Intravenous Therapy 3 Flashcards Preview

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Flashcards in Intravenous Therapy 3 Deck (44):
1

IV Discontinuation

have to have an order, there can be complications

2

IV Discontinuation Guidelines:

CDC; Facility policy; 72-96 hours/site & tubing; Tubing Exceptions-TPN, Blood, Lipids/24 hrs

3

IV Discontinuation Steps

1. Explain to patient 2. Clamp tubing 3. Remove dressing & tape/stabilizing catheter 4. Inspect site 5. Using sterile gauze & light pressure 6. Pull catheter straight in line with insertion 7. Apply pressure 2-3 min (5-10 as indicated) 8. Inspect cannula 9. Document 10. Reassess site

4

Removing CVCs

Position patient with head as low as possible; Remove sutures and pull line with steady motion as patient holds breath or during expiration (have pt take deep breath and remove with exhale); Assure tip is present. For PICCs, see measurement obtained at time of insertion; Hold pressure until bleeding stops, apply dressing.

5

IV Complications -

1. Occlusion 2. Bleeding 3. Infiltration 4. Phlebitis 5. Infection 6. Fluid Overload

6

Occlusion Causes -

Tubing clamped or kinked, Positional, Tape or dressing, Damaged cannula, Clot

7

Occlusion Assessment:

Tubing & site, Lower IV bag

8

Occlusion Intervention:

Correct any problem or discontinue site

9

downstream occlusion:

from pump to pt; tube clamped, pt postion

10

upstream occlusion:

from pump to bag

11

bleeding causes:

Anticoagulation therapy
• Low PLTs • Dislodged or disconnected

12

bleeding assessment:

Site- blood, hematoma or disconnection

13

bleeding intervention:

Small amount- change dressing & clean site; Discontinue site, apply pressure as needed

14

Infiltration causes:

Ruptured vessel • Dislodge cannula • Occlusion

15

Infiltration assessment:

Swelling, Blanched, Cool, Pain, Occlusion

16

Infiltration intervention:

Discontinue site; Elevate & Warm compress

17

with infiltration will not have what?

blood return

18

Infiltration Scale

Blanching & Cool plus-
1 Edema < 1”; With or without pain
2 Edema 1-6”; With or without pain
3 Gross Edema > 6”; Mild-Mod Pain; Possible numb
4 Gross Pitting Edema >6”; Skin tight; Leaking; Discolored; Circulation impaired; Mod-Severe Pain
OR any amount of blood, irritant or vesicant

19

Phlebitis causes:

Irritant solution • Dehydration • Infection

20

Phlebitis assessment:

Erythema, Warmth, Pain

21

Phlebitis intervention:

Discontinue site; Warm compress

22

Phlebitis site

warm to touch, "burned the vein", can get blood return

23

Phlebitis Scale

1 Erythema; With or without pain
2 Erythema and/or edema; Pain
3 Erythema and/or edema: Pain; Streak, Palpable venous cord
4 Erythema and/or edema: Pain; Streak, Palpable venous cord >1” Drainage

24

infection causes:

Contamination at insertion • Migration of skin organism • Catheter hub or port contamination

25

infection assessment

Warmth, tenderness, redness, fever of unknown origin

26

infection intervention:

Discontinue site • Notify provider (because of if pt gets discharged)

27

Fluid Overload causes:

Rapid or large volume fluid administration, Compromised cardiac function

28

Fluid Overload assessment:

SOB & Crackles, Tachycardia, Agitation or anxiety

29

Fluid Overload interventions:

Slow infusion; Raise HOB (set up pt); Monitor VS ; Notify Provider

30

ways to get hemotomia

leave turnicate on, puncturing the back wall of a vessel

31

parental nutrition

pt failing to mature oral intake

32

Common Indications for PN

Patient has failed EN with appropriate tube placement
 Severe acute pancreatitis  Severe short bowel syndrome  Mesenteric ischemia  Paralytic ileus  Small bowel obstruction
 GI fistula unless enteral access can be placed distal to the fistula or where volume of output warrants trial of EN

33

Contraindications for PN

Functional and accessible GI tract
 Patient is taking oral diet
 Prognosis does not warrant aggressive nutrition support (terminally ill)
 Risk exceeds benefit  Patient expected to meet needs within 14 days

34

PN Central Access

May be delivered via femoral lines, internal jugular lines, and subclavian vein catheters in the hospital setting
 Peripherally inserted central catheters (PICC) are inserted via the cephalic and basilic veins
 Central access required for infusions that are toxic to small veins due to medication pH, osmolarity, and volume

35

last resort PN -

femoral lines

36

most common PN -

subq

37

peripheral can cause

plebitis

38

TPN -

Total Parenteral Nutrition, glucose, amino acids, vitamins & minerals; used for 7 days

39

PPN -

Peripheral Parenteral Nutrition; ph, amino acids

40

TNP -

Total Nutrient Admixture, glucose, amino acids, vitamins & minerals, & lipids

41

Monitoring Needs

(monitor every 4-6 hours) Glucose Monitoring  Intake and Output  Daily weight
 Labs...CBC, BUN/CRE, Electrolytes (Mag, K+, Phosphate levels, Ca+), ABGs, Liver function test, PT/PTT, Urine osmolality, 24-hour urine collection.

42

Complications of TPN

Sepsis (because of glucose because mediator for bacteria )  Electrolyte Imbalance  Hyperglycemia  Hypoglycemia  Hypervolemia  Hepatic Dysfunction (lipids) Hypercapnea (CO2 in the blood)  Lipid Intolerance

43

Prior to administration:

Obtain a complete health history including allergies, drug history, and possible
drug interactions.
■ Obtain a complete physical examination.
■ Assess for the presence or history of nutritional deficits such as inadequate oral intake, GI disease, and increased metabolic need.
■ Obtain the following laboratory studies: total protein/albumin levels, creatinine/ blood urea nitrogen (BUN), CBC electrolytes, lipid profile, and serum iron levels.

44

Ongoing Nursing Interventions

Use a pump to administer infusion of parenteral nutrition. Infusions should be started slowly to observe for untoward reactions. Check infusion rate at least every 2 hours.
 If administration is interrupted, administer a 5% to 10% dextrose solution to prevent hypoglycemia, based on facility policy.
 Check vital signs every 4 hours to monitor for the development of infection or sepsis. ; Monitor blood glucose levels every 6 hours.  Use aseptic technique when changing solution, tubing,
filter or dressings according to agency policy.
 Compare the client’s daily weights to fluid intake and output. Total weight gain should not be greater than 3 lb. per week. Weight gain greater than 1 lb. per day indicates fluid retention.