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More IV Fluids
| Question | Answer |
|---|---|
| What is the purpose of IV fluid therapy? | Maintenance, to replace or correct deficits, to restore ongoing loss, for meds, nutirtion, phlebotomy, transfusions or blood product therapy. |
| What is oncotic pressure? | Colloids, plasma proteins, albumin |
| What is hydrostatic pressure? | Blood pressure |
| What is normal serum osmo? | 280 - 295 or approx. twice that of the serum Na level. |
| What can expand the intravascular compartment? | Hypertonic fluids. |
| What is the problem with using hypertonic fluids? | If done too fast will draw too much fluid into the intravascular, dehydrating intracellular, especially the brain? |
| What is a S/sx of fluids administered too fast? | decreased LOC / Confusion. |
| What happend if you expand the intraCellular compartment too fast? | Deplete the intravascular, decreasing BP and causing edema. |
| What are the two basic types of parenteral fluids? | Crystalloid and Colloid |
| What is a crystalloid fluid? | An Electrolyte containing solution. |
| What are the three basic types of crystalloid fluids? | Isotonic, HypOtonic and Hypertonic |
| Why are crystalloid fluids called true solutions? | Because they can pass through semipermeable membranes. |
| What is a Colloid fluid? | Contains proteins and starches. |
| What can't a Colloid fluid do? | Pass between compartments. They draw the fluid to them. |
| Name three problems with IV fluid therapy. | Phlebitis, extravasation and incompatabilities. |
| What three things can and LVN NOT do? | cannot han, flush or change bags on a central line even if certified. |
| What can an RN NOT do with a central line. | Cannot assign to LVN or supervise LVN with anything to do with a central line. |
| How do you determine whether it is a central line or a peripheral line? | Ask the doctor for an x ray order to determine. |
| Name some isotonic fluids | D5W, LR and NS |
| Why do you need to be careful with LR and dehydration? | It is hard for the renal system to process the elecetrolytes. |
| What does the liver do to lactate? (LR) | It metabolizeds the lactate to bi-carbonate which buffers acidosis |
| What are two common uses for Normal Saline (NS)? | To treat hyponatremia and intravascular dehydration. |
| Name a HypOtonic solution? | 0.45 NS ( 1/2 NS) |
| What is a problem with HypOtonic solutions? | Use too long and it will lower BP. It is low in solutes so fluid will move out of the vascular space. |
| What makes Hyper tonic fluids different than the others? | It has moce dissolved particles than bldy fluid. |
| What does a hypertonic fluid do? | It moves fluid out of the intracellular and interstitial compartments into the intracascular. |
| What are hypertonic fluids used for? | Hydration and nutrition |
| What is dangerous about hypertonic dextrose saline solutions? | they can move fluids very quickly. |
| What is a hypertonic dextrose saline fluid solution used for? | TPN and PPN. Nutrition. |
| What type IV line do you use with Hypertonic dextrose saline? | 10% solutions can go peripheral but all others 20% and above must use a central line? |
| Why must most hypertonic dextrose saline solutions be used with a central line? | Because the fluids are very irritating to veins. |
| How do you infuse hypertonic dextrose saline solutions? | You must use an infusion pump. |
| Plasma expanders are not considered what? | Blood products. |
| What do you NOT have to do with plasma expanders? | Type and cross match. |
| Which of the two main categories of fluids do plasma expanders fall into? | Colloid. |
| What are Colloids used for? | Maintenence of blood volume, hypovolemic shock, dialysis. |
| In which patients do you need to use colloid product with cautiously? | renal insufficiency and CHF |
| PPN is used in what type of line? | Peripheral |
| TPN is used in what type of line? | Central |
| What are the components of TPN? | H2O, PRO, CHO, fat, vitamins, trace minerals. |
| TPN usually come in a _____hour supply. | 24 hour supply |
| Name some indications for TPN. | Non-function GI, Bowel obstruct., acute inflam, colitis, Crohns, malabsorption, chemo, burns, sepsis, ooncology, pancreatitis. |
| How do you know TPN is working? | By weighing daily. |
| What is the consideration with IVs and glucose? | Must use the appropriate IV access for concentration of glucose, must use pump, don't play catch up, taper TPN, accu-checks, used micron filters |
| What should you monitor with TPN? | I & O, weight, liver and renal function and electrolytes. |
