Iv Therapy

Front 1

What is infiltration?

Back 1

-an inadvertent administration of a nonvesicant solution into surrounding tissues

Front 2

What causes infiltration?

Back 2

-faulty catheter insertion
-infusion device not secured properly
-high delivery rate
-high pressure from pump
-obstruction of blood flow through the catheter and phlebitis

Front 3

What are the S/S of infiltration?

Back 3

-infusion rate stopped or slowed
-coolness of skin around site
-taut skin
-edema
-pain may or may not be present
-absence of back flow or diluted blood return

Front 4

What are the possible complications of infiltration?

Back 4

-ulceration
-possible tissue necrosis
-compartment syndrome
-reflex sympathetic dystrophy syndrome

Front 5

How can you as a nurse prevent infiltration?

Back 5

-check IV site q 2 hours
-check placement of patients IV site
-checking for infiltration by applying pressure above the site to see if the flow stops or continues

Front 6

What are the treatment options for a patient with IV infiltration?

Back 6

-STOP IV flow
-use a cold or warm compress
-refer to IV manual or hopital policy

Front 7

What is phlebitis?

Back 7

Inflammation of a vein

Front 8

What causes phlebitis?

Back 8

-use of a large catheter in a small vein
-improper taping causing the catheter tip to rub against the vein wall and damage the endothelial cells
-improper dilution of medications
-rapid infusion
-presence or particulates in fluid
- vesicant solutions
-bacterial infection from improper aseptic technique

Front 9

What are some preventative measures for phlebitis?

Back 9

-use large veins and central line for hypotonic solution
-rotate IV site q 72-96 hours
-stabilize catheter
-use .22 micron filter on-line
-use smallest catheter appropriate for solution

Front 10

What is the treatment for phlebitis?

Back 10

-discontinue infusion
-apply warm or cold compress
-notify doctor
-notify infection control depending on hopitol policy

Front 11

What is thrombosis in regaurds to IV therapy?

Back 11

A blood clot which is the result of trauma to the vein causing red bloos cells to adhere to the vein wall.

Front 12

How do you prevent thrombosis with IV therapy?

Back 12

-use of IV pumps
-avoid placing IV catheter in areas of flexion and lower extremities
-if infusing by gravity at rates less than 50mL/hr use a micro drip tubing for more movement

Front 13

What is the treatment of thrombosis with IV therapy?

Back 13

-never flushing a catheter to remove an occlusion
-discontinue IV and move to another site
-assess the site for circulatory repairment

Front 14

What is thrombophlebitis in regaurds to IV therapy?

Back 14

It's two injuries in one. Thrombosis and phlebitis.

Front 15

What are the S/S of thrombophlebitis during IV therapy?

Back 15

-sluggish flow rate
-edema
-tender and cordlike vein
-site warm to touch
-red line above puncture site
-mottling and cyanosis of involved extremity

Front 16

What preventative measures should be taken with prevention of thrombophlebitis?

Back 16

-check IV site for redness, and swelling q 4 hours
-use veins in forearm rather than hands for infusing medication
-dont use veins in joint flexion areas

Front 17

What is the treatment for thrombophlebitis associated with IV therapy?

Back 17

-never flush catheter
-remove entire IV and restart in opposite extremity
-apply warm, moist compress
-notify doctor
-aspirate blood with 5cc syringe and discard clot
-try to start flow again and if does not work remove

Front 18

What are some possible causes of thrombophlebitis?

Back 18

-IV rate too slow to keep patency
-lock not being flushed regularly
-IV bag allowed to run dry
-precipates formed from incompatible medications

Front 19

What is extravasation in regaurds to IV therapy?

Back 19

An inadvertant administration of a vesicant solution into the surrounding tissues which results in the formation of blisters and subsequant sloughing of tissues due to necrosis.

Front 20

What are the possible causes of extravasation?

