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107 Cards in this Set
- Front
- Back
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the indications for IV therapy fall in 3 categories
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maintenance therapy
replacement therapy restoration therapy |
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additional indications for IV therapy and maintaining restoration include?
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the establisment of access to a vein for administration of medication and fluids reguired to maintain fluid
electrolyte balance or both administration of medication that cannot be ingested by oral route a ready available access for treatment by keeping the vein open |
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an IV that is administered at a slow rate to maintain access to a vein is often referred to as?
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KO-keep open
so it is available for immediate access for emergency situations or for adminstering medications (important for the ability to adminster med's rapidly if needed) |
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further indications for IV therapy and maintaining restoration
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adminstration of blood components
adminsteration of chemotherapy administration of anesthesia or diagnostic reagents adminstration of medication using bolus or piggyback setup |
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IV adminstration of drugs and fluids is useful in Patients who are?
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unconscious or unable to ingest food
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maintenance therapy involves providing necessary?
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nutrients for daily needs of:
water, electrolyes, and nutrition for patients having reduced or no intake of oral fluids and nutritional elements |
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replacement therapy is indicated when the patient has experienced?
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a deficit in the intake of fluids and nourisment
(usually over a period of 48 hours) |
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restorative therapy involves?
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daily restoration of fluids and electrolytes
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one of the major advantages of IV therapy is?
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rapid absorption of medication and this is also a major diadvantage when errors or adverse reactions occur...most dangerous
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IV therapy becomes an important asset for health care providers and patient to provide?
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drugs in emergency situations
when rapid absorption of medication is needed |
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common medications that are administered IV?
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antimicrobial agents:
cephalosporin, aminoglycosides, and penicillins |
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other drugs that may be administered IV route?
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anticoagulants, antifungal, antiviral agents, bronchodilators, hypoglycemic drugs, insulin(regular only), immunosupressants, biotherapy drugs
Chemotherapy drugs may also be administered IV but usually as an ifusion Opiod drugs may be delivered in a bolus form for intermittent pain relief or continous analgesia |
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methods of administering IV medications
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continous infusion, either as intermitent infusion, bolus injection, or piggyback
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IV fluids are considered a type of drug therapy in the form of?
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isotonic
hypotonic or hypertonic solutions additonally chemical replacements such as electrolyes may be added to the solution to manage homeostasis and fluid balance |
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controlled drip rates as ordered by the physcian must be maintained when medications are added to ?
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The primary bag of soultion
this is a necessary action to prevent overdose of the medication |
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bolus injections may be administered through ?
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an existing IV line or directly into the vein
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bolus injections are often?
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drawn up in a syringe and administered through an access port by way of slow or rapid push
care should be taken... |
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what health care professionals can give IV bolus push routes
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Physicians, paramedics, speicially trained registered nurses, radiology techs,
refer to practice acts & legislation of your state |
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IV piggyback IVPB is a ?
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secondary set attached to the primary adminstration set
medications dissolved in the smaller amount of solution can be administered using this route without disconnecting the primary IV line is often used for dosages to be administered at regular intermittent intervals(every 8 hours) |
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different from IV bolus- IV piggyback
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IVPB provides medication that have been diluted but the ordered flow rate for the fluids must be carefully followed
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dangers of IV therapy are associated with?
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human error, where as complications are from IV fluids
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an obvious danger of IV therapy is?
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the possiblitity of introduction of microorganisms directly into the bloodstream when aseptic technique is not followed precisely
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any possible loss of asepsis must be?
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confronted and the equipment must be discarded to protect the Patient.
"remember sterility is not measured in degrees" |
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safety issues related to human error that are associated with medication errors-
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review basic concepts of infection control:correct dosage, and calculations, including weight and volume of the metric are necessary for safety of patient and the prevention of dangerous conditions
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health care providers have the responsibility of continually?
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observing the infusion site & Patients general status to detect any complications and caring for these complications in a timely manner
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complications of IV therapy can be of different origins.
