Week 5 - IV therapy Flashcards
what is the most commonly used IV access for fluid therapy, medication and blood administration?
PVAD
where is a PVAD inserted?
into a small peripheral vein
how long can a PVAD stay in one spot for?
leave them there as long as needed as long as they are patent and free from complications
what are the indication for a PVAD?
- medication admin
- surgical access
- blood transfusions
- venous access for high volume fluid replacement
what are some possible complications for PVADS?
- infiltration
- mechanical phlebitis
- chemical phlebitis
- cellulitis
- occluded IV
- infection
- hyervolemia
- extravasation
vesicants are medications that can cause what?
- blistering
- tissue sloughing
- necrosis
describe extravasation with vesicant IV solution
infiltration of a solution or medication with the ability to cause tissue damage in tissue around the vein
what are risks for extravasation?
- poor IV insertion/ securing
- fragile veins
- multiple attempts bellow previous puncture site
- altered circulation to limb
- large gauge cannula
- drug amount, concentration, length of use
what are some signs and symptoms for extravasation?
- moderate/ severe pain at site
- redness
- coolness
- swelling
- leakage at site
- ulceration
- blistering
- sloughing
- occlusion
how do you treat extravasation?
- stop infusion
- leave cannula in place
- aspirate as much vesicant as possible
- do not flush
- remove cannula
- outline area with marker
- apply cold/ warm compress
- elevate 24-48hrs
- notify MRP
- document
what type of extravasation is the most common in neonates?
calcium gluconate
what can calcium gluconate extravasation cause?
- tissue necrosis
- sloughing
- calcification of affected area
what are the different types of hypertonic fluids?
- D5NS
- 3% NaCl
- D51/ 2NS
- D5LR
- D10W
what are hypertonic fluids used to treat?
- hypovolemia
- hyponatremia
when treating someone with a hypertonic fluid what do you need to frequently assess?
- BP
- lung sounds
- serum Na
what are the different types of isotonic fluids?
- 0.9% NaCl
- ringer’s lactate
- D5W
what are isotonic fluids used to treat?
- fluid loss
- vascular replacement
- electrolyte replacement
what does ringers lactate contain?
- Na
- K
- Cl
- Ca
- lactate
what is an example for a hypotonic solution?
0.45% NaCl
what is hypotonic solution used for?
maintenance fluids
what type of patient would you NEVER give hypotonic fluids to?
- risk for increased cranial pressure
- extensive burns
- trauma
what are different types of plasma expanders?
- colloids
- plasma
- albumin
what do plasma expanders do?
stay in vascular space and increase osmotic pressure
what do PRBCs do?
increase pressure and pull fluid into the vascular space
what is often given with blood and why?
- diuretics
- prevent fluid overload
how often do IV fluid bags need to be changed after being spiked?
Q24H
when do you need to change primary IV tubing?
Q96H
when d you need to change secondary IV tubing?
Q24H
How often do you need to assess an IV site? What are you assessing for?
- Q1H
- phlebitis
- infiltration
when selecting a site for an IV when do you start?
distal and work proximal
how many times can you try and insert an IV before you have to get a different nurse?
2 attempts
what do you need to include in patient education around IVs?
- purpose
- do not touch IV pump
- proper position for arm
- avoid kinking tube
- mobilize with IV pole
- shower with IV/ keep dry
- watch for redness, swelling, increased pain
as a nursing student what age of patient can you attempt to insert an IV into?
16 +
as a nursing student what age group can you insert an IV into AFTER 3 successful PVAD insertions on adult clients?
5-15 years
what do you need to include in your documentation after an IV initiation?
- date/ time
- gauge of needle/ catheter
- location
- number of attempts
- type/ flow of IV solution
- patient teaching/ understanding
- patient tolerance
what IV fluids change states once infused into the body and why?
- hypertonic and isotonic
- body consumes a portion of the sugar in each solution changing its concentration once inside the body
define extracellular space
space between cells
what is included in extracellular spaces?
- tissue fluid
- water derived from plasma
define intravascular space
within a cell or cells
define intracellular fluid
fluid within the tissue cells
define extracellular fluid
all fluid outside of cells
define third spacing
loss of extracellular fluid from the vascular to other body compartments
what factors should you take into consideration when selecting an IV gauge?
- client specific
- vascular condition
- device specifications
- therapy prescribed
in regards to factors you should take into consideration when selecting an IV gauge, what is included in client specific considerations?
- medical history
- diagnosis
- physical assessment
- activity level
- client preference
- comfort during insertion
in regards to factors you should take into consideration when selecting an IV gauge, what is included in vascular condition considerations?
- condition/ size of vein compared to gauge/ length
- assessment of previous punctured site
- avoid affected areas
in regards to factors you should take into consideration when selecting an IV gauge, what is included in device specifications?
- choose least invasive device
- suitable VAD for required influsion
in regards to factors you should take into consideration when selecting an IV gauge, what is included in therapy prescribed?
- chemical nature
- type
- urgency
- duration
what gauge would you use for an elderly patient?
22-24 gauge
what gauge would you use for a patient receiving blood products?
