Basic Review of Chapter 40 IV's
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| The bottom of each IV bag has two ports | 1) injection port for meds 2) access port for connecting the administration set
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| D5W (5% destrose in water) is often reserved for________ | Administrating medication
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| Normal Saline and lactated Ringer's solution is _____ | Isotonic crystalloids
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| Bags of IV solution come in different fluid volumes. More common volumes are _____ and ____ | 1,000 mL and 500 mL
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| Smaller IV bags 250 mL and 100 mL are used for _______ | Mixing and administering Meds and more commonly contain D5W
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| Each IV administration set has a ______ ______ | Piercing spike protected by a plastic cover
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| The number on the administration sets indicate the number of drops it takes for a milliliter of fluid to pass thru the orifice and into the _______ ________ | Drip chamber.
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| Drip sets come in two primary sizes: | Microdrip and macrodrip sets
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| ______ sets allow 60 gtt (drops)/mL thru the small, needlelike orifice inside the drip chamber. | Microdrip
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| _____ sets allow 10 to 15 gtt/mL thru a large opening between the piercing spike and the drip chamber | Macrodrip
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| Macrodrip sets are best used for rapid fluid replacement but can also be used for maintenance and _________ setups | (KVO)Keep-the-vein-open IV setups
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| A ______ is a hollow, laser-sharpened needle inside a hollow plastic tube inserted into a vein to keep the vein open. | Catheter
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| Most common types of catheters are _____ and ______ | Butterfly catheters and over-the-needle catheters
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| Catheters are sized by their diameter and referred to by the _______ of the catheters | gauge (a 14-gauge cath is larger than a 20-gauge)
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| Tear the tape before the IV catheter is inserted. double back the tubing to create a loop that will act as a shock absorber if the line is _____ ______. | pulled accidentally
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| Avoid circumferential taping around any extremeity because: | circumferential taping can act like a constricting band and stop circulation.
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| ______ _____ (buff caps) are a way to maitain an active IV site without having to run fluids through the vein. | Saline locks
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| A saline lock is attached to the end of an IV catheter and filled with approximately _____ mL of normal saline to keep blood from clotting at the end of the catheter. | 2 (Saline remains in the port without entering the vein)
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| ______ ______ are used for emergency venous access in pediatric pts as defined by protocol when immediate IV access is difficult or impossible. | Intraosseous (IO) needles (these children are experiencing a life threatening situation such as: cardiac arrest; status epilepticus; progressive shock
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| The IO (intrasseous) needles are inserted in the _____ _____ with a rigid, boring IV catheter, commonly known as _____ ______. | Proximal tibia; Jamshedi needle
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| _____ ____ double needle, consisting of a solid boring needle inside a sharpened hollow needle, is pushed into the bone with a screwing twisting action | Jamshedi Needle
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| ____ _____ IV's provede venous access through the external jugular veins of the neck. | External jugular (these are the same veins used to access jugular vein distention (JVD)the vein is compressed by placing a finger on the vein above the clavicle, causing the vein to fill.)
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| External jugular IV insertion point is very specific. Catheter is inserted midway between the angle of the jaw and the midclavicular line, with the cather pointed toward the shoulder on the same side as the puncture site...difficult because: | these veins are surrounded by a very tough fibrous sheath that makes access difficult.
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| Two possible complications of IV therapy are ____ ____ and ____ _____. | Local reactions and systemic complications
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| Local IV site reactions require that the IV catheter be removed and reinserted at an alternative site. some examples include: | infiltration; phlebitis; occlusion; vein irritation and hematoma
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| ____ is the escape of fluid into the surrounding tissue. | Infiltration (the escape of fluid can cause localized area of edema or simply swelling.
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| Reasons for infiltration include the following: | IV cath passed completely thru vein and out the other side; pt is moving excessively; tape used to secure the area has become loose/dislodged; cath inserted too shallow an angle and has only entered the tissue surrounding the vein
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| Signs and symptoms of Infiltration: | edema at cath site; extremely slow IV flow despite use of a large cath; pt complaint of tightness and pain around the site
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| To correct Infiltration... | an ALS provider must remove the IV cath and reinsert it at an alternative site. apply direct pressure over swollen are to reduce further swelling or bleeding into tissue. **avoid wrapping tape around the extremity to apply direct pressure.