Back 20

-puncture of any portion of the vein wall during venupuncture
-mechanical friction from catheter while infusing vesicant solution
-dislodgement of catheter
-poorly secured infusion device
-high delivery or high pressure from infusion pump
-thrombus at catheter tip

Front 21

What are the S/S of extravasation?

Back 21

-slow or stopped infusion
-complaint of pain or burning
-swelling either proximal or distal of site
-puffiness or edema at site
-skin tightnesss
-blanching or coolness at site
-damp or wet dressing
**severity is determined by tyoe, concentration, and volume infused**

Front 22

What are the methods of prevention used for extravasation?

Back 22

-use of practioner knowledgable of the vesicant used
-verify present of good blood return
-use free flowing IV to push medication
-remove gauze or dressing to fully assess site
-note the condition of the patient

Front 23

What is the treatments for extravasation?

Back 23

-most effective treatment is prevention
-stop infusion
-leave catheter in place nad aspirate the medication and blood
-insert antidote immediately through catheter
-remove catheter
-apply cold compress
-notify doctor
-photograph area and fill out incident report per hospital policy
-

Front 24

What is ecchymosis or a hematoma resulting for IV therapy?

Back 24

The infiltration of the patients blood into the tissues at the puncture site.

Front 25

What are the possible causes of a hematoma or bruising?

Back 25

-nicking the vein in an unsuccessful puncture attempt
-discontinuing an IV cannula without sufficient pressure on site
-applying tourniquet too tight or longer than too mins or to soon before puncture

Front 26

What is a vasospasm?

Back 26

A sudden contracion of a vein resulting in a temporary cessation of blood flow.

Front 27

What are the S/S of a vasospasm?

Back 27

-include a sharp pain at the IV site that travels up the arm
-slowing of flow

Front 28

What are the preventions for vasospasms?

Back 28

-dilute the medication as recommended in IV drug book
-consider using a warmer fluid for rapid transfusion of cold agglutins
-wrap extremity with warm compress during infusion

Front 29

What is the treatment for a vasospasm?

Back 29

Decress flow rate until spasm subsides then restart and apply a warm compress to affected extremity

Front 30

What are the causes of local infections?

Back 30

-related to catheters left in place for more than 5 days
-field sticks not changed after 24 hours
-poor technique in placing the catheter
-poor technique in maintaining and monitoring the peripheral site

Front 31

What are the S/S of a local infection with IV therapy?

Back 31

-redness and swelling at the site
-exudates of purulent material
-elevated WBCs
-fever

Front 32

What is the cause of septecemia related to IV therapy?

Back 32

The presence of microorganisms or their toxic products in the blood stream.

Front 33

What are the risk factors associated with septecemia?

Back 33

-lack of hand washing
-break in sterile technique
-inexpierence in insertion of IV
-inadequately stabilized IV
-repeated manipulation of IV system
-Infusion factors such as: solution container, catheter material, insertion site, and duration of infusion
-Patient factors such as: age, underlying disease, immune status, presence of other infectious factors

Front 34

What are the S/S of septecemia?

Back 34

-fever
-cold sweat
-tachycardia
-hyperventilation
-hypotension
-altered mental status
-nausea
-vomiting
-abdominal pain

Front 35

What are the preventative measures for septecemia?

Back 35

-use only freashly opened solution
-albumin should be used as soon as it is opened

Front 36

What is the treatments used for septecemia?

Back 36

-determine if patient needs to be transferred to ICU
-supportive

Front 37

What is fluid overlaod and it's causes?

Back 37

-caused by infusing excessive amount of isotonic or hypertonic solution rapidly
Causes
-failure to monitor IV infusion
-too rapid infusion in a patient compromised by cardiopulmonary or renal disease and elderly patients
**can lead to pulmonary edema**

Front 38

What is the preventative measures for fluid volume overload?

