Intravenous Therapy Craven 29

Front 1

IV Therapy is prescribed for many reasons, list 6

Back 1

1. Maintenance or replacement fluids for daily body fluid requirements.
2. Electrolytes to maintain normal electrolyte balance.
3. Glucose and nutrients for client use as an energy source
4. An access route to administer medications intravenously
5. Venous access to administer blood products.
6. Venous access for emergencies

Front 2

What is the most common method of accessing the venous system?

Back 2

Percutaneous insertion of a needle or flexible catheter into a peripheral vein.
Peripheral vein usually provides the quickest and easiest approach to establishing IV access for administration of solutions and medications.

Front 3

________ involves placing a catheter into one of the client's large veins.

Back 3

Central venous therapy

Front 4

With central venous therapy, the tip of the catheter is placed in either the ________ or the __________.

Back 4

superior vena cava or right atrium.

Front 5

Use central catheters when infusing _______ solutions or when the client's peripheral venous access is inadequate for the duration or type of IV therapy required.

Back 5

Hypertonic solution

Front 6

IV solutions are classified as _________ (fluids that are clear) or __________(fluids that contain proteins or starch molecules, for example whole blood, packed cells, white blood cells, platelets, albumin (as volume expander) and cryoprecipitate, a clotting factor; it also includes parenteral nutrition, such as TPN)

Back 6

Crystalloids and Colloid

Front 7

Crystalloids can be classified as:
____________
____________
____________

Back 7

Isotonic
Hypotonic
Hypertonic

Front 8

Crystalloids can be further classified as isotonic, hypotonic or hypertonic, according to how closely the solution's osmolarity matches that of plasma, which is between _______ and _______ mOsm/L

Back 8

275 and 295 mOsm/L

Front 9

Peripheral insertion devices:
_____ or _______ devices-used for short term therapy or infant/child use, for small veins.

Back 9

Winged or butterfly

Front 10

Over the needle catheter are ______ catheters that are placed over metal stylets or introducer needles.

Back 10

Plastic catheter

Front 11

Lumen size is measured in gauges:
Winged sizes ______, ______, _____
Catheter sizes _____, ______, _____

Back 11

Winged sizes: 19, 21, 23
Catheter sizes 22, 20, 18

Front 12

As the number increases, the lumen size ________, so that a 22 gauge needle is _____ in diameter than an 18 gauge needle.

Back 12

Lumen size "decreases"
Needle is "Smaller"

Front 13

Injections:
Intradermal Site:

Back 13

Sites: Deltoid, Ventrogluteal, Vastus Lateralis, Dorsogluteal

Front 14

Injections: Intradermal

Gauge
Length
Angle
Volume

Back 14

Gauge: 27-30g
Length: 1/4-3/8"
Angle: 10*-15*
Volume: 0.1-0.2 ml

Front 15

Injections:
Subcutaneous (SC)

Back 15

Upper posterior arm,
Upper back
Low back
anterior lateral thigh
abdomen

Front 16

Injections:
Subcutaneous (SC)
Gauge:
Length:
Angle:
Volume:us

Back 16

Gauge: 25-28g
Length: 3/8-5/8"
Angle: 90* or 45* for very thin patients
Volume: 0.5-1 mL

Front 17

Injections:
Intramuscular (IM) Sites

Back 17

Gluteus, thigh and deltoid muscles

Front 18

Injections:
Intramuscular (IM)
Gauge:
Length
Angle
Volume

Back 18

Gauge: 21-23g
Length: 1-1 1/2"
Angle: 90*
Volume: up to 3mL; small muscles (deltoid) no more than 1 mL

Front 19

A variety of catheter needles are available, usually 1 to ____ inches long

Back 19

1 1/4

Front 20

Winged needles are approximately _____ inches long and range in diameter from ___ to ____ gauges bore.

Back 20

3/4
16 to 27 gauges bore

Front 21

Intermittent Infusion Devices:

Back 21

Available as winged needle sets or as over the needle catheters and each has an attached latex cap adapter, commonly referred to as a heplock but don't always use heparin, can use saline.

Used when client has intermittent infusions.

Use a small amount of sterile saline, 1-3mL to irrigate to prevent blood clot.

