Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NRSG250 > IV administration > Flashcards

IV administration Flashcards

1
Q

types of admin sets

A
  • primary set
  • secondary set (runs higher than primary, think a piggy back)
  • metered volume chambered set (extra chamber for measuring fluid better, allow to keep track of how much pt is getting. seen mainly in peds, critical care)
  • clamping mechanisms
  • flow control device (on the clamp. ie roller clamp regulates without using a machine. some clamps are just open/close. some home care clamps have numbers for gtt/min)
  • add on devices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

add on devices

A
  • luer lock (screw.)
  • stopcock (example of multiflow. on g tube and IV. allows more than one fluid to be connected at one time. then can turn it to run one or the other fluid without changing tubing or resetting pump etc)
  • extension set
  • multiflow adapter and y set (blood)
  • injection port or cap (all needleless.)
  • filter (Filter: takes out microparticles, meds that get precipitate easily. ALWAYS use it for TPN, never for lipids)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when is IV needed?

A

necessary when pt is unable to take sufficient fluids by mouth, if pt can do by mouth, go by mouth.
Better PO if possible because it goes to GI tract, body takes what it needs, sends everything else away. vs putting stuff right into vasculature, you get what you get, surpass body’s homeostatic abilities.
(Areas like ER, they all get IV unless like CHF pt regardless of PO stuff but that’s an exception.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why keep a close eye on IV orders?

A

if have an order for IV, think about whether or not prescriber may have considered PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

infusion delivery devices

A
  • gravity (no pump)
  • electronic
  • PCS pump
  • syringe pump (set to run certain rate, put syringe in it, and little by little itll push the end of the syringe)
  • PCA pump usually opioid (dilaudid, morphine etc). always want 2 nurses to set up just to make sure it’s working. enclosed in plastic except for some buttons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

considerations for infusion pumps:

when an alarm rings, what do you do FIRST?

A

Look at the screen. see if it says occlusion is above or below pump, or if there is air, etc. look at what screen says to do.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Calculations for infusion

A

need drip factor (macrodrip, microdrip) and flow rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

patient assessment for infusions

A
  1. baseline assessment: why are they on the IV? whats in the IV?
  2. check the order very carefully: 5 rights
  3. compatibility. if running 2 things in one line, sometimes not compatible. like can’t run some things with dextrose.
  4. Lab data: electrolytes (Na check for NS), serum proteins (albumin), blood chemistries, renal fx/cardiac fx for fluids because need to make sure body can handle the fluid given *fluid overload risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

catheter-related LOCAL complications

A
  1. bruising/ecchymosis/hematoma
  2. infiltration/extravasation
  3. phlebitis
  4. chemical, mechanical, bacterial, post-infusion
  5. thrombosis
  6. infection
  7. occlusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

bruising from IV site

A

just some capillaries have burst/leaked. doesn’t mean IV is not running but little bit of blood came out (usually when starting iv.) sometimes there will be bruising but IV still runs
NOT same for infiltration/extravasation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

infiltration + tx

A

nonvesicant medication into surrounding tissues. uncomfortable, may take a while to go down.

Tx: For pt with infiltration, elevate arm and use warm compress because it will speed up blood flow and allow the fluid to be drawn back into the vasculature. warm speeds up blood flow so fluid can be drawn back into vasculature even tho normally we use cold for swelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

extravasation + tx

A

vesicant medication into surrounding tissues, blister like formations.
Tx: Do NOT put warm compress on this. Get further instruction depending on what the medication was.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

phlebitis

A

inflammation of tunica intima. just irritation, will go away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

chemical, mechanical, bacterial, post-infusion

A

for these things damage will depend on what’s running, how much gets in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

thrombosis

A

formation of a blood clot. thrombophlebitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

occlusion + consideration

A

of vasculature OR catheter.
Happens by thrombus, drug precipitates, lipid deposits in vasculature.
Know if the drug tends to have precipitates so u can watch for occlusion very carefully (TPN, lipids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

common vesicants?