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local at the infusion site or generalized and systemic
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Local complications include?
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mechanical problems:
infiltration into the surrounding tissues a leak of fluids at the site displaced catheter localized infection within a vein or phlebitis can result in break in asepsis |
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systemic complications include?
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circulatory overload
phlebitis thrombus formation pulmonary embolism air embolism |
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after the infusion is discountinued possible complications may include?
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bleeding at the site
excessive bleeding hemmorrhage "demands prompt management" applying pressure can prevent this and when documenting-state "applied pressure" |
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local complications may occur?
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at the initiation of the IV
during the IV infusion after the IV catheter or needle is removed |
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local complications include?
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infiltration of fluids into the surrounding tissues caused by improper placement of needle
trauma to the vein on insertion of needle leaving the tourniquet in place following the initiation of the flow of fluids |
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infiltration of fluids into the surrounding tissues occurs when?
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the device used for insertion of the IV line is displaced from the vein, allowing fluid to flow into the tissues
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SSX of infiltration?
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skin will feel tight and appear stretched and taunt, with increased discomfort at the insertion site
signs are seen close to the insertion site: slowing or stopping of the fluid infusion, tissue induration, and swelling around theinjection site with tissue remaining COOL to the touch |
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infiltration is less likely to happen because?
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infusion devices have alarms sounds when the fluids infiltrate
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treatments of infiltration-local complication
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lowering of the IV bag below venipuncture site provides a quick check to determine if the IV has infiltrated.
If there is blood return-the IV is still in vein when no blood return is evident, the device for the IV aparently has been displaced from the vein The infusion site will have to be changed and the affected limb elevated and covered with warm compresses or any other therapy ordered by physcian. |
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local complication-hematoma and ecchymosis can be found when?
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a tourniquet is placed above the infusion site
the vein is nicked or a leaky vein occurs because of freguent use of the same vein for venipuncture or IV therapy |
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local complication-hematoma and ecchymosis
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leaky vein-blood seeps or leaks into the tissue, causing pooling of blood and formingthe hematoma or the area of bruising
( the complication is preventable with careful venipuncture technique and the correct placement of the tourniquet |
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SSX= of local complication-hematoma and ecchymosis-
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discoloration of the skin, swelling and discomfort are the most freguent signs
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treatment of local complication-hematoma and ecchymosis
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assess the situation and usually the cannula or needle will need to be removed. elevate the affected limb and apply warm compresses
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local complication-leakage of fluid around the venipuncture site
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IV fluids leaks around the infusion device or from the connection of the device to the IV tubing
In addition, bleeding from the venipincture site may occur during infusion |
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how is hematomas and ecchymosis preventable?
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careful venipuncture techniques and the correct placement of the tourniquet
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SSX of local complication of leakage of fluid around the venipuncture site
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the cannula or the needle has become slightly dislodged allowing fluid to run out of the site onto the dressing. Pt. complains of the dressing covering the venipuncture site to feel wet & cool
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treatment of local complication of leakage of fluid around the venipuncture site
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when it caused by poor connection, the IV is discountinued and restarted with new equipment because the tubing connection and the hub of the cannula are now considered to be contaminated
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local complications-Infection
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can be localized or generalized throughout the body
First line of defense to protect PT-practice good and consistant handwashing proper asepsis maintenance of sterility as appropriate |
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local complications-Infection-othe additional potenial sources of contamination
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problems during manufacturing
packaging storage (should be evalusted prior to fluid being used) when blood flows back into tubing and allowed to remain there break in asepsis technique during the therapy injection ports should be properly cleansed with an aseptic soultion prior to administration of any medications or solutions all needles and devices used to insert medications or solutions into ports must be sterile and added medications or fluids should be prepared in a manner that preserves sterility as appropriate |
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localized infections @ the venipuncture site
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the practice of medical asepsis and sterile technique when starting an IV is the first step in preventing an infection @ the site
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localized infections @ the venipuncture site the breach in the integrity of the skin with the venipuncture disturbs?
