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NRSG 302 > Week 5 - IV therapy > Flashcards

Week 5 - IV therapy Flashcards

1
Q

what is the most commonly used IV access for fluid therapy, medication and blood administration?

A

PVAD

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2
Q

where is a PVAD inserted?

A

into a small peripheral vein

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3
Q

how long can a PVAD stay in one spot for?

A

leave them there as long as needed as long as they are patent and free from complications

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4
Q

what are the indication for a PVAD?

A
  • medication admin
  • surgical access
  • blood transfusions
  • venous access for high volume fluid replacement
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5
Q

what are some possible complications for PVADS?

A
  • infiltration
  • mechanical phlebitis
  • chemical phlebitis
  • cellulitis
  • occluded IV
  • infection
  • hyervolemia
  • extravasation
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6
Q

vesicants are medications that can cause what?

A
  • blistering
  • tissue sloughing
  • necrosis
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7
Q

describe extravasation with vesicant IV solution

A

infiltration of a solution or medication with the ability to cause tissue damage in tissue around the vein

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8
Q

what are risks for extravasation?

A
  • poor IV insertion/ securing
  • fragile veins
  • multiple attempts bellow previous puncture site
  • altered circulation to limb
  • large gauge cannula
  • drug amount, concentration, length of use
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9
Q

what are some signs and symptoms for extravasation?

A
  • moderate/ severe pain at site
  • redness
  • coolness
  • swelling
  • leakage at site
  • ulceration
  • blistering
  • sloughing
  • occlusion
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10
Q

how do you treat extravasation?

A
  • stop infusion
  • leave cannula in place
  • aspirate as much vesicant as possible
  • do not flush
  • remove cannula
  • outline area with marker
  • apply cold/ warm compress
  • elevate 24-48hrs
  • notify MRP
  • document
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11
Q

what type of extravasation is the most common in neonates?

A

calcium gluconate

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12
Q

what can calcium gluconate extravasation cause?

A
  • tissue necrosis
  • sloughing
  • calcification of affected area
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13
Q

what are the different types of hypertonic fluids?

A
  • D5NS
  • 3% NaCl
  • D51/ 2NS
  • D5LR
  • D10W
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14
Q

what are hypertonic fluids used to treat?

A
  • hypovolemia
  • hyponatremia
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15
Q

when treating someone with a hypertonic fluid what do you need to frequently assess?

A
  • BP
  • lung sounds
  • serum Na
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16
Q

what are the different types of isotonic fluids?

A
  • 0.9% NaCl
  • ringer’s lactate
  • D5W
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17
Q

what are isotonic fluids used to treat?

A
  • fluid loss
  • vascular replacement
  • electrolyte replacement
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18
Q

what does ringers lactate contain?

A
  • Na
  • K
  • Cl
  • Ca
  • lactate
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19
Q

what is an example for a hypotonic solution?

A

0.45% NaCl

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20
Q

what is hypotonic solution used for?

A

maintenance fluids

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21
Q

what type of patient would you NEVER give hypotonic fluids to?

A
  • risk for increased cranial pressure
  • extensive burns
  • trauma
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22
Q

what are different types of plasma expanders?

A
  • colloids
  • plasma
  • albumin
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23
Q

what do plasma expanders do?

A

stay in vascular space and increase osmotic pressure

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24
Q

what do PRBCs do?

A

increase pressure and pull fluid into the vascular space

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25
Q

what is often given with blood and why?

A
  • diuretics
  • prevent fluid overload
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26
Q

how often do IV fluid bags need to be changed after being spiked?

A

Q24H

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27
Q

when do you need to change primary IV tubing?

A

Q96H

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28
Q

when d you need to change secondary IV tubing?

A

Q24H

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29
Q

How often do you need to assess an IV site? What are you assessing for?

A
  • Q1H
  • phlebitis
  • infiltration
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30
Q

when selecting a site for an IV when do you start?

A

distal and work proximal

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31
Q

how many times can you try and insert an IV before you have to get a different nurse?

A

2 attempts

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32
Q

what do you need to include in patient education around IVs?

A
  • purpose
  • do not touch IV pump
  • proper position for arm
  • avoid kinking tube
  • mobilize with IV pole
  • shower with IV/ keep dry
  • watch for redness, swelling, increased pain
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33
Q

as a nursing student what age of patient can you attempt to insert an IV into?

A

16 +

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34
Q

as a nursing student what age group can you insert an IV into AFTER 3 successful PVAD insertions on adult clients?

A

5-15 years

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35
Q

what do you need to include in your documentation after an IV initiation?

A
  • date/ time
  • gauge of needle/ catheter
  • location
  • number of attempts
  • type/ flow of IV solution
  • patient teaching/ understanding
  • patient tolerance
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36
Q

what IV fluids change states once infused into the body and why?