A

chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

systemic complications , interventions

A
  • med emergency! no more assessments. you need to ACT.
    1. air embolism
    2. catheter embolism
    3. pulmonary embolism
    4. septicemia
    5. allergic rxns (not anaphylaxis, but that’s possible)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

air embolism

A

entry of air into vasculature system.

takes a significant amount of air to create this. usually air gets caught at next port.

20
Q

catheter embolism + how to notice

A

first thing you do is get an xray! cath tip is radio opaque.
Piece of catheter ends up in circulatory system.

Assess cath after removal, see if it’s smooth. Mainly has to do with technique on insertion damaging the cath itself

21
Q

pulmonary embolism

A

excess fluid in circulatory system. very had to breathe, once fluid reaches the PE (made of fluid or bood), it’s a med emergency.

22
Q

septicemia

A

pathogenic bacteria, infection of bloodstream

23
Q

allergic rxn from infusions

A

most common with antimicrobial, biologic, blood products

24
Q

vascular access device is? goes where? how long?

A

Short peripheral catheters

  • Superficial veins of the hand and forearm
  • Dwell for 72 to 96 hours and then require re insertion into another venous site *but follow hospital policy. some research shows leaving one in longer may be more beneficial then re insertion up to 1 wk
25
Q

what indicates nerve damage with vascular access?

A

Complaints of tingling, feeling of “pins and needles” in the extremity, or numbness during the venipuncture can indicate nerve puncture. not rly puncture usually, more like bumped into it.

26
Q

peripheral IV gauges

A

Different colors indicate changes in sizes (gauges).
The smaller the number, the larger the catheter
Yellow- 24 g (very small/pediatric)
Blue- 22 g (small)
Pink- 20 g (moderate)
-Can give blood at this size but not ideal. Vesicant IVPBs/F/uids should go through no smaller than this
Green - 18 g (trauma, rapid infusion)
Orange - 14 g (trauma, rapid infusion)

Butterfly makes it easier to hold, also it’s usually a smaller gauge

27
Q

goal in ER for IV?

A

get biggest access (biggest gauge IV) as you can since in ER usually giving lots of fluids and need good access and stuff

28
Q

where to start an IV

A

When you start IV, always start it in hands if possible. Start there. Then if it gets infected or infiltrated or something, you can move proximally for new sites. You start AC, you have basically nowhere to go. Ideal place is btwn wrist and elbow but start in hand because u have more sites.

29
Q

midline catheter indication, description

A

-3 to 8 inches long, inserted through veins of the antecubital fossa
• The tip is advanced no farther than the
axillary vein in the upper arm.
• Used for therapies lasting from 1 to 4 w

Not gonna see very often cause they go in usually peripherally, same place as pICC line, but they don’t go all the way to SVC. Stop before that. So not a central line. Not as good as PICC. Might as well just use PICC. Might see this if someone getting outpatient chemo or something, but usually won’t see.
Looks similar to PICC: need to know terminal length to be sure of catheter type.

30
Q

midline cath contraindications

A

Should not be used for infusion of vesicant medications, which can cause tissue damage if they escape into the subcutaneous tissue (extravasation).
Vesicants usually given more thru like central lines.

31
Q

Central line types

A
  • implanted venous access device (port, port a cath)
  • external venous access device (tunneled)
  • PICC
  • nontunneled
32
Q

can nurses insert a PICC?

A

Nurses can get PICC line insertion certified. Usually done in patient’s room. Use sterile drapes and everything in the room.

33
Q

benefits of central line?

A

Benefits of going all the way to SVC: nice big vein, easier to mix things with blood, mix faster, better for more dangerous drugs like vesicants. got a lot of blood in the area.

34
Q

PICC description, site, confirmation

A

Type of central line.
• Length ranges from 40 to 65 cm. Range from Single to Triple Lumen
• Basilic vein is the preferred site for insertion, cephalic vein can be used.
• Tip of catheter usually sits in the SVC/RA junction
• Placement is confirmed by chest x-ray examination or EKG. *Don’t give ANYTHING until xray confirms tip is in SVC. EKG just if pt is symptomatic, but not common/routine.

