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IV Maintenance Flashcards

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1
Q

Body fluid breakdown

A

-Body is 60% water
-In two compartments (ICF, ECF)
-2/3rds of all fluid within body in cells (ICF)
-1/3rd outside cells (ECF)

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2
Q

ECF 3 compartments

A

-Interstitial (fluid between cells and outside blood vessels)
-Intravascular (blood plasma)
-Transcellular (fluid separated from other fluid by epithelium = a thin tissue forming outer layer of structure)

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3
Q

Example of transcellular fluid

A

-Include CSF, pleural, peritoneal, synovial, and fluids in GI tract, intraocular, pericardial fluid

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4
Q

Osmosis

A

-The movement of water through a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration
-A semipermeable membrane allows water (solvent) to flow through but not salt (solute)
-Fluid will continue to shift until an equilibrium is reached

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5
Q

Osmotic Pressure

A

-Pressure needed to counter the movement of water across a semi permeable membrane from a low to high concentration of solutes
-Force opposing osmosis

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6
Q

Colloid osmotic (Oncotic) Pressure

A

-Pressure in the body that keeps fluid in the intravascular compartments by pull water from interstitial space back into the capillaries
-Plasma proteins (albumin, globulin, fibrinogen) affect the bloods osmotic pressure
-Low albumin will get leaking of fluid into the interstitial space = edema

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7
Q

Hydrostatic Pressure

A

-The opposing pressure to Oncotic pressure
-It is the force within a fluid compartment that pushes water out of the vascular system at the capillary level
-In the blood vessels, hydrostatic pressure is the blood pressure generated by the contraction of the heart

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8
Q

1st Spacing

A

-Is the normal distribution of fluid in the ICF and ECF compartments
-Fluid moves freely between these spaces to maintain fluid balance

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9
Q

2nd spacing

A

-An abnormal accumulation of interstitial fluid
-Eg. Edema
-Fluid is still in contact with the area it’s suppose to be in so fluid can easily move back into 1st spacing areas through osmosis, hydrostatic pressure, & diffusion

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10
Q

3rd Spacing

A

-Fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of ECF =fluid is trapped and unavailable
-Eg. Fluid shifting associated with burns and ascites

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11
Q

What are IV Infusions

A

-Instillation of fluid, electrolytes, medications, blood, or nutrients into a vein
-May be ordered to supply supplemental or complete fluid, electrolytes, nutrition, administer blood or blood products, provide vitamins and medications or establish a lifeline for rapidly needed medications

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12
Q

NS

A

-Normal Saline
-0.9% NaCl

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13
Q

1/2 NS

A

-Half strength normal saline
-0.45% NaCl

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14
Q

1/3 NS

A

-One third strength normal saline
-0.33% NaCl

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15
Q

LR or RL

A

-Lactated ringers or Ringers lactate

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16
Q

D5W

A

-5% dextrose in water

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17
Q

D5NS

A

-5% dextrose and normal saline
-5% dextrose & 0.9% NaCl

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18
Q

D51/2NS

A

-5% dextrose and half strength normal saline
-5% dextrose & 0.45% NaCl

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19
Q

2/31/3

A

-Two thirds dextrose and one third normal saline
-3.3% dextrose & 0.3% NaCl

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20
Q

IV Solutions: Crystalloids

A

-Contains solutes that cross semipermeable membranes
-They have 3 different tonicities: hypotonic, isotonic, hypertonic
-Can also be categorized by purpose (ie. electrolytes or nutrient)

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21
Q

IV Solutions: Colloids

A

-Contain a protein or starch which does not cross the semipermeable membrane so it remains in the intravascular space
-Colloids are used to increase osmotic pressure to increase vascular volume (they draw fluid in and keep it in the vein so the patient has more circulating volume for the heart to pump)
-Also called a volume or plasma expander

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22
Q

Examples of Colloids

A

-Albumin, pentaspan, voluven

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23
Q

When are colloids used

A

-Used short term in critically ill patients
-For conditions such as hemorrhaging, or burns which draw large amounts of plasma from the bloodstream to the burn site

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24
Q

Osmolarity

A

-Term used to refer to the concentration or the amount of solute in fluids outside of body (such as IV solutions)
-Measured in milliosmoles per litre (MOsm/L)

