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More IV Fluids

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, HICKMANĀ® 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
Created by: pamachia