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68 Cards in this Set
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- Back
Local Problems & Complications |
Adverse reactions that occur at the IV insertion site or near the site
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Pain & Irritation
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Pain at insertion siteVein irritationSevere pain radiating away from site
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Infiltration
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escape of non-vesicant solution from a vessel into surrounding tissue
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Extravasation
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escape of vesicant solution from a vessel into surrounding tissue
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Vesicant
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agent that is irritating & can cause blistering
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S/S of Infiltration and Extravasation
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Pain at or near insertion site Puffiness around site Taut, rigid skin around site Coolness of skin around site Damp or wet dressing Pump keeps beeping “occlusion”
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Infiltration and Extravasation: If S/S occur: |
D/C IV; may apply moist heat (check protocol)
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Catheter Displacement
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Catheter is out of vein; may have come out during movement or transfer
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Occlusion & Loss of Patency: Causes
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Positional IV (IV placed in vein that is close to a joint) Empty IV bag not replaced in a timely manner Too large cannula used (tip presses against vein wall) Not flushing SL as prescribed Kinks in tubing
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Occlusion & Loss of Patency: S/S
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S/S: Infusion stops running Infusion site pain (with normal appearance) Blood backed up into tubing
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Occlusion & Loss of Patency: If position and tubing seem O.K. may try gentle ?
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aspiration/irrigation
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Occlusion & Loss of Patency: When do you use smaller than a 3mL syringe to irrigate or aspirate?
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NEVER
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Phlebitis
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Inflammation of vein
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Phlebitis: S/S
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redness, warmth, or edema at site Pain, burning at site Vein hard & cordlike
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Phlebitis Tx
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DC/IV & apply warm compress
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Thrombosis
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process whereby a clot develops
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Thrombophlebitis
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inflammation of a vessel D/T development of a thrombus
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Hematoma
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Accumulation of clotted blood in tissues & results in ecchymosis (black & blue skin discoloration) and area may be raised & hardened
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Hematoma Tx
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D/C IV immediately
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Venous Spasm
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Very painful, cramping to site; pain may radiate up the extremityCan be caused by irritating or cold solutionsCan usually be reversed by slowing rate of infusion or by applying warm compresses around IV site if solution is cold
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Venous Spasm Tx
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D/C IV if spasms continue
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Cellulitis
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Inflammation & infection of cellular & SC tissueBacterial in nature (usually from Staph or Strep)
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Systemic Complications of IV Therapy (Local problems may lead to this)
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Contamination & infection, sepsis, medication and fluid interactions, Hypersensitivity reaction, embolism
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Contamination and infection
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Can result from any break in asepsisUse proper hand hygiene(Systemic Complication)
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Contamination and infection Tx
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D/C IV and restart at another site with new tubing/solution (systemic complications)
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Contamination and infection: S/S
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elevated leukocytes, chills, fever IV site usually appears normal(systemic complications)
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Sepsis
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Leading cause of death in non-coronary ICU patientsCaused by microorganisms in circulatory system(systemic complications)
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Sepsis S/S:
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chills, fever, malaise, tachycardia, tachypnea, hypotension, and altered mental status (Systemic Complication)
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Medication & Fluid Interactions
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Check for compatibility before mixing any IV drugs and/or fluids (Systemic Complication)
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Hypersensitivity Reaction
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Allergic reactionOne of most serious consequences of IV therapyAnaphylaxis (anaphylactic shock): severe allergic reactionAlways check for allergies(systemic complication)
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Hypersensitivity Reaction Tx
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D/C infusion & KVO with NS; do not D/C cannula; take VS; notify M.D.; stay with patient (systemic complication)
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Embolism
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Collection of undissolved material carried by circulatory flowMay be solid, liquid, or gaseousCaused by clot dislodgement or by accidental admission of air into circulatory system. Blood clot, Air embolism (systemic complication)
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Blood clot
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Can break off & become an embolism; may display chest pain & cough Avoid use of leg veins; use cannula that is not too large for vein Treat with anticoagulants(systemic complication)
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Air Embolism
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Vessels can be obstructed by air that enters the circulationCan be caused by severed IV lines; tubing that is not primed; or by vented infusion containers that run dry(systemic complication)
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Air embolism Tx
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position pt. on left side and lower head of bed below heart level(systemic complication)
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Infusates (Infusions)
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IV fluids are isotonic, hypotonic, or hypertonic when compared to serum osmolality
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Isotonic Infusions