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25
Osmolality
-Refers to the concentration of fluids inside the body (blood plasma) -Measureed in millimoles per kilogram (mmol/Kg) -Measures concentration of plasma and tells us about fluid/electrolyte balance -Normal serum osmolality is 280-320mmol/kg -If increased that means the blood is concentrated and there is a state of dehydration -If decreased that means the blood is dilute and there is a state of over hydration
26
If you compare the concentration of an IV solution to the concentration of blood serum…
-Will tell you if/how fluid will shift once it’s infused into the body through IV catheter
27
Isotonic IV solutions
-Have the same concentration of solutes as the blood plasma -Osmolarity ranges from 250-375 -So fluid stays in intravascular space -Used to restore vascular volume, more fluid for heart to pump around and more fluid for kidneys to filter so watch for hypervolemia
28
Examples of Isotonic Solutions
-NS -LR -D5W
29
D5W ..
-Is chemically (in the bag) isotonic, but clinically (in the body) hypotonic -D5W fluid quickly becomes hypotonic as the dextrose is metabolized -Insulin pulls the glucose into the cell leaving free water in the intravascular space -The water then quickly shifts from the intravascular space to the cells by osmosis like any other hypotonic solution
30
Hypotonic IV Solutions
-Have a lesser concentration of solutes than plasma -Osmolarity is less than 250 mOsm/L -Lower the Osmolarity/osmotic pressure within the intravascular space so fluid shifts out of the intravascular space into intracellular/interstitial space (cells enlarge)
31
Hypotonic Solutions are Used for
-To provide free water -To treat cellular dehydration -Dilute excess electrolytes as in hyperglycemia (because solvent > solute)
32
Examples of Hypotonic Solutions
-1/2 NS -1/3 NS
33
Do not give hypotonic solutions to …
-Patients with increased ICP or 3rd space fluid shifting
34
What to watch for when giving Hypotonic solutions
-Watch BP as fluid is pulled out of the intravascular space and monitor for edema
35
Hypertonic IV Solutions
-Have a greater concentration of solutes than plasma -Osmolarity is >375 mOsm/L -Cause a higher osmotic pressure in the plasma which pulls fluid from the intracellular/interstitial space (cells shrink) into the intravascular space expanding vascular volume
36
What are hypertonic solutions used for
-Used to correct electrolyte imbalances as in loss from excess vomiting or diarrhea
37
Examples of hypertonic solutions
-D10 -3% NS -D5NS -D51/2NS -D5LR
38
Caution: Hypertonic solutions
-Use caution with patients with kidney or heart disease or who are dehydrated (giving fluid into vascular space but drying out the cells) -Watch for hypervolemia -Because of elevated Osmolarity in comparison to normal blood serum, hypertonic solutions can be very irritating to veins
39
D5NS
-chemically hypertonic becomes just NS (which is isotonic) once the dextrose is metabolized
40
D51/2NS
-Chemically hypertonic, becomes just 1/2 NS (which is hypotonic) once the dextrose is metabolized
41
D5LR
Which is chemically hypertonic becomes just LR (which is isotonic) once the dextrose is metabolized
42
Crystalloid: Nutrient
-IV solutions can also be categorized by purpose -Nutrient IV solution contains some form of carbohydrate (CHO) and water -Used to prevent dehydration and ketosis -With the nutrient solutions, water is supplied for fluid requirements and CHO for calories and needed energy -However nutrient solutions do not provide sufficient calories to promote wound healing, weight gain, or normal growth in children -NOT a replacement for food
43
Examples of Nutrient Crystalloids
-D5W -D51/2NS
44
Crystalloids: Electrolyte
-Electrolyte IV solution contains various electrolytes -Used to correct electrolyte imbalance or restore vascular volume -May be infused for trauma, surgery, and when there are continuing losses from gastric suction or wound drainage
45
Examples of electrolyte Crystalloids
-NS -LR
46
Glass Bottle IV
-Glass bottles require special IV tubing that is vented -Vented tubing allows air to enter the bottle and replace fluid that enters the vein
47
Drop factor
-Number of drops delivered per ML (Number of drops that have to fall in the chamber in order to infuse 1mL of solution)
48
Back check valve
-Prevents fluid from going back up into the primary IV bag
49
Anti siphon valve
-Prevents accidental free flow/gravity infusion -Can be removed if needed for emergency gravity infusions
50
Rate TKO
-Goal to keep IV catheter patent and working -Typically rate is 30ml/hr or less -Slower rates may be used for those at high risk for fluid volume excess such as 5/10mL/hr
51
Rate Maintenance
-Goal is to prevent dehydration when there is poor or no PO intake and losses are normal -Rate between 50-75mL/hr may be ordered
52
Rate Replacement
-Treat fluid volume deficit related to losses -Rate of 100-250mL/hr may be ordered -Idea is to have the flow rate exceed losses by about 50mL/hr
