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Therapeutic Skills > Week 11/12 - IV Therapy > Flashcards

Week 11/12 - IV Therapy Flashcards

1
Q

Purposes of IV Therapy (6)

A
  • To maintain fluid, electrolyte and energy demands
    To prevent fluid and electrolyte imbalances
  • To administer blood and blood products
  • To administer TPN (total parenteral nutrition)
  • To administer prescribed IV medications (ex: antibiotics)
  • To have venous access in emergency situations: TKVO (to keep vein open) or KVO (keep vein open)
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2
Q

Nursing responsibilities for IV therapy (5)

A
  1. Assess need for IV therapy
  2. Assess IV site
  3. Assess/maintain prescribed IV flow rate
  4. Assess patient response to IV therapy
  5. Prevent complications associated with IV therapy
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3
Q

Two types of vascular access devices

A

Peripheral Vascular Access Devices (PVADs)

Central Vascular Access Devices (CVADs)

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4
Q

Peripheral Vascular Access Devices (PVADs)

A

Short term use

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5
Q

Central Vascular Access Devices (CVADs)

A
  • Long term use
  • Medications and solutions irritating to veins
  • Peripheral access is limited or contraindicated
  • Large volumes of fluid
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6
Q

Angle of inertion of IV cannula

A

30 degrees

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7
Q

Age-related considerations for IV therapy (6)

A
  • Use a smaller gauge needle (22 – 24g)
  • Choose site that does not interfere with ADLs
  • Use minimal tourniquet pressure
  • Lower angle of insertion
  • Apply traction to the skin below insertion site
  • Use a protective device
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8
Q

Intracellular Fluid

A

Fluid within the cells

Accounts for 60% of body fluids

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9
Q

Extracellular Fluid

A

Fluid outside of the cells:

Interstitial – between the cells and outside of the vessels

Intravascular – blood plasma

Transcellular – cerebrospinal fluid, peritoneal, synovial and GI tract

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10
Q

Cystalloids

A

IV Fluid

Contain solutes that mix, dissolve and cross semi-permeable membranes easily.

Examples:
Na Cl (electrolytes)
Dextrose
Lactated Ringer’s

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11
Q

Colloids

A

IV Fluid

  • Contain proteins or starch that do not cross semi-permeable membranes.
  • Remain in extracellular space/intravascular fluid
  • Used to increase vascular volume

Examples:
Blood
Plasma proteins
Pentastarch

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12
Q

Total Parenteral Nutrition (TPN)

A

Nutritionally adequate solution
Glucose
Nutrients
Other electrolytes

Can be given continuously or intermittently.

Almost exclusively infused by central line.

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13
Q

Isotonic solution

A

Same osmolarity as blood

Expands fluid volume without causing fluid to shift between compartments

Used when we need to increase intravascular volume (e.g. diarhea, vomiting, shock)

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14
Q

Hypotonic solution

A

Lower osmotic pressure

Moves fluid into cells, causing them to enlarge (hydrates cells)

Used to treat cellular dehydration (e.g., dialysis or pts on diuretics)

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15
Q

Hypertonic solution

A

Higher solute concentration (osmolarity)

Pulls fluid away from cells, causing them to shrink (dehydrates)

Used when clients have cerebral edema, severe hyponatremia

Short-term use only.

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16
Q

Examples of isotonic solutions

A

Normal Saline (0.9%)
Dextrose 5% in water (D5W)
Lactated Ringer’s (LR)

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17
Q

Examples of hypotonic solutions

A
  1. 45% NS

0. 225% NS

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18
Q

Examples of hypertonic solutions

A

Dextrose 10% in water (D10W)
3-5% NaCl/NS
D50.45%NaCl
D5LR

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19
Q

Considerations for hypertonic solutions

A

Risk of fluid overload

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20
Q

Considerations for isotonic solutions

A

Risk of fluid overload

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21
Q

Considerations for hypotonic solutions

A

Monitor for hypovolemia (fluid is leaving vessels and going into cells, resulting in hypovolemia and hypotension)

Careful with pts with increased intracranial pressure, because we
don’t want fluid to shift into cell of brain tissue.

