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N150B - Fundamentals in Nursing > IV Therapies and Central Lines > Flashcards

IV Therapies and Central Lines Flashcards

1
Q

What are the purposes of establishing an IV?

A
  1. Helps maintain or restore the fluid volume and electrolyte balance of the body.
  2. Provide a way to nourish and feed a patient calories.
  3. A way to give needed medication (both routine and emergent) – such as pain meds
  4. To transfuse blood products.
  5. To provide avenue for diagnostic lab testing.
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2
Q

Do RNs need orders for IVs? What other instances would RNs need orders?

A

Yes, also for saline lock, blood draws, and IV removal; check orders prior do doing any action mentioned.

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3
Q

What are some occupational risks related to IV therapy?

A
  1. Needlesticks
  2. Chemical exposure
  3. Latex allergy
  4. Biological hazards
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4
Q

How might you prevent occupational hazards?

A
  1. Facility practice policies
  2. Personal protective equipment
  3. Vaccinations
  4. Training
  5. Hand washing
  6. Safer equipment
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5
Q

What are some things that might cause someone allergies?

A

Drugs, iodine, tape/adhesive, and latex (i.e., tourniquets, bp cuffs, vials, gloves, injection caps, tubing)

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6
Q

What is a 14G catheter used for and what color is it?

A

Orange and massive traumas.

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7
Q

What is a 16G catheter used for and what color is it?

A

Gray; trauma, surgery, multiple larger volume transfusions

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8
Q

What is an 18G catheter used for? What color?

A

Green; blood transfusions and large fluid volume of fluids

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9
Q

What is a 20G catheter used for? What color?

A

Pink; multi-purpose, medication, hydration, routine therapy.

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10
Q

What is a 22G catheter used for? What color?

A

Blue; chemotherapy infusions, patients with small veins, elderly, peds

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11
Q

What is a 24G catheter used for? What color?

A

Yellow; very fragile veins and elderly patients.

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12
Q

How do you find the vein before starting a peripheral IV?

A

(First step) Go by “feel” and not by site, lay arm hang downward, avid areas of joint flexion, start distally and work upward.

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13
Q

Would you start an IV in extremities with same side mastectomy?

A

No because this can cause lymphedema and high risk infections.

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14
Q

True or false: it is safe to start an IV in any extremity that has dialysis shunts or AV fistulas.

A

False

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15
Q

True or false: I would not start an IV where there are present signs and symptoms of infection

A

True

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16
Q

True or false: I would not start an IV in areas with extensive scarring, burns, or surgeries.

A

True

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17
Q

True or false: I would start an IV on CVA paralysis side

A

False

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18
Q

True or false: I would not start an IV in extremities that have previous recent infiltration, extravasation, phlebitis.

A

True

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19
Q

True or false: I would not start an IV in a site distal to previous puncture

A

True

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20
Q

What are some procedural technical pointers for starting an IV?

A

(Second step); prepare equipment, tourniquet 6-8 inches above intended site, pull skin taunt, bevel up, 10-30 degree angle, insertion toward the heart, and one smooth movement.

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21
Q

How would you never tie a tourniquet?

A

In a knot

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22
Q

What are some alternatives to dilate the vein?

A

If vein is not adequately dilated, massage vein prn, clench fist prn, and use heat prn.

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23
Q

What is extension tubing used for?

A

Connects to the patients IV catheter to make a saline lock (with a cap on the end)

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24
Q

What are some things to document after inserting an IV?

A

Record the date and time of insertion, gauge, type of catheter, number of attempts, location of insertion site; if saline lock or if IVF infusion; patient tolerance.

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25
Q

How often should the peripheral IV (PIV) be changed?

A

No more frequently than 96 hours, but at least every 7 days. Consult hospital policy.

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26
Q

How would you maintain the peripheral IV catheter patency?

A

Intermittent flushing; common practice if Saline flush q 8 hours or q 4 hours.

