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IV Therapy LPN
IV Solutions, Types of Catheters
| Question | Answer |
|---|---|
| What is purpose of IV therapy? | Provides H20, electrolytes, & nutrientsAdminister medications & blood products. |
| Two types of IV solutions | 1. Crystalloids 2. Colloids |
| Able to pass through semipermeable membrane. Isotonic, hypotonic, hypertonic | Crystalloids |
| Protein substances that cannot pass into extravascular space. Move fluid from interstitial space - Blood vessels | Colloids |
| Ok to use in peripheral IV (PIC), Concentration close to ECF, Solution of choice. 1 L only expands plasma by 0.25 | Isotonic Solutions |
| Normal saline solution, 0.9% sodium chloride, NaCl, NS | Isotonic Solutions |
| Lactated Ringers (common for surgery) | Isotonic Solutions |
| D5W 5% dextrose in water, becomes hypotonic rapidly | Isotonic Solutions |
| Pull fluid out of vascular space & into cells. 0.45% sodium chloride (half-normal saline) Ok to use in PIV | Hypotonic Solutions |
| Main use: Replaces cellular fluid. Administer cautiously: Fluid shift from vascular system to cells, may lead to intravascular fluid depletion, may result in CV collapse & increased intracranial pressure | Hypotonic Solutions |
| Draw fluid from ICF to ECF. From cells to blood vessels. May cause fluid volume excess. | Hypertonic Solutions |
| Should be administered via central vein. 50% dextrose (D50) Only emergency such as hypoglycemia, | Hypertonic Solutions |
| TPN | Total parental nutrition. Do not mix with meds. (Hypertonic solution) |
| Types of Venous Catheters | Peripheral & Central |
| < 7 days 72-96 hrs. | PIV |
| > 7 days Get order | PICC, Midline |
| > 6 months | Tunneled Catheter, Implanted port |
| Emergency IV | Intraosseous (IO) |
| Over the needle catheter, most commonly used, lengths 0.75"-1.25", diameters: 12 gauge-24 gauge | Peripheral IV |
| Disadvantages of peripheral IV's | Site change every 72-96 hrs. Dressing change: gauze every 48 hrs. transparent 3-7 days. |
| Lower extremeties IV site? | No might cause embolism |
| Warm pack, have them relax extremity, fear can result in venous constriction | Peripheral IV's patient preparation |
| Not recommended for continuous infusions. Non-pliable, infiltrate easily. Uses: blood draws, short term infusions 1-4 hrs. | Winged-Infusion Set |
| Peripheral insertion, still in arm, tip located in proximal portion of extremity, may stay in place 2-4 weeks. 7-8 inch. long Not a central line | Midline Catheter |
| Midline Catheters should not be used for | TPN, some antibiotics, chemotherapy, high pressure boluses, peripheral IV solutions only. |
| Confirm placement by x-ray | Central venous catheters |
| Types of Central venous catheters | Peripherally inserted central catheter (PICC), non tunneled catheter, tunneled catheter, implanted port |
| PICC | Antecubital vein-most common insertion site, Tip located in superior vena cava, 20-24 inches long |
| PICC advantages | Ease of insertion, low complication rates, low infection rates, multi-lumen access, comfortable for patients, easy to cover up, can be used long-term up to a year. |
| PICC Disadvantages | Mechanical phlebitis, frequency of dressing change |
| Non-Tunneled Central Lines | Used for therapy <2 weeks, generally limited to 5-7 days, Commonly used in ICU/ER, Multi-lumen access, Neck, chest or groin |
| Non-Tunneled Central Lines Advantages | Infuse large volumes quickly, any medication or blood, hemodynamic monitoring, multi-lumen access |
| Non-Tunneled Central Lines Disadvantages | High infection rate, limited time of use (1 week) Increased complications with insertion, pneumothorax, bleeding, air embolus |
| Designed to be permanent, but may be removed, Healed after 6-8 weeks, inconspicuous under clothing, may perform all daily activities except swimming (infection) | Skin-Tunneled Catheters |
| Commonly called: Broviac, Hickman Tunnel provides distance between entry site in vein and exit site in skin | Skin-Tunneled Catheters |
| Indicated for frequent or continuous administration of IV substances, commonly called Port-a-Cath Central, long term | Implanted Ports |
| Surgically inserted under skin, minor surgical procedure, usually upper chest, sometimes in arm or abdomen | Implanted Ports |
| Port, Septum: silicone bubble for needle insertion, self sealing, may be punctured up to 1,000 times. | Implanted Ports |
