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foundations
exam 1: intravenous medication administration
| Question | Answer |
|---|---|
| purpose of IV therapy | Replace lost fluids and electrolytes or hydrate patients who cant take adequate oral fluids on their own. Administer meds that would be destroyed in the GI tract. Get meds into bloodstream quickly to reduce symptoms. Most potent and dangerous route! |
| principles of IV therapy | all bags and tubing =sterile standard IV never provides enough calories (only 170 calories) change tubing 72-96 hours. TPN and lipids are key sources to sig calories. change tubing 24h. intermittent: change tubing 24h Compare fluids and meds to order |
| vented tubing needing for glass bottles | Used for bottles that don't collapse as they empty pressure. Vent allows air to enter glass bottle as fluid leaves to keep fluid flowing. some meds bond with plastic and need to be placed in glass containers. |
| crystalloids - IV fluids | contain small molecules that easily pass through capillary membranes risk: fluid overload |
| isotonic IV fluids | (same osmolarity as plasma) normal saline (0.9% NaCl) Lactated ringer (RL) PlasmaLyte |
| isotonic fluids used for | shock, dehydration, surgery, burns |
| hypOtonic IV fluids | (lower osmolarity) 0.45% NaCl (half NS) 0.33% NaCl |
| hypOtonic fluids used for | cellular dehydration, hypernatremia |
| HypErtonic fluids | (higher osmolarity) 3% NaCl D5NS D10W |
| HypErtonic fluids used | severe hyponatremia, cerebral edema |
| common IV solutions | normal saline, lactated ringers, dextrose 5% (D5W), DNS |
| normal saline used for | dehydration, shock |
| lactated ringers used for | burns, trauma |
| dextrose 5% (D5W) | energy and trauma |
| DNS | dehydration and calorie support |
| hypOtonic | osmolarity < than that of plasma/blood |
| isOtonic | osmolarity close to extracellular fluid/blood (the same concentration of solutions as blood plasma) hypovolemia |
| hypErtonic | osmolarity > than that of plasma/blood (higher concentration of solutes than blood plasma) |
| intravascular volume expanders | increases circulating volume and osmotic pressure they contain protein or starch, they treat shock and severe fluid volume deficits, salt poor albumin (5%), dextran, fresh frozen plasma (FFP) |
| types of IV tubing | primary (macro or micro drip) - longer in length secondary - shorter in length |
| primary IV tubing | macro or micro drip, longer in length macro drip, drops her ml determined by manuf. might be 10,12,15, or 20 drops per mL. Becomes very important when regulating drips manually |
| secondary IV tubing | shorter in length (for piggybacking medications that are compatible with primary solution) no ports to add anything to it |
| micro drip tubing | always 60 drops per mL (drop factor/infusion volume) / time in minutes |
| starting an IV | 1. check arms first, liml alert? 2. apply tourniquet above elbow and have pt open and close fist 3. prep all equipment first and clean site 4. thread cath into vein until blood is seen "flash", then advance 5. tape in place, extension dressing, flush |
| common sites for IV | hands and forearm depends what will be infused |
| IV sizes | 26G, 24G, 22G, 20G, 18G, 16G, 14G the bigger the gauge number, the smaller the needle |
| 26G needle color, mL, used for | purple 13mL/min neonates |
| 24G needle color, mL, used for | yellow 20mL/min fragile veins, Peds |
| 22G needle color, mL, used for | Blue 36mL/min IV fluids, small veins |
| 20G needle color, mL, used for | Pink 60mL/min IV fluids, meds |
| 18G needle color, mL, used for | Green 90mL/min blood transfusions |
| 16G needle color, mL, used for | Grey 180mL/min Rapid Infusion, surgery |
| 14G needle color, mL, used for | Orange 240 mL/min rapid infusion, surgery |
| tourniquet | should be taken off within 60 seconds of putting on should be tight |
| starting an IV | insert at 10-30 degree angle wash for flash of blood return in chamber connect to tubing and flush with NS flush |
| four ways to administer an IV medication | as primary bag as a piggyback or secondary bag IV push through running IV IV push through a saline lock |
| primary bag | main line flowing into the pt |
| piggyback or secondary line | small bag plugged into primary bag and hung HIGHER so that it could flow in by gravity must check with compatibility with primary solution |