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the body's first line of defense against pathogens.
Proper cleansing of the intended site before the venipuncture and the application of a sterile dressing to the site postpuncture are proactive measures for limiting the indcednce of infection, as importance of maintaining sterility of IV equipment that will be introduced to the vein |
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SSX of localized infections @ the venipuncture site
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swelling, redness, and pain in the area
A purulent discharge also may be present at the site the skin in the surrounding area is usually warmer than normal red streaks may radiate from the site or area and Pt may experience fever and chills white blood count may be elevated |
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treatment of localized infections @ the venipuncture site
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to discontinue the IV and remove the catheter or needle to study it for culture and sensitivityantiseptic ointment may be applied and a new sterile dressing is placed over the site
observation and actions are charted A new site is selected and the IV is restarted usually with new tubing, and needle or infusion device if it is determined that fluids have not been compromised or according to the policies of the facility changing the dressing every 24 hours which is important in preventing local infections |
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systemic complications
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include sepsis/septicmia circulatory overlaod; and vascular complications such as phlebitis, thrombus, and embolus(pulmonary and air embolus)
Overdose, toxicity, or both may occur(the medication is finsued to rapidly or the dosage is not calculated correctly "once a systemic problem is suspected immediate intervention is mandated to prevent life-threatening complications |
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systemic complications-sepsis/septicemia
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generalized infection or sepsis may occur when pathogens enter the blood through the IV fluids or from pathogens present on the tubing that are able to migrate from equipment through the venipuncture into the blood
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SSX of systemic complications-sepsis/septicemia
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chills, fever, increasing heart rate, respiratory rate, and dropping blood pressure
the white blood count is usually elevated PT. may display anxiety, and restlessness or lethargy and complain of not feeling right or will say something is wrong this may be a delayed reaction after the IV has been discontinued any of these signs requires immediate attention and reported to the physician |
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treatment of systemic complications-sepsis/septicemia
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after blood cultures have been obtained, the physician will order appropriate antibiotics to be administered
An open IV line is necessary for maintenace of fluid intake vital signs are monitored and recorded on regular basis Pt is watched carefully for life-threatening situations |
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systemic complications of fluid overlaod
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when IV fluids are infused too rapidly, systemic complications such as cardiac overlaod and respiratory difficuties may occur
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systemic complications of fluid overlaod...responsibilites of the person performing the infusion
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calculations of the flow rate
checking the infusion rate on regular basis after the infusion has started each time the patient is checked the flow rate should also be checked-this is the responsibility of the health care provider any SOB, or swelling should be followed closely, vital signs should be obtained and the physician should be notified of the PT condition on regular basis if the early signs of complications are observed |
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systemic complications-circulatory overlaod
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is a major complication that can be life threatening if prompt intervention does not occur
an infusion administered too rapidly or reduced kidney function may be responsibel for this major complication Impaired cardiac contraction as a result of increased blood volume does not allow for adequate blood supply to reach the kidneys for filtration and excretion |
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SSX of systemic complications-circulatory overlaod
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Pt will display apprehension and SOB
Pulse, RR, BP increase as the overlaod increases the PT may exhibit additional SOB, anxiety, elevated BP and bounding pulse Edema is often present around eyes and in limbs-especially hands and ankles neck and limb veins will appear distended skin appears taunt and shiny and there may be peripheral cyanosis capillary refill is delayed fluid is auscultated in the lungs weight gain gongestive heart failure and pulmonary edema are sequelae that may be seen |
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treatment of systemic complications-circulatory overlaod
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IV flow rate slowed and physician notified
provide PT with oxygen and assist to semi-fowlers position vitals taken and recorded all observations and interventions documented administering diuretics to remove the fluid from the body Intake & Output are carefully monitored with the desired urinary output of 60 ml/hr calculations of flow rates should be checked at least twice before infusion begins and then every hour during the infusion |
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vascular complications-phlebitis
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an inflammation process in the vein, may occur above the site if the therapy is given on successive days, or with an irritating substance being administered through the vein
