IVs

Question 1

what is the nurses role in IV admin
1. check: (4)
1. change tubing/fluids per _______
1. medication rights: (3)
1. help with …
1. monitor for …

Answer 1

1. expiration date + discoloration/sediment + pt identifiers + order
2. facility policy (96 hrs)
3. flush or dilution, speed, monitoring + 7 others
4. self care activities
5. complications

Question 2

IV

**never **administer IV meds through tubing that is infusing _______

Answer 2

blood

Question 3

4 ALWAYS of IVs

Answer 3

• check med compatibility if they share a line
• check for 7 + 3 med rights
• maintain integrity of IV line (kinks, leaks, damage, etc)
• respect the line for every pt, every time (clean hub)

Question 4

what does saline locked mean?

Answer 4

the last thing to go into the IV was saline + they are not connected to IV pump/recieving fluids

Question 5

what is the SASH technique?

Answer 5

saline flush
administer
saline flush
heparin (if applicable)

Question 6

what is the purpose large volume/primary/continuous IV infusion?

Answer 6

maintain steady blood levels of meds/fluid

usually pharmacists mix meds, but we can mix in emergency

Question 7

what volume of fluids do primary IV’s dispense?

Answer 7

250 - 1000+ mL

Question 8

what do we need to monitor with primary/continuous infusions?

2

Answer 8

1. adeverse rxn
2. fluid overload (edema, crackles, SOB, JVD)

Question 9

what are volume-controlled/piggyback infusions?

Answer 9

medications that are delivered intermittently (commonly ABs)

Question 10

what volume of fluids do secondary/piggyback IV’s dispense?

Answer 10

50 - 250 mL over 30 - 60 mins

Question 11

what are the advantages of piggyback IV’s?

Answer 11

able to give medications that are only stable for a limited amount of time

Question 12

what is the process of setting up a primary IV?

Answer 12

1. Gather supplies (IV fluid bag, tubing, IV pole, gloves, etc.)
2. Verify the provider’s order (10 Rights)
3. Inspect the IV bag (clarity, expiration, leaks)
4. Close roller clamp on tubing
5. Remove caps and spike the IV bag (keep sterile)
6. Hang the bag on the IV pole
7. Squeeze drip chamber halfway full
8. Open roller clamp and prime tubing to remove air
9. Clean IV port with alcohol swab
10. Connect tubing to IV catheter or extension set
11. Set flow rate (IV pump or gravity drip)
12. Monitor patient and IV site
13. Document all relevant details

Question 13

How do you spike the IV bag?

Answer 13

• Close roller clamp
• remove protective caps (sterile)
• insert spike into IV bag port with a twisting motion

Question 14

How do you prime the primary IV tubing?

Answer 14

• spike bag
• Hang bag
• fill drip chamber halfway
• open roller clamp to remove air bubbles
• close clamp when tubing is fully primed

Question 15

Where do you connect the primed tubing?

Answer 15

To the patient’s IV catheter or extension set after cleaning the port with an alcohol swab.

Question 16

What are the steps to set up an IV piggyback infusion?

Answer 16

1. Gather supplies (med bag, secondary tubing, gloves, pump)
   1.Verify the order (10 Rights)
2. Inspect medication bag (clarity, expiration, compatibility)
3. Close roller clamp on secondary tubing
4. Remove caps and spike the medication bag
5. Hang piggyback above primary fluid bag
6. Prime tubing using back-prime method (lower piggyback, allow primary fluid to fill tubing)
7. Re-hang piggyback bag above primary
8. Connect tubing to Y-site above the pump on primary line
9. Set pump to “secondary” mode, input correct rate/volume
10. Monitor infusion and IV site
11. Document medication, dose, time, and site condition

Question 17

what happens after the secondary medication is done running?

Answer 17

the primary IV fluid starts running

Question 18

what are the differences between the Y sites on the primary tubing?

above and below

Answer 18

above: secondary IV connects here
below: IV push meds

Question 19

what is an injection of bolus/IV push?

Answer 19

concentrated medication into the blood = immediate + irreversible effect

Question 20

what is the volume and time of an IV push?

Answer 20

1 to 10 ml over seconds to minutes

Question 21

what ar ethe advantages of IVP

Answer 21

small volume = good for fluid restrcition or pt’s with risk of fluid overload

kidney issues, liver disease, HF, etc

Question 22

what are disadvantages of IVP?

Answer 22

quick onset (10 mins)
irritating to BV’s
rate of admin/push is important

Question 23

what are examples of isotonic fluids?

3

Answer 23

0.9% NS
Lactated ringers (LR)
D5W

Question 24

when is isotonic solution used?

Answer 24

general fluid replacement (restore circulating volume)
* shock ( expands intravascular volume to improve BP + perfusion = good CO via increase in preload + SV)
* blood transfusions (compatible, keeps the line open and prevents hemolysis of RBC;s)
* **burns **(estore intravascular volume lost through plasma leakage)
* resuscitations (restores circulating blood volume)

Question 25

what are examples of hypotonic fluids?

Answer 25

0.45% NS (1/2 NS) 0. 33% NS ## Footnote leading numbers are less than 0.9% = hypotonic

Question 26

what are examples of hypertonic fluids?

Answer 26

D5 NS D5 LR D5 1/2 NS D10W 3% or 5% NS ## Footnote leading numbers are more than 0.9% = hypertonic

Question 27

physiology of hypertonic solution

Answer 27

**E**nter the vessel from cells = cells shrink the vessel is now more concentrated + high osmolarity, so water leaves the cells | hyp**e**rtonic

Question 28

physiology of hypotonic solution

Answer 28

go **o**ut of the vessel = into the cell = cell swells the BV is "diluted" + the cells are more concentrated/ higher osmolarity, so water enters cells | hyp**o**tonic

Question 29

when is hypotonic solution used? | 4

Answer 29

**dehydration** (Moves water into cells to restore cell volume and function) **DKA **(Helps rehydrate cells that have shriveled due to osmotic diuresis) **Gastric fluid loss **(replenish intracellular hydration while allowing for gradual correction of electrolyte imbalance **free water replacement** (hypernatremia require water replacement to dilute extracellular sodium and move fluid into cells)

Question 30

when is hypotonic solution contraindicated? | 3

Answer 30

**high ICP** (moves water into cells = cerebral edema = brain swelling + inc ICP) **burns** (damaged capillaries = fluid to leak into 3rd spaces = hypotonic shifts fluid out of BV = hypovolemia, edema, and shock) **trauma** (lowers intravascular volume, worsening hypotension and perfusion) ## Footnote TBH

Question 31

when is hypetonic solution used? | 5

Answer 31

**hyponatremia ** (low Na = cells swell = hypertonic = inc in serum Na = draws water out of swollen cells) **cerebral edema** (inc in serum Na = draws water out of swollen cells) **hypoglycemia prevention** (NPO pt = dextrose hypertonic = provide calories/glucose to cells) **circulatory insufficiency **(hypertonic fluids rapidly expand intravascular volume by drawing water into vessels) **post op fluid shifts** (surgery = hypovolemia = hypertonic = pull fluid back into the bloodstream, restoring circulatory volume and BP) ## Footnote HCe, HCi, PO

Question 32

in what setting is hypertonic solution used in?

Answer 32

ICU (via central line) requires close monitoring