be used with hypotonic fluids?
- stroke - fluid shift
- head trauma - fluid shifts
- increased ICP - fluid shifts
- severe burns - fluid shifts out of the skin (they already lose water through burns)
How often do we change primary infusion tubing?
every 96 hours ( 4 days)
how often do we change IV bag?
every 24 hours
What are 2 benefits to PIV saline locks?
- patient more mobile
- intermittent infusions
how often do we change needleless connectors?
- every 7 days
- contaminated or residual blood is in the device after flushing
how many cc of NS do we use to flush IV ?
2-3cc of NS
Do we aspirate for blood before or after initial flush?
After. Flush first, aspirate second.
if no blood return, how many cc’s of NS while watching for swelling, pain, patency?
min 3cc - max 10 cc
if NS lock is not in use, how often do we flush?
Q 24 hrs or D/C if not required anymore
What are 3 causes of Phlebitis?
- Mechanical
- Chemical
- Bacterial
How often do we assess running IV’s for inpatient and nursing facilities?
at least every 4 hours
how often do we assess running IV’s for patients who are critically ill/sedated or have cognitive deficits?
Q1-2 hours b/c they can’t tell us how the IV is going
How often do we assess running IV’s for neonatal/pediatric patients?
Q1h
How often do we assess running IV’s for patients receiving infusions of vesicant medications?
more often
Can prefilled syrnges be used for dilution and reconstitution? Why or why not?
no
1. because the label says NS so any additional medication makes the label wrong
2. volume is “approximate” and not good for reconstitution
When do we do first check for mini bag?
When we gather supplies
When do we do second check for mini bag?
just before dilution (just before mini bag)
When do we do our third check for mini bag?
patient bedside
Do we use the MAR or Doctor’s order for mini bag and why?
MAR because the order doesn’t have the right “time”
how often must any IV tubing be changed?
96 hours or 4 days
Any tubing (primary or secondary) that is disconnected from the patient must be changed how often?
q 24 hrs
The 96 hour tubing rule does not apply to which solutions/liquids?
lipids
TNA
propofol
blood/blood products
Can we use the same tubing for a newly inserted central line that we used for peripheral?
no. must get new tubing
How many mL must we use to flush the line after piggy back medication is done?
15 mL - set pump