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SSX-vascular complications-phlebitis
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indicated by at least 2 of the following:
redness oain swelling warmeth @ the site red streaks may radiate from the site pain & tenderness are noted in the area along the vein the inflammationmay cause the vein to feel like a cord the vein should be assessed rregularly for this sign, especially if the IV therapy occurs over long period of time |
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treatment-vascular complications-phlebitis
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the IV is discontinued and started in another site
warm compresses may be applied observations and actions should be documented |
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vascular complications-thrombus
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a blood clot that obstructs a blood vessel-often a result of stasis blood at the catheter or needle tip or in the vein
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SSX of vascular complications-thrombus
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indications of this condition-slowing infusion rate, swelling, and discomfort
often can be felt as a firm, threadlike formation along the course of the vein |
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treatment of vascular complications-thrombus
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IV discontinued, a sterile dressing is applied to the infusion site and the IV restarted at another site(preferably on the other limb)
pysician notified and wram compresses applied |
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vascular complications-embolus
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clot of aggregated material such as:
bits of tumor tissue cells air bubbles bacteria foreign bodies the embolus can lodge in any vessel and inhibit the blood flow beyand the obstruction |
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vascular complication-embolus
SSX |
depend on the location of the occluded vessel and the magnitude of the area of tissue served by the vessel
initial symptoms: severe pain in the area of the embolus embolus lodging in the arteries of the extremities cause the area to become pale, numb, and cold to touch emobli from IV therapy usually are in the veins-with the most severe area being the pulmonay vessels |
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treatment of vascular complication-embolus
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elevate the limb and to emoblize it to prevent movement
the physician is notified and specific symptomatic treatment is instituted all observations and interventions are documented |
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vascular complication-pulmonary embolism
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occurs when a mass of foreign material lodges in and occludes an artery in the pulmonary circulation resulting in the interuption of blood supply to the area
this is caused by the migration of the clot from the limb to the pulmonary circulation where it becomes lodged in a smaller pulmonary vessel PULMONARY embolism is the MOST severe complications and support with ventilation is necessary |
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SSX-vascular complication-pulmonary embolism
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determined by the size and location of the embolism along with the general condition of the Patient(SOB)
Apprehension is common small uncomplicated embolism=a cough, chest pain, and low grade fever Patient with more extensive infarction will experience sudden onset of chest pain, acute SOB, dyspnes, and tacypnea with extreme anxiety HR will become rapid and BP drops significantly |
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treatment of vascular complication-pulmonary embolism
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the life threatening occurance demands immediate intervention
the physician is notified immediately oxygen is administered physicians presence to manage the emergency is reguired anticoagulent med's (usually heparin) are ordered and administered thrombolytic drugs may be used to dissolve the clot without immediate attention-could rapidly become fatal |
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vascular complication-air embolism
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similar to pulmonary embolism-an air embolism occurs when a large air bubble enters the systemic circulation and is transported to the pulmonary circulation
the air mass causes an interuption in blood flow to the pulmonary vessels |
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SSX of vascular complication-air embolism
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signs of pulmonary embolism
demands the same immediate intervention as pulmonary embolism the situation occurs when large air bubbles not being purged from the IV tubing prior to fluid adminstration care must be taken at all times to ensure air is not in the tubing |
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treatment of vascular complication-air embolism
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treatment is similar to pulmonary embolism
oxygen vital signs are monitored and physician is notified all observations and interventions are documented |
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overdose/toxixity-vascular complcations
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medications used to treat respiratory conditons(theophylline), hyperglycemia(insulin, cardiac arrythmias(lidocaine), hypotension(dopamine), hypertension(hydralazine{apresoline} may cause an overdose or toxicity when an excess dose is administered-infused
may be any drug used drug blood levels must be observed closely |
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SSX- of overdose/toxixity-vascular complcations
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an unusual symptom occurs during administration must be considered serious
should be recorded a brought to the attention of the physician |
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theophylline toxic will exhibit signs of?