Back 38

-monitor fluid infusion
-maintain prescribed flow rate
-if behind schedule do not catch up
-monitor I&O
-know patients cardiac and renal history

Front 39

What is the treatment for fluid volume overload?

Back 39

-decrease teh flow rate
-position the patient in high fowlers
-monitor vital signs
-place on continuous O2 saturation
-administer O2 if stauration less than 95%
-call doctor
-keep patient warm

Front 40

What is an air embolism and what causes it?

Back 40

-rare but lethal complication especially involving vascular access device
-the air pocket causes an obstruction to the forward flow of the blood causing pulmonary hypoxia
-it then causes vasoconstricton in the lung tissue and reduces the blood flow out of the right heart which leads to decreased CO, shock and death

Front 41

What are the causes of an air embolism?

Back 41

-improper priming of the tubing with air still in the tubing
-superimposing a new IV bag to a line that has run dry without clearing the line of air
-loose connections that allow air to enter the system
-poor technique in tubing changes for central lines
-allowing solution in container to run dry

Front 42

What are the S/S of an air embolism?

Back 42

-palpitations
-lightheadedness
-weakness
-cough
-dyspnea
-cyanosis
-pulmonary edema
-tachycardia
-chest pain
-hypotension
-JVD
-anxiety and confusion
-seizure
-if untreated it can lead to hemiplegia, aphasia, coma and ardiac arrest

Front 43

What are the preventative measures for an air embolism?

Back 43

-instruct patient to valsalva maneuver when changing tubing
-remove air from administration set
-follow protocol for tubing changes of central line
-superimpose IV solution before the previous bag runs dry
-attach pig to the injection prt closest to drip chamber
-do not by pass IV pump

Front 44

What is the treatment for an air embolism?

Back 44

-call for help and call docor immediately
-position patient on left lateral decubitis with head down (will causer air to rise in the R atrium away from the pulmonic valve preventing from entering pulmonary artery)
-monitor vital signs and O2 sat
-administer 100% O2 (causes nitrogen in the air embolus to disolve and decrease the size of the bubble)
-large emboli require hybaric therapy and surgeon will try to remove air embolus by percutaneous aspiration through R ventricle

Front 45

What is speed shock?

Back 45

-occurs when medication is rapidly introdused into the circulation which allows the medication to reach toxic levels

Front 46

What are the S/S of speed shock?

Back 46

-dizziness
-facial flushing
-headache
-tightness in the chest
-hypotension
-irregular pulse
-shock

Front 47

what is the preventative measures for speed shock?

Back 47

-use an IV pump
-follow recommendation as to how slow or fast to administer IV medication

Front 48

What are the treatments for speed shock?

Back 48

-call for help
-give antidote or resuscitation medication as needed

Front 49

What is a catheter embolism?

Back 49

-a piece of the catheter breaks off and travels through the vascular system which may migrate to the R ventricle or pulmonary artery

Front 50

What are the causes of a catherter embolism?

Back 50

-reinsertion of the same catheter thaqt was used in an unsuccessful venipuncture
-pressure directly over the catheter during discontinuation
-placement of catheter in joint flexion
-removing a stylet and reinserting in thus sheraing off the tip

Front 51

What are the S/S of a catheter embolism?

Back 51

-sharp sudden pain at the catheter site
-minimal blood return
-rough or uneven catheter noted on removal

Front 52

What are the preventative measures with a catheter embolism?

Back 52

-never reinsert a needle in the catheter
-do not apply pressure to site when removing a catheter
-avoid inserting catheter over joint flexion when movement causes catheter to bend back and forth
-splint the arm if patient tends to bend at elbow

Front 53

What is the treatment for a catheter embolism?

Back 53

-have patient apply digital pressure on the vein above the insertion site
-apply a tourniquet above the elbow
-contact doctor
-start new IV line
-prepare patient for x ray
-keep catheter in a clean specimen container to facilitate measuring the remainder of the catheter tip

Front 54

What is anaphylaxis?