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27
Q

How often would you assess the IV?

A

every 8 hours and prn for any abnormalities or complaints.

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28
Q

When would you discontinue an IV?

A

Upon provider order or discharge OR if complications occur (then it is restarted in another area).

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29
Q

What would you document for PIV discontinuation?

A

Catheter and fluids were discontinued, appearance of site and dressing applied, whether or not the cannula was intact, condition of patient.

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30
Q

What is the most common cause of infiltration?

A

Damage to the wall during insertion or angle of placement.

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31
Q

When does infiltration occur?

A

When fluid or medications leak into the surrounding tissue - caused by improper placement of the catheter.

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32
Q

What are the signs and symptoms of infiltration?

A

Swelling, discomfort, burning and/or tightness; cool skin and blanching; decreased or stopped IV flow rate.

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33
Q

What are the different types of phlebitis?

A

Chemical, mechanical, bacterial.

34
Q

What is chemical phlebitis?

A

IV solution has caused inflammation (usually associated with acidic or alkaline solutions)

35
Q

What is mechanical phlebitis?

A

Irritation caused by insertion of cannula (vein trauma during insertion or inappropriate IV catheter size)

36
Q

What is bacterial phlebitis?

A

Introduction of bacteria into the vein.

37
Q

What is cellulitis and what is it caused by?

A

Inflammation of loose connective tissue around insertion site; caused by poor aseptic technique.

38
Q

How is cellulitis treated?

A

With antibiotics.

39
Q

How does cellulitis physiologically manifest?

A

Red swollen area spreads from insertion site outwardly in a diffuse circular pattern.

40
Q

What is extravasation?

A

Leaking of vesicant drugs into surrounding tissue.

41
Q

What does extravasation cause?

A

Severe local tissue damage, delayed healing, infection, tissue necrosis, disfigurement, loss of function, even amputation.

42
Q

What are the signs and symptoms of extravasation?

A

Blanching, burning, or discomfort at the IV site.
Cool skin around the IV site, swelling at or above the IV site blistering and/or skin sloughing (shedding cells from the skin).

43
Q

What are vesicant drugs?

A

Highly toxic medications that make it out of the veins and into the tissues, causing severe tissue damage and necrosis.

44
Q

What causes circulatory overload related to IV insertion?

A

Iv infused too rapidly.

45
Q

What are the early and late signs of circulatory overload?

A

Early signs - crackles and SOB
Late signs - edema

46
Q

Who is at high risk for circulatory overload?

A

Patients with heart failure, kidney transplant/failure.

47
Q

What are nursing interventions for circulatory overload?

A

Stop fluids and order diuretics.

48
Q

What is an air embolism?

A

Air in vein from unpurged (unprimed) syringe or tubing.

49
Q

What are the S/S of an air embolism?

A

Sudden onset dyspnea, chest pain, hypotension, tachycardia, Decreased LOC.

50
Q

What are nursing interventions for an air embolism?

A

Clamp tubing; head down/Trendelenburg and left lateral decubitus position; aims to trap air in the right atrium and ventricle.

51
Q

Who will you call if a patient has an air embolism?

A

RRT

52
Q

What is a central line?

A

An access device that terminates in a central vein (superior vena cava).

53
Q

What are the different types of central line?

A
  1. PICC (peripherally inserted central catheter) - cephalic, basilic, brachial
  2. Jugular vein (Internal jugular = IJ) or subclavian vein usually secured with sutures.
  3. Ports and Quinton catheters are inserting in the subclavian vein.
54
Q

What is the lumen part of the central line?

A

There is single, double or triple; each lumen its its own tube. The medications do not mix until the CVC.

55
Q

What is the port part of the central line?

A

Where you attach the IV via Luer-lock.

56
Q

What is a stat lock part of the central line?

