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NUR171-IVs
IVs
| Question | Answer |
|---|---|
| IV fluid and electrolyte therapy | crystalloids |
| blood and blood component | colloids |
| Vascular access devices (VADs) | catheters, cannulas, or infusion ports designed for repeated access to the vascular system |
| Peripherally placed cannulas are for | short-term use (fluid restoration postoperatively & short-term antibiotic administration) |
| Devices such as ___ are for long-term use | central line catheters, peripherally inserted central venous catheters (PICCs), & implanted ports |
| isotonic fluids are indicated for | extracellular volume replacement (FVD after prolonged vomiting) |
| Pt w/hypertonic fluid imbalance will generally receive a | hypotonic solution to dilute ECF & rehydrate the cells. |
| __ solutions pull fluid into vascular space by osmosis, resulting in incr. vascular vol.= pulmonary edema, pt w/heart or renal failure | hypertonic |
| Safety alert regarding potassium | never IV push potassium chloride (KCl) - may be fatal. |
| D5W | dextrose 5% in water – isotonic |
| D10W | dextrose 10% in water – Hypertonic |
| 1/2 NS | 0.45% sodium chloride – hypotonic – is one half normal saline |
| 0.45% NS | same as 1/2 NS - 0.45% sodium chloride – hypotonic – is one half normal saline |
| What is Isotonic saline solution called? | NS, 0.9%NS, or 0.9%NaCl |
| 0.33% Sodium chloride | One third normal saline – hypotonic – 1/3 NS |
| Name some common hypertonic saline solutions | 3% - 5% sodium chloride |
| D50.9% NS or NaCl | Dextrose 5% in 0.9% sodium chloride – hypertonic |
| D5NS | Dextrose 5% in 0.9% sodium chloride – hypertonic |
| Name a hypertonic dextrose solution | D50.45% NaCl or D5 1/2NS – dextrose 5% in 0.45% NaCl sodium chloride |
| LR | Lactated Ringers – contains sodium, potassium, calcium, chloride, and lactate – isotonic |
| D5LR | Dextrose 5% in lactated Ringers – hypertonic |
| Piggybacked | injectable meds added to a sm IV solution bag – secondary to primary line admin. Over 30 – 60 min |
| An infusion given rapidly is done with ___ tubing | macrodrip – large drops |
| Macrodrip delivers drops at what rate? | 10 or 15 gtt/ml |
| Microdrip delivers drops at what rate? | 60 gtt/ml |
| What sized cannula is appropriate for fluid maintenance? | 22 |
| Steel-winged infusion sets is used only for | short term therapy |
| Tacycardic rhythm changes may occur with which electrolyte abnormalities? | potassium, calcium, and magnesium – fluid volume deficit would cause too |
| Average daily output of urine is | 1500 ml |
| Urine output less than ___ is oliguria | 400 mL in 24 hours – signals retention of metabolic wastes |
| Apply tourniquet ___ inches above proposed insertion site | 4-6 or 10-15 cm |
| Which veins are preferred in an adult? | veins found on dorsal and ventral surfaces of upper arms – cephalic, basilica, and metacarpal |
| Perform venipuncture __ to __ | distal to proximal |
| Why don’t we tap veins to get them to dilate? | can cause hematoma and/or venous constriction |
| Name some methods to foster venous distention | stroking from distal to proximal below site, applying warmth to extremity |
| Avoid which veins in older adults? | fragile dorsal veins andvessels in extremity w/compromised circulation |
| What is preferred site cleaning solution? | chlorhexidine 2% preparation |
| The pressure of the tourniquet causes the vein to | dilate |
| What degree should needles enter? | 10-30 degree angle to the vein |
| Positive pressure flushing does what? | creates positive pressure in cannula & prevents reflux of blood during flushing |
| Change peripheral IV access every | 72 – 96 hours |
| When should you have next solution ready to change IV bag? | when less than 100 ml remaining |
| Swelling above insertion site and cool temp indicates? | infiltration of fluids into tissues |
| Where are central cannulas placed? | into a central vein like the subclavian or superior ven cava – delivers lg amt of fluids and TPN |
| Too slow infusion rate can lead to | cardiovascular collapse in pt w/dehydration, in shock, or critically ill – blood clots |
| Too fast infusion rate can cause | fluid overload – cardio, kidney, and neuro complications |
| How will little subQ tissue affect IV insertion? | vein will roll away from needle |
| What is necessary when infusing small hourly volumes? | EIP – electronic infusion pumps |
| What is a small hourly volume? | less than 20 mL/hr |
| What is a high volume of IV fluids? | more than 150 mL/hr |
| EIPs deliver via | positive pressure – electronic infusion pumps |
| Patency | no clots at tip and not against vein |
| Why rate increases when bag raised | increased hydrostatic pressure |
| KVO | keep vein open |
| In microdrip, ML/hr always equals | gtt/min |
| Pediatric tubing | microdrip tubing |
| mL/hr equals? | total infusion (mL) divided by hours of infusion |
| How do you regulate flow rate manually? | count drips in drip chamber for 1 min by watch and then adjust roller clamp |
| How high above IV site for gravity controller? | 36 inches |
| Volutrol burette | prevents sudden excessive increases in volume of IV solution infused – volume control device |
| Line maintenance | keep sys sterile, change solutions/tubing/site dressing, assist client w/self care activities |
| CDC recommends changing tubing no more frequently than | every 72 hours – to 96 hours |