| Why do you monitor liver and renal function with TPN? | To make sure that they are excreting electrolytes. |
| Why do you use a micron filter with TPN? | to filter out bacterial growth. |
| Why do you taper TPN? | To avoid hypOglycemic shock from cutting of the sugar. |
| Can you run other things in the TPn IV tubing? | No, don't mix with anything else. |
| What is an important consideration with albumin? | May cause anaphylaxis |
| What are some potential complications with TPN? | Fluid imbalances, metabolic acidosis, liver dysfunction, hyperglycemia and infection. |
| What lab can you use to monitor liver function? | BUN |
| What is the first thing that you assess wtih a patient? | the IV |
| What are some items of IV that you should assess? | What type line, correct solution according to MAR, what time hung, how much left to infuse, correct rate, everything current? |
| How long is the IV bag good for? | 24 hours |
| How long is IV tubing good for? | 72-96 hours depending on hosp |
| How long is a peripheral site good for? | 72 - 96 hours depending on hosp |
| Why do you want to know how much infusion time is left? | So you can be prepared and have the next bag order from pharm and ready. |
| Why inspect for blood return? | Good indicatino of patent IV but not alwyas. |
| When you look up an IV drug what is an important item that you will check? | Y siet compatibility with other drugs you may be administering. |
| If you add another drung in and it becomes cloudy what is happening and what do you do? | It is incompatible and you stop it and throw away the tubing. |
| What happens if you see crystals? | Incompatibility. Stop IV and throw away the tube. |
| Who do you determine what is compatible in an IV? | Use the drug book, call the pharmacy |
| How long do you continue a "continous or maintenance" infusion? | Until the Dr has ordered it stopped. |
| How is an IV push administered? | Usually by syringe. |
| Where can you find the drip factor? | Printed on the bag. |
| How is gravity or free flow regulated? | By roller clamp or clip. |
| Does the IVPB hang higher or lower or equal to the regular IV? | Higher |
| Name an important act you must do with continous infusion ( it's a competency) | Time tape the bag. |
| Continous infusion limits what and is what type of risk? | It limits mobility because you have to take it with you and it is a fall risk. |
| What method of infusion should you not use with a central line? | Gravity or free flow. |
| What anti-biotic can you NOT use with gravity/free flow infusion? | Vancomycin |
| Name three things you cannot use gravity free flow with.. | TPN, peripheral line and medication administration. |
| What does primary rate mean with a pump? | the running rate of the IV |
| What does secondary rate mean with a pump? | running the medications or antibiotics. |
| What is the standard mix for Heparin with an IV? | 25,000 units in 250 ml of D5W |
| One ml of Heparin for IV contains how many heparin units? | 100 units. |
| What is an important check that you do with Heparin? | You check the dose with a second person. |
| what must you be careful about with the secondary rate of an IVPB? | You must check to make sure that the rate has been changed back to the primary rate when the secondary has finished. |
| What is positive pressure technique? | closing slide clamp at the same time as flush. |
| Infusion time on an IVPB is regulated by what? | The roller clamp of the primary bag. |
| PCA administration can be programed for what three things? | intermittent (PCA), continous ( basal) or both rates. |
| What does the Dr order for PCAs? | dose/ml, delay time, lockout, patient administered does, basak rate and loading or PRN dose. |
| Name six types of IV access? | Peripheral, central, HICKMAN® catheter, quinton, implanted ports and PICC. |
| What is an important intervention with epidural IV? | Catheter management. Check site of inserting but do not change, pull dressing. |
| What is the routine flush times for a peripheral line? | Q8hr and before and after meds. |
| Why do you flush a line before giving the medication? | To check patency. |
| How much is a routine flush of NS for a peripheral line? | 2-3 ml. |
| Where is the central line placed? | Superior vena Cava. |
| A Quinton catheter is used for what? | Short term dialysis, longer and a shunt is placed instead. |
| Implanted ports are put in place where? | Put in and taken out in the OR |
| You need to be certified to access what type of port? | implanted port. |
| Implanted ports are used in what population? | Oncology |
