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NRSG 202 > week 8 - IV infusion meds and PICC line meds > Flashcards

week 8 - IV infusion meds and PICC line meds Flashcards

1
Q

what is the catheter size determined by?

A

outer diameter (OD) of the catheter

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2
Q

in regards to catheters describe the French size

A
  • 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
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3
Q

How do you measure a PICC without visible markings?

A

measure from the hub to the insertion site

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4
Q

How do you measure a PICC with visible markings starting at 0?

A

measure from 0 to the insertion site

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5
Q

What are some examples of CVAD/ PICC complications?

A
  • catheter occlusion
  • embolism
  • catheter related infection (local or systemic)
  • pneumothorax
  • catheter migration
  • arrhythmia
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6
Q

What causes a catheter occlusion?

A
  • clamped/ kinked catheter
  • tip against wall of vessel
  • thrombosis
  • precipitate buildup in lumen
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7
Q

what are the signs/ symptoms of a catheter occlusion?

A
  • sluggish infusion/ aspiration

- unable to infuse/ aspirate

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8
Q

what are some interventions for a catheter occlusion?

A
  • 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
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9
Q

What causes an embolism?

A
  • catheter breaking
  • dislodgement of thrombus
  • entry of air into circulation
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10
Q

what are the signs/ symptoms of an embolism?

A
  • chest pain
  • respiratory distress
  • hypotension
  • tachycardia
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11
Q

what are some interventions for an embolism?

A
  • administer oxygen
  • clamp catheter
  • place patient on left side c head down (air embolism)
  • notify physician
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12
Q

What causes a catheter-related infection (local or systemic)?

A
  • contamination during insertion/ use
  • migration of organisms along catheter
  • immunosuppressed client
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13
Q

what are the signs/ symptoms of a catheter-related infection (local or systemic)?

A

local

  • redness
  • tenderness
  • purulent drainage
  • warmth
  • edema

systemic

  • fever
  • chills
  • malaise
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14
Q

what are some interventions for a local catheter-related infection?

A
  • culture of drainage from site
  • warm/ moist compresses
  • catheter removal if indicated
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15
Q

what are some interventions for a systemic catheter-related infection?

A
  • blood cultures
  • antibiotic therapy
  • antipyretic therapy
  • catheter removal if indicated
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16
Q

What causes a pneumothorax?

A
  • inadvertent puncture of the lung at the time of inserting needle into vein
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17
Q

what are the signs/ symptoms of a pneumothorax?

A
  • decreased/ absent breath sounds
  • respiratory distress
  • chest pain
  • distended bilateral chest
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18
Q

what are some interventions for a pneumothorax?

A
  • administer oxygen
  • position in semi-flower position
  • prepare for chest tube insertion
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19
Q

What causes a catheter migration?

A
  • improper suturing
  • insertion site trauma
  • changes in intrathoracic pressure
  • forceful catheter flushing
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20
Q

what are the signs/ symptoms of a Catheter migration?

A
  • sluggish infusion/ aspiration
  • edema of chest/ neck during infusion
  • client complaint of gurgling in ear
  • dysrhythmias
  • increased external catheter length
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21
Q

what are some interventions for a Catheter migration?

A
  • fluoroscopy to verify position

- assist with removal and new CVAD placement

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22
Q

What causes an arrhythmia?

A

line advances into right atrium irritating heart

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23
Q

what are the signs/ symptoms of an arrhythmia?

A
  • palpitations/ pounding in chest
  • tachycardia/ bradycardia
  • chest pain/ discomfort
  • SOB
  • weakness, fatigue, dizziness
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24
Q

what are some interventions for an arrhythmia?

A
  • medications
  • vasovagal maneuvers
  • cardioversion/ defibrillation
  • catheter procedure
  • pacemaker
  • heart surgery
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25
Q

what is the antidote for heparin?

A

protamine sulphate

26
Q

What supplies do you need if you’re adding medication to a bag?

A
  • med vial/ ampule
  • blunt filtered or nonfiltered needle
  • alcohol swap
  • syringe
  • IV tubing
  • mini bag
  • orange label
27
Q

What are the 6 steps to adding a medication to an infusion bag?

A
  • 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
28
Q

what is something you need to remember when adding medication to an infusion bag?