Back 54

a systematic and immediate hypersensitivity reaction caused by an immunoglobulin Ig-E mediated release of mediators fro the mast and basophils. It is often unpredictable.

Front 55

What are the causes of anaphylaxis?

Back 55

medications such as: antibiotics, muscle relaxants, radio-contrast media, anesthetics, non-steroidal anti-inflammatory drugs, latex materials, foods, stings, idiopathic causes

Front 56

What are the S/S of anaphylaxis?

Back 56

range from mild skin reactions to respiratory problems to cardiovascular collapse

Front 57

What are the preventative measures for anaphylaxis?

Back 57

-identify patients with known allergies
-ensure patients H&P and physical exam in performed
-inquire about adverse drug reactions with family
-ensure proper knowledge of the medication

Front 58

What is tthe treatment for anaphylaxis?

Back 58

-discontinue suspected medication
-monitor vital signs and O2 sat
-EKG
-administer O2 and IV fluids and adrenaline as ordered or per hospital protocol
-get help
-activate emergency button
-maintain airway, breathing and circulation
-start CPR if pulse is not present

Front 59

What are the local complications of IV therapy?

Back 59

-infiltration
-phlebitis
-thrombophlebitis
-infection

Front 60

What are the systematic complications of IV therapy?

Back 60

-Fluid overload
-speed shock
-septecemia
-air embolism
-catheter embolism
-anaphylaxis

Front 61

What commonly used IV solutions are isotonic?

Back 61

-normal saline (0.9% sodium chloride)
-lactated ringers
-5% dextrose in water

Front 62

What commonly used IV solutions are hypotonic?

Back 62

-1/2 normal saline (0.45% sodium chloride)

Front 63

What commonly used IV solutions are- hypertonic?

Back 63

-D5NS
-D5 1/2NS
-D5LR
-D10W

Front 64

What are the purposes of IV therapy?

Back 64

-administration of medication
-restore and maintain fluid and electrolyte balance
-transfusion of blood and blood products
-total parenteral nutritonal supplemntation delivery
-replacement therapy for present or continuing losses
monitors hemodynamic function

Front 65

What are the various methods of of administering IV solutions?

Back 65

-continuous
-intermittent
-intravenous push
-KVO (keep vein open)
-intermittent/continuous dosing
-bolus

Front 66

What is a continuous infusion?

Back 66

a set amount of IV solution delivered over an ordered time range

Front 67

What is an intermittent infusion?

Back 67

set amount of medication in a volume of mL to be delivered at a regular interval

Front 68

What is an IV push?

Back 68

administration of a prescribed concentration of medication by injecting through a Y port of primary tubing or through a salne lock

Front 69

What is a KVO?

Back 69

minimal volume of IV solution on continuous infusion to lessen the possibility of occlusion andmaintain IV access

Front 70

What is intermittent/continuous dosing?

Back 70

pateient self administers preset amount of PRN pain med-demand dose while pump may deliver a hourly fixed dose

Front 71

What is an IV bolus?

Back 71

a rapid delivery of an IV medication or solution

Front 72

What is a hypotonic solution? What is its effect and indication?
also its cautionary uses

Back 72

-below 240mOsm/L
-effect->shifts fluid out of the intravascular space into the interstitial and intracellular space
-indication->to correct cellular dehydration caused by hypergylcemia and excessive diuresis due to diuretics
-caution->can cause cellular edema, can worsen 3rd spacing, caution in patients with burns, liver disease, renal failure, trauma and can lower blood pressure

Front 73

What is an isotonic solution? What is its effects?

Back 73

-240-340 mOsm/L
-effect->expands intravascular volume

Front 74

What is a hypertonic solution? What are its effects and indications? also its cationary uses

Back 74

-above 340 mOsm/L
-effects->shifts fluid from intracellular and interstitial space into the intravascular space
-indications->may be used post operatively to stabilize BP, maintain urine output, reduce edema
-cautions->patients with heart and renal problems may not be able to handle the increased intravascular volume

Front 75

What are the classifications of IV solutions?

