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foundations exam 1
IV administration
| Question | Answer |
|---|---|
| purpose of IV therapy is to replace | lost fluids and electrolytes or hydrate patients who can’t take adequate oral fluids on their own. |
| purpose of IV therapy is to administer | medications that would be destroyed in the GI tract |
| purpose of IV therapy is to get | medicine into the bloodstream quickly to reduce symptoms (hypovolemia, pain, pulmonary edema, infection, during a code) |
| IV therapy is | Most potent and dangerous route – Use caution at all times! |
| All bags and tubing must remain | sterile |
| how often do you have to change tubing for standard IV | 72-96 hr |
| Standard IV therapy never provides enough | calories by itself (only 170 calories per liter) |
| Total Parenteral Nutrition (TPN) and lipids are key sources for | significant calories and fatty acids |
| how often do you have to change tubing for TPN | Change tubing 24h |
| how often do you have to change tubing for intermittent | Change tubing 24h |
| vented tubing is needed for | glass bottles, bottles that don't collapse as they empty by atmospheric pressure |
| vent allows | air to enter glass bottle as fluid leaves to keep fluid flowing |
| crystalloids contain | small molecules that easily pass through capillary membranes |
| crystalloids examples | isotonic fluids, hypotonic fluids, hypertonic fluids |
| isotonic fluids | NS, LR, plasmalyte |
| uses for isotonic fluids | shock, dehydration, surgery, burns |
| hypotonic fluids | .45% NaCl - half NS .33% NaCl |
| uses for hypotonic fluids | cellular dehydration, hypernatremia |
| risk for hypotonic fluids | cerebral edema |
| hypertonic fluids | 3% osmolality D5NS D10W |
| uses for hypertonic fluids | severe hyponatremia, cerebral edema |
| risk for hypertonic fluids | fluid overload |
| normal saline | dehydration, shock |
| ringer lactate | burns, trauma |
| dextrose 5% (D5W) | energy and hydration |
| DNS | dehydration and calorie support |
| colloids are used for | more critical pts |
| hypotonic | Osmolality < than that of plasma/blood |
| isotonic | Osmolality close to extracellular fluid/blood (the same concentration of solutions as blood plasma) Hypovolemia |
| hypertonic | Osmolality > than that of plasma/blood. (higher concentration of solutes than blood plasma ) |
| colloids are | Intravascular volume expanders – increases circulating volume and osmotic pressure |
| colloids contain | protein or starch |
| colloids treat | shock and severe fluid volume deficits |
| colloids examples | Salt poor albumin (5%), Dextran, Fresh frozen plasma |
| types of IV tubing | primary and secondary |
| primary IV tubing | aka macro or micro drip – longer in length |
| primary IV tubing have more ports to | piggyback |
| macro drip | drops per mL determined by manufacturer might be 10, 12, 15 or 20 drops per mL, becomes very important when regulating drips manually |
| secondary IV tubing | shorter in length, used for PB meds with compatibility to primary solution |
| microdrip tubing is always | 60 drops per mL |
| starting an IV requires | special training and checking the arm first |
| first thing to do before starting an IV | Ask patient if can be used or check for do not use band |
| second thing to do before starting an IV | Apply tourniquet above the elbow and have patient open and close fist – you wear clean gloves |
| common sites for an IV | hands and forearms |
| colors are | standard around the world |
| you should | prepare all equipment first and clean site with disinfectant |
| thread catheter into | vein until blood is seen "flash" then advance a bit more |
| when done inserting, | tape in place, extension set dressing, flush |
| purple gauge | 26G, 13mL/min used for neonates |
| yellow gauge | 24G, 20mL/min used for fragile veins, peds |
| blue gauge | 22G, 36mL/min used for IV fluids, small veins |
| pink gauge | 20G, 60mL/min used for IV fluids, meds |
| green gauge | 18G, 90mL/min used for blood transfusions |
| gray gauge | 16G, 180mL/min used for rapid infusion surgery |
| orange gauge | 14G, 240mL/min used for rapid infusion surgery |
| when using a tourniquet | make sure it is tight not loose! |
| IV start kits contain | a tourniquet, alcohol wipes, transparent dressing, gauze, tape |
| NS flushes are | 1 time uses |
| IV is started by needle going in at | 10-30 degrees |
| flash | always want to see a flash of blood return! |
| four ways to administer an IV medication | As a primary bag As a piggyback or secondary bag IV push through a running IV. IV push through a saline lock |
| primary bag | NS or LR, continuous longer tubing |
| piggy back or secondary bag | hung higher than primary bag, Abx always closest to pump |
| IV push through a running IV | each drug has different push rate, if pushed too fast, can cause symptoms |
| primary bag is the | main line flowing into the patient |
