IVs
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Ladystorm