| Implanted Ports Uses: | Delivery of TPN & other fluids, including blood products, chemotherapy & other drugs, obtaining blood specimens |
| Implanted Port Risks: | Infection, thrombosis, mechanical failure, age- can grow out of |
| Systemic IV complications | Fluid overload/pulmonary edema, embolism, infection, allergic reaction |
| Fluid overload s/s | Dyspnea, tachypnea, crackles, tachycardia, edema, weight gain, pulmonary edema |
| Pulmonary edema s/s | Restlessness, tachycardia, dyspnea, cough, crackles on auscultation, frothy sputum |
| Fluid Overload Treatment | High fowler's position, Notify RN/MD, Frequent vital signs, frequent assessment of breath sounds |
| Fluid Overload Intervention | Slow or stop infusion rate, O2, diuretics |
| Fluid Overload Prevention | Infusion pump, close monitoring check every hr., patient teaching: report dizziness, pain at IV site, short of breath |
| Accidental entry of air into vasculature. Piece of catheter breaks off & enters circulation, can block major vessel, blood clot into heart & pulmonary artery | Embolism |
| Air embolism s/s | Usually associated with central line, chest, shoulder, low back pain, dyspnea, weak pulse, hypotension, cyanosis, sudden loss of consciousness, cardiac arrest |
| Air embolism treatment | Clamp cannula, ABC'S, left-sided trendelenburg position, Notify RN/MD, Frequent assessment & vital signs, High-flow O2 if ordered |
| Air embolism Prevention | Use air filters, clamp tubing when changing administration set, use luer lock connection, prime all tubing |
| Intracellular fluid | Inside of cells |
| Extracellular fluid | Outside of cells |
| Catheter related blood stream infection | Septicemia |
| Bacteria on skin enters on catheter insertion, catheter movement at insertion site, external sources | Septicemia |
| Septicemia s/s | Fever, backache, headache, malaise, tachypnea, signs of poor perfusion: delayed cap. refill, poor color |
| TPN can't hang longer then | 24 hrs. due to infection |
| #1 cause of CRBSI's | Hub contamination, wipe vigorously every time accessed, change cap every 7 days |
| Biopatch | Designed to continually release chlorhexidine over 7 days (antimicrobial & antifungal) Provides one inch zone of inhibition, infection decreased 60% |
| Stat-lock | Preferred method of stabilization PICC lines |
| Allergic reaction s/s | Chills & fever, erythema, itching, dyspnea or wheezing, anaphylatic shock, cardiac arrest |
| Allergic reaction treatment | Stop infusion immediately, maintain vascular access, notify RN/MD, frequent assessment including VS |
| Allergic reaction interventions | O2, antihistamines, epinephrine, steroids |
| Local complications | Infilltration & extravasion, phlebitis, thrombophlebitis, hematoma, clotting & obstruction |
| IV solution enters surrounding tissues, occurs when IV cannula dislodges or perforates wall of vein | Infiltration |
| Infiltration s/s | Edema at insertion site, leaking at site, pain, site cool to touch, decreased rate of infusion, drip rate, blanching, can cause permanent damage |
| Extravasation | Similar to infiltration, Inadvertent adminstration of chemo, vesicant or irritant |
| Extravasation s/s | Pain, Burning, redness at site, blistering, inflammation, tissue necrosis |
| Extravasation treatment | Don't take IV out. Leave in place to administer antidote |
| Phlebitis s/s | Reddened, warm area around site or along vein path, pain, vein may feel hard when palpated |
| Plebitis treatment | Stop infusion, assess site, notify RN/MD, disinfect site and remove catheter, restart IV opposite extremity, warm moist compress |
| Phlebitis prevention | Aseptic technique during IV insertion, clean gloves ok, sterile for central line |
| Phlebitis | Inflammation of vein r/t chemical or mechanical irritation or both, catheter moving in and out |
| Hematoma | Blood leaks into tissues surrounding IV insertion site |
| Hematoma possible causes | Opposite wall of vein perforated, catheter slipping out of vein, insufficient pressure to site after catheter removal |
| Hematoma s/s | Ecchymois-bruising, immediate swelling, blood leaking at site |
| Catheter Occlusion possible causes | Clot or precipitate, kinked tubing, very slow infusion rate, allowing IV bag to run dry |
Created by:
angienoriega
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