| What is a Huber Needle? | A right angled needle that you must be certified to use and accesses an implanted port. |
| What is a PICC? | Peripherally Inserted Central Catheter |
| Is a PICC used for short or long term therapy? | Both |
| How many lunmens does a PICC have? | One or two, two is preferred |
| Before placement of a PICC what do you need to have? | Informed Consent |
| You need to flush a PICC if there is no...what? | Continous infusion. Flush Q8hr. |
| Who inserts a PICC. | Speciality trained RN and dc'd by same. |
| What is the amount of NS used to flush a PICC? | 5 ml flush |
| What sixze syringe do you used to flush a PICC? | 10 ml syringe |
| What approached is used for a PICC? | The brachial approach. |
| What is the problem with a PICC line and the brachial approach? | It is easliy occluded when they bend their arm (because it is so flexible)and DVTs are becoming more common as a result. |
| What are the seven complication of IV therapy? | Infiltration, extravasation, phlebitis, air embolism, speed shock, fluid overload, infection. |
| What is infiltration? | administration of a non vesicant into tissue surrounding the vein or collapse or vein dissolving. |
| What is the difference between infiltration and extravasation? | Not much except extravasation is infiltration that results in tissue damage and necrosis from the product administered |
| S/Sx of infiltration? | swelling, Coolness, pain, tigh, hard, blanch or red, maybe leaking due to pressure |
| What may be a first indication of infiltration? | Slow or sluggish IV rate |
| Infiltration causes: | loss of vein integrity , catheter dislodgement |
| Tx for infiltration.. | dc IV, warm soaks, elevate, check pulse and cap refill, |
| Prevention of Infiltration.. | Tape IV site well, special attention if on a pump, and educate pt to watch for signs. |
| Patient education for infiltration? | Watch for cool, swollen hard or painful site. |
| Extrasavation is.. | administratino of a vesicant ( blistering) solution into surround tissue. |
| A Vesicant is.. | agent capable of causing tissue damage or necrosis to surrounding tissue |
| An irritant is.. | an agent capable of producing pain at site |
| Phlebitis is.. | Inflammation of the vein |
| S/Sx of Phlebitis.. | Pain, erythema, dedma, streak formation, hardness of vein, increased temp. |
| When phlebitis damages a vein it is permanent or temporary? | Permanent |
| If the phlebitis shows erythema where is it usually? | localized, at tip of catheter and on. |
| Causes of Phlebitis? | Poor blood flow around cath, friction, iv left in too long, clotting. |
| What is the Tx for Phlebitis? | d/c IV faster is better, always apply warm compress, watch for infection. |
| Infection causes: | Sever phlebitis, equipment contamination, outdated solutions, poor technique |
| S/Sx of infected IV | pain, tenderness, warmth, redness, elevated temp, chills, purulent drainage, elevated WBC |
| Infected Iv Tx? | d/c IV, culture tip, call Dr |
| S/Sx of FVE | HTN, JVD, Dyspnea, SOB, Rales, cough |
| Tx of FVE | HOB high Fowlers, decrease EV rate temporarily, call Dr. |
| Prevention of FVE with IV | Montior rate, know risk population, watch out if you have a position IV |
| What is a positional IV | One that has multiple positions for drip rate on it. Check all positions for the drip rate to avoid FVE |
| Who is the at risk population for FVE with IV? | CHF, valve replacement surg, new valves, bad valves |
| S/Sx of air embolism | weak, rapid pulse, chest pain, SOB, cyanosis, decease in blood pressure, anxiety |
| Air Embolism is a problem with what type line and not with what type line? | Problem with Central line, very hard to geton a peripheral line as you need lots of air. |
| Tx for Air Embolism? | Clam IV, Place with right side up to trap air in right atrium, ( left side down,) trendelenburg, give O2, call Dr. |
| Prevention of Air Embolism? | #1 is careful priming of IV tubing, dc central lines properly, careful clamping during tube changes, valsalva manuever during changes. |
| Speed Shock is.. | sudden increase in plasman level of a drug after administration |
| S/sx of speed shock? | syncope( transient sudden loss of conciousness with inability to maintain upright posture) cardiac arrest and shock |
| Prevention of speed shock? | Know what you are giving and how fast you can administer it, rate of administration |
| Name a drug that speed shock can come with | Vancomyacin |
| Home care considerations with IV therapy are? | careplan, clean house, safe, support, family, who do you teach. |
| Most common line for home therapy? | PICC line |
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