Ther - Iv Therapy

Front 1

What does blood consist of?

Back 1

-Blood consists of cells and
formed elements, surrounded by plasma
-About 95% of the volume of formed elements consists of red blood cells (erythrocytes)
-The remaining 5% consists of white blood cells (leukocytes) and cell fragments (platelets)

Front 2

What are the chief functions of blood?

Back 2

-Delivery of substances needed for cellular
metabolism in the tissues
-Defense against invading microorganisms
and injury
-Acid-base balance

Front 3

Where is blood formed?

Back 3

-In the adult, the red bone marrow is primarily found in membranous bone like, ribs, sternum, scapula, clavicles, hip bones, skull and spine
-Yellow marrow produces some white cells, but is composed mainly of connective tissue and fat

Front 4

What are other blood forming organs?

Back 4

=Lymph nodes
-Produce lymphocytes and antibodies
=Spleen
-Produces lymphocytes, plasma cells, and antibodies
=Liver
-A blood-forming organ only during intrauterine life
-Plays an important role in the coagulation process

Front 5

What is Plasma?

Back 5

Plasma

Clear portion of blood

About 92% water

Contains three important proteins

Albumin*

Globulins*

Fibrinogen*

Front 6

What is the purpose of plasma?

Back 6

-Maintaining blood pH
-Transporting fat-soluble vitamins, hormones,
and carbohydrates
-Allowing the body to digest them temporarily for food

Front 7

What are red blood cells?

Back 7

-Most abundant cells in the body
-Primarily are responsible for
tissue oxygenation
-Comprised of mainly water and the red protein hemoglobin

Front 8

How long do red blood cells live and what happens as they age?

Back 8

=Red blood cells have a life span of about 120 days
=As the cells age:
-Their internal chemical machinery weakens
-They lose elasticity
-They become trapped in small blood vessels in the
bone marrow, liver, and spleen
-They are then destroyed by specialized white blood cells

Front 9

What are White Blood Cells
(WBCs)?

Back 9

=WBCs arise from the bone marrow and are released into the blood stream
-Normal WBC count is about 5000 to 10,000 cells/cubic millimeter
=Function
-Destroy foreign substances
-Clear the blood stream of debris
-Leukocyte production increases in response to infection
-Causes an elevated WBC count in the blood

Front 10

What are platelets?

Back 10

=Platelets are small, sticky cells that play an important role in blood clotting
=Hemostasis is the process that stops bleeding after injury. Platelets travel to the site and adhere to the damaged vessel wall and seal them within minutes of injury

Front 11

What are the indications for IV therapy or access?

Back 11

-Fluid and blood replacement
-Drug administration

Front 12

What are the types of IV access?

Back 12

-Peripheral venous access
-Central venous access

Front 13

What are Colloids?

Back 13

=Solutions that contain molecules (usually
protein) that are too large to pass through the capillary membrane

Exhibit osmotic pressure and remain within the vascular compartment for a considerable length of time

Examples

Whole blood

Plasma

Packed red blood cells

Front 14

What are Crystalloids?

Back 14

-Primary out-of-hospital solutions
-Isotonic solutions
-Hypertonic solutions
-Hypotonic solutions
-Prehospital Solutions

Lactated Ringer’s

Normal saline solution

5% dextrose in water

Front 15

What are the sizes of catheters and what are they used for?

Back 15

=14 Gauge – Used for patients in shock, cardiac
arrest or volume replacement for trauma patients.
=16 Gauge – Used for patients in shock, cardiac
arrest or volume replacement for trauma patients.
=18 Gauge – Very common. Used for patients who may require blood or when administering D50W
=20 Gauge – Very common.
=22 Gauge – used for infants, toddlers, children,
adolescents, and the elderly.
=24 Gauge – Used mainly for neonates, infants,
small children and the elderly

Front 16

What are Factors Affecting IV Flow Rates

Back 16

-Constricting band
-Edema at puncture site
-Cannula abutting the vein wall or valve
-Administration set control valves
-IV bag height
-Completely filled drip chamber
-Catheter patency

Front 17

What are some IV Access Complications?

Back 17

-Pain
-Local infection
-Pyrogenic reaction
-Circulatory
overload
-Thrombophlebitis
-Thrombus
-Allergic reaction
-Catheter shear
-Inadvertent arterial puncture formation
-Air embolism
-Necrosis
-Anticoagulants

Front 18

What should you do with Infiltration?

Back 18

-Discontinue IV infusion
-Remove the needle or catheter
-Apply a pressure dressing to the site
-Choose an alternative puncture site and initiate IV therapy with new equipment
-Document the incident

Front 19

What is an air embolism?

Back 19

An uncommon complication of IV therapy. Caused by air entering the blood stream via the catheter tubing. If enough air enters the heart chamber it can impede the flow of blood leading to shock.

It can be avoided by ensuring that air is purged from the tubing before being connected to the IV canula.

Front 20

What are the signs and symptoms of an air embolism?

Back 20

Hypotension, Cyanosis, Weak and Rapid pulse, Loss of consciousness

Front 21

What is the management for an air embolism?

