Exam 2 Iv Therapy

Front 1

Local Problems & Complications

Back 1

Adverse reactions that occur at the IV insertion site or near the site

Front 2

Pain & Irritation

Back 2

Pain at insertion siteVein irritationSevere pain radiating away from site

Front 3

Infiltration

Back 3

escape of non-vesicant solution from a vessel into surrounding tissue

Front 4

Extravasation

Back 4

escape of vesicant solution from a vessel into surrounding tissue

Front 5

Vesicant

Back 5

agent that is irritating & can cause blistering

Front 6

S/S of Infiltration and Extravasation

Back 6

Pain at or near insertion site Puffiness around site Taut, rigid skin around site Coolness of skin around site Damp or wet dressing Pump keeps beeping “occlusion”

Front 7

Infiltration and Extravasation: If S/S occur:

Back 7

D/C IV; may apply moist heat (check protocol)

Front 8

Catheter Displacement

Back 8

Catheter is out of vein; may have come out during movement or transfer

Front 9

Occlusion & Loss of Patency: Causes

Back 9

Positional IV (IV placed in vein that is close to a joint) Empty IV bag not replaced in a timely manner Too large cannula used (tip presses against vein wall) Not flushing SL as prescribed Kinks in tubing

Front 10

Occlusion & Loss of Patency: S/S

Back 10

S/S: Infusion stops running Infusion site pain (with normal appearance) Blood backed up into tubing

Front 11

Occlusion & Loss of Patency: If position and tubing seem O.K. may try gentle ?

Back 11

aspiration/irrigation

Front 12

Occlusion & Loss of Patency: When do you use smaller than a 3mL syringe to irrigate or aspirate?

Back 12

NEVER

Front 13

Phlebitis

Back 13

Inflammation of vein

Front 14

Phlebitis: S/S

Back 14

redness, warmth, or edema at site Pain, burning at site Vein hard & cordlike

Front 15

Phlebitis Tx

Back 15

DC/IV & apply warm compress

Front 16

Thrombosis

Back 16

process whereby a clot develops

Front 17

Thrombophlebitis

Back 17

inflammation of a vessel D/T development of a thrombus

Front 18

Hematoma

Back 18

Accumulation of clotted blood in tissues & results in ecchymosis (black & blue skin discoloration) and area may be raised & hardened

Front 19

Hematoma Tx

Back 19

D/C IV immediately

Front 20

Venous Spasm

Back 20

Very painful, cramping to site; pain may radiate up the extremityCan be caused by irritating or cold solutionsCan usually be reversed by slowing rate of infusion or by applying warm compresses around IV site if solution is cold

Front 21

Venous Spasm Tx

Back 21

D/C IV if spasms continue

Front 22

Cellulitis

Back 22

Inflammation & infection of cellular & SC tissueBacterial in nature (usually from Staph or Strep)

Front 23

Systemic Complications of IV Therapy (Local problems may lead to this)

Back 23

Contamination & infection, sepsis, medication and fluid interactions, Hypersensitivity reaction, embolism

Front 24

Contamination and infection

Back 24

Can result from any break in asepsisUse proper hand hygiene(Systemic Complication)

Front 25

Contamination and infection Tx

Back 25

D/C IV and restart at another site with new tubing/solution (systemic complications)

Front 26

Contamination and infection: S/S

Back 26

elevated leukocytes, chills, fever IV site usually appears normal(systemic complications)

Front 27

Sepsis

Back 27

Leading cause of death in non-coronary ICU patientsCaused by microorganisms in circulatory system(systemic complications)

Front 28

Sepsis S/S:

Back 28

chills, fever, malaise, tachycardia, tachypnea, hypotension, and altered mental status (Systemic Complication)

Front 29

Medication & Fluid Interactions

Back 29

Check for compatibility before mixing any IV drugs and/or fluids (Systemic Complication)

Front 30

Hypersensitivity Reaction

Back 30

Allergic reactionOne of most serious consequences of IV therapyAnaphylaxis (anaphylactic shock): severe allergic reactionAlways check for allergies(systemic complication)

Front 31

Hypersensitivity Reaction Tx

Back 31

D/C infusion & KVO with NS; do not D/C cannula; take VS; notify M.D.; stay with patient (systemic complication)

Front 32

Embolism

Back 32

Collection of undissolved material carried by circulatory flowMay be solid, liquid, or gaseousCaused by clot dislodgement or by accidental admission of air into circulatory system. Blood clot, Air embolism (systemic complication)

Front 33

Blood clot

Back 33

Can break off & become an embolism; may display chest pain & cough Avoid use of leg veins; use cannula that is not too large for vein Treat with anticoagulants(systemic complication)

Front 34

Air Embolism

Back 34

Vessels can be obstructed by air that enters the circulationCan be caused by severed IV lines; tubing that is not primed; or by vented infusion containers that run dry(systemic complication)

Front 35

Air embolism Tx

Back 35

position pt. on left side and lower head of bed below heart level(systemic complication)

Front 36

Infusates (Infusions)

Back 36

IV fluids are isotonic, hypotonic, or hypertonic when compared to serum osmolality

Front 37

Isotonic Infusions

Back 37

Have same tonicity as body fluidsUsed to treat hypotension resulting from hypovolemiaCompatible with plasma & can be administered more rapidly than hypo or hypertonic solutions