- 16 gauge for rapid infusion
- 18 gauge for general administration
what gauge would you use for paediatric and neonate patients?
22-24 gauge for paediatrics
24 gauge for neonatal
what gauge would you use for a trauma patient with high fluid volume loss?
16 gauge
what gauge would you use for a renal patient?
22 gauge or smaller
what gauge would you use for a healthy adult patient?
20-22 gauge
define hypervolemia
to much fluid inside body
what are some signs and symptoms of hypervolemia?
- edema in extremities
- cramping
- headache
- bloating
- hypertension
- SOB
- increased weight
what lung sounds would you expect to hear in a patient with hypervolemia?
- crackles
- pleural effusion
what causes hypervolemia?
- heart failure
- cirrhosis
- kidney failure
- diabetes
- nephrotic syndrome
- pregnancy
- premenstrual edema
which patients would be at an increased risk for hypervolemia?
- chronic alcoholics
- kidney failure
- heart failure
- diabetics
what is included in nursing and medical management for a patient with hypervolemia?
- low sodium diet
- diuretics
- daily weights
- fluid restriction
- sugar-free candy/ gum
define hypovolemia
low levels of fluid in body
what are signs and symptoms of hypovolemia?
- loss of color
- cool skin
- increased HR
- decreased BP
- lightheadedness
- confusion
- fatigue
what causes hypovolemia?
- dehydration
- vomiting
- diarrhea
- hyperglycaemia
- infections
- bleeding from injuries
which patietns are at an increased risk for hypovolemia?
- athletes
- diabetics
- hemorrhage
- surgery
- severe trauma
what are some nursing and medical managements for patients with hypovolemia?
- orthostatic BP
- IV fluids
- increased fluid intake
what are some signs and symptoms of fat emulsion?
- dyspnea
- back/ chest pain
- diaphoresis
- N/V
- headache
- hyper coagulability
- thrombocytopenia
what causes fat emulsion?
- parental nutrition
- not getting enough calories in diet
- low or no intake of fat
what are some nursing and medical management considerations for patients with fat emulsion?
- do not add medication to emulsion fluid
- assess lab work regularly assess for allergic reaction
what lab work do you need to check regularly for patients with fat emulsion?
- complete blood count
- liver/ kidney count
- lipid panel
define re-feeding syndrome
sudden shift in electrolytes that help body metabolize food
what is refeeding syndrome characterized by?
- fluid retention
- electrolyte imbalances
1. hypophosphatemia
2. hypokalemia
3. hypomagnesium - hyperglycaemia
what are the signs and symptoms of re-feeding syndrome?
- fatigue
- weakness
- confusion
- inability to breathe
- high BP
- seizures
- heart arrhythmias
- heart failure
- coma
what causes re-feeding syndrome?
- anorexia
- chronic alcoholism
- vomiting/ diarrhea
- cancer
- uncontrolled diabetes
- malnourished
- history of using some medications
what medications could potentially cause re-feeding syndrome ?
- insulin
- chemotherapy drugs
- diuretics
- antacids
what are some nursing and medical management considerations used when treating a patient with re-feeding syndrome?
- start feeds slow
- monitor electrolytes closely with blood tests
- If fluid replacement slowly
why might a patient require an IV?
- maintain/ correct fluid/electrolyte balance
- administer meds
- admin blood/ blood products
- maintain/ correct nutritional state
- venous access incase emergency
- diagnostic agents
- general anaesthesia
what is required to start a peripheral IV?
doctors order
what should the doctors order include on it for a peripheral IV initiation?
- date
- type of IV solution
- rate of infusion
- signature
- if a local anaesthetic has been ordered
Prior to beginning an IV what do you need to assess the pt for ?
level of anxiety
how can anxiety affect a peripheral IV start?
- vasoconstriction
- make vein hard to find
what are some methods to reduce anxiety in a patient about to get an IV started?
- approach pt in confined/ relaxed manner
- make sure all. equipment is ready/ available
- use distracting conversation
- be patient with yourself
- take your time
where are digital veins located?
- along the lateral portion of the fingers
- joined to each other by communicating branches
when should you use digital veins?
- used only for last resort for fluid administration
- do not have a large blood supply
where are metacarpal veins located? How are they formed?
- on the dorsal surface of the hand
- formed by the union of the digital veins
use of metacarpal veins is contraindicated for the administration of what?
vesicants
which site is not suitable for IV initiation in the elders?
- metacarpal
who are metacarpal veins suitable for? with what fluid?
- adult patients when infusing nonirritating IV fluids c small gauge
can using a metacarpal vein for an IV limit mobility?
yes
where is the cephalic vein located?
on the radial surface of the lower arm
where is the accessory cephalic vein located?
on the posterior aspect of the lower arm
Where is the basilica vein located?
on the ulnar surface of the lower arm
the basilic vein is a large vein suitable for what?
IV insertion
where is the medial cubital vein located?
in the antecubital fossa
the medial cubital vein is a large stable, superficial vein that is suitable for what?
placement of large gauge IV and blood withdrawal
when selecting a site for IV insertion where do you always want to try first ?
in the pt’s non dominant hand
Which sites do you want to avoid when inserting an IV?