Back 21

=Close the tubing

=Turn the patient on their left side with the head down

=Check tubing for leaks (replace tubing)

=Administer high flow O2

= Notify medical direction

Front 22

How should an IV bag be changed?

Back 22

=Prepare the new bag or bottle.

=Occlude the flow from depleted bag or bottle.

=Remove spike from depleted bag or bottle.

=Insert spike into the new IV bag or bottle.

=Open the clamp to appropriate flow
rate.

Front 23

What do you need to know to calculate infusion rate?

Back 23

The amount of fluid required, the gtts of the drop set and the time over which it is required to be supplied.

Front 24

What is the equation?

Back 24

(Volume to be supplied x Drop Set) / Time to be infused

Front 25

What is a saline lock?

Back 25

An intermittent infusion device used to maintain a route for medication administration. They are cost effective and aids in patient comfort.

Front 26

How should a saline lock be maintained?

Back 26

They should be flushed with a minimum of 3ml of Normal Saline to ensure vein patency.

SL's should be flushed prior to any medication or solution being administered with normal saline and at least once per day.

Front 27

How can IV medications be given?

Back 27

=By a previously established IV infusion line
=By an implantable port
=Directly into the vein with a sterile needle or butterfly device

Front 28

What do IV injections normally consist of?

Back 28

A small amount of medication, usually less than 5ml. The exception is for D50W.

They are called IV push or IV bolus medications.

Front 29

Describe the IV injection procedure?

Back 29

1) Inject slowly - Rate depends on the type of medication and the patient response.

2) Give through one way valves on the IV tubing or by clamping the tubing above the injection site during drug administration

3) Following the injection continue the injection of fluids.

Front 30

What is IO infusion?

Back 30

=A rigid needle is inserted into the cavity of a long bone.

=Used for critical situations when a peripheral IV is unable to be obtained

=Initiate after 90 seconds or three unsuccessful IV attempts

Front 31

When should external jugular vein cannulation be attempted?

Back 31

In life threatening situations where no obvious peripheral site is noted.

Front 32

Where does the External Jugular vein lie?

Back 32

It is a large vein that lies along the side of the neck. It extends from the angle of the mandible and ends in the subclavian vein.

Front 33

What is a disadvantage of this site?

Back 33

The catheter and tubing are hard to secure and can be easily displaced.

Front 34

What are the steps for an external jug cannulation?

Back 34

Place patient in supine or trendelenburg position.

Turn the patients head to the side opposite of access and cleanse the site.

Occlude venous return by placing a finger just above the clavicle.

Point the catheter at the medial third of the clavicle and insert it bevel up at a 10-30 degree angle.

Front 35

How should IV's be started in scenario land?

Back 35

After primary assessment get partner to establish an IV at TKVO.

Once you have a set of vitals determine what the level of treatment is required. IE if BP is low enough.

Front 36

What is the language that should be used?

Back 36

250ml fluid bolus and then reassess blood pressure

Also depends on the fluid lost! If there is evidence of a large loss then give more.

IE Femur break may need 500ml's or a pelvic fracture may need 1000ml's or more.

Front 37

What needs to be done when reassessing?

Back 37

Need to look at lung sounds for evidence of pulmonary edema indication fluid overload.

Front 38

What is the max for pre-hospital care?

Back 38

2-3 litres and contact medical control.

20ml per kilo of body weight is the the theoretical max.

Front 39

What are chest tubes?

Back 39

Chest tubes are inserted in the 5th intercostal space on the midaxillary line to relieve hemothorax, simple or tension pneumothorax. The skin is prepared with antiseptic such as providone iodine and local anaesthetic is injected. An incision is made through the skin, then passage through the intercostal muscles is made manually with a finger. Once the pleural space has been accessed, a long large bore catheter with multiple holes is inserted. The tube is secured with sutures and attached to a drainage system. The drainage container is graduated to measure volume and usually contains saline or other liquid and must be kept below the level of the patient. The chest tube may be inserted after needle thoracostomy (for example, field chest decompression).

Front 40

What are Nasogastric tubes?

Back 40

These tubes are inserted to relieve gastric distention by decompressing the stomach of built up gases or fluids for patients who may benefit from lavage to prevent ensuing accumulations and pressures. They can also be used for enteral feedings. Inserted through a nare, the tube will pass through the naso and oropharynx, the esophagus, the lower esophageal sphincter, and into the stomach. In the hospital they are usually attached to intermittent low-pressure suction (different from the mechanical suction units in prehospital use), or are left open as a vent. Usually secured with tape to the patient’s nose or face, and have markings for depth. Care must be taken in moving patient’s so as not to dislodge the NG tube. If intermittent suction is required in transport, it should be done either by bringing the hospital equipment with the patient, or by using a large syringe (50 or 60cc) attached to the end of the tube. Oxygen and ventilations with BVM can be provided with the NG tube in place, so long as the proximal end of the NG tube remains outside the mask. Gastric tubes can also be inserted through the mouth.

