week 8 - IV infusion meds and PICC line meds Flashcards
what is the catheter size determined by?
outer diameter (OD) of the catheter
in regards to catheters describe the French size
- superior to gauge system
- begins at 0
- each increment of 1 French unit represents an increase of 1/3 (0.33)mm in outer diameter
How do you measure a PICC without visible markings?
measure from the hub to the insertion site
How do you measure a PICC with visible markings starting at 0?
measure from 0 to the insertion site
What are some examples of CVAD/ PICC complications?
- catheter occlusion
- embolism
- catheter related infection (local or systemic)
- pneumothorax
- catheter migration
- arrhythmia
What causes a catheter occlusion?
- clamped/ kinked catheter
- tip against wall of vessel
- thrombosis
- precipitate buildup in lumen
what are the signs/ symptoms of a catheter occlusion?
- sluggish infusion/ aspiration
- unable to infuse/ aspirate
what are some interventions for a catheter occlusion?
- instruct patient to change positions, raise arm, cough
- assess for/ alleviate clamping/ kinking
- flush c NS 10mL do not force
- fluoroscopy to determine cause
- anticoagulant/ thrombolytic agents
What causes an embolism?
- catheter breaking
- dislodgement of thrombus
- entry of air into circulation
what are the signs/ symptoms of an embolism?
- chest pain
- respiratory distress
- hypotension
- tachycardia
what are some interventions for an embolism?
- administer oxygen
- clamp catheter
- place patient on left side c head down (air embolism)
- notify physician
What causes a catheter-related infection (local or systemic)?
- contamination during insertion/ use
- migration of organisms along catheter
- immunosuppressed client
what are the signs/ symptoms of a catheter-related infection (local or systemic)?
local
- redness
- tenderness
- purulent drainage
- warmth
- edema
systemic
- fever
- chills
- malaise
what are some interventions for a local catheter-related infection?
- culture of drainage from site
- warm/ moist compresses
- catheter removal if indicated
what are some interventions for a systemic catheter-related infection?
- blood cultures
- antibiotic therapy
- antipyretic therapy
- catheter removal if indicated
What causes a pneumothorax?
- inadvertent puncture of the lung at the time of inserting needle into vein
what are the signs/ symptoms of a pneumothorax?
- decreased/ absent breath sounds
- respiratory distress
- chest pain
- distended bilateral chest
what are some interventions for a pneumothorax?
- administer oxygen
- position in semi-flower position
- prepare for chest tube insertion
What causes a catheter migration?
- improper suturing
- insertion site trauma
- changes in intrathoracic pressure
- forceful catheter flushing
what are the signs/ symptoms of a Catheter migration?
- sluggish infusion/ aspiration
- edema of chest/ neck during infusion
- client complaint of gurgling in ear
- dysrhythmias
- increased external catheter length
what are some interventions for a Catheter migration?
- fluoroscopy to verify position
- assist with removal and new CVAD placement
What causes an arrhythmia?
line advances into right atrium irritating heart
what are the signs/ symptoms of an arrhythmia?
- palpitations/ pounding in chest
- tachycardia/ bradycardia
- chest pain/ discomfort
- SOB
- weakness, fatigue, dizziness
what are some interventions for an arrhythmia?
- medications
- vasovagal maneuvers
- cardioversion/ defibrillation
- catheter procedure
- pacemaker
- heart surgery
what is the antidote for heparin?
protamine sulphate
What supplies do you need if you’re adding medication to a bag?
- med vial/ ampule
- blunt filtered or nonfiltered needle
- alcohol swap
- syringe
- IV tubing
- mini bag
- orange label
What are the 6 steps to adding a medication to an infusion bag?
- swab vial c alcohol swab/ air dry
- inject air into vial using blunt needle/ syringe
- draw up appropriate amount of med
- swab IV port of bag
- inject medication into port of IV bag
- label IV bag
- label tubing for continuous infusion
what is something you need to remember when adding medication to an infusion bag?
switch to a non-filter needle if you used a filter needle to draw up med
what do you need to include on an IV label?