| Alaris IV infusion pump | volume control administration set for intermittent IV infusion. mini infusion pump (syringe pump) for intermittent infusion is battery operated and allows meds mixed in a syringe to be connected to primary line |
| two ways to prime a piggyback | 1. open roller clamp and slowly allow solution to flow through the tubing until all air is removed. 2. back priming (back flushing) |
| back priming (back flushing) | attach secondary bag to tubing with roller clamp closed. lower the bag to your waist, open roller clamp, and allow it to flow in by gravity. this method maintains a closed system, decreases the chance of contamination, and doesn't waste meds |
| IV push | single dose of concentrated solution directly into an IV line. med can be scheduled or PRN. |
| two ways to give IV push | through running IV through saline lock |
| IV push - through running IV | at tubing port closest to the patient bend the tubing above this port to prevent the med from traveling up the IV tubing |
| IV push - through saline lock | IV catheter not attached to a bag. must always assess patency |
| IV push | single dose of concentrated solution directly into an IV line. meds can be scheduled or PRN |
| two ways to give IV push | - through a running IV -through a saline lock |
| IV push - through a running IV | at tubing port closest to the pt bend the tubing above this port over to prevent medication from traveling back up the iv tubing |
| IV push - -through a saline lock | IV catheter not attached to a bag. must always assess patency |
| important steps of IV push | must know the rate and compatibility. FLUSH- MED- FLUSH |
| IV push first steps | check for blood return |
| checking for blood return | wipe off port with alcohol and attach flush. pull back on plunger and you should see blood in the tubing. slowly flush a small amount of saline, monitor for resistance, leaking, pain or swelling |
| when would you not get blood return? | IV not in vein, catheter is against vein, or the pt has low blood pressure |
| IV complications: infection | occurs when microorganisms invade the IV line, port, or skin on the site of injection. can be prevented with proper sterilization. |
| symptoms of IV infection | local: pain, warmth, edema, induration, and malodorous drainage systemic: fever, chills, malaise, elevated WBS |
| IV complications: Phlebitis | occurs when the cannula is too large for the vein or its improperly secured. inflammation of the vessel wall |
| phlebitis IV symptoms | erythema, edema, warmth, and pain the vein may be indurated might observe a red streak that follows the superficial vein |
| IV complications: infiltration | occurs when IV fluids or medications leak out of the vein and into surrounding tissue. can be caused by displacement, dislodgment, or fragile veins. stop infusion and remove IV, elevate limb |
| infiltration symptoms | swelling, damp site, cold to touch, PAIN slowed rate of IV infusion (fluid may leak from IV site) |
| IV complications: extraversion | another type of infiltration: occurs when a vesicant fluid (chemo, vasopressors, vancomycin) in the IV leaks into surrounding tissues and causes serious tissue damage |
| extraversion symptoms | PAIN, edema, BURNING, erythema formation of blisters, necrotic tissue, slough or eschar may lead to amputation of lim if severe |
| IV complications: hematoma | occurs when the IV angiocatheter passes through more than one wall of a vein or if pressure is not applied to the IV site when catheter is removed |
| hematoma symptoms | swelling, pain, ecchymosis |
| IV complications: air embolism | occurs when air enters the venous system from the IV catheter and circulates >>> can be fatal |
| air embolism symptoms | hypotension, tachycardia, difficulty breathing, cyanosis |
| factors that contribute to development of phlebitis | pt factors (age, gender, and underlying conditions) chemical (types of drugs and fluids) mechanical (catheter size, material, duration) health professional practices |
| other IV complications | fluid overload electrolyte imbalance embolus sepsis |
| removing IVs | validate order gloves, tape, gauze remove tape and dressings pull catheter straight out putting pressure on vein, hold to make sure no bleeding. document removal |
| assessment of pt with an IV | check bag (rt solution, expiration, charted, labeled) tubing (labeled, expired) check pump (settings and alarms, correct rate) site (dressing dry and intact, complications) patient (fluid overload? I/O, heart, lungs) labs |
Created by:
ago24