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| _____ is inflammation of the vein | Phlebitis
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| Phlebitis is associated with... | fever, tenderness, and red streaking along the course of the associated vein.
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| If phlebitis is associated with the IV administration you assisted with the ALS provider must... | discontinue and reestablish the IV therapy at another location, using new equipment.
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| _____ is the physical blockage of a vein or catheter | Occlusion *if the flow rate is not sufficient to keep fluid moving out of the cath clot may form and occlude the flow.
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| First clue of possible occlusion is: | decreasing drip rate or the presence of blood in the IV tubing *caused by proximity of valve; pt movement that physically blocked line such as resting on the IV line or crossing of arms; also if bag is almost empty and blood pressure overcomes the flow
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| Occassionally, a pt will experience a ____ _____ in reaction to the IV fluid. | Vein irritation; common with IV medication administration and very uncommon with administration of pure IV fluids
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| Pts who have vein irritation often complain immediately that the IV is bothering them. It may tingle, sting, or itch. Note... | Note these complaints, and observe the pt closely in case a more serious allergic reaction develops.
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| The cause of venous irritation is usually excessively rapid infusion of an _____ _____. | Irritating solution.
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| If redness develops at the IV site with early phletis the _____ | IV fluid should be discontinued and the administration set and fluid saved for later analysis. ALS provider should reestablish new IV site distant of the initial site and use new equipment
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| A_____ is an accumulation of blood in the tissues surround an IV site. | Hematoma - result from vein perforation or improper catheter removal, which allows blood to accumulate in the surrounding tissues.
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| Pts with history of vascular diseases (like diabetes) or receiving certain drug therapies like corticosteroids can have a predisposition to vein rupture or tend to develop _____ | hematomas rapidly with IV insertion.
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| If a hematoma develops when IV catheter insertion is attempted, the procedure should | stop. Direct pressure applied to help minimize bleeding. Application of ice may help. if develops after a successful catheter insertion, evaluate the IV flow...by lowering the IV bag and watch for blood backup into the line.
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| Systemic complications usually involve other body systems and can be life threatening. 5 common systemic complications are..... | Allergic reactions; Air embolus; Catheter shear; Circulatory overload; Vasovagal reactions
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| Allergic Reactions can be related to an individual's unexpected sensitivity to an IV fluid or medication. Pt presentation depends on the extent of the reaction. Common Signs and Symptoms of an allergic reaction include the following: | Itching; Edema of face and hands; Bronchospasm; Wheezing; Shortness of breath; Urticaria (hives); Anaphylaxis
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| If Allergic Reaction occurs discontinue the IV fluid and remove the solution. The catheter will be left in place as an emergency medication route. Medical Control should be notified..... | Maintain an open airway, and monitor ABCs and vital signs. Keep the solution or medication for evaluation by the hospital.
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| Air Embolus | Introduction of air into a pt.
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| Healthy adults can tolerate 200 mL of air introduced into the circulatory system, but pts who are already ill or injured can be affected if any air is introduced.... | properly flushing an IV line will help eliminate any potential of Air Embolus.
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| If your pt begins to develop respiratory distress, consider the possibility of an ____ ____. | Air Embolus.
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| Air Embolus signs and symptoms: | Cyanosis (even in the presence of high-flow O2); Signs and symptoms of shock; Loss of consciousness; Respiratory arrest
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| Treat pt with suspected Air Embolus by placing pt on left side with the head down. Be prepared to ventilate the pt if experiences increasing shortness of breath. | Symptomatic Air Embolus(extremely rare); only considered after more common explanations for pts presenting symptoms have been excluded.