53
Rate Resuscitation
-Rates May be 500-2000mL/hr -Rapid replacement is used short term to avoid/treat hypovolemic shock -When a certain amount of fluid is ordered to be administered relatively quickly this is referred to as a “fluid bolus” (ie. 500ml over 30 minutes)
54
Factors Influencing Flow Rates
-Position of forearm -Position of tubing -Height of infusion bag/bottle -Infiltration or leakage -Size of catheter -Solution viscosity
55
Factors Influencing Flow Rates: Position of forearm
-If IV site is located in a joint and that joint is flexed, that IV catheter May be temporarily occluded and flow blocked -If the IV site is higher than the IV bag, flow will be decreased or stopped
56
Factors Influencing Flow Rate: Position of Tubing
-If the patient lies on the tubing or the tubing dangles below the Venipuncture site, flow will be decreased
57
Factors Influencing Flow Rate: Height of infusion Bag
-If using a gravity infusion, the higher the IV bag is hung the faster the solution will flow
58
Factors Influencing Flow Rate: Infiltration or Leakage
-If the IV catheter is no longer in the vein and is in the interstitial space, there will be increased pressure which will reduce flow rate
59
Factors Influencing Flow Rate: Size of Catheter
-If a large catheter is placed in a small vein, the flow rate will be reduced
60
Factors Influencing Flow Rate: Solution Viscosity
-The thicker the solution the slower it will flow -Eg. Red blood cells are thicker than NS and would flow slower
61
When Infusion Pump Must be Used
-Used for patients at risk for fluid volume overload -Eg, Pediatrics, older adults, cardiac and renal patients -Should also be used when infusing high risk (ie. potassium) -Or when you need to administer a certain volume really fast (bolus) or really slow (TKO
62
Why Infusion Pumps Still Need Frequent Monitoring
-Can not readily detect infiltration or if IV has been pulled out of patient
63
Risk of infection increases …
-With each connection -Means try to minimize how many times you disconnect the IV tubing from the patients VAD
64
How often do IV bags need to be changed ?
-As needed -AT LEAST every 24 hours -Even if that bag is still half full, it gets changed after 24 hours
65
How often to change Continuous Tubing
-Every 96 hours (4 days) -Continuous tubing means that the IV tubing does not get disconnected from the patients VAD -IV tubing should be changed when a new VAD is inserted
66
How often to changed Intermittent Tubing
-Every 24 hours -Intermittent means that the IV tubing get connected and disconnected from the patients VAD several times
67
Signs of hypervolemia
-Must monitor for when infusing -Pulmonary edema -Heart failure -Dyspnea -Tachypnea -Laboured breathing -Increased WOB -Crackles -Tachycardia
68
What is the point of a saline lock
-creates a closed system for IV catheter -maintains venous access without having a continuous infusion running
69
If blood cannot be flushed …
-needless connector should be changed
70
Checking Patency and Blood Return
-Theoretically you should be able to get blood return from all VADs including peripheral IV catheter but sometimes when you attempt to aspirate a peripheral IV catheter, catheter May be against vein wall and vein May collapse -Why we don’t routinely do it even tho considered best practice
71
How often to flush
-Flush with 3mL NS q24h -Before and after fluid or medication admin and before and after blood specimen collection -Ask patient if they experience any burning/stinging or swelling during flushing = signs of infiltration
72
Clamping Saline Lock
-If not using saline lock, clams when not in use -Helps prevent reflux of blood into the end of the IV catheter -If blood sits inside the lumen of IV catheter it will clot and IV will have to be removed and restarted
73
Complications of IV Therapy
-Bleeding -Thrombus Formation -Phlebitis -Infiltration -Extravasation -Infection -Air embolism
74
Complications of IV Therapy: Bleeding
-Can occur around Venipuncture site during infusion -Usually slow seepage and not a big concern -Common in patients receiving anticoagulants or when a bleeding disorder (ie thrombocytopenia, leukemia) -Treatment: preform dressing change at more frequent intervals (May use pressure dressing over site or a gauze dressing) can only stay on for 48 hours
75
Complications of IV Therapy: Thrombus Formation
-Trauma to endothelial cells of the venous wall causes formation of a thrombus at the end of an IV cannula -Causes: IV running dry causing reflux of blood into the catheter, really slow IV rate, inadequate flushing, or IV location
76
Manifestations and treatment of thrombus formation
-Slowed or stopped IV, resistance when flushing -Do not push against resistance (this could lead to the clot dislodging and travelling into the lungs causing a pulmonary embolus) discontinue (remove) IV
77
Complications to IV Therapy: Phlebitis
-Inflammation of a vein: This inflammation can be chemical or mechanical in nature
