Download Intravenous Therapy Adults Exam 1 and more Exams Nursing in PDF only on Docsity!
Intravenous Therapy
Adults Exam 1
What are 5 purposes of IV Therapy? - Maintenance or replacement of fluids and electrolytes (dehydration) Provide glucose and nutrition Access route to administer medications intravenously (like antibiotics since IV meds absorb quickly) Venous access to administer blood products Venous access for emergencies (since it absorbs quickly) What is the most common type of IV? - Peripheral IV Peripheral IV's: -Long or short term use? -How often do these need to be changed? -What do we use for intermittent access? -What do we use to flush peripheral IV's? - Peripheral IV's: -Short term use -Change Q 96 Hours OR according to agency's policy
-If intermittent access: Use SAS (saline, administer med, and than saline flush) -w/ peripheral use flush 3-5 ml saline What is an IID (intermittent infusion device) or Heplock? - AKA: Saline lock -an intravenous (IV) catheter that is threaded into a peripheral vein, flushed with saline, and then capped off for later use What does PICC stand for in a PICC line? - Peripherally Inserted Central Catheter line PICC Lines: -Used for how long? -How is it inserted? (How? Where? Who?) - PICC Lines: -Used for long term therapy -Can be inserted at bedside as a sterile procedure. Can be inserted by a specially trained nurse PICC Lines Insertion: -Technique used to give meds? -How many mL for flush? -Nursing & Nursing Assistant care for PICC? - PICC Lines Insertion: -SAS or SASH (Saline-administer med-Saline flush-heparin) -Central line use 10mL flush -NO BP in arm with PICC -NO venipunctures from the arm with the PICC
What is the drawback of using a Port a cath/ Medport over a Broviac/Hickman? - The Port a cath/ Medport cant be used right away because we have to wait for it to heal What is more common? Port a cath/ Medport or the Broviac/Hickman? Why? - Port a cath/ Medport more common because it generally has a lower infection rate Implanted Ports Administration Guidelines: -Access port using _________________________ -Assure correct initial placement via? -Establish _________ return -Assess site -Use occlusive dressing - -Access port using noncoring needle (then put a see through dressing) -Verify placement with a chest Xray to make sure it's in the right place before we start giving meds through it -Establish blood return -Assess site -Use occlusive dressing CVC (Central Venous Catheter) Administration Guidelines: -What should you do prior to initial use? -What 2 things should you assess carefully? -What should you assure before administration? - CVC (Central Venous Catheter) Administration Guidelines: -Verify line placement prior to initial use (with Xray) -Assess exit site and ipsilateral chest carefully -Assure blood return before administration What size/kind of syringe should you use to check blood return for a CVC? - 10 cc syringe used to check for blood return
What should you do if blood return is absent for a CVC? - -Flush with saline -Reposition patient, ask patient to cough -Hold therapy, explain reason -Obtain order for declotting -Confirm proper line placement: X-ray If you can't get blood return and other tricks don't work to get blood return what should you do in terms of meds? - if tricks don't work and no blood return = *do not give meds * What should you remember to check for before giving IV push or IV piggy back medications? - Remember to check for: -Allergies -Incompatibilities (if med can be given with another med) -Dilution -Rate of administration (look in drug book because some meds need to go into slowly and some don't. Some if you push too quickly it will cause projectile vomiting) Explain the steps of giving an IV push/piggyback medications after checking for allergies/incompatibility - -Clean port closest to patient -Administer drug at recommended rate with constant flow -SAS What are 2 things you should never administer IV push/piggyback meds into? - Never administer IVP or IVPB meds into TPN or PCA Line!!! (TPN has like 50 different ingredients so any could react with the med. PCA has narcotics which can also react)
-Used to replace cellular fluid -Cause the cells to swell -Pulls fluid in Between Hypotonic and Hypertonic IV solutions which exert more and which exerts less osmotic pressure than ECF? - Hypotonic: excert less osmotic pressure than ECF Hypertonic: excert more osmotic pressure than ECF What are 3 examples of Hypotonic IV solutions? What are they used for? - -0.45% NaCL -2.5% dextrose and water -Sterile water -These add fluid to cells so for hypernatremia or diabetic ketoacidosis What are 5 types of hypertonic solutions? - -5% dextrose in 0.45% NaCL -5% dextrose in .9% NaCL -5% dextrose in Ringers -5% dextrose in lactated Ringers -3% NaCl What are hypertonic solutions given for? - Edema For the following solutions list whether they are isotonic, hypotonic, or hypertonic: -2.5% dextrose in water -5% dextrose in .9% NaCL -5% dextrose in water (D5W) -5% dextrose in lactated Ringers - -2.5% dextrose and water [Hypotonic] -5% dextrose in .9% NaCL [Hypertonic]