A
  • hypertonic and isotonic
  • body consumes a portion of the sugar in each solution changing its concentration once inside the body
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37
Q

define extracellular space

A

space between cells

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38
Q

what is included in extracellular spaces?

A
  • tissue fluid
  • water derived from plasma
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39
Q

define intravascular space

A

within a cell or cells

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40
Q

define intracellular fluid

A

fluid within the tissue cells

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41
Q

define extracellular fluid

A

all fluid outside of cells

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42
Q

define third spacing

A

loss of extracellular fluid from the vascular to other body compartments

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43
Q

what factors should you take into consideration when selecting an IV gauge?

A
  • client specific
  • vascular condition
  • device specifications
  • therapy prescribed
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44
Q

in regards to factors you should take into consideration when selecting an IV gauge, what is included in client specific considerations?

A
  • medical history
  • diagnosis
  • physical assessment
  • activity level
  • client preference
  • comfort during insertion
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45
Q

in regards to factors you should take into consideration when selecting an IV gauge, what is included in vascular condition considerations?

A
  • condition/ size of vein compared to gauge/ length
  • assessment of previous punctured site
  • avoid affected areas
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46
Q

in regards to factors you should take into consideration when selecting an IV gauge, what is included in device specifications?

A
  • choose least invasive device
  • suitable VAD for required influsion
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47
Q

in regards to factors you should take into consideration when selecting an IV gauge, what is included in therapy prescribed?

A
  • chemical nature
  • type
  • urgency
  • duration
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48
Q

what gauge would you use for an elderly patient?

A

22-24 gauge

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49
Q

what gauge would you use for a patient receiving blood products?

A
  • 16 gauge for rapid infusion
  • 18 gauge for general administration
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50
Q

what gauge would you use for paediatric and neonate patients?

A

22-24 gauge for paediatrics

24 gauge for neonatal

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51
Q

what gauge would you use for a trauma patient with high fluid volume loss?

A

16 gauge

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52
Q

what gauge would you use for a renal patient?

A

22 gauge or smaller

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53
Q

what gauge would you use for a healthy adult patient?

A

20-22 gauge

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54
Q

define hypervolemia

A

to much fluid inside body

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55
Q

what are some signs and symptoms of hypervolemia?

A
  • edema in extremities
  • cramping
  • headache
  • bloating
  • hypertension
  • SOB
  • increased weight
56
Q

what lung sounds would you expect to hear in a patient with hypervolemia?

A
  • crackles
  • pleural effusion
57
Q

what causes hypervolemia?

A
  • heart failure
  • cirrhosis
  • kidney failure
  • diabetes
  • nephrotic syndrome
  • pregnancy
  • premenstrual edema
58
Q

which patients would be at an increased risk for hypervolemia?

A
  • chronic alcoholics
  • kidney failure
  • heart failure
  • diabetics
59
Q

what is included in nursing and medical management for a patient with hypervolemia?

A
  • low sodium diet
  • diuretics
  • daily weights
  • fluid restriction
  • sugar-free candy/ gum
60
Q

define hypovolemia

A

low levels of fluid in body

61
Q

what are signs and symptoms of hypovolemia?

A
  • loss of color
  • cool skin
  • increased HR
  • decreased BP
  • lightheadedness
  • confusion
  • fatigue
62
Q

what causes hypovolemia?

A
  • dehydration
  • vomiting
  • diarrhea
  • hyperglycaemia
  • infections
  • bleeding from injuries
63
Q

which patietns are at an increased risk for hypovolemia?

A
  • athletes
  • diabetics
  • hemorrhage
  • surgery
  • severe trauma
64
Q

what are some nursing and medical managements for patients with hypovolemia?

A
  • orthostatic BP
  • IV fluids
  • increased fluid intake
65
Q

what are some signs and symptoms of fat emulsion?

A
  • dyspnea
  • back/ chest pain
  • diaphoresis
  • N/V
  • headache
  • hyper coagulability
  • thrombocytopenia
66
Q

what causes fat emulsion?

A
  • parental nutrition
  • not getting enough calories in diet
  • low or no intake of fat
67
Q

what are some nursing and medical management considerations for patients with fat emulsion?

A
  • do not add medication to emulsion fluid
  • assess lab work regularly assess for allergic reaction
68
Q

what lab work do you need to check regularly for patients with fat emulsion?

A
  • complete blood count
  • liver/ kidney count
  • lipid panel
69
Q

define re-feeding syndrome

A

sudden shift in electrolytes that help body metabolize food

70
Q

what is refeeding syndrome characterized by?

