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Flashcards in Infusion Therapy Deck (91):
1

Normal serum osmolarity

270-300

2

When must therapy be infused in central circulation where greater flow provides adequate hemodilution?

Osmolarity >600
pH 9

3

TPN osmolarity

>1400

4

Primary tubing is good for how long?

72-96 hrs

5

Lipids/TPN tubing is good for how long?

24 hrs

6

Propofol tubing is good for how long?

6-12 hrs

7

Blood tubing is good for how long?

4 hrs

8

Piggyback

Must have primary infusion, Y-site connection above infusion pump

9

Int tubing

No primary infusion, cap when not in use, both ends being manipulated when hanging drug, good for 24 hrs

10

Where to place filters?

As close to cath hub as possible

11

Standard blood filter size

170-220 microns

12

Gross particles filter size

0.5 microns

13

Filter lipid containing TPN

1.2 microns

14

Filter all particles and microorganisms

0.22 microns

15

More potent drugs with what?

Central accesses

16

24-26 G

Infants and small children, not for viscous infusions

17

22 (blue)

Adequate from most therapies, elderly w/ fragile veins

18

20 (pink)

Adequate for all therapies, minimum size for sx

19

18 (green)

Requires large vein, preferred for sx

20

14-16

Requires large vein, large volume resuscitation

21

Antecubital vein

Reserve for lab draws and emergency access

22

IV dwell time

72-96 hours

23

What to clean site w/

70% alcohol or chlorohexidine

24

Length of IV therapy

3-7 days

25

When to remove PIVs inserted in emergency?

ASAP

26

When to change transparent (tegaderm) dressing?

Q 7 days and PRN

27

When to change opaque (gauze and tape/island)

Q 48 hrs and PRN

28

How long are midline caths?

3-8 inches, 3-5 Fr

29

Lumen of midline caths

Single or double

30

Where are midline caths inserted?

Through vein in upper arm.
Median AC vein is common
-Basilic over cephalic

31

Where does the tip of midline caths reside?

In peripheral vein

32

Indications for midline caths

Hydration fluids
Therapies lasting 1-4 wks
Difficult stick r/t impaired skin
Anticoagulation/steroids

33

What not to use midline cath for

Vesicant drugs, TPN, drawing blood

34

Who can insert midline cath?

Qualified nurse
-Sterile technique, sterile dressing changes

35

Where does tip reside in central cath?

Central circulation vein, specifically the superior vena cava

36

Positioning for PE

Left lateral trendelenburg

37

PICC length

19-29 inches

38

Lumen of PICC

Single, double, or triple

39

Who can insert PICC

Requires special training

40

Where is PICC inserted

AC fossa or middle of upper arm

41

PICC is good for what?

-Long term therapy (wks-1 year)
-No limitations on pH or osmolality
-Draw blood from larger port

42

Nursing implications for PICC

-Informed consent
-Sterile insertion (CVL bundle)
-Sterile dressing change
-Chest x-ray prior to use
-Routine flushing (SASH)

43

Common complications of PICC

-Cath breakage
-Phlebitis
-Thrombophlebitis
-DVT
-Cath related bloodstream inx
-Tip migration

44

Non-tunneled central venous cath insertion site

Subclavian, IJ, femoral

45

Non-tunneled length

1-10 inches

46

Non-tunneled lumens

1-5

47

Which cath is available w/ antimicrobial coats

Non-tunneled

48

Where does tip reside with non-tunneled

Superior vena cava, typically sutured in

49

Non-tunneled is commonly used for what?

Emergent trauma, critical care, sx
*Short-term use

50

Nursing implications for non-tunneled

-Informed consent
-Trendelenburg
-Roll between shoulders
-X-ray verification
-Sterile insertion/change
-Site assessment

51

Common complications of non-tunneled

Infection, occlusion

52

Cath-related bloodstream infection prevention bundle

-Use a checklist
-Wash hands before
-Maximal barrier precautions (pt is draped from head to toe w/ sterile barrier)
-Sterile gloves, gown, mask
-Minimal people in room during insertion
-Chlorhexidine
-Preferred sites
-Post-placement care
-Review daily the need for cath

53

Tunneled central cath

Portion is tunneled through subq tissue, cuff resides in tunnel, tissue granulates into cuff which secures cath, cuff may have antimicrobial solution applied

54

Benefits of tunneling

Infection prevention
Frequent, long term therapy (months-years)
Good when pt is not PICC candidate

55

Lumens of tunneled

1-3

56

Why do some pts prefer tunneled over a port?