-5% dextrose in water (D5W) [Isotonic] -5% dextrose in lactated Ringers [Hypertonic] For the following solutions list whether they are isotonic, hypotonic, or hypertonic: -3% NaCl -Lactated Ringers -0.45% NaCL -5% dextrose in 0.45% - -3% NaCl [Hypertonic] -Lactated Ringers [Isotonic] -0.45% NaCL [Hypotonic] -5% dextrose in 0.45% [Hypertonic] For the following solutions list whether they are isotonic, hypotonic, or hypertonic: -Normal Saline (0.9% NaCl) -5% dextrose in Ringers -Sterile water - -Normal Saline (0.9% NaCl) [Isotonic] -5% dextrose in Ringers [Hypertonic] -Sterile water [Hypotonic] What is Infiltration? - Fluid in subcutaneous tissue Infiltration: -Definition -Swelling in reference to the IV site -Temperature -Color -Smooth or firm? - Infiltration: -Fluid in subcutaneous tissue -Swelling above IV site -Cool to touch -Pallor -Tissue has increased firmness
What are 3 types of meds that can cause Extravasation? - Vasopressors: -Dobutamine -Dopamine -Epinephrine Chemotherapeutic agents: -Adriamycin -Vincristine -Bleomycin Electrolytes -Potassium Chloride -Calcium Chloride -Calcium Gluconate What's the antidote for Vasopressor extravasation? - Antidote - phentolamine mesylate (Regitine) (5mg/9mlNS) For infiltration and extravasation what temperature would you put on it? - -infiltration: Add warm -extravasation: Apply cold Prevention & Nursing Considerations for Extravasation: -Check IV site every hour for s/sx -Use stabilization device/proper dressing -Protect IV tubing and site when ambulating patient -Check patency and position of access device prior to administration of all medications and fluids -Be aware if antidote available - -Check IV site every hour for s/sx -Use stabilization device/proper dressing -Protect IV tubing and site when ambulating patient -Check patency and position of access device prior to administration of all medications and fluids -Be aware if antidote available
What should you do for extravasation? - -STOP infusion! -Discontinue IV if any signs of infiltration -Restart the IV at a different site -Be aware if antidote available (and may apply heat) What is Phlebitis? - Inflammation of a Vein Symptoms of Phlebitis: -What does it look like? -Temperature? -What does it feel like? (2) -What does the pt feel? - -Red streak along vein -Skin is warm, hot along vein -Vein firm / Cord-like -Causes Discomfort What are possible complications of phlebitis? (3) - -Clots -Infection -Recurrent thrombophlebitis Long periods of cannulation, catheter in a flexed area, catheter gauge larger than vein, poorly secured catheter causes this type A: Bacterial Phlebitis B: Chemical Phlebitis C: Mechanical Phlebitis D: Post Infusion Phlebitis - C: Mechanical Phlebitis Phlebitis from an irritating medication or solution, rapid infusion rate, medication incompatibilities A: Bacterial Phlebitis B: Chemical Phlebitis C: Mechanical Phlebitis D: Post Infusion Phlebitis - B: Chemical Phlebitis
Document Is infection more prevalent with peripheral or central catheters? Why? - More prevalent with central lines due to: -In longer -Poor hand hygiene -Frequent disconnecting of tubing -Poor insertion technique -Multi lumens -Frequent dressing changes -Poor hub care -Improper tubing changes What is the leading cause of death in the ICU? - Sepsis from central lines is leading cause of death in ICU Systemic sepsis: -Occurs throughout body -Involves several systems -Organisms/toxins in blood -Leading cause of deaths in ICU's -60-70% deaths caused by Gram Neg. Bacteria -CLABSI: Central Line-associated Bloodstream Infection - Systemic sepsis: -Occurs throughout body -Involves several systems -Organisms/toxins in blood -Leading cause of deaths in ICU's -60-70% deaths caused by Gram Neg. Bacteria -CLABSI: Central Line-associated Bloodstream Infection Prevention & Nursing Considerations: -Hand hygiene -Hand Washing, Gloves -NO Artificial Nails
