Criado por Gwen Paparone
aproximadamente 8 anos atrás
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Questão | Responda |
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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