Week 5- IV initiation Flashcards
how to treat extravasation
- stop infusion and leave cannula in place
- aspirate vesicant (DO NOT FLUSH)
- remove cannula, outline area with penetrable marker and photograph
- apply cold or warm compress elevate limb for 24-48 hours
- notify mrp
- document psls
PVAD pre/post flush
3ml Q12h
10 ml after med, PN, blood sample collection, transfusion
Dressing changes are required Q
7D and PRN
anatomy of vein
tunica externa
tunica media
tunica interna
endothelium
valve
less than 7 days
- ph between 5-9
non vesicant/irritant
PVAD short
7 days -1 month
PVAD extended dwell
PVAD midline
7 days- 1 month and vesicant
percutaneous CVAD (non tunneled)
PICC
more than 1 month less than 1 year
picc
more than 1 yr
2
ivad or tunneled cvad
hypertonic fluids
cause the cell to
water into
examples
shrink
vascular space
D5NS [isotonic in the body], 3% NaCl, D51/2NS, D5LR, D10W
hypertonic fluid characteristics
treat what
complications
Greater concentration of solutes than blood plasma, useful for treatment of hypovolemia and hyponatremia
increase in intravascular volume and hydrostatic pressure may lead to volume overload or pulmonary edema
Hypertonic
Use cautiously in
assess
patients with preexisting cardiac and pulmonary abnormalities
Assess BP, lung sounds [pulmonary edema] and serum Na
isotonic characteristics
examples
ideal for
Does not change the volume of a cell
0.9% NaCl, Ringer’s Lactate, D5W [hypotonic in the body] -
Same concentration of solutes as blood plasma,
ideal fluid replacement for volume deficiency, LR contains Na/K/Cl/Ca/Lactate, NS used for fluid and sodium loss or as vascular replacement in hypovolemic shock, RL for electrolyte replacement
hypotonic cause
example
used for
cell to swell
0.45% NaCl, D2.5%W. 0.33%NS
Lesser concentration of dissolved solutes that blood, osmosis then produces a movement of water from vascular system to cellular tissue, used to treat cellular dehydration (diabetic ketoacidosis and hypernatremia)
hypotonic should not be used for
should not be given to patients who are at risk for increased cranial pressure, extensive burns and trauma
plasma expanders used for
Used to expand the circulating volume of a hypovolemic patient
colloids
PRBC
colloids
examples
wat they do
[e.g. albumin, dextran] - stay in vascular space and increase osmotic pressure pulling fluids inward
PRBC increase
what is given during transfusion
volume of the vascular space, diuretics are often given with transfusions to prevent fluid overload (TACO)
scope for IV insertion
Peripheral Venous Access Device [PVAD] insertion on clients 16 years of age and over
Peripheral Venous Access Device [PVAD] insertion on clients 5-15 years of age (only once student has had at least 3 successful PVAD insertions on adult clients and have been deemed competent)
yellow
blue
pink
green
grey
why use them
Yellow- 24g- Babies, fragile veins, short in time infusion as outpatient
Blue- 22g- allows for good flow of infusate as well as small enough for most veins to have good flow around the catheter to dilute infusate
Pink- 20g- preferred gauge for blood to decrease damage to cells, preferred for CT contrast under pressure (inserted at ACF)
Green- 18g- rapid infusions/traumas-think about the size of vein required to be able to accommodate this gauge and still have flow around the angiocatheter itself
Grey- 16g- mass/rapid transfusions- most people do not have veins large enough to accommodate the size of angiocatheter and will not have adequate flow around this catheter, replace as soon as able.
tourniquet placement
10-15cm above site or above ACF
dont put IV in
3
Post mastectomy with lymph nodes removed don’t put IV in this arm
Don’t use arm with AV fistula
limbs with diminished sensation
document (7)
Site (vessel used),
Gauge of angiocatheter,
number of attempts (unsuccessful goes in narrative notes as well),
Flush,
Insertion,
dressing and site assessment,
patient tolerance
teach your patient
The purpose of IV therapy,
to avoid playing with IV pump or kinking the tubing,
how to position their arm if applicable,
how to mobilize with the IV pole,
to keep the IV clean and dry (cover for showers with plastic,
to alert the nurse is dressing starts to lift,
they notice redness, swelling or experience pain