-Sterility of access/equipment -Know agency policy -Do not use expired solution, tubing, fluids - Prevention & Nursing Considerations: -Hand hygiene -Hand Washing, Gloves -NO Artificial Nails -Sterility of access/equipment -Know agency policy -Do not use expired solution, tubing, fluids What is Occlusion? - Partial Blockage of IV Access How can we prevent and occlusion? - -Avoid use of AC for IV start -Use only "combatable" mixtures -Peripheral "locked sites" short term access: -Use SAS technique -Central line "locked sites" long term access: -Use SASH technique -check if arm is occluding it, may need to use saline Fluid Overload: -Definition -What does it do to BP/central venous pressure? -Signs and symptoms of fluid overload? - Fluid Overload: -Inadvertent administration of excess fluid -Increases BP and central venous pressure -S/S of fluid overload: moist crackles, edema, weight gain, dyspnea, rapid/ shallow respirations What are things we can do to prevent fluid overload? - Use IV Pump, monitor IV rate Check IV Q 1-2 Hours with stable adult patients
-Place Pt in left side lying Trendelenburg if you suspect an air embolism (helps prevent air from traveling to right side of heart into pulmonary arteries) -Monitor vitals and pulse ox -Call for help What position should you put a patient in if you suspect an air embolism? - left side lying Trendelenburg (helps prevent air from traveling to right side of heart into pulmonary arteries) IV catheter size: -What 2 are most common (color and size)? -What color is 18? - Most common: -Blue 22 -Pink 20 Green is 18 What is Whole Blood? How often do we use it? Why? - All blood components (RBC's, plasma, WBC's, platelets) -In US we don't really give whole blood since we just give the specific part of the blood they need. -Also Whole blood requires T&C, ABO identification What is the most commonly transfused blood product? - Platelets What are Platelets given IV for? Do platelets need to be ABO compatible? - -To control or prevent bleeding associated with platelet deficiencies -To treat thrombocytopenia -Need to be ABO compatible
Your pt is ordered PRBC's. What are they? Why are they given for? - Packed Red Blood Cells (PRBC's) -Improves oxygen-carrying capacity Why are PRBC's given over whole blood? What advantages do they have over whole blood? - -Provides the same oxygen- carrying capacity as whole blood without the additional volume -Decrease plasma volume -Less citrate, potassium, ammonia, & other metabolic byproducts Do PRBC's need to be ABO compatible? - Yes they need to be ABO compatible PRBC's -Volume: 250-350 mL 1 unit raises Hgb 1 g & Hct 3-4% - PRBC's -Volume: 250-350 mL 1 unit raises Hgb 1 g & Hct 3-4% A pt is order IV FFP. What is this? Why is it given? - Fresh Frozen Plasma (FFP) -Liquid portion of blood & lymph Used for: -Coagulation factor replacement (primary use) -Provides clotting factors -Reversal of warfarin Does plasma/FFP need ABO compatible? - Needs to be ABO compatible How long does administration of FFP infuse over? What's the max time for infusion? - Administration: -Infuse over 1-2 hours, 4 hours max. -Standard blood administration set with blood filter
-Does not need ABO compatibility Cryoprecipitate: -What is it? -What is it used for? -Does this need ABO compatibility? - Cryoprecipitate: -Frozen blood product from blood plasma -Used for clotting due to low fibrinogen -Does not need ABO compatibility Albumin: -Used to restore? -Maintains ___________ ___________ in pts with
-Does this need ABO compatibility? - Albumin: -Used to restore intravascular volume -Maintains cardiac output in patients with hypoproteinemia (low protein) -Does not need ABO compatibility Albumin: -Albumin helps with osmotic pressure (helps pull fluid to vascular space—if albumin is low than can cause edema) -Used to restore intravascular volume -Maintains cardiac output in patients with hypoproteinemia (low protein) - Albumin: -Albumin helps with osmotic pressure (helps pull fluid to vascular space—if albumin is low than can cause edema) -Used to restore intravascular volume -Maintains cardiac output in patients with hypoproteinemia (low protein) Nursing Considerations for Blood Products: -Physician's order (so MD responsible for consent)
-Patient signed informed consent -Type and cross (T & C) -Verification of T & C per licensed professionals -Obtain blood and verify in lab -Verify blood with patient and two licensed nurses - Nursing Considerations for Blood Products: -Physician's order (so MD responsible for consent) -Patient signed informed consent -Type and cross (T & C) -Verification of T & C per licensed professionals -Obtain blood and verify in lab -Verify blood with patient and two licensed nurses Nursing Considerations for Blood Products: -Consent? -Verifying blood? - Nursing Considerations for Blood Products: -Physician's order (so MD responsible for consent) Patient signed informed consent -Verify blood with patient and two licensed nurses (2 RN's needed for blood verification) A good nurse knows you can only use what fluid with blood products? - Only use 0.9% Saline (Normal Saline) with blood products