A
  • fluid retention
  • electrolyte imbalances
    1. hypophosphatemia
    2. hypokalemia
    3. hypomagnesium
  • hyperglycaemia
71
Q

what are the signs and symptoms of re-feeding syndrome?

A
  • fatigue
  • weakness
  • confusion
  • inability to breathe
  • high BP
  • seizures
  • heart arrhythmias
  • heart failure
  • coma
72
Q

what causes re-feeding syndrome?

A
  • anorexia
  • chronic alcoholism
  • vomiting/ diarrhea
  • cancer
  • uncontrolled diabetes
  • malnourished
  • history of using some medications
73
Q

what medications could potentially cause re-feeding syndrome ?

A
  • insulin
  • chemotherapy drugs
  • diuretics
  • antacids
74
Q

what are some nursing and medical management considerations used when treating a patient with re-feeding syndrome?

A
  • start feeds slow
  • monitor electrolytes closely with blood tests
  • If fluid replacement slowly
75
Q

why might a patient require an IV?

A
  • maintain/ correct fluid/electrolyte balance
  • administer meds
  • admin blood/ blood products
  • maintain/ correct nutritional state
  • venous access incase emergency
  • diagnostic agents
  • general anaesthesia
76
Q

what is required to start a peripheral IV?

A

doctors order

77
Q

what should the doctors order include on it for a peripheral IV initiation?

A
  • date
  • type of IV solution
  • rate of infusion
  • signature
  • if a local anaesthetic has been ordered
78
Q

Prior to beginning an IV what do you need to assess the pt for ?

A

level of anxiety

79
Q

how can anxiety affect a peripheral IV start?

A
  • vasoconstriction
  • make vein hard to find
80
Q

what are some methods to reduce anxiety in a patient about to get an IV started?

A
  • approach pt in confined/ relaxed manner
  • make sure all. equipment is ready/ available
  • use distracting conversation
  • be patient with yourself
  • take your time
81
Q

where are digital veins located?

A
  • along the lateral portion of the fingers
  • joined to each other by communicating branches
82
Q

when should you use digital veins?

A
  • used only for last resort for fluid administration
  • do not have a large blood supply
83
Q

where are metacarpal veins located? How are they formed?

A
  • on the dorsal surface of the hand
  • formed by the union of the digital veins
84
Q

use of metacarpal veins is contraindicated for the administration of what?

A

vesicants

85
Q

which site is not suitable for IV initiation in the elders?

A
  • metacarpal
86
Q

who are metacarpal veins suitable for? with what fluid?

A
  • adult patients when infusing nonirritating IV fluids c small gauge
87
Q

can using a metacarpal vein for an IV limit mobility?

A

yes

88
Q

where is the cephalic vein located?

A

on the radial surface of the lower arm

89
Q

where is the accessory cephalic vein located?

A

on the posterior aspect of the lower arm

90
Q

Where is the basilica vein located?

A

on the ulnar surface of the lower arm

91
Q

the basilic vein is a large vein suitable for what?

A

IV insertion

92
Q

where is the medial cubital vein located?

A

in the antecubital fossa

93
Q

the medial cubital vein is a large stable, superficial vein that is suitable for what?

A

placement of large gauge IV and blood withdrawal

94
Q

when selecting a site for IV insertion where do you always want to try first ?

A

in the pt’s non dominant hand

95
Q

Which sites do you want to avoid when inserting an IV?

A
  • bruised sclerosed veins
  • below traumatized tissue
  • sites near previously discontinued IVs
  • below existing phlebitis
  • veins with impaired circulation
  • veins in limbs c reduced sensation
  • inner surface of rist
96
Q

which patients are difficult to start IVs on?

A
  • elderly
  • paediatric
  • obese
  • pts receiving anticoagulant therapy
97
Q

why is it hard to insert an IV on elderly patients?

A

have delicate thin walled veins

98
Q

what would you use on an elderly pt when finding a vein?

A

light tourniquet

99
Q

describe a light tourniquet

A

does not completely obstruct blood flow

100
Q

after applying a light tourniquet on an elderly pt when do you want to initiate the IV? Why?

A
  • as soon as possible
  • will decrease change of vein rupturing
101
Q

what should be used for paediatric pts if time permits regards IV insertion? how long should it be applied for prior to insertion?

A
  • topical anaesthetic
  • 1 hour prior to insertion
102
Q

for obese pts where do you want to position the tourniquet? why?

A
  • closer to the desired IV insertion site
  • may enhance cap fill
103
Q

what tool can you use to help locate veins in obese pts?

A

illumination device

104
Q

do you want to use a tourniquet for a patient receiving anticoagulant therapy? why?