- bruised sclerosed veins
- below traumatized tissue
- sites near previously discontinued IVs
- below existing phlebitis
- veins with impaired circulation
- veins in limbs c reduced sensation
- inner surface of rist
which patients are difficult to start IVs on?
- elderly
- paediatric
- obese
- pts receiving anticoagulant therapy
why is it hard to insert an IV on elderly patients?
have delicate thin walled veins
what would you use on an elderly pt when finding a vein?
light tourniquet
describe a light tourniquet
does not completely obstruct blood flow
after applying a light tourniquet on an elderly pt when do you want to initiate the IV? Why?
- as soon as possible
- will decrease change of vein rupturing
what should be used for paediatric pts if time permits regards IV insertion? how long should it be applied for prior to insertion?
- topical anaesthetic
- 1 hour prior to insertion
for obese pts where do you want to position the tourniquet? why?
- closer to the desired IV insertion site
- may enhance cap fill
what tool can you use to help locate veins in obese pts?
illumination device
do you want to use a tourniquet for a patient receiving anticoagulant therapy? why?
- avoid but if required use lightly
- can result in subcutaneous bleeding
what do you need to ensure you do when removing an IV from a pt receiving anticoagulant therapy?
- direct pressure over site c slight elevation of limb until bleeding stops
when would you use a 16 gauge Iv?
- truama
- major surgery
- situations requiring rapid infusion of large large volumes of blood products
when would you use an 18 gauge IV?
- general admin of blood products
- general surgery
when would you use a 20 gauge IV?
- most adult pts
when would you use 18-20 gauge IVs?
elective infusion of blood products at moderate rate/ volume
when would you use a 22 gauge IV?
- community clients
- pediatric
- elderly c fragile veins
when would you use a 24 gauge IV?
- neonatal
- pediatric
- elderly
- pt c small veins
if the tourniquet is left on too long what can form? How long is to long?
- hematoma
- more than 2 minutes
can you leave the bedside once a tourniquet is applied?
no
what should you clean tourniquets with between pts?
hot soapy water
after taking the catheter out of the package what do you need to do to it?
rotate it 360 degrees on the needle
what angle do you insert the IV in at? what if its a shallow or deep vein?
- 15-25 degrees to the skin
- shallow > use lower angle
- deep > slightly deeper angle
do you always need to have one hand on the angiocatheter until its secure?
yes
what do you use to secure the anti-catheter once inserted?
- tape
- stabilization device
- dressing
what are the 2 purposes of an IV dressing?
- stabilize/ secure IV device
- protect IV site
what should you never use under the transparent dressing ?
non-sterile tape
to prevent going to deep and puncturing the vein what can you do?
- hold IV catheter in the exact direction of the vein
- do not hold the needle at too steep of an angle (over 25)
what are the potential causes of infiltration?
- catheter dislodged
- solution leaks through vein wall into tissue
- fluid leaks around catheter/ out insertion site
- opposite side of vein is perforated
what are some signs and symptoms of infiltration?
- swollen above/ bellow insertion site
- swollen area cool to touch
- IV runs slow
- pump alarms often
- blood may or may not return
- pain
how do you treat infiltration?
- tubing not taped over vein being infused
- D/C
- apply warm compress to site
how do you prevent infiltration?
- avoid areas of flexion
- tape tubing away from vein being used
- avoid fragile veins
what causes mechanical phlebitis?
- in area of flexion
- site not taped securely
- IV line unstable
- catheter moves in/ out of vein when limb moves
what are some signs and symptoms of mechanical phlebitis?
- IV site sore/ red
- redness may be present along the vein
how do you treat mechanical phlebitis?
- D/C IV
- apply warm compress
- depending on severity notify physician
how do you prevent mechanical phlebitis?
- avoid areas of flexion
- avoid inserting IV into distal portion of hand
what cause chemical phlebitis?
vein is irritated by the solution or medication
what are the signs and symptoms of chemical phlebitis?
- vein may appear red along vein pathway
- hard to palpate
- feels like its burning
what are the treatments for chemical phlebitis ?
- D/C IV
- if intermittent infusions given once daily consider using butterfly
- flush catheter with 50 mL of primary solution to flush vein fully
- dilute irritating medication
how do you prevent chemical phlebitis?
- use largest vein possible for hemodilution
- discuss with physical about central line use
- consult IV nurse to recommend alternate venous access
what causes cellulitis?
improper:
- insertion technique
- hand washing
- aseptic technique
- site preparation
- dressing change
what are the signs and symptoms of cellulitis?
large area around insertion is:
- painful
- tender
- warm
- oedematous
- may have red streaking along skin
- skin may feel like orange peel
- fever and chills
what is the treatment for cellulitis?
- D/C
- send catheter tip to lab
- notify physician
- antibiotics
how do you prevent cellulitis?
- good hand hygiene
- maintain aseptic teqchnique
- assess IV site frequently
- ensure dressing labelled c date
- ensure IV tubing changed q96H