Front 22

Central Venous Access Devices:

Back 22

used for concentration solutions TPN
Physicians insert
RN's can insert with advanced training

Complications: pneumothorax, air embolism b/c tip lies in the SUPERIOR VENA CAVA or RIGHT ATRIUM.

Risk of infection diminished with impregnated catheters w/ bacterial chemicals.

Front 23

Multilumen Central Catheters:
What are they made of?

Back 23

Central Venous catheters include single or multilumen catheters, can be made of nonthrombogenic Silastic materials or antimicrobial agents.

Front 24

Multi lumen central catheters can monitor??

Back 24

can monitor central venous pressure

Multilumen allow multiple drugs can be administered simultaneously without the risk of incompatibility of solutions.

Front 25

What are 3 types of Tunneled Central Venous Catheters?

Back 25

Hickman
Groshong
Broviac

Front 26

What do you flush Groshong caths with?

Back 26

Irrigate with Normal Saline rather than Heparin

Front 27

Peripherally Inserted Central Catheters: (PICC)

Back 27

cath placed peripherally but deliver meds & solutions centrally

Front 28

What vein is usually used for PICC?

Back 28

Basilic vein, but can use medial cubital and cephalic vein in the antecubital area.

Front 29

PICC Line Facts:

Back 29

used for intermediate or long term venous access, can be left in for several months.

Front 30

PICC Line Facts continued:

Back 30

PICC have small diameter so use with young and elderly is ideal; catheter flexibility does not restrict arm movement or normal activity; carry fewer risks, care givers need instructions on care an maintenance.

Front 31

IV Solution Container Sizes

Back 31

Plastic is usual container
Insulin binds with plastic bag
Sizes: 1L, 500mL, 250mL, 100mL, 50mL.

Front 32

Macro drip sizes:

Back 32

10, 15, 20 drops/mL

Front 33

Micro drip sizes

Back 33

60 drops/mL

Front 34

Ideal IV locations:

Back 34

When possible use larger veins and the distal portion of the vein is punctured first, late the more proximal sites for later use.

Front 35

What to avoid for IV injections:

Back 35

Avoid movable joints, as well as lower extremities.

Front 36

IV injections:
Place tourniquet on the extremity __ to ___ inches above the intended venipuncture site to distend the vein with blood;

Back 36

4 to 6 inches

Front 37

Preparing IV Site

Back 37

using a vigorous circular motion with 70% alcohol and work from the center outward to a diameter of 2 to 3 inches; follow with an application of provodine-iodine; allow to dry, if allergic use 70% alcohol with friction for at least 30 seconds.

Front 38

Evaluate the clients IV at least _______.

Back 38

Once each hour

Front 39

IV gauge dressings should be changed every ______ hours on peripheral sites or whenever the integrity of the dressings is compromised.

Back 39

change every 48 hours

Front 40

Transparent dressings can changed every _____ to ____ hours.

Back 40

48 to 72 hours

Front 41

Dressings on central catheters should be changed every ___ to ____ days or sooner if needed.

Back 41

3 to 7 days

Front 42

Changing IV bottles and tubing:

Back 42

Change when empty, new order or when the IV bottle has been hanging for more than 24 hours.

Front 43

Intermittent Flushing of an Intravenous Lock:

Back 43

Lines are flushed before and after medication and every 8 hours when medications are not being given.

Front 44

Define IV Infiltration

Back 44

fluid in subcutaneous tissue, pain, swelling, coolness, slow infusion

Front 45

Define Phlebitis

Back 45

inflammation of vein

Front 46

Thrombophlebitis

Back 46

phlebitis inflammation of vein; blood clot accompanies this is called thrombophlebitis; discomfort, redness, warmth, hardness or cordlike, sluggish running.

Front 47

Signs of Fluid Overload

Back 47

increased weight, decreased urine output, crackle (rales) lung sounds.

Front 48

What to do at first sign of air embolism?

Back 48

Position the client on her or his left side in the trendelenburg position to allow the air to rise into the right ventricle and allow blood to pass into the lungs.

Front 49

Catheter Breakage or Damage:

Back 49

All IV devices are made of radiopaque material, breakage will show up on X-Ray.