A

switch to a non-filter needle if you used a filter needle to draw up med

29
Q

what do you need to include on an IV label?

A
  • date
  • time
  • drug name
  • dose
  • concentration
  • base solution
  • rate of admin
  • 2 patient identifiers
  • initials
30
Q

how long can a continuous infusion be hung for?

A

72-96hrs

31
Q

What are the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD?

A
  1. administer herapin IV bolus
  2. hang heparin infusion OR if bolus not required
  3. start infusion
  4. document
32
Q

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

A
  • SL lock as an IV push per policy (over 1min)
  • patency check
  • pre-med flush (3-5ml)
  • post med flush (10mL)
33
Q

in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe hanging heparin infusion

A

place tubing in pump

- program pump to appropriate medication name/ rate

34
Q

in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe if bolus not required

A
  • 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
35
Q

in reagards to the 4 steps to administer a heparin bolus IVP and start heparin infusion through a PVAD describe documenting

A
  • on MAR
  • VAD record
  • intake/output record
36
Q

after heparin drip has been initiated infusion rates are adjusted based on what?

A

PTT results

37
Q

What supplied do you need when reconstituting a powder medication?

A
  • medication
  • compatible solution
  • blunt non filter needle
  • syringe
  • alcohol swab
38
Q

What is a diluent?

A

Ingredient in a medicinal preparation that lacks pharmacologic activity but is pharmaceutically necessary or desirable

39
Q

What is a diluent mixed with?

A

the medication powder in a vial to reconstitute to a liquid for drawing up in a syringe

40
Q

what must you ensure about a diluent prior to drawing it up?

A

is compatible with medication

41
Q

if adding medication to an infusion bag do you need to take any fluid our of the bag prior to adding med?

A

if volume of additive is +10% of the bag volume the equivalent volume must be withdrawn from diluent bag first and discarded

42
Q

what are the steps when hanging an IV intermittent medication ?

A
  • 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)
43
Q

What injection type can you not give heparin through?

A

IM

44
Q

the heparin direct IV bolus is a loading dose that when given achieves what? when is this done?

A
  • a therapeutic heparin blood level faster

- only given if patient has not received heparin in last 6hrs

45
Q

if the intermittent secondary IV tubing is not out-dated then what?

A

you do not need to change the tubing when hanging mini bag medication

46
Q

what does back flushing mean?

A

to clear the old medication fluid out of the line

47
Q

When can you not complete a back flush?

A

when hanging an incompatible mini med bag

48
Q

What can lead to under-dosing of medication and non-therapeutic drug levels?

A

when discarding medication infusion set where there is still a residual amount of IV drug left in tubing

49
Q

How do you avoid underusing of IV infusion medication?

A

flush fluid to administer remaining med by either doing this manually or hang a 50mL bag of compatible fluid and run at same rate

50
Q

nurse’s decision-making about IV administration set replacement is based on what?

A
  • infection prevention
  • physical safety
  • patient preference
  • clinical knowledge and beliefs
  • workload
51
Q

excluding lipid, blood and blood products most hospitals routinely change IV tubing every 96 hours or up to 96 hours. Why?

A

prevent catheter-related bloodstream infection

52
Q

What is a tandem infusion?

A

second IV line connected to the primary line at the lower port below pump

53
Q

when can medication be given in regards to tandem infusions?

A

intermittently or at the same time as primary infusion

54
Q

What is the difference between a tandem and a piggyback infusion?

A

tandem
- connected below the pump

piggyback
- connected above the pump

55
Q

Where do you document an IV med infusion?

A
  • MAR
  • VAD record
  • in/out record
  • narrative notes if needed
56
Q

can a nursing student transcribe a doctors order?

A

yes but has to be double checked by an RN

57
Q

what is the leading cause of harm, most if it preventable, in health care systems across the world?

A

unsafe medication

58
Q

When do medication incidents occur?

A
  • weak medication systems/ human factors affect prescribing, transcribing, dispensing
59
Q

What human factors are included in medication incidents?

A
  • fatigue
  • poor environmental conditions
  • staff shortages
60
Q

if you need to temporarily disconnect IV line what can you put at the port to keep line sterile?

A
  • blunt fill needle
  • blue cap
  • white cap off of SF syringe

NRSG 202 (11 decks)

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