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22
Q

Common additives to IV solutions

A

Potassium Chloride (KCl) - must be given carefully (lethal)

Multivitamins

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23
Q

Macrodrip IV tubing

A

Primary Infusion IV Tubing

10 or 15 ggt/mL

Used for all routine IVs in adult setting

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24
Q

gtt

A

drop

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25
Q

Microdrop IV tubing

A

Primary Infusion IV Tubing

60 ggt/mL

Used in peds and neonatal and critical care to give IV volume with increased precision

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26
Q

Buretrols

A
  • volume control devices
  • used in peds to avoid fluid overloading

This chamber can be filled with a smaller volume than the IV bag… but it’s used less and less in practice

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27
Q

Two ways to regulate IV Flow Rate

A

Manual regulation using roller clamp (Drops/min aka ‘drip rate’)

Electronic infusion devices (EIDs)/Infusion pumps (mls/hour)

28
Q

Complications of incorrect flow rate

A

Too slow = fluid deprivation; potential for catheter to clot

Too fast = fluid overload

29
Q

Factors that influence flow rate (6)

A 
Patency of IV catheter
Patency of IV tubing
Height of solution
Restrictive IV dressing
Position of extremity
Infiltration (infusion into surrounding tissue)
30
Q

Troubleshooting an IV (6)

A
  • Check site for infiltration
  • Check for kinks
  • Reposition arm
  • Lower bag below arm to check for blood return
  • Raise IV pole
  • Check that slide clamp & roller clamp are open
31
Q

Complications of IV Therapy (7)

A 
Infiltration
Extravasation
Phlebitis
Infection
Bleeding/Bruising
Fluid Overload
Air Embolism
32
Q

Infiltration

A

IV fluids (non-vesicant) enter the subcutaneous space

Characterized by:
Swelling
Pallor
Coolness
Pain (in some cases)
Change in IV flow rate
Leaking from IV site
33
Q

Extravasation

A

Vesicant medications/fluids enter the subcutaneous space

Characterized by:

  • Burning or pain at IV site
  • Swelling
  • Coolness
  • Blistering or skin sloughing
  • Change in IV flow rate
  • Leaking from IV site
34
Q

Phlebitis

A

Inflammation of the vein

Characterized by:

  • Pain
  • Edema
  • Redness (may travel along the vein)
  • Warmth

Can result in blood clots and emboli

35
Q

Infection

A

Characterized by:

  • Redness and possible discharge at IV site
  • Elevated temperature
36
Q

Bleeding/Bruising

A

Risk Factors:

  • Patients receiving heparin
  • Patients with bleeding disorders

Nursing interventions:
- Apply a pressure dressing at the site

37
Q

Fluid Overload

A

Occurs when fluids are given at a higher rate or in a larger volume than the body can absorb or excrete.

Possible complications: hypertension (HTN), heart failure, and pulmonary edema

Treatment will depend on severity (ex: fluid management and/or medication administration)

38
Q

Air Embolism

A

Presence of air in the vascular system that travels into the right ventricle and/or pulmonary circulation.

Characterized by:
SOB
Cough
Neck/shoulder pain
Anxiety/feelings of doom
Light headedness
Hypotension
Increased HR
39
Q

Infection: prevention and interventions

A

Prevention:

  • Use aseptic technique during IV insertion
  • Perform hand hygiene before any contact with the infusion system or the patient
  • Clean injection ports before each use
  • Follow your institution’s policy for dressing changes and changing of the solution and administration set.

Nursing interventions:

  • Stop the infusion and notify the physician
  • Remove the device, and culture the site and catheter as ordered
  • Monitor the patient’s vital signs
40
Q

Air Embolism: prevention and interventions

A

Prevention:

  • Ensure drip chamber is 1/3 -1/2 full
  • Ensure IV connections are secure
  • Remove all air when priming tubing

Nursing interventions:

  • Occlude source of air entry (if known)
  • Trendelenburg position (if not contraindicated)
  • Oxygen
  • Vital signs
  • Notify physician
41
Q

Advantages of IV medication (5)

A 
Rapid Response
Effective Absorption
Accurate titration
Less discomfort
Can be stopped immediately
42
Q

Disadvantages of IV medication (4)

A
  • Solution and drug incompatibilities
  • Immediate adverse reactions
  • Can result in the most serious outcomes of medication errors
  • Long-term use damages vessel intima
43
Q

Physical or pharmaceutical incompatibility

A

When multiple additives are combined

Results in precipitate and cloudiness; can result in occlusion and can be fatal

44
Q

Chemical incompatibility

A

When two drugs are mixed so potency of their active ingredients is changed

45
Q

Therapeutic incompatibility

A

When two incompatible medications are given at the same time

46
Q

Infusion methods for IV meds (5)