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overstimulation of the CNS:
nervousness restlessness tremors possibly convulsions gastric upset & tachycardia |
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PT. ssx of experiencing insulin reaction?
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anxiety
tachycardia irritability trembling cool moist skin w/ perspiration, confusion, seizures and loss of consciousness |
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Lidocaine is often given by bolus or continuous drip...Pt with toxemia often exhibit signs of?
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GI distress
lightheadedness and tremors |
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Dopamine is used in an emergent or possible maintenance situation to treat hyptension-what are the SSX?
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toxicity will be demonstrated by a hypertension reaction
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the Pt with hypertension being treated with Apresoline or any other antihypertensive IV medication becomes toxic the primary symptom will be?
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a sudden or gradual hypotensive state
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treatments for overdose or toxicty
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slowing or discontinuing the IV drip or medication
assessing vitals signs notifying the physician documenting observation and events continuing to monitor the PT and the situation when an antidote is indicated the physician oreders it! Pt. should not be left alone until he or she is stabilized |
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complications after an IV infusion
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including bleeding at the site or hemorraging can occur and demand prompt management
Mechanical problems related to the infusion system or trauma to the veins may be the causes of the delayed adverse reactions |
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bleeding following the IV therapy
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may occur once the cannula has been removed
it may occur immediately or the onset may be delayed if the blood clot is dislodged |
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bleeding following the IV therapy SSX?
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bleeding occurs as the cannula is removed and it may not be controlled by gentle pressure
pressure dressing halts the blood flow for a short time delayed bleeding may occur after a pressure dressing is applied to the venipuncture site the Pt will complain of the hand feeling damp or wet and cold inspection reveals the presence of blood flow that has not been controlled by the dressing dressing is usually saturated and clothing, blankets and sheets |
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treatments of bleeding following the IV therapy?
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controling the bleeding
gentle pressure is applied and the dressing is not removed vital signs monitored and reassurance is given if bleeding subsides but there is oozing, the outline of the blood saturation and the time of the outline is marked on the dressing if bleeding continues and efforts to control is not successful the physician should be notified and all assessments and interventions documneted additional pressure dressings are to be applied over the previous dressing until physician can assess the situation |
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7 rights of medication administeration
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right drug
right dose right time right route right patien right technique right documnetation |
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the 3 before giving medication:
medication labels should be read? |
before taking from storage
before pouring befroe returning the medication to the storage site |
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the professional responsibility of administering medication and IV therapy have other responsibilities besides just starting the IV?
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the calculation of the accurate dose and dosage is the most important because medications in IV therapy cannot be retrieved
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legally it is the responsibility of the person administering the medication to be aware of the?
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dosage
indications side effects adverse reactions allergic reactions to any medications being given |
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professional should assess the PT for what before giving medication through IV
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allergies to food
drugs and the environmental factors lifestyle of the PT and the availability of resources for care, as appropriate |
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any area that may altar the response to the medication should be evaluated including?
