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67 Cards in this Set
- Front
- Back
What are the three main indications for injections, phlebotomy, blood cultures, ABG and IV's?
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1. Illness or injury that requires parenteral medication
2. Analysis of venous or arterial blood in evaluating disease. 3. Fluid resuscitation |
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What are the six "Rights" of drug administration?
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Right DRUG
Right DOSE Right PATIENT Right TIME Right ROUTE Right DOCUMENTATION |
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What is associated with the "RIGHT" of drug administration - Right DOCUMENTATION?
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Patient's name
Date and time of administration Name of the drug and dosage Route of Administration Reactions Signature and Title |
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What are the primary drug errors?
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Drug given to the wrong patient
Incorrect drug is administered Drug given by an incorrect route Drug given at wrong time Incorrect dose is administered Incorrect data is entered on chart |
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Of all the six "Rights" of drug administration this one is key for patient protection?
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Right Documentation
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What three parts make up the syringe?
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Tip, Barrel, Plunger
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3 CC hypodermic syringes are used for what?
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IM and SC injections
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5 CC hypodermic syringes are used for what?
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IM injections, venipuncture
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10, 30, and 60 CC hypodermic syringes are used for what?
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Aspirations and Irrigations
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What type of syringe is a tuberculin syringe?
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1 CC for intradermal injections
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These syringes are usually labeled in units.
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Insulin Syringes
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Sharpened end of the needle at the tip
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Point
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Hollow core of the needle that forms the opening
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Lumen
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Hollow steel tube of the needle
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Shaft
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Point where the shaft and the hub of the needle join
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Hilt
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Proximal end of the needle that mounts onto the syringe
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Hub
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The length of a needle varies from what to what?
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3/8 of an inch to 2 inches
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This is determined by the diameter of the lumen. The large this number, the smaller the bore of the needle. This ranges between 16-30.
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Gauge
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What are the routes of injection?
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Intradermal
Subcutaneous Intramuscular |
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This is when there is an injection in the dermal layer
The injection angle is 10-15 degrees with the bevel up The injection sites are those such as Mantoux/PPD-forearm and back-allergy testing. |
Intradermal
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This is when an injection is just below the skin surface. The injection angle is 45 degrees with the bevel up. The injection sites include abdomen, thighs, upper arms. Insulin is given this way.
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Subcutaneous
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Low weight molecular heparin is given how?
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Subcutaneous injection, but not in the upper extremities.
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This is when an injection is deep into the muscle. The injection angle is 90 degrees with the bevel up. Injection sites include dorsogluteal, ventrogluteal, vastus lateralis and deltoid. Antibiotics and other agents are given this way.
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Intramuscular
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The landmarks for this injection site is the posterior iliac spine and the greater trochanter of the femur. This is a traditional IM injection site for adults. The needle length is usually 1 1/4 inches to 3 inches and this is not used in infants and children.
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Dorsogluteal site
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The landmarks for this injection site are the greater trochanter of the femur, the anterior super iliac spine (ASIS), Iliac crest. This is used in infancy through adulthood. Adult needle length is 1 1/4 to 3 inches and the child length is 5/8 to 1 1/2 inches. The needle gauge is 18-23 and you give the injection at 90 degrees with the bevel up.
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Ventrogluteal site
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This injection site is used in adults. The middle third of the anterolateral aspect of the quadriceps muscle. Needle length is 1 1/4 to 1 1/2 inches. Needle Gauge is 20-23, 90 degrees and bevel up.
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Vastus lateralis site in adults
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This is below the greater trochanter but within the upper lateral aspect of the quadriceps muscle. The needle length should be 1/8 of an inhc, needle gauge 22-25 with 90 degrees and bevel up.
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Vastus lateralis site in infants and children
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This injection site has landmarks at the acromion and deltoid tuberosity. Adults needle length 5/8 to 1 1/2 inches. Needle gauge 23-25 90 degree with bevel up consider not using in the frail and elderly. Do not use this in infants and children.
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Deltoid site
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This is the most common method for the collection of blood for the laboratory.
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Phlebotomy
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What are the four main preferred venipuncture sites?
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Median antecubital vein
Cephalic vein Basilic vein Veins in the hands or feet |
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What are contrindications to venipuncture and tourniquet application?
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Site of active skin infection
Sclerotic vein Extensive scarring Edematous or impaired arm or hand Post-masectomy arm-lymphostasis Hematoma Previously injured vein Dialysis with shunt Femoral bypass |
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When you use a 24 gauge needle in phlebotomy it is for what patients?
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Neonates, infants, sometimes elderly patients.
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When you use a 22 gauge needle in phlebotomy it is for what patients?