Needless access

57

Implanted ports lumen

Single or double

58

Parts of implanted ports

Body, septum, reservoir, catheter

59

Where is an implanted port inserted?

Into a subq pocket in skin, cath is inserted into a vein

60

Where are implanted port sites?

Upper chest or upper extremity

61

Implanted ports feed into what?

SC or IJ, tip in SVC

62

How many sticks with implanted ports?

Good for long-term use
Chest: 2000 sticks
UE: 750 sticks

63

How to access an implanted port?

Non-coring needle with deflected point (huber)
*Needle stick injury risk on removal, sterile access

64

Power port

Used for contrast to identify the implanted port location. Identify the triangle shape and palpate 3 bumps

65

Hemodialysis caths

-Large bore lumen
-Tunneled or non
-Perm cath (tunneled)
-Vas cath
-Use only for hemodialysis/pheresis

66

Heparin locked hemodialysis cath

-1,000-10,000 units/mL
-LABEL!
-Ports typically labeled w/ volume of heparin to infuse for locking purposes

67

How to care for phlebitis

1. Remove IV
2. Warm compress
3. Monitor
4. Document

68

How to care for infiltration

1. Remove IV
2. Cool or warm compress
3. Monitor
4. Document

69

How to care for extravasation

1. Stop infusion
2. Aspirate drug
3. Leave cath in place
4. Notify doc
5. Admin antidote
6. Cool compress
7. Document

70

How to care for hematoma

1. Remove device
2. Apply direct pressure, elevate
3. Check for bleeding

71

How to care for occlusion

1. Assess for bends/kinks or clamped tubing
2. Assess pt flexion
3. Use mild flush. If not successful, remove device

72

How to care for pain at IV site

1. Decrease flow rate
2. Dilute fluid if possible
3. Consider central access

73

Signs of circulatory overload

SOB, cough, HTN, peri-orbital edema, dependent edema, JVD, crackles

74

How to care for circulatory overload

Slow rates, notify MD/HCP, monitor VS, place upright, admin o2 prn, admin diuretics prn

75

Speed shock

Rapid infusion of drugs or bolus infusion that causes drugs to reach toxic level quickly

76

S/s of speed shock

Lightheaded/dizzy, chest tightness, flushed appearance, irregular pulse, cardiac arrest

77

How to care for speed shock

Discontinue infusion and hang isotonic solution to keep vein open, monitor VS, notify doc

78

Causes of catheter embolism

Insertion, dressing change, excessive admin forces

79

S/s of catheter embolism

Depends where the catheter embolizes, cardiac arrest

80

How to care for catheter embolism

Emergently notify doc, determine how much of catheter has embolized (may require removal of catheter if not already done), x-ray, sx intervention may be required

81

Pneumothorax

Puncture of pleural covering by introducer. Metal stylet is used during insertion and can puncture things other than vein

82

S/s of pneumothorax

Chest pain, dyspnea, apprehension, cyanosis, decrease BS on affected side, abnormal x-ray

83

Tx of pneumothorax

O2, chest tube

84

Hemothorax

Puncture of vein or artery

85

S/s of hemothorax

Dyspnea, tachycardia, decreased Hgb

86

Tx of hemothorax

Apply pressure at site, insert chest tube

87

With lumen occlusion, the catheter lumen is partially or totally blocked. You will not be able to aspirate blood, and may or may not be able to flush. If you can flush, it will be very sluggish flow. How can this be prevented?

With appropriate maintenance flushing

88

S/s of air embolism

Chest pain, dyspnea, hypoxia, anxiety, hypotension, nausea, lightheaded, possible loud churning over pericardium on auscultation

89

Tx of air embolism

Clamp cath, place pt in left lateral trendelenburg, notify doc, O2, ABG, EKG

90

S/s of cath malposition

May have none. Found on chest x-ray. May have ear, neck, back pain or heart palpitations or dysrhythmias

91

Tx of cath malposition

Notify doc to reposition cath. Verify placement with x-ray prior to use