A
  • avoid but if required use lightly
  • can result in subcutaneous bleeding
105
Q

what do you need to ensure you do when removing an IV from a pt receiving anticoagulant therapy?

A
  • direct pressure over site c slight elevation of limb until bleeding stops
106
Q

when would you use a 16 gauge Iv?

A
  • truama
  • major surgery
  • situations requiring rapid infusion of large large volumes of blood products
107
Q

when would you use an 18 gauge IV?

A
  • general admin of blood products
  • general surgery
108
Q

when would you use a 20 gauge IV?

A
  • most adult pts
109
Q

when would you use 18-20 gauge IVs?

A

elective infusion of blood products at moderate rate/ volume

110
Q

when would you use a 22 gauge IV?

A
  • community clients
  • pediatric
  • elderly c fragile veins
111
Q

when would you use a 24 gauge IV?

A
  • neonatal
  • pediatric
  • elderly
  • pt c small veins
112
Q

if the tourniquet is left on too long what can form? How long is to long?

A
  • hematoma
  • more than 2 minutes
113
Q

can you leave the bedside once a tourniquet is applied?

A

no

114
Q

what should you clean tourniquets with between pts?

A

hot soapy water

115
Q

after taking the catheter out of the package what do you need to do to it?

A

rotate it 360 degrees on the needle

116
Q

what angle do you insert the IV in at? what if its a shallow or deep vein?

A
  • 15-25 degrees to the skin
  • shallow > use lower angle
  • deep > slightly deeper angle
117
Q

do you always need to have one hand on the angiocatheter until its secure?

A

yes

118
Q

what do you use to secure the anti-catheter once inserted?

A
  • tape
  • stabilization device
  • dressing
119
Q

what are the 2 purposes of an IV dressing?

A
  • stabilize/ secure IV device
  • protect IV site
120
Q

what should you never use under the transparent dressing ?

A

non-sterile tape

121
Q

to prevent going to deep and puncturing the vein what can you do?

A
  • hold IV catheter in the exact direction of the vein
  • do not hold the needle at too steep of an angle (over 25)
122
Q

what are the potential causes of infiltration?

A
  • catheter dislodged
  • solution leaks through vein wall into tissue
  • fluid leaks around catheter/ out insertion site
  • opposite side of vein is perforated
123
Q

what are some signs and symptoms of infiltration?

A
  • swollen above/ bellow insertion site
  • swollen area cool to touch
  • IV runs slow
  • pump alarms often
  • blood may or may not return
  • pain
124
Q

how do you treat infiltration?

A
  • tubing not taped over vein being infused
  • D/C
  • apply warm compress to site
125
Q

how do you prevent infiltration?

A
  • avoid areas of flexion
  • tape tubing away from vein being used
  • avoid fragile veins
126
Q

what causes mechanical phlebitis?

A
  • in area of flexion
  • site not taped securely
  • IV line unstable
  • catheter moves in/ out of vein when limb moves
127
Q

what are some signs and symptoms of mechanical phlebitis?

A
  • IV site sore/ red
  • redness may be present along the vein
128
Q

how do you treat mechanical phlebitis?

A
  • D/C IV
  • apply warm compress
  • depending on severity notify physician
129
Q

how do you prevent mechanical phlebitis?

A
  • avoid areas of flexion
  • avoid inserting IV into distal portion of hand
130
Q

what cause chemical phlebitis?

A

vein is irritated by the solution or medication

131
Q

what are the signs and symptoms of chemical phlebitis?

A
  • vein may appear red along vein pathway
  • hard to palpate
  • feels like its burning
132
Q

what are the treatments for chemical phlebitis ?

A
  • D/C IV
  • if intermittent infusions given once daily consider using butterfly
  • flush catheter with 50 mL of primary solution to flush vein fully
  • dilute irritating medication
133
Q

how do you prevent chemical phlebitis?

A
  • use largest vein possible for hemodilution
  • discuss with physical about central line use
  • consult IV nurse to recommend alternate venous access
134
Q

what causes cellulitis?

A

improper:
- insertion technique
- hand washing
- aseptic technique
- site preparation
- dressing change

135
Q

what are the signs and symptoms of cellulitis?

A

large area around insertion is:
- painful
- tender
- warm
- oedematous

  • may have red streaking along skin
  • skin may feel like orange peel
  • fever and chills
136
Q

what is the treatment for cellulitis?

A
  • D/C
  • send catheter tip to lab
  • notify physician
  • antibiotics
137
Q

how do you prevent cellulitis?

A
  • good hand hygiene
  • maintain aseptic teqchnique
  • assess IV site frequently
  • ensure dressing labelled c date
  • ensure IV tubing changed q96H

NRSG 302 (8 decks)

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