A
  1. Continuous infusions
  2. Piggy-back or mini bag infusions
  3. Intermittent infusions
  4. Direct injection (IV push/bolus)
  5. Other methods:
    - volume control (buretrols)
    - PCAs
    - Syringe and smart pumps
47
Q

ENtry-to-practice competency: “Above the drip chamber”

A

All RNs can give IV drugs “above the drip chamber”

48
Q

Continuous Infusions

A
  • Given continuously
  • May or may not contain medication
  • Mixture within large volume of IV fluid

Pre-mixed: heparin drip, morphine drip, KCl added

Added by RN: morphine drip, multivitamins and more

49
Q

Tandem IV set-up

A
  • Equal height to primary infusion
  • Simultaneous infusion with primary line (like a splitter)
  • Monitor closely to ensure primary line doesn’t back up into tandem line
50
Q

Piggy-back of mini-bag infusion

A

Piggy-back (Add-a-Line or secondary medication set) through:

  • Primary IV
  • Device such as saline or heparin lock
51
Q

Piggy-back set-up: which bag is higher and why

A

“Secondary IV” hung alongside primary or main-line and is attached to mainline through injection port below mainline IV.

Used for medications, smaller volumes (50-250cc). Intermittent that we want to interrupt the mainline, and then we want the primary IV to resume once it has finished.

Since we want secondary to infuse first, we hang it HIGHER than mainline generating higher pressure and preventing the primary line from infusing.

Infuse ONE-AT-A-TIME

52
Q

Intermittent Infusion Devices (Saline or Heparin Locks)

A

“Infusion-Port-Adapters”

For medication administration at specific times (not continuously)

Some clients only need an intermittent infusion. Can use extension set or lock so IV can be disconnected between doses.

53
Q

Advantages of Intermittent Infusion Devices (3)

A
  • Freedom for client
  • Cost savings
  • Minimal amount of fluid for patient
54
Q

Disadvantages of Intermittent Infusion Devices (2)

A
  • Must be flushed after each use

- Can clot easily if blood backs up

55
Q

Positive Pressure Caps

A

Used for CVADs

Caps redirects a small amount of fluid into the internal catheter tip when the tubing or syringe is disconnected from the device hub preventing blood reflux into the lumen

56
Q

Use of Positive Pressure Locking Technique

A

To prevent blood reflux from the vein into the lumen of the VAD – thus preventing fibrin build up, clots and device occlusions

57
Q

How to apply Positive Pressure Locking Technique

A

Maintain a forward motion on the syringe plunger as the syringe is removed from the access/injection site. If there is a slide clamp on extension tubing, close it while you are injecting the saline.

58
Q

Direct IV injections (IV push or IV bolus)

A

Administration of medication directly into vein via lock (no IV line) OR through an existing infusion line via port

59
Q

Speed shock

A

Serious, potentially fatal, systemic reaction when a foreign substance is RAPIDLY introduced into the circulatory system.

Direct IV should be given over 1-2min.

Symptoms:
syncope, headache, flushed face, chest tightness, irregular pulse, hypotension shock or cardiac arrest can occur

60
Q

Flushing Method

A

S-A-S

Saline (S)
Administration of med (A)
Saline (S)

Volume per flush is 3-5ml

*Check IV patency first!

61
Q

When to flush (6)

A
  • After blood sampling
  • When converting from continuous to intermittent therapies
  • Before and after medication administration
  • Before and after administration of blood components
  • Before and after intermittent IV therapy
  • For maintenance of a dormant device

*q12h

62
Q

Turbulent Flush Technique

A

Start-stop method to clean inside the device (push-pause)

63
Q

Administering IV Medications Via Buretrol

A

Volume controlled device for very small doses

64
Q

PCA (Patient-Controlled Analgesia)

A

Volume controlled device where pt controls the dose

Maintains a steady and constant level of pain control

Not okay for people with confusion or memory loss

65
Q

Syringe Pumps

A

For small medication volume (5 ml/hr or less)

  • IVPiggy-Backed into primary line or lock
  • Convenient, compact, battery-operated
66
Q

Smart Pumps

A

Have safety features with dose error reduction software to reduce medication error.

Therapeutic Skills (11 decks)

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