| piggyback or secondary line | Small bag plugged into primary bag and hung higher so that it could flow in by gravity |
| what must you check before giving PB/secondary line | Must check compatibility with primary solution |
| hanging a secondary line | use a secondary hook the bag is smaller and hung higher, |
| IV pump name | Alaris Infusion Pump |
| Alaris Infusion Pump is a | Volume-control administration set for intermittent intravenous infusion |
| mini infusion pump (syringe pump) for intermittent infusion is | operated and allows medication mixed in a syringe to be connected to the primary lin |
| in hospital setting | scan drug, then the pump, program the pump THIS DECREASES MED ERRORS |
| one way to prime a piggyback | Open roller clamp and slowly allow the solution to flow through the tubing until all of the air is removed. |
| another way to prime a piggyback | Back priming: Attach secondary bag to tubing with roller clamp closed. Lower the bag, open roller clamp, and allow it to flow in by gravity |
| back priming maintains | a closed system, decreases the chance of contamination, and doesn’t waste medication. |
| IV push is a | Single dose of concentrated solution directly into an IV line Med can be scheduled or PRN |
| IV pushes can be | daily, PRN |
| two ways to give an IV push | through a running IV, through a saline lock |
| through a running IV | Bend the tubing above this port over to prevent the medication from traveling up the IV tubing |
| through a saline lock | IV catheter not attached to a bag, must always assess patency |
| when giving an IV push, | You must know the rate and compatibility |
| pneumonic for giving an IV push | FLUSH-MED-FLUSH |
| first check | for a blood return |
| FLUSH-MED-FLUSH | Wipe off the port with an alcohol wipe and attach the flush. Pull back on the plunger, and you should see blood in the tubing |
| No blood return if | the catheter is against the vein, or the patient has low blood pressure |
| Slowly flush | a small amount of saline, monitor for resistance, leaking, pain or swelling |
| 2nd flush rate must equal | med push rate! |
| when doing an IV push through line, make sure to | pinch line because this will stop anything from flowing |
| infection occurs when | microorganisms enter the IV insertion site, the IV line, or the port |
| infection prevented by | using proper sterilization and good hygiene |
| infection local symptoms | pain, warmth, redness, swelling, induration, and malodorous or purulent drainage at the site |
| infection systemic symptoms | fever, chills, malaise, and an elevated white blood cell count |
| phlebitis occurs when | the IV cannula is too large for the vein or when the catheter is not properly secured |
| phlebitis symptoms | erythema, warmth, swelling, and pain along the vein vein may be indurated red streak may follow along vein |
| infiltration occurs when | IV fluids or non-vesicant medications leak out of the vein and into the surrounding tissues |
| infiltration symptoms | swollen, cool to the touch, and pale, and the dressing may feel damp slowed rate of IV infusion |
| extravasation occurs when | a vesicant medication leaks into the surrounding tissue and causes tissue damage chemo agents, vasopressors, vancomycin |
| extravasation symptoms | pain, burning, erythema, and edema at the site formation of blisters, necrotic tissues, slough or eschar |
| hematoma occurs when | IV catheter punctures through more than one wall of the vein or when adequate pressure is not applied after the catheter is removed |
| hematoma symptoms | blood leaking into the surrounding tissue, causing swelling, bruising (ecchymosis), and pain |
| air embolism occurs when | air enters the venous system through the IV line and travels through the circulation |
| air embolism can be | fatal |
| air embolism symptoms | hypotension, tachycardia, difficulty breathing, and cyanosis |
| other IV complications | fluid overload electrolyte imbalances embolus (central lines) sepsis |
| removing IVs | Validate order Need clean gloves, tape, alcohol pad 2X2s Remove tape and dressing Pull catheter straight out putting pressure on vein with 2X2. Hold pressure on site to make sure not bleeding. Inspect catheter to make sure was removed intact. Document |
| assessment of pt with an IV | check bag tubing check pump check site check patient check labs |
| if extravasation, | notify MD stat – antidote must be given, and a very short window for treating |
| Factors contributing to development of phlebitis are divided into four main groups namely | patient factors such as age, gender and underlying conditions chemical factors such as type of drugs and fluids mechanical factors such as catheter material, size and duration of cannulation Health Professional Practices |
| Immediate treatment of infiltration | involves stopping the infusion, removing the IV, and elevating the affected limb |
Created by:
leh195