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genetic factors
prexisting conditions or illnesses and age Age, genetics, amount of body fat and prexisting conditions of body organs that influence absorption, distribution, metabolism or excretion of administered drugs will also influence the manner in which the pt. responds to the treatment (renal & Liver for examole) |
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unexpected or undesirable effects that may occur
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these reactions are not side effects becasue the effects although undisrable, are not completely unexpected
these unexpected effects can be life threatening: as drug allergies tolerance to medications because of composition of the body tissues or idiosyncratic reaction |
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pharmacokinetics
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relates to how the body processes medications, including IV fluids and is the base for the adminstration of medication
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the 4 processes of pharmacokinetics
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absorption
distribution metabolism transformation excretion |
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pharmacokinetics the processes
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1. the IV administration of medication, the absorption rate is immediate because the drug is injected directly into the bloodstream and the absorption through other organs into the bloodstream is not necessary
2. the distribution of the drug is not slowed down because of the rate of absorption (the amount of drug circulating in the blood is called the drug blood level and with IV drugs this is the amount that infused) 3. metabolism is in the liver so any liver condition would affect the amount of medication the patient metabolizes for excretion allowing excessive amounts of medications to remain in the body over longer period of time. The rate of metabolism is important for the elderly, people with liver diasease and those with debilitating illnesses 4. excretion of drugs occurs through respiration, perspiration, urination and defecation. The rate of ecretion is dependent on the chemical composition of the drug, the rate of metabolism, and the route of administration. IV infusions will be absorbed, distributed, metabolized and excreted faster than medications given orally, thus some may have to given more frequently |
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order for IV therapy and assess the patient
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first step in initiating an IV are to check the physicians orders and confirm the identity of the patient
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First step....physicians orders are checked for the following?
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patients name
IV solution any medication to be added to the fluids amount of solution to be infused time over which solution is to be infused or the time appropriate for the number of milliltiers (review PT's history prior to initiating the infusion as circumstances allow) |
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the elvauation process
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infoemation about the patients illness(to assess how pt fluid balance may be affected by the IV therapy and expected results of the therapy)
medication or other treatment the patient is recieving the PT's ability to take oral fluids and nutrition the relationship of fluid intake & output dietary restrictions (the hand sanitization procedure is preformed as the first step in fection control |
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GATHERING UP EQUIPMENT
Second step in preparing for IV therapy |
assemble all the proper equipment for initiating the IV infusion
1.correct solution and amount (must be checked against the prescribers orders) 2. correct solution administration set or tubing(the prescribed rate will dictate if a microdrip or macrodrip set is indicated |
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GATHERING UP EQUIPMENT
third step...antiseptic solutions and applicators |
70% isopropyl alcohol
iodine preparation chlorhexidine gluconate |
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GATHERING UP EQUIPMENT
venipuncture/infusion devices |
infusion devices:
over-the-needle catheters butterfly needle through-the-needle catheter ( an assortment of sizes, types should be carried to PT room) |
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GATHERING UP EQUIPMENT
dressing materials |
sterile gauze
transparent semipermeable membran dressing antimicrobial patches adequate tape supplies(check for allergy to tape, or latex) these supplies should be transported with the venipuncture devices and antiseptic wipes |
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PREPARATION OF THE PATIENT
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the technique used to identify the patient may be verbal. asking his or her name, or nonverbal reading identification bracelet
explaining the procedure-reduces anxiety and encourages cooperation answer questions honestly about the procedure to build confidence and trust |
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PREPARATION OF THE PATIENT-initial pateinet screening
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those PT that do not require emergency care:
temperature pulse respirations blood pressure weight allergies |
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PREPARATIONS OF THE EQUIPMENT
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ASSEMBLE THE EQUIPMENT FOR THE INITIATION OF iv THERAPY:
PREPARE THE iv SOLUTION |
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PREPARATIONS OF THE EQUIPMENT
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Prepare the IV solution:
the appropriate solution must be suspended above the infusion site on the device needed for the type of infusion a pole is required for an infusion regulation device when gravity is the force used for infusion the pole or hanger loop is set at a height to maintain a good flow rate. The clamp on the infusion set will also provide a control of the rate of infusion |
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PREPARATIONS OF THE EQUIPMENT
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recheck medication and dosage calculations
should be rechecked to ensure the proper drug and dose to be administered medications added to the fluids will be afixed to the fluid bag so they can be checked against the orders expiration dates are found on solution containers and sterilized supplies checking the fluids includes: expiration dates medications the actual fluid composition |