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Have same tonicity as body fluidsUsed to treat hypotension resulting from hypovolemiaCompatible with plasma & can be administered more rapidly than hypo or hypertonic solutions
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Isotonic infusion examples
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NS RL D5W (D5W is isotonic, but it becomes hypotonic when it is infused because the dextrose is metabolized rapidly)
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Hypotonic Infusions
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Used to hydrate cells & lower Na levelsNot used with hypotensive patientsEx: ½ NS
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Hypertonic Infusions
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Raise serum osmolality by causing a pull of fluids from intracellular & interstitial compartments into blood vessels (or plasma)Administered with serious saline depletion
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Hypertonic Infusions Examples
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Ex.: D5 ½ NS D5 NS D10 NS D5 RL
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Patient Preparation and Site Selection
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Important to select most appropriate vein at time of insertionVeins have thinner walls than arteries & are lined with valves
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Patient Preparation
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Psychological preparation, physical preparation
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Psychological Preparation
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Explain procedureBe honest about discomfort involved
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Physical Preparation
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1. SafetyVerify M.D. orderI.D. patientCheck allergies2. ComfortStart IV in non-dominant hand/arm when possibleAvoid antecubital (AC) veins if possible3. PositionPlace patient in Fowler’s or semi-Fowler’sPosition arm below heart (promotes venous filling)
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IV Site Selection
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Never use an AV (arteriovenous) fistula or shunt that has been placed for hemodialysis for IV therapy The arm containing the AV graft should not be used for IV therapy or for obtaining blood pressures
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Upper Extremity Routes
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Peripheral IV Routes
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Peripheral IV Routes: Venous cannulation should start at ________ area of upper extremity (hand) and proceed proximally (_________)
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distal; (forearm, upper arm)
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Peripheral IV Routes: Subsequent (re-sticks) cannulation
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should be made proximal to previously cannulated site
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Peripheral IV Routes: When selecting a vein:
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assess pt. condition, reason for IV therapy, product(s) to be infused & projected time therapy will last
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Peripheral IV Routes: Hand veins are good for _______________& _______________
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short-term use & for use with nonirritating fluids
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Peripheral IV Routes: Veins of forearms impair __________, less than use of hand veins
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mobility
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Peripheral IV Routes: Veins of upper body
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subclavian, internal/external jugular are central venous routes
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Peripheral IV Routes: Veins of upper body channel blood into the heart; are called _____________.
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central lines
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Peripheral IV Routes: Why should veins of the lower extremities not be routinely used in adults?
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risk of embolism and thrombophlebitis
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Infusion Containers
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Check expiration datesMake sure fluid has no particulate matter
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Infusion Containers: 1. Glass containers
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must be vented (use a vented tubing)
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Infusion Containers: 2. Plastic containers (IV bags)
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Very commonly usedDo not require ventingMany different sizes availableOne problem: can be punctured when spiked
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Infusion Administration Sets
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Vented or non-vented tubingDrop factor of tubing (number of drops needed to deliver 1 mL of fluid) tells how much fluid the administration set deliversMacro drip sets: 10 – 20 gtt/mLMicro drip sets: 60 gtt/mLDrop factor stated on tubing package
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Primary Administration Sets
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a. Single LineOne spike inserted into one main bag of fluidb. Y-TypeBlood tubing: two equal length tubes & can access two primary solutions simultaneously or alternately
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Secondary Administration Sets
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Piggyback set used to deliver continuous or intermittent doses of fluid or medsPlugged into highest portPositioned higher than primary infusion
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Volume-Control Administration Sets
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Example: Buretrol (used with pediatric infusions)
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Blood/Blood product Administration Sets
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Y-tubingHave in-line filterUse should not exceed a four hour time period
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C. Needless Systems & Needlestick Safety Systems
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After initial IV stick there is no need for further use of needles due to needless systemSafety devices on syringes/needles must be activated prior to placing in sharps container
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Venous Access Devices
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Peripheral venous access devices are the most commonly usedONC: over-the-needle peripheral catheter: flexible cannula that encases a stylet (needle); once vein is accessed, catheter is threaded into vessel & stylet is withdrawn
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Infusion Regulation Systems: Electronic Infusion Control Devices
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Pumps, syringe pumps
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Electronic Infusion Control Devices: Pumps
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Run by electricity and by batteryPumps used in hospitalsPump provides a driving force to overcome resistance to pressure to propel the solutionHas pre-set pressure restrictions, so it will not overcome pressures that exceed the pre-set limit
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Electronic Infusion Control Devices: Syringe pumps
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Used to administer very small volumesExample: PCA (Patient Controlled Analgesia)Allows patient to self-deliver & regulate administration of pain medication; has pre-set dose limits
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