Week 2- Venous Access Flashcards
What are the 3 objectives to Intravenous therapy?
- Restore & replace intravascular volume
- Administer medications & or emergency pharmacological tx
- Maintain venous access in emergency situations
What is IV cannulation used to gain?
the body’s circulation
What are the indications for intravenous therapy?
- To administer fluids, TKVO
- Admin drugs
- Obtain specimens for laboratory determinations
What are macro drip sets?
- 10, 15, 20gtt/ml
What are macro drips sets used for?
- Most commonly used
- Effective for TKVO & large fluid bolus
What are micro drip sets?
- Always 60gtts/ml
What are 4 reasons micro drip sets used for?
- To deliver meds over a long period of time
- Assist in the precise measurement of meds
- To control amount of fluid
- To control fluid overload in certain pts
What are the benefits to using saline lock?
- No tubing to worry about
- Easy to move pt
- Still allows quick access to vein
- More cost effective
- Greater freedom for pt
- Reduces fluid overload
- PCP can monitor pt’s with heparin & saline locks during transfer without an escort
What will catheter size depend on?
- Your purpose (fluid replacement vs med admin)
- Size of the vein you’re going for (fluid bolus= bigger vein)
- Pt’s age & condition (hypothermia/ shock/ elderly/ obese)
- Nature of infusion (TKVO?)
What are the catheter selections and colours?
Yellow= 24
Blue= 22
Pink= 20
Green= 18
Grey= 16
Orange= 14
What is the most common gauge used on adults?
20 gauge
What is the most common gauge used on peds & elderly?
22 gauge
What are crystalloids?
- Dissolving crystals such as salts & sugars in water
- Contain NO PROTEINS
What are examples of crystalloids?
- Normal saline & Lactated ringers
What is the action of crystalloids?
- Remain in the intravascular space for only a short time before diffusing across the capillary walls into the tissue
What are colloids?
- Contain large molecules such as PROTEIN
What are examples of colloids?
- Plasma subsititutes
- Plasma
- Packed red blood cells & whole blood
- Plasmanate
- Dextran
- Hetastarch
What is the action of colloids?
- Don’t pass through the capillary membranes as readily as crystalloids
What does hypotonic mean?
- Lower solute in the solution- causes water to go into the cell
What does hypertonic mean?
- Higher solute in the solution- causes water to leave the cell
What does isotonic mean?
- Equal inside and outside the cell
What solutions can PCP’s monitor without an escort?
- NS/ Ringers/ D5W/ Potassium chloride/ Thiamine & multivitamins/ saline locks
What solutions require an escort?
- Blood products/ meds being infused/ IV Pumps/ Central lines/ Jugular lines
When checking the solution, what should you being looking for?
- Leak/ precipitation- while in plastic wrap
- Correct solution name
- Expiry date
- Cloudiness/ discolouration
Each bag contains enough solution to:
- Flush the admin set (good for 24 hours)
- Allow for accurate reading of volume even with sterile air in the bag
What equipment do you require for IV?
- Tourniquet
- 2x2/ 4x4 dressing
- IV pole
- Opsite
- Alcohol wipes
- Sharps container
- Catheters
- Admin set/ IV bag/ or saline lock
What puncture sites should be avoided?
- Injury or disease to an extremity
- Trauma (# rt hip= IV on Lt. arm)
- Deficits- CVA
- Dialysis fistula
What are common causes to unsuccessful IV’s?
- Angle of entry too steep- cut through the vein
- Not enough tension on skin- vein rolling
- Attempting while in a hurry
- Stylet not retracted enough during disconnection phase
- Lack of confidence & experience
What are some flow rate complications?
- Venous pressure (position of pt’s extremity)
- Vein spasms (irritating or chilled fluids)
- Phlebitis & thrombi
- Viscosity
- Amount of fluid in bag
- Height of fluid
- Tubing occlusions
- Needle or gauge size
- Needle/ cannula position
- Infiltration (edema & intersitial site)
What are some local complications?
- Pain & irritation
- Infiltration & extravasation
- Phlebitis
- Thrombosis & thrombophlebitis
- Hematoma formation
- Venous spasm
- Vessel collapse
- Cellulitis
- Nerve, tendon, ligament and limb damage
What can cause infiltration?
- Dislodgement of catheter or needle cannula
- Puncture of distal vein
- Leakage of solution into surrounding tissue from cannula insertion site
- Poorly secured IV
- Poor vein or site selection
- Irritating solution or med that inflames the intima of his vein and causes it to weaken
- Improper cannula size
- High delivery rate or pressure of the solution or med
What are the sign & symptoms of infiltration?
- Coolness of skin around IV site
- Swelling at the IV site, w or wout pain
- Sluggish or absent flow rate
- Infusion conts to infuse when pressure is applied to the vein above the tip of the cannula
- No back flow of blood into IV tubing when clamp is fully opened & solution container lowered below IV site
What are systemic complications?
- Contamination & infection
-Hypersensitivity rxns - Sepsis
- Emboli (blood clot, air, catheter)
What can cause a hematoma?
- Leakage of blood from the vessel into the surrounding soft tissue
- This can occur when pressure is not applied to the IV site when the catheter is removed
Sign and symptoms of hematoma?
- Bruising at the insertion site
Prevention & management of hematoma?
- Controlled with direct pressure & will resolve over 2 wks
Cause of extravascular injection?
- Injection of a drug extravascularly
What are the sign & symptoms of extravascular injection?
- Pain
- Delayed absorption or tissue damagE
What is the prevention and management of extravascular injection?
- DC IV and treat with specific antidote to the agent
What is the s&s of air embolism?
- Hypertension
- Cyanosis
- Weak & rapid pulse
- LOC
What is the management of air embolism?
- Close tubing
- Turn pt on left side with head down
- Check tubing for leaks
- Administer high O2
- Notify medical direction
What are mechanical complications?
- Changes in the position of needle
- Height of solution
- Amount of solution
- Position of pt- kinked tubes
- Disconnected tubes
- Plugged air vents & or plugged needles/ cannula
What are our IV monitoring limitations?
- Blood products
- Meds
- Central lines/ or jugular
- IV pumps
- IV restarts- unless previously authorized
- Neonate or ped pt’s with IV’s
What should you report to hospital staff?
- Location of IV
- Size of catheter
- Flow rate & how much fluid pt has received
- Any problems encountered/ failed attempts
What are the indications for intravenous and fluid therapy medical directive?
- Actual or potential for intravenous med OR fluid therapy
What are the conditions for IV cannulation?
Age= > 2 yrs
What are the conditions for NaCl fluid bolus?
- Age= >2 yrs
- SBP= Hypotension
Contraindications for IV cannulation?
- Suspected fracture proximal to the access site
Contraindication for NaCl fluid bolus?
- Fluid overload
Treatment for IV NaCl maintenance infusion? (between 2-12)
- Infusion= 15ml/hr
Treatment for IV NaCl maintenance infusion? (>12 yrs)
- Infusion= 30-60ml/hr
Mandatory Provincial Patch Point
- Patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive pt’s 2-12 yrs with suspected DKA
Treatment for IV NaCl fluid bolus? (2-12 yrs)
- Infusion= 20ml/kg
- Reassess every= 100ml
- Max Volume= 2,000ml
Treatment for IV NaCl fluid bolus? (>12 yrs)
- Infusion= 20ml/kg
- Reassess every= 250ml
- Max volume= 2,000ml