Front 38

Isotonic infusion examples

Back 38

NS RL D5W (D5W is isotonic, but it becomes hypotonic when it is infused because the dextrose is metabolized rapidly)

Front 39

Hypotonic Infusions

Back 39

Used to hydrate cells & lower Na levelsNot used with hypotensive patientsEx: ½ NS

Front 40

Hypertonic Infusions

Back 40

Raise serum osmolality by causing a pull of fluids from intracellular & interstitial compartments into blood vessels (or plasma)Administered with serious saline depletion

Front 41

Hypertonic Infusions Examples

Back 41

Ex.: D5 ½ NS D5 NS D10 NS D5 RL

Front 42

Patient Preparation and Site Selection

Back 42

Important to select most appropriate vein at time of insertionVeins have thinner walls than arteries & are lined with valves

Front 43

Patient Preparation

Back 43

Psychological preparation, physical preparation

Front 44

Psychological Preparation

Back 44

Explain procedureBe honest about discomfort involved

Front 45

Physical Preparation

Back 45

1. SafetyVerify M.D. orderI.D. patientCheck allergies2. ComfortStart IV in non-dominant hand/arm when possibleAvoid antecubital (AC) veins if possible3. PositionPlace patient in Fowler’s or semi-Fowler’sPosition arm below heart (promotes venous filling)

Front 46

IV Site Selection

Back 46

Never use an AV (arteriovenous) fistula or shunt that has been placed for hemodialysis for IV therapy The arm containing the AV graft should not be used for IV therapy or for obtaining blood pressures

Front 47

Upper Extremity Routes

Back 47

Peripheral IV Routes

Front 48

Peripheral IV Routes: Venous cannulation should start at ________ area of upper extremity (hand) and proceed proximally (_________)

Back 48

distal; (forearm, upper arm)

Front 49

Peripheral IV Routes: Subsequent (re-sticks) cannulation

Back 49

should be made proximal to previously cannulated site

Front 50

Peripheral IV Routes: When selecting a vein:

Back 50

assess pt. condition, reason for IV therapy, product(s) to be infused & projected time therapy will last

Front 51

Peripheral IV Routes: Hand veins are good for _______________& _______________

Back 51

short-term use & for use with nonirritating fluids

Front 52

Peripheral IV Routes: Veins of forearms impair __________, less than use of hand veins

Back 52

mobility

Front 53

Peripheral IV Routes: Veins of upper body

Back 53

subclavian, internal/external jugular are central venous routes

Front 54

Peripheral IV Routes: Veins of upper body channel blood into the heart; are called _____________.

Back 54

central lines

Front 55

Peripheral IV Routes: Why should veins of the lower extremities not be routinely used in adults?

Back 55

risk of embolism and thrombophlebitis

Front 56

Infusion Containers

Back 56

Check expiration datesMake sure fluid has no particulate matter

Front 57

Infusion Containers: 1. Glass containers

Back 57

must be vented (use a vented tubing)

Front 58

Infusion Containers: 2. Plastic containers (IV bags)

Back 58

Very commonly usedDo not require ventingMany different sizes availableOne problem: can be punctured when spiked

Front 59

Infusion Administration Sets

Back 59

Vented or non-vented tubingDrop factor of tubing (number of drops needed to deliver 1 mL of fluid) tells how much fluid the administration set deliversMacro drip sets: 10 – 20 gtt/mLMicro drip sets: 60 gtt/mLDrop factor stated on tubing package

Front 60

Primary Administration Sets

Back 60

a. Single LineOne spike inserted into one main bag of fluidb. Y-TypeBlood tubing: two equal length tubes & can access two primary solutions simultaneously or alternately

Front 61

Secondary Administration Sets

Back 61

Piggyback set used to deliver continuous or intermittent doses of fluid or medsPlugged into highest portPositioned higher than primary infusion

Front 62

Volume-Control Administration Sets

Back 62

Example: Buretrol (used with pediatric infusions)

Front 63

Blood/Blood product Administration Sets

Back 63

Y-tubingHave in-line filterUse should not exceed a four hour time period

Front 64

C. Needless Systems & Needlestick Safety Systems

Back 64

After initial IV stick there is no need for further use of needles due to needless systemSafety devices on syringes/needles must be activated prior to placing in sharps container

Front 65

Venous Access Devices

Back 65

Peripheral venous access devices are the most commonly usedONC: over-the-needle peripheral catheter: flexible cannula that encases a stylet (needle); once vein is accessed, catheter is threaded into vessel & stylet is withdrawn

Front 66

Infusion Regulation Systems: Electronic Infusion Control Devices

Back 66

Pumps, syringe pumps

Front 67

Electronic Infusion Control Devices: Pumps

Back 67

Run by electricity and by batteryPumps used in hospitalsPump provides a driving force to overcome resistance to pressure to propel the solutionHas pre-set pressure restrictions, so it will not overcome pressures that exceed the pre-set limit

Front 68

Electronic Infusion Control Devices: Syringe pumps

Back 68

Used to administer very small volumesExample: PCA (Patient Controlled Analgesia)Allows patient to self-deliver & regulate administration of pain medication; has pre-set dose limits