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Adult 2 > Infusion Therapy > Flashcards

Infusion Therapy Flashcards

1
Q

Normal serum osmolarity

A

270-300

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2
Q

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

A

Osmolarity >600

pH 9

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3
Q

TPN osmolarity

A

> 1400

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4
Q

Primary tubing is good for how long?

A

72-96 hrs

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5
Q

Lipids/TPN tubing is good for how long?

A

24 hrs

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6
Q

Propofol tubing is good for how long?

A

6-12 hrs

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7
Q

Blood tubing is good for how long?

A

4 hrs

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8
Q

Piggyback

A

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

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9
Q

Int tubing

A

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

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10
Q

Where to place filters?

A

As close to cath hub as possible

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11
Q

Standard blood filter size

A

170-220 microns

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12
Q

Gross particles filter size

A

0.5 microns

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13
Q

Filter lipid containing TPN

A

1.2 microns

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14
Q

Filter all particles and microorganisms

A

0.22 microns

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15
Q

More potent drugs with what?

A

Central accesses

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16
Q

24-26 G

A

Infants and small children, not for viscous infusions

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17
Q

22 (blue)

A

Adequate from most therapies, elderly w/ fragile veins

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18
Q

20 (pink)

A

Adequate for all therapies, minimum size for sx

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19
Q

18 (green)

A

Requires large vein, preferred for sx

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20
Q

14-16

A

Requires large vein, large volume resuscitation

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21
Q

Antecubital vein

A

Reserve for lab draws and emergency access

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22
Q

IV dwell time

A

72-96 hours

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23
Q

What to clean site w/

A

70% alcohol or chlorohexidine

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24
Q

Length of IV therapy

A

3-7 days

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25
Q

When to remove PIVs inserted in emergency?

A

ASAP

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26
Q

When to change transparent (tegaderm) dressing?

A

Q 7 days and PRN

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27
Q

When to change opaque (gauze and tape/island)

A

Q 48 hrs and PRN

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28
Q

How long are midline caths?

A

3-8 inches, 3-5 Fr

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29
Q

Lumen of midline caths

A

Single or double

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30
Q

Where are midline caths inserted?

A

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

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31
Q

Where does the tip of midline caths reside?

A

In peripheral vein

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32
Q

Indications for midline caths

A

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

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33
Q

What not to use midline cath for

A

Vesicant drugs, TPN, drawing blood

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34
Q

Who can insert midline cath?

A

Qualified nurse

-Sterile technique, sterile dressing changes

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35
Q

Where does tip reside in central cath?

A

Central circulation vein, specifically the superior vena cava

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36
Q

Positioning for PE

A

Left lateral trendelenburg

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37
Q

PICC length

A

19-29 inches

38
Q

Lumen of PICC

A

Single, double, or triple

39
Q

Who can insert PICC

A

Requires special training

40
Q

Where is PICC inserted

A

AC fossa or middle of upper arm

41
Q

PICC is good for what?

A
  • Long term therapy (wks-1 year)
  • No limitations on pH or osmolality
  • Draw blood from larger port
42
Q

Nursing implications for PICC

A
  • Informed consent
  • Sterile insertion (CVL bundle)
  • Sterile dressing change
  • Chest x-ray prior to use
  • Routine flushing (SASH)
43
Q

Common complications of PICC

A
  • Cath breakage
  • Phlebitis
  • Thrombophlebitis
  • DVT
  • Cath related bloodstream inx
  • Tip migration
44
Q

Non-tunneled central venous cath insertion site

A

Subclavian, IJ, femoral

45
Q

Non-tunneled length

A

1-10 inches

46
Q

Non-tunneled lumens

A

1-5

47
Q

Which cath is available w/ antimicrobial coats

A

Non-tunneled

48
Q

Where does tip reside with non-tunneled

A

Superior vena cava, typically sutured in

49
Q

Non-tunneled is commonly used for what?

A

Emergent trauma, critical care, sx

*Short-term use

50
Q

Nursing implications for non-tunneled

A
  • Informed consent
  • Trendelenburg
  • Roll between shoulders
  • X-ray verification
  • Sterile insertion/change
  • Site assessment
51
Q

Common complications of non-tunneled

A

Infection, occlusion

52
Q

Cath-related bloodstream infection prevention bundle

A
  • 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
Q

Tunneled central cath

A

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

54
Q

Benefits of tunneling

A

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

55
Q

Lumens of tunneled

A

1-3

56
Q

Why do some pts prefer tunneled over a port?

A

Needless access

57
Q

Implanted ports lumen

A

Single or double

58
Q

Parts of implanted ports

A

Body, septum, reservoir, catheter

59
Q

Where is an implanted port inserted?

A

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

60
Q

Where are implanted port sites?

A

Upper chest or upper extremity

61
Q

Implanted ports feed into what?

A

SC or IJ, tip in SVC

62
Q

How many sticks with implanted ports?

A

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

63
Q

How to access an implanted port?

A

Non-coring needle with deflected point (huber)

*Needle stick injury risk on removal, sterile access

64
Q

Power port

A

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

65
Q

Hemodialysis caths

A
  • Large bore lumen
  • Tunneled or non
  • Perm cath (tunneled)
  • Vas cath
  • Use only for hemodialysis/pheresis
66
Q

Heparin locked hemodialysis cath

A
  • 1,000-10,000 units/mL
  • LABEL!
  • Ports typically labeled w/ volume of heparin to infuse for locking purposes
67
Q

How to care for phlebitis

A
  1. Remove IV
  2. Warm compress
  3. Monitor
  4. Document
68
Q

How to care for infiltration

A
  1. Remove IV
  2. Cool or warm compress
  3. Monitor
  4. Document
69
Q

How to care for extravasation

A
  1. Stop infusion
  2. Aspirate drug
  3. Leave cath in place
  4. Notify doc
  5. Admin antidote
  6. Cool compress
  7. Document
70
Q

How to care for hematoma

A
  1. Remove device
  2. Apply direct pressure, elevate
  3. Check for bleeding
71
Q

How to care for occlusion

A
  1. Assess for bends/kinks or clamped tubing
  2. Assess pt flexion
  3. Use mild flush. If not successful, remove device
72
Q

How to care for pain at IV site

A
  1. Decrease flow rate
  2. Dilute fluid if possible
  3. Consider central access
73
Q

Signs of circulatory overload

A

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

74
Q

How to care for circulatory overload

A

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

75
Q

Speed shock

A

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

76
Q

S/s of speed shock

A

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

77
Q

How to care for speed shock

A

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

78
Q

Causes of catheter embolism

A

Insertion, dressing change, excessive admin forces

79
Q

S/s of catheter embolism

A

Depends where the catheter embolizes, cardiac arrest

80
Q

How to care for catheter embolism

A

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
Q

Pneumothorax

A

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

82
Q

S/s of pneumothorax

A

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

83
Q

Tx of pneumothorax

A

O2, chest tube

84
Q

Hemothorax

A

Puncture of vein or artery

85
Q

S/s of hemothorax

A

Dyspnea, tachycardia, decreased Hgb

86
Q

Tx of hemothorax

A

Apply pressure at site, insert chest tube

87
Q

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?

A

With appropriate maintenance flushing

88
Q

S/s of air embolism

A

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

89
Q

Tx of air embolism

A

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

90
Q

S/s of cath malposition

A

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

91
Q

Tx of cath malposition

A

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

Adult 2 (8 decks)

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