| Change gauze dressing every | 48 hours |
| Have client hold pole with | involved hand while walking |
| Infiltration occurs in which layer? | subQ |
| Why be sure drip chamber is at least half full when changing solution? | provides fluid to vein while bag is changed |
| Incompatibilities in IV fluids can lead to | precipitate formation & can cause physical, chemical, and therapeutic ct changes |
| How can you remove bubbles from tubing? | closing roller clamp below bubbles, stretch tubing downward, tap tubing w/fingers to make bubbles rise – can aspirate w/needle at port |
| Drip chamber should be | half to one third full – too full means cannot observe drip rate |
| How to remove fluid from drip chamber? | pinch of tubing below chamber, invert, squeeze chamber, release tubing, then hang bag |
| Why use a saline/heprin lock (flush)? | removes air to prevent embolism |
| Notify doc if infusion is ___ less or greater than expected | 100 – 200 mL |
| Postinfusion phlebitis may occur ___ hours after catheter removal | 48 – 96 |
| Risk factors for phlebitis | cannula material, chemical irritation of drugs, position |
| Why is phlebitis dangerous? | can result in blood clots – thrombophlebitis |
| Name one way to help prevent phlebitis | rotation of IV sites |
| Signs of too-rapid IV solution admin | shortness of breath, crackles in lungs, tachycardia – FVE |
| Autologous Transfusion | collection and reinfusion of ct own blood |
| Cathether no smaller than __ gauge should be used | 20 |
| When priming tube for blood transfusion use what saline? | 0.9% normal saline – prevents hemolysis of RBCs |
| When is rxn most likely to occur during transfusion? | first 15 mins |
| Beyond __ hours infusion there is risk for bacterial contam of blood during transfusion | 4 hours |
| Where is ABG drawn? | from peripheral artery (usually radial) – then submerge synringe in crushed ice to transport |
| Epidermis | First line of defense against infections, Thickest on the palms of hand ad feet, Thinnest on inner surface of extremities |
| Artery | Thick-walled, 25% of arterial wall, Lacks valves, Pulsates – If it pulsates its an artery - WE DO NOT CANULATE ARTERIES peripherally |
| Vein | Thin-walled, 10% of vein wall, Greater distensibility, Valves present apx every 3 Tunica adventitia |
| Tunica media | nerve tissue & elastin – pain on pierce, Stim by heat & cold - layer that vaso constricts/dilates - can spasm too |
| When ivs enter, veins can spasm and vein will | collapse down - Blood will not return and you have to start over |
| Tunica intima | innermost layer |
| Metacarpal veins | a common place – smaller and more fragile than basillic and cephalic. |
| Basilic vein | larger vein - runs along the “baby finger” |
| Cephalic vein | larger vein - runs along the radial artery |
| 14 gauge | orange - put in when people are crashing – very large needle - Used in metacarpal veins |
| 24 Gauge | Yellow - flimsy & difficult to put in- Used in metacarpal veins – very rarely used in practice |
| 22 Gauge | Light blue - Used in metacarpal veins |
| 20 Gauge | pink – more approp for cephalic or antecubital area – used for blood transfusion, but 18 more preferred. |
| 18 Gauge | green – not suggested in metacarpal area – could cause damage to sm veins – best in cephalic, antecuibal, or basalic – best for blood transfusion, but 20 still acceptable |
| Blowing a valve | when you go right through it and out the other side |
| Veins should be | nice, soft, straight, bouncy, and don’t have valves |
| Don’t choose valve that is | cordlike or sclerosed |
| Why avoid joint areas if possible | because of motion and IV could kink and catheter could break in half |
| Tourniquet used to | suppress venous flow |
| Transillumiation | illuminates vein that looks like glucometer - Shines over veins and they glow |
| Cannula | hollow plastic tube used for accessing vascular system – stays in the patient |
| Gauge | size of cannula opening |
| Hub | Female connection point of IV cannula where the tubing or other equipment attaches – colored area |
| Stylet | needle or guide that is found inside a catheter used for vein penetration |
| Bevel | ALWAYS UP – Slanted edge on opening of a needle or cannula device |
| Needlestick Safety and Prevention Act, April 2001 | hands remain behind needle as covered - shielded needle provides protection for practioner after stylet withdrawn from catheter |
| Site Preparation – to avoid infection | Alcohol, 2% Chlorhexidine gluconate preferred, Providone – iodine, Tincture of iodine, Alcohol first then betadine –2 minute contact time |
| Bloodstream infections | Coagulase-negative staphylococci |
| Labeling | Label side of transparent dressings cross hub, Don’t place label over insertion site - obstructs visualization |
| Frequency of monitoring | every 2 – 4 hours while infusing |
| Infiltration | inadvertent admin of nonvesicant solution or med into surrounding tissues - catheter dislodgement s/s swelling, stretched skin, coolness, around insertion site |
| Phlebitis | Inflam of vein, pain & tenderness along vein s/s Inflammation, redness at site, site warm, pain, palpable venous cord |
| Extravasation | causes blisters, sloughing of tissue, and necrosis) s/s: Grade 4 infiltration, c/o pain & burning, skin tightness, blanching & coolness of skin |
| Azygous vein | NOT considered a peripheral vein |
Created by:
Ladystorm