78
Causes of Mechanical Phlebitis
-The IV catheter is too big for the vein -Catheter movement/Catheter not stabilized
79
Causes of Chemical Phlebitis
-Vein inflamed by medication/fluid -Meds not diluted properly -High infusion rate -Acidic or hypertonic solution -Long term use -Dehydration (increased blood viscosity)
80
Clinical Manifestations of Phlebitis
-Pain -Edema -Erythema -Increased skin temp -Redness travelling along path of vein -Palpable venous cord
81
Phlebitis Treatment
-Discontinue IV and insert new catheter, apply warm moist heat
82
Complications of IV Therapy: Infiltration
-Occurs when IV fluids enter the surrounding space around the Venipuncture site
83
Causes of Infiltration
-Puncture vein wall during insertion -Cannula friction -Line not secured -Movement/manipulation -High infusion rate
84
Clinical Manifestations Infiltration
-Swelling from increased tissue fluid -Pallor and coolness caused by decreased circulation -Pain from edema
85
Treatment for Infiltration
-Discontinue infusion and insert new catheter -Elevate extremity to promote venous drainage -Wrap in warm towel to promote venous return
86
Complications to IV Therapy: Extravasation
-Term for infiltration involving a vesicant -Vesicant is any medication or fluid with the potential for causing blisters, severe tissue injury, or necrosis if it escapes from the vein (can get skin sloughing) -Eg. Chemotherapy drug Paclitaxel -An irritant is any medication that causes burning sensation, pain, tightness, with or without inflammation but no tissue necrosis
87
Treatment of Extravasation
-Attempt to aspirate residual vesicant with blood return -Elevate and immobilize extremity for 48hrs to decrease potential edema -Outline border for monitoring -Depending on vesicant May apply heat or ice
88
Examples of irritant drugs
-Drugs with a very alkaline pH (10-12) or drugs that are very acidic (5.5) -Clinically we try to give vesicants in a central line because it sits in a much larger vessel with greater blood flow and mixing
89
Complications of IV Therapy: Infection
-With infection there is microbial contamination of the cannula -If the infection gets into the bloodstream it’s called septicaemia -This can cause multi organ dysfunction and failure -More common in central lines than peripheral IV catheters
90
Causes of Infection
-Lack of asepsis or contaminated equipment -Dressing may have lifted allowing microorganisms to get in -Contaminated IV cannula -Poor cleansing of skin prior to the IV insertion
91
Clinical Manifestations of Infection
-Warmth -Redness -Swelling -Pain -Exudate -Febrile -Increased WBC -Similar to phlebitis but would likely have Purulent discharge
92
Treatment of infection
-Remove IV -Take culture & sensitivity -Antibiotics
93
Complications of IV Therapy: Air Embolism
-Air bubble in systemic circulation -Air bubble can travel in the blood stream to the heart and lungs and block blood flow
94
Causes of Air Embolism
-Forgetting to remove air from IV tubing prior to attaching IV catheter -Empty solution container -Catheter breaking -Accidental removal of needleless connector
95
Clinical Manifestations of Air Embolism
-Dyspnea -SOB -Chest pain (heart failure) -Hypotension -Tachycardia -Thready pulse -Change in LOC -Cyanosis
96
Treatment of Air Embolism
-Clamp line -Place patient in Trendelenburn (head down) to keep air bubble away from coronary artery (air could cause MI) and on left side to trap air in the right ventricle so it doesn’t go to the lungs -Administer O2 to counteract Ischemia and accelerate absorption -Monitor VS -Notify physician (May aspirate with intracardial needle in extreme circumstances) -More likely an issue with central lines but could happen with a peripheral IV catheter
97
Fluid Volume Deficit Clinical Manifestations
-Dry skin and mucous membranes -Hypotension -Tachycardia -Decreased skin turgor -Thirst -Decreased urinary output
98
Fluid Volume Excess Clinical Manifestations
-Peripheral edema -Increase in body weight (>20%) -Distended neck veins -Hypertension -Crackles in lungs -SOB
99
What to do if patient experiencing Fluid Volume Excess
-Slow infusion or lock it -If experiencing SOB sit upright in semi or high Fowler’s -Monitor VS -May need to apply O2 if says are low -Report findings & interventions to health care provider
100
Pediatric Considerations
-Increased risk for fluid volume overload because they are more vulnerable to alterations in fluid balance -Monitor I&O carefully -Fluid to be administered based on child’s weight -Use infusion pump (vs gravity) to allow for more accurate flow rates
101
Geriatrics Considerations
-Increased risk for fluid overload due to heart and kidney failure -Veins more fragile with aging (closely monitor IV site) -Co-morbidities (low platelet count, anticoagulant or anti-platelet therapy ) -Apply pressure for 5 min to prevent formation of a hematoma (apply pressure for longer than normal)

Tech 3 (4 decks)

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