fundamentals chapter 29
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| What is Intravenous therapy? | is the infusion of a fluid into a vein to prevent or to treat fluid or electrolyte imbalance or to deliver medications, nutrition, or blood products
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| what is venipuncture? | is the technique that permits insertion of a needle or catheter into a vein
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| In most facilites who is responsible for starting IVs? | nurses
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| what are crystalloid types of intravenous solutions? | fluids that are clear
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| what are colloid types of intravenous solutions? | fluids that contain proteins or starch molecules
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| how can crystalloids be classified? | isotonic, hypotonic, or hypertonic.
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| what is osmolarity? | refers to the number of particles or solutes that are in a liter of a solution
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| Isotonic fluids... | have an osmolarity of 250-375mOsm/L, which is the same osmotic pressure found within the cell
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| What are isotonic fluids used for? | used to expand the intravasular compartment and thus increase circulating volume
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| when would an isotonic solution be helpful? | for hypotension caused by hypovolemia
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| What are examples of isotonic fluids? | normal saline(0.9%NaCl) and lactated Ringer's
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| Hypotonic fluids... | have an osmolarity below 250mOsm/L or a lower osmotic pressure thatn the cell.
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| When a hypotonic solution is infused what happens? | it lowers serum osmolarity, causing body fluid to shift out of the blood vessels and into the cells and interstitial space
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| when are hypotonic fluids administered? | when a client needs cellular hydration
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| what is an example of hypotonic solution? | one-half normal saline (0.45 NaCl)
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| What is 5% dextrose in water before entering the body and after entering the body? | isotonic before administration but quickly becomes hypotonic once in the body bc dextrose is quickly metabolize
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| hypertonic solutions _______ fluid from cells | draw
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| hypotonic solutions _________ fluid into cells | shift
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| Hypertonic fluids.... | have an osmolarity of 375 mOsm/L or higher and a greater osmotic pressure than the cell
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| When hypertonic fluid is infused... | it raises serum osmolarity, pulling fluid from the cells and the interstitial tissues into the vascular space
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| What is an example of a hyptertonic solution? | 3% saline and 5% saline
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| How should hypertonic fluids be administered? | slowly to prevent circulatory overload
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| isotonic indications could be? | intravascular dehydration
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| hypotonic indications could be? | cellular dehydration
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| hypertonic indications could be? | intravascular dehydration with interstitial and intracellular fluid overload
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| what are the common devices used for peripheral IV therapy? | winged infusion needles and over-the-needle IV catheters
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| describe winged infusion needles.. | short, beveled needles with plastic flaps or wings, short term therapy, used with children or infants
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| odd numbers are used to measure... | winged infusion needles, 19,21,23
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| even numbers are used to measure... | designated catheter sizes.
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| how long are most catheters? | 1 or 1 1/4 inches long
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| intermittent infusion devices are sometimes referred to as.... | saline or heparin locks. and are infused with saline to prevent clot formation
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| who usually inserts a central venous catheter? | physician
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| what are some complication associated with central venous access devices? | pneumothorax and air embolisms
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| what are the four main types of central veous catheters? | single or multilumen catheter(short term therapy at hospital), tunneled catheters(long term therapy),PICC(long term therapy at hospital or at home), Implanted access device(cancer, and surgically implanted)
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| what is the most commonly used central venous catheter? | multilumen central catheter;two or three lumens;placement is confired with x-ray
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| what does a electronic infusion device do? | bc it accurately regulates the infusion rate
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| what are the two general classifiations of tubing? | macrodrip and microdrip
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| macrodrip tubing delivers... | 10,15,or 20 drops/mL and is used for adults
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| microdrip tubing delivers... | 60 drops/mL used for children and infants and when fluid is infused slowly
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| what are factors that affect flow rate? | height of solution container, position of extremity, tubing obstruction, postion of the IV access, and IV patency, and clogged air vents
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| what are the components of an IV order? | type and amount of solution, other medications or electrolytes to be added to the solution, length of time for infusion to be given or infusion rate
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| what can influence the flow rate of IV? | viscosity, height of container, cannula position, position or extremity
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| what are the peripheral sites for IV? | arms and legs
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| what are the central sites of IV? | subclavin, internal jugular
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| what are isontic solutions used for? | intravascular dehydration
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| When would you avoid using lactated ringers in a client? | liver disease or metabolic acidosis
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| when administering an isotonic solution what would be a nursing consideration? | to monitor patient closly for signs of fluid overload, especially if they have a history of cardiovascular disease
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| What are hypotonic solutions used for? | cellular dehydration
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| when would you not administer a hypotonic solution to a client? | clients at risk for increased cranial pressure, abnormal fluid shifts into the intersititial cavity, or abdominal cavity(burn victims, trauma, liver failure, severe protein malnutrition)
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| Why would a nurse need to monitor someone who has been adminitered a hypotonic solution? | bc these solutions can cause sudden shit of fluid into the cells and lead to intravascular fluid depletion and cardiovascular collapse
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| What are hypertonic solutions used for? | intravascular dehydration w/interstitial and intracellular fluid overload
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| Why does a nurse need to closely monitor someone who has been administered hypertonic solution? | for fluid overload bc solution can expand int intravascular compartment
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| when would you avoid using hypertonic solutions? | renal, cardiac impairment. diabetics, ketoacidosis. (rarely used outside of ICU).
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| hypertonic solutions draw fluid fluid... | from intracellular to intravascular compartments
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| Never irrigate the catheter if you meet pressure when attempting to flush, why? | bc irrigation may push clot into the circulatory system
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| in acute care or long-term care facility evaluate the clients IV at least... | once each hour. if child perform assessment more frequently
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| gauze dressing change should be done? | every 48 hours on peripheral site
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| what are s/s of infiltration? | swelling, coolnes, discomfort at site, slowed infusion rate, absence of blood return
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| what should your action be when infiltration occurs? | discontinue IV, start another one;apply warm soaks to decrease swelling
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| How can you prevent infiltration? | select site over long bones, avoid over joints, use manufactured stabilization devices, use long-term cath.
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| what are s/s of phlebitis? | pain, warmth, redness, veing may feel hard and cordlike, slowed infusion rate
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| what should your action be when phlebitis occurs? | discon. and start another one; apply warm soak, do not irrigate
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| how can you prevent phlebitis? | change IV site every 72 hrs, use large veins and large gauge-needle rather than cath, dilute meds well and infuse slowly, use central line for very irritating solutions
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| what are s/s of infection of IV? | local: red, warm, and purulent drainage at IV site. systemic:fever, chills, malaise, and elevated WBC
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| What should you do if infection occurs? | discontinue IV and restart; culture catheter tip and draw blood cultures;treat appropriate antibiotics
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| how can you prevent infection at IV site? | asepsis, handwashing, change tubing and dressing every 72 hrs.
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| What are s/s of fluid overload? | elevate BP, increased pulse and respirations, dyspnea, crackles, neck vein distention, weight gain
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| what should you do if fluid overload occurs? | slow IV to "keep open" rate and notify physician; place client in high or semi-fowlers posistion; administer O2.
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| How can fluid overload be prevented? | minitor rates carefully especially high risk(elderly,infants, CHF, renal disease);Use EID; don't catch up when IV gets behind for high-risk clients.
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| what are s/s for air emobolism (usually in central venous catheters) | chest, shoulder,back pain; dyspnea, hypotenstion; thready pulse;cyanosis;loss of consciousness
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| What should you do if air embolism occurs? | place on left side in Trendelenburg position, call doc, monitor VS
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| how can you prevent air embolism? | tape all connectors or use luer lock connectors, use air-eliminating filters,use EID, instruct client to use valsalva maneuver when changing tubing or discontinuing a central line
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| what is thrombophlebitis? | a blood clot accompanied by inflammation
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| phlebitis | inflammation of a vein
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| infiltration | when fluid enters subcutaneous tissue
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| what are IV sites on the hand? | basilic vein, cephalic vein, dorsal venous network, dorsal metacarpal veins
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| what are s/s of a hematoma? | discoloration, swelling, tenderness
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| where should the tourniquet be placed? | 4-6inches above site
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| what type of vein is preferred? | distalvein
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| how should you stabilize the vein uponn insertion? | pull the skin taut below the site
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| at what degree(s) should you insert the catheter and what should yo watch for? | 10-30 degrees, flashback
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| what should you do to the skin while changing from stylet to tubing? | apply pressure above site
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| in between infusions you should flush the catheter every ____ hours or once a shift as policy requires | 8
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| when catheter is out apply firm pressure for how long? | 2-3 minutes or 5-10 minutes if taking anticoagulants
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| what should you note when discontinuing IV? | amount remaining in the bag for I & O
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| how long should you assess the site after a cath is taken out? | 15-30 minutes
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| post infusion phlebitis may occur withing _______ hours after the catheter is removed | 48-96
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| when may fluid overload occur? | when a client receives IV fluid too rapidly
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| should an EID be used for very young clients? | yes EID should always be used for continous therapy bc too rapid an infusion of fluid can be lethal
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| what size needle should be used for blood transfusions? | 18 gauge
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| what is usually administered with blood transfusion? | normal saline
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