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| _____ _____ occurs when part of the catheter is pinched against the needle, and the needle slices thru the catheter, creating a free-floating segment which could travel thru the circulatory system | Catheter Shear; if ends up in circulatory system could cause Pulmonary Embolus
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| Catheter Shears involves surgical removal of the sheared tip.... | tips are radiopaque (show up white on x-ray)
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| Catheter Shears are caused by... | rethreading needles thru catheters after they have been removed.....NEVER do this
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| An unmonitored IV bag can lead to ____ ____. | Circulatory Overload; Healthy adults can handle up to 2 - 3 extra liters of fluid without compromise.
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| Circulatory Overload problems occur when the pt has.... | Cardia; Pulmonary; or Renal Dysfunction. These types of conditions do not allow the pt to tolerate the additional demands associated with increased circulatory volume.
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| Common Cause for Circulatory Overload in the pre-hospital settings is.... | failure to readjust the drip rate after flushing an IV line immediately after insertion. Always monitor IV bags to ensure the proper drip rate.
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| Signs/Symptoms of Circulatory Overload..... | Shortness of breath; JVD; Increased Blood Pressure. Crackles are often heard; Acute peripheral edema can also indicate Circulatory Overload.
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| Treatment for Circulatory Overload.... | Slow the IV rate to keep the vein open and raise the pts head to ease respiratory distress. Administer high-flow O2 and monitor vital signs and shortness of breath. MC should be contacted immediately..drugs can be given to reduce circulatory volume.
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| Some pt have anxiety concerning needles or in response to the sight of blood. May lead to a drop in BP, and the pt may collapse is called ___ ____. | Vasovagal Reactions
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| Treatment for Vasovagal Reactions... | Treat for shock..Place pt in shock position; Apply Hi-Flo O2; Monitor vital signs; ALS provider should insert an IV catheter in case fluid resuscitation is needed.
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| IV Troubleshooting 1) Check your IV Fluid | Thick, viscous fluids infuse slowly; cold fluids run slower than warm fluids; if possible warm IV fluids should be administered during cold months.
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| IV Troubleshooting 2) Check your Administration set | Macrodrips are used for rapid fluid delivery, whereas Microdrips are designed to deliver a more controlled flow.
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| IV Troubleshooting 3) Check the height of the IV bag | The IV bag must be hung high enough to overcome the pt own blood pressure. Hang the bag as high as possible.
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| IV Troubleshooting 4) Check the type of Catheter used | The wider the catheter (the smaller the gauge), the more fluid can be delivered; 14 gauge is the widest, 27 gauge the narrowest.
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| IV Troubleshooting 5) Check the constricting band (tourniquet) | The ALS provider applies a constricting band during the IV insertion process. Leaving this on could restrict IV fluid from flowing at the proper rate.
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| IV for PEDS | If over-the-needle IV cath is used, the 20-22-24-or 26 gauge are best. Butterfly caths are ideal for PEDS anc can be placed in the same locations as Over-the-needle caths, as well as in visible scalp veins.
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| PEDS - Intraosseous Administration (IO) equipment contains special needles that puncture the bone tissue of the proximal tibia. | Stabilization is critical for these lines to maintain adequate flow.
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| PEDS - Fluid control is important. | Using a special type of microdrip set called a Volutrol IV allows you to fill the large drip chamber with a specific amount of fluid and administer only this amount to avoid fluid overload. 100-mL calibrated drip chamber can be shut off from the IV bag.
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| IV for GEMS | Smaller catheters may be preferable for geriatric pt unless rapid fluid replacement is needed.
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| GEMS and meds | some meds used by GEMS create fragile skin and veins. simply pucturing the vein will cause a massive hematoma. The use of tape can lead to skin damage..be careful when taping IV caths and tubing on older pts
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| IV size for GEMS | such as 20-22-or 24 gauge may be more comfortable and can reduce the risk of extravasation. If fluid resuscitation is necessary, an appropriately sized cath must be used. B careful using macrodrips; can allow rapid infusion of fluids - may lead to edema
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| GEMS and PEDS | Fluid overloading is a real possibility. If necessary, use the Voltrol IV set to prevent fluid overloads
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