- date
- time
- drug name
- dose
- concentration
- base solution
- rate of admin
- 2 patient identifiers
- initials
how long can a continuous infusion be hung for?
72-96hrs
What are the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD?
- administer herapin IV bolus
- hang heparin infusion OR if bolus not required
- start infusion
- document
in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe administering a heparin IV bolus
- SL lock as an IV push per policy (over 1min)
- patency check
- pre-med flush (3-5ml)
- post med flush (10mL)
in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe hanging heparin infusion
place tubing in pump
- program pump to appropriate medication name/ rate
in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe if bolus not required
- perform patency check
- flush SL with NS
- attach heparin drip tubing to run as primary infusion
- if another IV running attach heparin to lowest port of running IV as a tandem if compatible
- press run
in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe documenting
- on MAR
- VAD record
- intake/output record
after heparin drip has been initiated infusion rates are adjusted based on what?
PTT results
What supplied do you need when reconstituting a powder medication?
- medication
- compatible solution
- blunt non filter needle
- syringe
- alcohol swab
What is a diluent?
Ingredient in a medicinal preparation that lacks pharmacologic activity but is pharmaceutically necessary or desirable
What is a diluent mixed with?
the medication powder in a vial to reconstitute to a liquid for drawing up in a syringe
what must you ensure about a diluent prior to drawing it up?
is compatible with medication
if adding medication to an infusion bag do you need to take any fluid our of the bag prior to adding med?
if volume of additive is +10% of the bag volume the equivalent volume must be withdrawn from diluent bag first and discarded
what are the steps when hanging an IV intermittent medication ?
- hang labelled mini bag in Iv pole
- remove secondary tubing from packaging and close clamp
- remove cap/ spike mini bag
- squeeze drip chamber to fill 1/3-1/2 full
- open clamp/ slowly prime line without wasting medication
- label tubing (24hrs)
What injection type can you not give heparin through?
IM
the heparin direct IV bolus is a loading dose that when given achieves what? when is this done?
- a therapeutic heparin blood level faster
- only given if patient has not received heparin in last 6hrs
if the intermittent secondary IV tubing is not out-dated then what?
you do not need to change the tubing when hanging mini bag medication
what does back flushing mean?
to clear the old medication fluid out of the line
When can you not complete a back flush?
when hanging an incompatible mini med bag
What can lead to under-dosing of medication and non-therapeutic drug levels?
when discarding medication infusion set where there is still a residual amount of IV drug left in tubing
How do you avoid underusing of IV infusion medication?
flush fluid to administer remaining med by either doing this manually or hang a 50mL bag of compatible fluid and run at same rate
nurse’s decision-making about IV administration set replacement is based on what?
- infection prevention
- physical safety
- patient preference
- clinical knowledge and beliefs
- workload
excluding lipid, blood and blood products most hospitals routinely change IV tubing every 96 hours or up to 96 hours. Why?
prevent catheter-related bloodstream infection
What is a tandem infusion?
second IV line connected to the primary line at the lower port below pump
when can medication be given in regards to tandem infusions?
intermittently or at the same time as primary infusion
What is the difference between a tandem and a piggyback infusion?
tandem
- connected below the pump
piggyback
- connected above the pump
Where do you document an IV med infusion?
- MAR
- VAD record
- in/out record
- narrative notes if needed
can a nursing student transcribe a doctors order?
yes but has to be double checked by an RN
what is the leading cause of harm, most if it preventable, in health care systems across the world?
unsafe medication
When do medication incidents occur?
- weak medication systems/ human factors affect prescribing, transcribing, dispensing
What human factors are included in medication incidents?
- fatigue
- poor environmental conditions
- staff shortages
if you need to temporarily disconnect IV line what can you put at the port to keep line sterile?
- blunt fill needle
- blue cap
- white cap off of SF syringe