A

A winged securement device applied underneath the PICC line and then the wings are clipped over it.
There is an opening on each side of
the PICC to nest into the stat lock; When applied, use skin barrier prep
(it’s sticky); When removed, use alcohol

57
Q

What is a biopatch?

A

CHG infused “patch” that you place
over the entrance of the skin; Has a slit in it to place around the
catheter; Be careful not to dislodged catheter
when changing the dressing

58
Q

What do we use to identify the vein when placing a central line? Where is it performed?

A

Ultrasound; bedside

59
Q

What is lidocaine for a central line used for?

A

It is administered intradermally to numb the skin.

60
Q

How is the placement of a central line confirmed?

A

X ray

61
Q

What are the responsibilities of the RN with respect to central lines?

A
  1. Placing supplies at the bedside.
  2. PICC line placement checklist/witness to patient consent.
  3. Assisting with the procedure
  4. assessing site
  5. educating pts and families
  6. changing the dressing
  7. monitoring the site
  8. know the catheter (midline, PICC line, power or not, french size, lumens?)
62
Q

What are the indications of the central line?

A

-Long term antibiotics (>28 days, up to 18 months)
-Medications too caustic (vesicants, irritants) for smaller veins (levophed)
-Long term nutrition (TPN)
-Chemotherapy
-Limited peripheral access
-Emergencies
-Frequent blood draws

63
Q

True or false: AV fistulas are not a contraindication for a central line

A

False; caution in all renal failure patients.

64
Q

True or false: DVTs are a contraindication for a central line

A

True

65
Q

True or False: Severe thrombocytopenia is not a contraindication for a central line

A

False

66
Q

True or false: Mastectomy, pacemaker, port/quinton placement, or history of surgery in
the pathway of the central line are not a contraindication for a central line

A

False

67
Q

True or false: bacteremia is a contraindication for a central line

A

True

68
Q

True or false: Allergy to components is a contraindication to a central line

A

True

69
Q

True or false: Mental conditions concerning for care of the line including IV drug misuse
or severe agitation/confusion.

A

True

70
Q

What are some complication related to central lines?

A

Infection (CLABSI), phlebitis, catheter breakage, pneumothorax, nerve damage, air embolism, arterial insertion, superior vena cava syndrome

71
Q

What is CLABSI?

A

Central line associated bloodstream infections

72
Q

What are some causes of CLABSI?

A

Contamination during insertion, migration of organisms along catheter,
immunosuppressed patient
-Treatment is not reimbursed by medicare/medical if not present on admission.

73
Q

What are local s/s of CLABSI?

A

-Redness, tenderness, purulent
drainage, warmth, edema
-Culture drainage from site, apply warm
compress, remove catheter

74
Q

What are systemic s/s and treatment of CLABSI?

A

-Fever, chills, malaise
-Treatment: Blood cx, abx, antipyretics,
possibly remove catheter

75
Q

How often do you change central line dressings?

A

-24 hours after placement
-then every 5-7 days depending on hospital policy
-when soiled or loose

76
Q

When would you remove a central line?

A

Per provider order

77
Q

What are some nursing considerations when removing a central line?

A

-Ask patient to take a deep breath and hold or bear down to prevent venous air
embolism
-Do not pull if resistance is met

78
Q

When removing a central line, what is considered a vascular emergency?

A

If the distance removed does not match that inserted, a piece of catheter could be inside
the patient. Notify provider immediately (this is a vascular emergency)

79
Q

What is a midline?

A

-A midline catheter is inserted into the arm
peripherally (brachial, cephalic, or basilic
veins)
-IT IS NOT A CENTRAL LINE
-Length: 8-15 cm and terminates in subclavian

80
Q

What is a precaution with respect to midlines?

A

It can look very similar to a PICC line

81
Q

What are some uses for a midline?

A

-Short-term antibiotics (<28 days)
-in patients with difficult venous access
-can run the same medications as peripehral IVs but not the same as a central line.

N150B - Fundamentals in Nursing (6 decks)

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