6563790
Description
Flashcards by Gwen Paparone, updated more than 1 year ago
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Created by Gwen Paparone
about 8 years ago
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| Question | Answer |
| Peripheral Insertion | Responsibility of the RN In the peripheral extremities (Arm/leg) |
| Central Placement | Intravenous line in a central vein- direct to the heart( Jugular, femoral or subclavian vein) Responsibility of the physician or nurse practitioner. |
| Whose responsibility is maintaining the IV Line? | The RN |
| Indications of IV placement | 1. Expand/reduce intravascular volume 2. To correct electrolyte imbalances. 3. To administer medications. 4. To administer blood/blood products. 5. Patient Status 6. Nutritional Support 7. Emergency access |
| Crystalloids | IV fluid containing various concentrations of electrolytes that may expand or reduce the intravascular volume |
| Intravascular volume | Volume of blood in a patients system |
| What determines whether or not an IV fluid expands or reduces intravascular volume? | Osmolarity |
| Isotonic Solution osmolarity? | 280-295 |
| Example of Isotonic solution? | Normal Saline Solution |
| Hypertonic Solution Osmolarity | >280-295 |
| Example of hypertonic solution | 5% Dextrose and normal Saline solution |
| Hypotonic osmolarity | <280-295 |
| Examples of Hypotonic Solutions | Half Normal Saline |
| Why is 5% dextrose in water isotonic in the bag and hypotonic in the plasma? What is the clinical significance? | the glucose (solute) dissolved in sterile water is metabolized rapidly by the body’s cells. |
| Colloids | IV solutions that contain large protein molecules and stay in the vascular space (plasma volume expanders) Increase osmotic pressure in vascular space |
| What is the major intracellular electrolyte? | Potassium (K) |
| What is the major extracellular electrolyte? | Sodium (Na) |
| What are the normal potassium levels? | 3.5-5.5 MEQ/L |
| What are the normal Na levels? | 135-145 MEQ/L |
| Why might an order for IV D5NSS with 20 MEQ KCL per liter be ordered? | For a patient with a potassium level below 3.5 |
| Name the methods of IV administration | 1. Direct IV push 2. Via secondary line in a piggyback or miniinfuser 3. ADD-vantage containers |
| When administering a piggyback medication what should you ALWAYS check? | The "compatibility" of the medication to the fluid in the primary IV tubing |
| How should blood be administered? | In a separate IV line, primed with 0.9 NSS ONLY |
| What tubing is specifically for blood? | The set Y tubing |
| Total Parenteral Nutrition (TPN) | Solution containing amino acids, electrolytes, glucose, and vitamins. |
| How is a TPN administered? | Via a central IV line |
| Can you ever administer nutritional solutions peripherally? | Yes but the solutions are made differently from TPN |
| Why would patient status effect the need for IV fluids? | Patients who are unconscious, or post-operative for example may need IV access for fluids, medications, and /or nutritional requirements to maintain homeostasis |
| What is meant by emergency access as an indication for IV placement? | Establishment of a worthwhile IV line. (It can be difficult to establish an iv line when a patient is in cardiac arrest for example) |
| QSEN Infection control considerations | -IV placement is invasive -Maintain proper hand hygiene -Chlorhexadineis preferable to alcohol and batadine |
| IV bags | Standard size- 1000 ml unbreakable- puncture-able bag |
| IV bottles | glass and subject to breaking- need to be vented. |
| When would an IV bottle be used | When using chemicals that have the potential to leech through the plastic |
| Macrodrip | 10-20 gtts per ml |
| Microdrip | 60 gtts per ml |
| Filter | Strain solution to remove contaminants |
| Extension sets | Extend tubing and add extra ports |
| Peripheral locks | Prevent IV from flowing out |
| Transparent Semipermeable membrane | stabilize the cannula, offer protection and provide visualization of the site |
| How often are dressing supposed to be changed? | Every 2 days or PRN |
| Pumps | measure in ml per hour |
| Mini infuser | Controlled intermittent administration of IV fluid |
| Patient Controlled Analgesia (PCA) | is any method of allowing a person in pain to administer their own pain relief. |
| PCA dosage | amount administered with each dose |
| PCA lockout period | time between dosage |
| Basal Rate | Continuous rate |
| How often should you assess the IV site? | Every 2 hours or whenever you enter the room |
| How long are most IV fluids good for? | 24 hours in most institutions |
| Occlusion | loss of patency |
| Causes for occlusions? | 1. kinked tubing 2. backflow of blood 3. Clot |
| How can you tell when an IV is occluded? | Flow is sluggish |
| Intervention for occlusion | Discontinue IV- Do not milk, aspirate, or irrigate |
| Infiltration | Seepage of non vessicant IV fluid into the tissue when IV cath penetrates the vein. |
| Vessicant | Irritating to the tissue |
| Causes of Infiltration | Dislodgment of catheter Overmanipulation of the catheter Failure to secure the catheter properly |
| Assessment of infiltration | Pain, Edema, cool skin, decreased IV flow, damp dressing, no blood return at IV site. |
| Intervention for infiltration | Discontinue IV Elevate extremity Apply warm compress insert IV in unaffected arm Document |
| Extravasation | Infiltration of vessicant fluid into the tissues |
| Indications for warm compress to treat extravasation? | Vasodilation- increases drug distribution- and local concentration |
| Indications for cold compress to treat extravasation? | Vasoconstriction- allows for local removal |
| Other interventions for extravasation? | Direct injection by the physician can be necessary |
| Phlebitis | Inflammation of inner layer of a vein |
| Causes of phlebitis | Bacterial- poor asepsis Chemical- irritating medications Mechanical - poorly secured caheter, too large for vein |
| Assessment of phlebitis | Redness, tenderness, pain, vein is often red hard and cordlike |
| Intervention | Discontinue IV apply warm compress restart IV in unaffected arm |
| Vascular Access Devices | catheters cannulas, or ports designed for repeated access to vascular system |
| Catheter | Soft flexible tube |
| Cannulas | Require a needle introducer, |
| Ports | Implanted under the skin |
| Insertion sites for VAD | Jugular, Subclavian, Cephalic, Femoral |
| Indications for VAD | no peripheral vein access Central venous pressure Complex treatment regimes Hyperosmolar Infusions Vesicant drugs Long term IV therapy |
| How would you confirm placement of a VAD? | X-Ray |
| How is dressing change on a VAD done? | Aseptic sterile technique |
| Types of cathter VADs | Single lumen Multiple lumen Triple Lumen Catheter (TLC) |
| Distal Port VAD | 16G best for viscous fluids, volume monitoring |
| Proximal port VAD | 18G Best for drawing labs and medications |
| Medial Port | 18G TPN |
| TLC placement | not for longer than 6 weeks- not routinely replaced Sterile dressing change X-ray for placement |
| PICC LINE indicated primarily for? | Long term antibiotics |
| PICC placement pearls | Sterile dressing change May remain up to 6 months or longer Never smaller than 10ml syringe X-ray for placement |
| Midline catheter | shorter than PICC - placed in peripheral vein- tip in distal part of vein- no x-ray necessary may remain 8 weeks |
| Implanted port | tip in subclavian or external jugular implanted in sub q of chest wall chemotherapy need x-ray for placement |
| Huber needle | Non-coring needle used to access an implanted port |
| Normal WBC | 5000-10,000 |
| IV formula | Gtts/min=(volume)(Set calibration)/Time in minutes |
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