IV Administration

Pregunta	Respuesta
Peripheral Insertion	Responsibility of the RN In the peripheral extremities (Arm/leg)
Central Placement	Intravenous line in a central vein- direct to the heart( Jugular, femoral or subclavian vein) Responsibility of the physician or nurse practitioner.
Whose responsibility is maintaining the IV Line?	The RN
Indications of IV placement	1. Expand/reduce intravascular volume 2. To correct electrolyte imbalances. 3. To administer medications. 4. To administer blood/blood products. 5. Patient Status 6. Nutritional Support 7. Emergency access
Crystalloids	IV fluid containing various concentrations of electrolytes that may expand or reduce the intravascular volume
Intravascular volume	Volume of blood in a patients system
What determines whether or not an IV fluid expands or reduces intravascular volume?	Osmolarity
Isotonic Solution osmolarity?	280-295
Example of Isotonic solution?	Normal Saline Solution
Hypertonic Solution Osmolarity	>280-295
Example of hypertonic solution	5% Dextrose and normal Saline solution
Hypotonic osmolarity	<280-295
Examples of Hypotonic Solutions	Half Normal Saline
Why is 5% dextrose in water isotonic in the bag and hypotonic in the plasma? What is the clinical significance?	the glucose (solute) dissolved in sterile water is metabolized rapidly by the body’s cells.
Colloids	IV solutions that contain large protein molecules and stay in the vascular space (plasma volume expanders) Increase osmotic pressure in vascular space
What is the major intracellular electrolyte?	Potassium (K)
What is the major extracellular electrolyte?	Sodium (Na)
What are the normal potassium levels?	3.5-5.5 MEQ/L
What are the normal Na levels?	135-145 MEQ/L
Why might an order for IV D5NSS with 20 MEQ KCL per liter be ordered?	For a patient with a potassium level below 3.5
Name the methods of IV administration	1. Direct IV push 2. Via secondary line in a piggyback or miniinfuser 3. ADD-vantage containers
When administering a piggyback medication what should you ALWAYS check?	The "compatibility" of the medication to the fluid in the primary IV tubing
How should blood be administered?	In a separate IV line, primed with 0.9 NSS ONLY
What tubing is specifically for blood?	The set Y tubing
Total Parenteral Nutrition (TPN)	Solution containing amino acids, electrolytes, glucose, and vitamins.
How is a TPN administered?	Via a central IV line
Can you ever administer nutritional solutions peripherally?	Yes but the solutions are made differently from TPN
Why would patient status effect the need for IV fluids?	Patients who are unconscious, or post-operative for example may need IV access for fluids, medications, and /or nutritional requirements to maintain homeostasis
What is meant by emergency access as an indication for IV placement?	Establishment of a worthwhile IV line. (It can be difficult to establish an iv line when a patient is in cardiac arrest for example)
QSEN Infection control considerations	-IV placement is invasive -Maintain proper hand hygiene -Chlorhexadineis preferable to alcohol and batadine
IV bags	Standard size- 1000 ml unbreakable- puncture-able bag
IV bottles	glass and subject to breaking- need to be vented.
When would an IV bottle be used	When using chemicals that have the potential to leech through the plastic
Macrodrip	10-20 gtts per ml
Microdrip	60 gtts per ml
Filter	Strain solution to remove contaminants
Extension sets	Extend tubing and add extra ports
Peripheral locks	Prevent IV from flowing out
Transparent Semipermeable membrane	stabilize the cannula, offer protection and provide visualization of the site
How often are dressing supposed to be changed?	Every 2 days or PRN
Pumps	measure in ml per hour
Mini infuser	Controlled intermittent administration of IV fluid
Patient Controlled Analgesia (PCA)	is any method of allowing a person in pain to administer their own pain relief.
PCA dosage	amount administered with each dose
PCA lockout period	time between dosage
Basal Rate	Continuous rate
How often should you assess the IV site?	Every 2 hours or whenever you enter the room
How long are most IV fluids good for?	24 hours in most institutions
Occlusion	loss of patency
Causes for occlusions?	1. kinked tubing 2. backflow of blood 3. Clot
How can you tell when an IV is occluded?	Flow is sluggish
Intervention for occlusion	Discontinue IV- Do not milk, aspirate, or irrigate
Infiltration	Seepage of non vessicant IV fluid into the tissue when IV cath penetrates the vein.
Vessicant	Irritating to the tissue
Causes of Infiltration	Dislodgment of catheter Overmanipulation of the catheter Failure to secure the catheter properly
Assessment of infiltration	Pain, Edema, cool skin, decreased IV flow, damp dressing, no blood return at IV site.
Intervention for infiltration	Discontinue IV Elevate extremity Apply warm compress insert IV in unaffected arm Document
Extravasation	Infiltration of vessicant fluid into the tissues
Indications for warm compress to treat extravasation?	Vasodilation- increases drug distribution- and local concentration
Indications for cold compress to treat extravasation?	Vasoconstriction- allows for local removal
Other interventions for extravasation?	Direct injection by the physician can be necessary
Phlebitis	Inflammation of inner layer of a vein
Causes of phlebitis	Bacterial- poor asepsis Chemical- irritating medications Mechanical - poorly secured caheter, too large for vein
Assessment of phlebitis	Redness, tenderness, pain, vein is often red hard and cordlike
Intervention	Discontinue IV apply warm compress restart IV in unaffected arm
Vascular Access Devices	catheters cannulas, or ports designed for repeated access to vascular system
Catheter	Soft flexible tube
Cannulas	Require a needle introducer,
Ports	Implanted under the skin
Insertion sites for VAD	Jugular, Subclavian, Cephalic, Femoral
Indications for VAD	no peripheral vein access Central venous pressure Complex treatment regimes Hyperosmolar Infusions Vesicant drugs Long term IV therapy
How would you confirm placement of a VAD?	X-Ray
How is dressing change on a VAD done?	Aseptic sterile technique
Types of cathter VADs	Single lumen Multiple lumen Triple Lumen Catheter (TLC)
Distal Port VAD	16G best for viscous fluids, volume monitoring
Proximal port VAD	18G Best for drawing labs and medications
Medial Port	18G TPN
TLC placement	not for longer than 6 weeks- not routinely replaced Sterile dressing change X-ray for placement
PICC LINE indicated primarily for?	Long term antibiotics
PICC placement pearls	Sterile dressing change May remain up to 6 months or longer Never smaller than 10ml syringe X-ray for placement
Midline catheter	shorter than PICC - placed in peripheral vein- tip in distal part of vein- no x-ray necessary may remain 8 weeks
Implanted port	tip in subclavian or external jugular implanted in sub q of chest wall chemotherapy need x-ray for placement
Huber needle	Non-coring needle used to access an implanted port
Normal WBC	5000-10,000
IV formula	Gtts/min=(volume)(Set calibration)/Time in minutes

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