Front 41

What are Ostomy Appliances?

Back 41

In major gastrointestinal diseases, trauma, or other therapies, it may be necessary to remove a section of the bowel, including the rectum. In these cases, the surgeon may make an opening from the bowel (anywhere along its length) to the outside. Alternatively, this can be done to “rest” the bowel, so there is no digestion, absorption or peristalsis. This ostomy may be temporary or permanent. Because the digestive system proximal to the ostomy is still functional, stool will still be formed and the patient must be fitted with a reservoir for the feces. If the ostomy is in the small bowel, there may be continual drainage of stool. If the ostomy is further down along the large bowel, stool may leave the body periodically, much the same as with any other bowel movement. Careful attention must also be paid to diet, particularly fiber content and fluid intake. There may be additional management with medications like laxatives. Stool contact with healthy skin on the abdomen is to be avoided, and in order for the patient to be able to function “normally” in day-to-day living, combinations of protective creams, wafers, deodorants, and sealable bags are used. There is a wide variety of types and size of ostomies the wafers and bags making each patients’ situation unique. It is therefore advisable to bring some of the patient’s supplies with them if transport is required. If the bag must be emptied or changed, use proper personal protection, and have a reservoir or receptacle ready before removing the bag. You must know how to change the particular equipment or leave it for someone who does know.

Front 42

What are Urinary catheters?

Back 42

Tubes can be inserted through the urethra up into the bladder to facilitate passage of urine. There are many different reasons for their use such as urethral or bladder obstruction, monitoring the patient for output volume, the patient is bedridden, the patient is unable to control urine release such as with some spinal injuries, M.S., CVA, or the patient is going for surgery. Catheters can also be used to instill medications into the bladder for localized use. (e.g. toxic antineoplastics) Careful attention to aseptic technique is required when urinary catheters are inserted in order to avoid infection of the bladder. An indwelling catheter or Foley has a balloon at the end, which remains in the bladder, this is inflated to help keep the catheter in place. (If this type of catheter is used, this balloon obviously must be deflated before the catheter is pulled out.) Be sure to attach the tubing on the drainage bag to the correct opening on the catheter. With careful maintenance, these can be left in place for prolonged periods. Other temporary catheters do not have the balloon end and use the same type of tubing and bag. Some patients may insert these catheters several times daily to empty their bladders, rather than have the catheter remain indwelling. The condom catheter is an alternate external system which can be worn and used where incontinence or “dribbling” is the problem, or when internal insertion is not possible or desirable. As with any other drainage tube, care must be exercised when moving the patient so as not to dislodge the catheter (or spill the contents of the drainage bag). If required to empty the bag, note the time, volume of urine, color, odor and any sediment or blood clots present.

Front 43

What are Penrose drains?

Back 43

Prehospital personnel may infrequently encounter patients after abdominal or thoracic surgery with a Penrose drain inserted. The physician simply makes a stab wound in the lower abdomen or utilizes a surgical opening in the thoracic area and inserts the soft flexible tubing. (Penrose drains are often used for tourniquets when starting IVs.) The Penrose drain prevents buildup of fluids and gases within the abdominal or thoracic cavity to reduce tension on the abdominal/chest wall and ease healing of the surgical scar. Don’t remove or dislodge the drain.

Front 44

What is a Peritoneal Dialysis Catheters?

Back 44

Many patients with kidney failure, waiting at home for transplant, etc. will be on dialysis. Dialysis uses the principles of osmosis, diffusion and ultra filtration to eliminate toxic materials from the body. If hemodialysis is unavailable another option is peritoneal dialysis. In peritoneal dialysis, the sterile dialysate is introduced into the abdominal cavity (outside of any organs) through a catheter in the midline abdomen. The fluid bathes the peritoneal membranes and capillary beds. Blood toxins diffuse from the abdominal capillaries into the dialysis fluid, which is then drained back out through the catheter. To introduce the fluid into the body, the bag of dialysis fluid must be hung high above the patient (e.g. the patient may sit on the floor with the bag hanging on something well above their head), and the reverse must happen for the fluid to drain back out of the abdomen into the same dialysis bag). The process takes about an hour, and is repeated several times daily. There are risks of infection, congestive heart failure, pulmonary edema and electrolyte imbalances if the dialysate is not drained properly, or hypovolemia, hypotension if fluid is removed to rapidly from the intravascular space.

Front 45

What are Enteral feeding tubes?

Back 45

Adequate nutrition depends on the ability to swallow and absorb nutrients. Major GI diseases, fistulas, trauma, burns, side effects from radiation or chemotherapy, dysphagia, unresponsiveness, prematurity in infants, etc. may make enteral nutrition necessary. Gastric or feeding tubes can be inserted as mentioned through the mouth or nose, or a special gastrostomy catheter can be inserted through the abdominal wall into the stomach or upper small bowel (e.g. jejunum). Liquid feedings can then be administered though the tube. Gastrostomy or jejunostomy tubes usually have stopcocks, which can be used to close off the tube after the feeding is completed.