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Children, Elderly
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When you use a 20 gauge/18 gauge needle in phlebotomy it is for use in what patients?
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Adults
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What are three collection methods for phlebotomy?
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1. Vacutainer
2. Butterfly winged 3. Syringe technique |
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What do you do during the phlebotomy procedure?
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Identify the patient - name and DOB
Reassure the patient Explain the procedure Position the patient in a comfortable sitting or reclining position Extend the patient's arm so that it is not bent at the elbow |
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What is something you never do in phlebotomy?
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You never perform phlebotomy with the patient standing due to a possible vasovagal reaction.
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Where do you apply the tourniquet?
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4-6 inches above the intended puncture site
2 minute maximum |
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If the vein is palpable, but not sufficiently dilated you can do what?
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Rub over it with alcohol pad
Ask patient to open and close fist Place extremity in dependent position Apply warm compress |
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When you are grasp the patient's arm in phlebotomy, how many inches and were do you place your thumb?
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2-3 inches below the phlebotomy site
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When performing phlebotomy you hold the needle at what angle?
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15-30 degree angle
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When you have blood flowing you do what?
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Remove the tourniquet - helps to prevent hemolysis
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When you are preparing a site for a blood culture what do you do?
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Clean the site with an antimicrobial in a circular bulls eye motion outward from site to a diameter of 2-4 inches to remove flora that would otherwise be introduced into the vascular system with venipuncture.
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What are the indications for an ABG?
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Assessment of ventilation and oxygenation - usually patients with respiratory issues.
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With an ABG there are increased risks of what?
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Coagulopathy
Anticoagulation |
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What are contraindications to doing an ABG?
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Arterial pulse not palpable
Negative allen test Surface landmarks not visible Arterial disease |
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What are the ABG sites?
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Radial
Brachial Femoral |
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What is the most common ABG site?
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Radial
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What is involved with the ABG procedure?
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Advance needle until flashback
Collect 3-5cm of blood Remove the needle IMMEDIATELY apply firm pressure for at least 10 minutes Hold syringe upright and tap out any bubbles Cork or Cap syringe |
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What do you do after you have collected the sample in ABG?
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Roll in fingers to mix heparin
Place syringe in ice Send to lab immediately Re check patient at five and fifteen minutes |
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What are the complications associated with ABG?
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Hemorrhage
Hematoma Thrombosis Arterial Spasm Nerve Damage |
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What is the purpose of peripheral IV insertion?
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Fluids
Medications Blood and blood components Parenteral nutrition Providing or maintaining intravenous access to the patient |
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What are the contraindications for placing and IV?
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Site of active skin infection
Sclerotic vein Extensive scarring Edematous or impaired arm or hand Postmasectomy arm-lymphostatisis Hematoma Previously injured vein |
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What is an 18 gauge IV used for?
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Blood, blood products, viscous medications, IV contrast
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What is a 16 gauge IV used for?
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Surgery, Trauma, Fluid Resuscitation
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What is a 14/12 gauge IV used for?
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major trauma, codes, emergency fluid resuscitation
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What are the preferred sites for IV insertion?
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Always start distally
Metacarpal and Cephalic veins of the hand Cephalic and basilic of the wrist/forearm Median antecubital vein |
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When do you use the median antecubital vein?
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If NO other access is available
To accommodate a large bore needle Administer drugs that require large volume dilution |
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What factors do you take into account when choosing a site for IV insertion?
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Prescribed therapy
Duration of therapy Condition or size of the vein - sclerosed, tortuousness, valves |
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What do you take into account when choosing an IV catheter?
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Choose the shortest catheter with the largest gauge appropriate for the type of procedure, solution and patient.
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When placing an IV what position do you place the patient in?
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Supine
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How many times do you clean using the circular bulls eye motion before putting in an IV?
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3 times
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You do not apply this after applying the antimicrobial prep because this negates the beneficial effect of the prep.
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Alcohol
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How far do you advance the catheter once the needle is inserted into the vein?
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2-3 cm
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When advancing the canula, you advance it up to the?
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hub
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After the needle is removed and the catheter is in place what do you do?
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Flush the catheter to insure patency
Attach the IV tubing or cap to the cannula hub. Check for flow and or infiltration Secure the cannula and dress the site Dispose of sharps and waste appropriately |
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What are complications associated with peripheral IV's?
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Dislodge canula:
Loose tape Cannula backed out of the vein Patient removed - "it fell out" Hematoma Tenderness Occlusion - inability to advance or flush the line Infiltration: Swelling at and above the IV site Discomfort Burning Pain Nerve, tendon, ligament damage: Extreme pain Muscle contraction Phlebitis: Tenderness and redness - tip of canula along the vein Vein is hard on palpation Fever |