Back 75

-crystalloids
-colloids
-blood products
-lipids

Front 76

What is a crystalloid solution?

Back 76

solution of sterile water with added electrolytes and non-electrolytes as glucose which diffuse across a semi-permeable membrane. It can be iso, hypo, or hyper

Front 77

What is a colloid solution?

Back 77

plasma expanders contain proteins or synthetic sugar/starch which remain in the intravascular space for several days

Front 78

What is blood and blood product solutions?

Back 78

whole blood, packed RBCs, fresh or frozen plasma, platelets, clotting factors, albumin 5% and 25%

Front 79

What are lipid solutions?

Back 79

fat emulsions made from soybean or safflower oil, eggyolk, phosolipids, and glycerol. Used in conjunction with total parenteral nutrition as a source of calories

Front 80

T or F
An infusion of packed RBC increases hematocrit.

Back 80

True

Front 81

What is a saline lock and its purpose?

Back 81

-an adapter fitted to an IV catheter with a resealable injectable port, used for peripheral venous access
-minimize restriction in ambulation, access for emergency medication, intermittent medication and has a limited IV intake

Front 82

How do you flush a peripheral saline lock?

Back 82

SAS

Front 83

What are some important factors with a central IV access?

Back 83

-patient consent for placement
-chest X ray needed for confimation of placement
-doctors order required
-tip is in superior vena cava
-may be sutured in place
-heparin may be use (MD order)
-can stay in place for days to months
-clear dressing change every 6 days
-gauze dressing change every 2 days and port to be changed every 6 days

Front 84

How many ccs for a central line flush?

Back 84

10 mL

Front 85

How many ccs for a peripheral line flush?

Back 85

3-5mL

Front 86

T or F
Do not flush against resistance.

Back 86

True
you may push a clot into circulation

Front 87

What is done when flushing a central line?

Back 87

-open clamp and clean port with alcohol for 30 sec
-and then SASH
-always open close open close a clamp

Front 88

What are the 15 steps in venipuncture with the nurse roles?

Back 88

-check MD order
-wash hands
-prepare equipment
-patient preparation
-site selection and vein dilatation
-needle selection
-gloving
-site preparation
-vein entry
-catheter stabilization
-labeling
-equipment disposal
-patient education
-rate calculation
-monitoring and documentation

Front 89

What three things must the nurse attach a label to in regaurds to IV therapy?

Back 89

-IV fluid- replaced every 24 hrs
-IV tubing- replaced every 72 hrs
-IV dressing- replaced every 72 hrs

Front 90

What are the patient risk factors that lead to IV complications?

Back 90

-age
-underlying illness: cardiac renal, liver, immunocompromised
-duration of illness
-medications used: steroids, antineoplastics, anticoagulent
-presence of other infectious processes
-frequent movement associated with coughing, vomiting, restlessness, cognitive impairment

Front 91

What are the nursing considerations when administering IV solution eith an additive?

Back 91

-observe patients 5 rights in drug administration
-verify allergies
-read IV book about the drug to be administered
-implement sterile technique
-use electronic pump
-verify IV placement

Front 92

What is parenteral adminstration and the gaols associated with it?

Back 92

administration of nutrients by a route other than the GI tract.
goals
-meet patients nutritional needs
-allow growth of tissues
-provide calories for resting energy

Front 93

What should you as a nurse do with a KCl order?

Back 93

-always dilute it, when not diluted it is fatal
-need to know the serum K level
-always obsereve the cardiac monitor

Front 94

who has developed the infusion nursing standard of practice to protect patients and nurses who administer IV therapy?

Back 94

Infusion Nurses Society

Front 95

Guidlines for supporting client care have been developed by who?

Back 95

OSHA-occupational safety and health administration
CDC-Centers for disease control