35
Q

PICC dwell time, pt ed

A

No info available on optimal dwell time. Go by hospital but PICCs stay weeks and weeks for when pt needs fluids often. can be given for pts who are going home too. Tabs can be sutured into pt. little circle at insertion site helps prevent infection.

teach pt to perform normal ADLs, avoid excessive physical activity or weight bearing for PICC extremity (give specific examples like picking up napkins but not a grocery bag or grandkid)

36
Q

nontunneled percutaneous central catheter site, description, placement confirmation?

A

very uncomfortable. try not to use if access needs to be there for a while.
• Inserted through subclavian vein in the upper chest or
jugular veins In the neck
*Jugular insertion site subject to turbulence r/t head motion, not ideal
-Usually 15 to 20 cm long. Tip resides in the superior vena
cava
Placement confirmed by chest xray. do NOT use the cath until xray confirms.
No recommendations for optimal dwell time. Longer dwell time than PIV for sure tho.

37
Q

Nontunneled central cath

A

areas where there’s not a lot of SC tissue.

if EJ, tape back so it doesn’t slap pt in face.

38
Q

tunneled central cath

A

• A portion of the catheter lying in a subcutaneous tunnel
separates the points at which the catheter enters the vein from where it exits the skin.
Tunneled central catheter is used for infusion therapy frequent and long term.

Very very stable because it’s going thru SUBQ tissue. Also entry point that is OTA is far from the point where it enters the bloodstream so it’ll take infection to reach blood longer. Can be used for weeks and weeks but still depends on hospital policy. Typical/ideal for long term therapy. Sutured to pt.

39
Q

how to differentiate dialysis cath from others?

A

Can tell because tubing is thick and one port is red and one port is blue: won’t see that for anything other than dialsysis

40
Q

dialysis catheter, lumens, when to use

A

• Lumens are very large to accommodate the hemodialysis
procedure or a pheresis procedure that harvests specific
blood cells.
• This catheter should not be used for administration of other fluids or medications, except in emergency. So dialysis pt may ALSO have PIV.

41
Q

can you draw blood from dialysis cath?

A

If you have an order to draw blood, you can’t draw blood from here, but you can ask the dialysis nurse to give u some blood from it.

42
Q

implanted cath, port a cath site, description

A

Inserted below skin, in area without lot of subq tissue, close to skin, can palpate it kinda see it.
• Implanted ports consist of a portal body, dense septum over a reservoir, and a catheter.
•A subcutaneous pocket is surgically created to house the port body.
• Port is usually placed in the upper chest upper extremity
-Port needs to be flushed after each use and at least once a month between courses of therapy
Used a lot with kids cause there’s not something dangling out, lot lower infection risk. But a process to put in.

43
Q

huber needle

A

Special needle for access to port a cath. There will always be portion of huber needle that sticks out top.
Huber needle can stick out temporarily while they’re getting their antibiotics or whatever. It’ll hold in place by itself like this (ppt) covered over with a dressing.

44
Q

central line dressing importance

A

Really important to do properly to prevent infections.
ALWAYS use antiinfective circle that goes at the insertion site for central lines.
Aseptic technique, sterile. Scrub the hub. Caps should be changed q 42-78h.

45
Q

central line drsg change considerations

A

If there’s gauze under occlusive dressing, needs to be changed q2d. No gauze, change dressing q7d. Danger of changing dressings: breaking aseptic technique, exposing to bacteria, etc. so longer is not necessarily bad. Also change if it’s damp, soiled. Inspection is necessary as part of phys assessment every single day, note if there’s anything that looks problematic ie like an infection.

46
Q

Look at the BB document for CLABSI bundle, memorize the dressing change procedure, know the steps.

A

memorize / insert

NRSG250 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions