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EMRG 1300- Advanced Skills Theory > Week 2- Venous Access > Flashcards

Week 2- Venous Access Flashcards

1
Q

What are the 3 objectives to Intravenous therapy?

A
  • Restore & replace intravascular volume
  • Administer medications & or emergency pharmacological tx
  • Maintain venous access in emergency situations
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2
Q

What is IV cannulation used to gain?

A

the body’s circulation

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3
Q

What are the indications for intravenous therapy?

A
  • To administer fluids, TKVO
  • Admin drugs
  • Obtain specimens for laboratory determinations
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4
Q

What are macro drip sets?

A
  • 10, 15, 20gtt/ml
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5
Q

What are macro drips sets used for?

A
  • Most commonly used
  • Effective for TKVO & large fluid bolus
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6
Q

What are micro drip sets?

A
  • Always 60gtts/ml
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7
Q

What are 4 reasons micro drip sets used for?

A
  1. To deliver meds over a long period of time
  2. Assist in the precise measurement of meds
  3. To control amount of fluid
  4. To control fluid overload in certain pts
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8
Q

What are the benefits to using saline lock?

A
  • No tubing to worry about
  • Easy to move pt
  • Still allows quick access to vein
  • More cost effective
  • Greater freedom for pt
  • Reduces fluid overload
  • PCP can monitor pt’s with heparin & saline locks during transfer without an escort
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9
Q

What will catheter size depend on?

A
  • Your purpose (fluid replacement vs med admin)
  • Size of the vein you’re going for (fluid bolus= bigger vein)
  • Pt’s age & condition (hypothermia/ shock/ elderly/ obese)
  • Nature of infusion (TKVO?)
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10
Q

What are the catheter selections and colours?

A

Yellow= 24
Blue= 22
Pink= 20
Green= 18
Grey= 16
Orange= 14

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11
Q

What is the most common gauge used on adults?

A

20 gauge

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12
Q

What is the most common gauge used on peds & elderly?

A

22 gauge

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13
Q

What are crystalloids?

A
  • Dissolving crystals such as salts & sugars in water
  • Contain NO PROTEINS
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14
Q

What are examples of crystalloids?

A
  • Normal saline & Lactated ringers
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15
Q

What is the action of crystalloids?

A
  • Remain in the intravascular space for only a short time before diffusing across the capillary walls into the tissue
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16
Q

What are colloids?

A
  • Contain large molecules such as PROTEIN
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17
Q

What are examples of colloids?

A
  • Plasma subsititutes
  • Plasma
  • Packed red blood cells & whole blood
  • Plasmanate
  • Dextran
  • Hetastarch
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18
Q

What is the action of colloids?

A
  • Don’t pass through the capillary membranes as readily as crystalloids
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19
Q

What does hypotonic mean?

A
  • Lower solute in the solution- causes water to go into the cell
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20
Q

What does hypertonic mean?

A
  • Higher solute in the solution- causes water to leave the cell
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21
Q

What does isotonic mean?

A
  • Equal inside and outside the cell
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22
Q

What solutions can PCP’s monitor without an escort?

A
  • NS/ Ringers/ D5W/ Potassium chloride/ Thiamine & multivitamins/ saline locks
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23
Q

What solutions require an escort?

A
  • Blood products/ meds being infused/ IV Pumps/ Central lines/ Jugular lines
24
Q

When checking the solution, what should you being looking for?

A
  1. Leak/ precipitation- while in plastic wrap
  2. Correct solution name
  3. Expiry date
  4. Cloudiness/ discolouration
25
Q

Each bag contains enough solution to:

A
  • Flush the admin set (good for 24 hours)
  • Allow for accurate reading of volume even with sterile air in the bag
26
Q

What equipment do you require for IV?

A
  • Tourniquet
  • 2x2/ 4x4 dressing
  • IV pole
  • Opsite
  • Alcohol wipes
  • Sharps container
  • Catheters
  • Admin set/ IV bag/ or saline lock
27
Q

What puncture sites should be avoided?

A
  • Injury or disease to an extremity
  • Trauma (# rt hip= IV on Lt. arm)
  • Deficits- CVA
  • Dialysis fistula
28
Q

What are common causes to unsuccessful IV’s?

A
  • Angle of entry too steep- cut through the vein
  • Not enough tension on skin- vein rolling
  • Attempting while in a hurry
  • Stylet not retracted enough during disconnection phase
  • Lack of confidence & experience
29
Q

What are some flow rate complications?

A
  • Venous pressure (position of pt’s extremity)
  • Vein spasms (irritating or chilled fluids)
  • Phlebitis & thrombi
  • Viscosity
  • Amount of fluid in bag
  • Height of fluid
  • Tubing occlusions
  • Needle or gauge size
  • Needle/ cannula position
  • Infiltration (edema & intersitial site)
30
Q

What are some local complications?

A
  • Pain & irritation
  • Infiltration & extravasation
  • Phlebitis
  • Thrombosis & thrombophlebitis
  • Hematoma formation
  • Venous spasm
  • Vessel collapse
  • Cellulitis
  • Nerve, tendon, ligament and limb damage
31
Q

What can cause infiltration?

A
  • Dislodgement of catheter or needle cannula
  • Puncture of distal vein
  • Leakage of solution into surrounding tissue from cannula insertion site
  • Poorly secured IV
  • Poor vein or site selection
  • Irritating solution or med that inflames the intima of his vein and causes it to weaken
  • Improper cannula size
  • High delivery rate or pressure of the solution or med
32
Q

What are the sign & symptoms of infiltration?

A
  • Coolness of skin around IV site
  • Swelling at the IV site, w or wout pain
  • Sluggish or absent flow rate
  • Infusion conts to infuse when pressure is applied to the vein above the tip of the cannula
  • No back flow of blood into IV tubing when clamp is fully opened & solution container lowered below IV site
33
Q

What are systemic complications?

A
  • Contamination & infection
    -Hypersensitivity rxns
  • Sepsis
  • Emboli (blood clot, air, catheter)
34
Q

What can cause a hematoma?

A
  • Leakage of blood from the vessel into the surrounding soft tissue
  • This can occur when pressure is not applied to the IV site when the catheter is removed
35
Q

Sign and symptoms of hematoma?

A
  • Bruising at the insertion site
36
Q

Prevention & management of hematoma?

A
  • Controlled with direct pressure & will resolve over 2 wks
37
Q

Cause of extravascular injection?

A
  • Injection of a drug extravascularly
38
Q

What are the sign & symptoms of extravascular injection?

A
  • Pain
  • Delayed absorption or tissue damagE
39
Q

What is the prevention and management of extravascular injection?

A
  • DC IV and treat with specific antidote to the agent
40
Q

What is the s&s of air embolism?

A
  • Hypertension
  • Cyanosis
  • Weak & rapid pulse
  • LOC
41
Q

What is the management of air embolism?

A
  • Close tubing
  • Turn pt on left side with head down
  • Check tubing for leaks
  • Administer high O2
  • Notify medical direction
42
Q

What are mechanical complications?

A
  • Changes in the position of needle
  • Height of solution
  • Amount of solution
  • Position of pt- kinked tubes
  • Disconnected tubes
  • Plugged air vents & or plugged needles/ cannula
43
Q

What are our IV monitoring limitations?

A
  • Blood products
  • Meds
  • Central lines/ or jugular
  • IV pumps
  • IV restarts- unless previously authorized
  • Neonate or ped pt’s with IV’s
44
Q

What should you report to hospital staff?

A
  • Location of IV
  • Size of catheter
  • Flow rate & how much fluid pt has received
  • Any problems encountered/ failed attempts
45
Q

What are the indications for intravenous and fluid therapy medical directive?

A
  • Actual or potential for intravenous med OR fluid therapy
46
Q

What are the conditions for IV cannulation?

A

Age= > 2 yrs

47
Q

What are the conditions for NaCl fluid bolus?

A
  • Age= >2 yrs
  • SBP= Hypotension
48
Q

Contraindications for IV cannulation?

A
  • Suspected fracture proximal to the access site
49
Q

Contraindication for NaCl fluid bolus?

A
  • Fluid overload
50
Q

Treatment for IV NaCl maintenance infusion? (between 2-12)

A
  • Infusion= 15ml/hr
51
Q

Treatment for IV NaCl maintenance infusion? (>12 yrs)

A
  • Infusion= 30-60ml/hr
52
Q

Mandatory Provincial Patch Point

A
  • Patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive pt’s 2-12 yrs with suspected DKA
53
Q

Treatment for IV NaCl fluid bolus? (2-12 yrs)

A
  • Infusion= 20ml/kg
  • Reassess every= 100ml
  • Max Volume= 2,000ml
54
Q

Treatment for IV NaCl fluid bolus? (>12 yrs)

A
  • Infusion= 20ml/kg
  • Reassess every= 250ml
  • Max volume= 2,000ml
55
Q
A

EMRG 1300- Advanced Skills Theory (5 decks)

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