peripheral iv – Flashcards

The administration of fluids or medication via a needle or catheter directly into the bloodstream

Intravenous fluids are given for a variety of reasons. Some intravenous medications are given when a patient cannot take medications orally or when rapid absorption is needed (e.g., an NPO patient returning from surgery). What type of patient would need rapid infusion of IV fluids or electrolyte replacement? (trauma patient, hypotensive patient) A patient needing bowel rest, such as with pancreatitis, requires nutritional support with TPN. Hydration Electrolyte replacement Nutrition (TPN) Emergency treatment Blood product transfusions Administer diagnostic reagents Administer intravenous anesthesia Monitor hemodynamic functions

The date and time of the order The type and amount of solution Any additives and their concentration, such as 10mEq potassium chloride in 500 ml of D5W The rate or volume of the infusion The physicians signature If an order is incomplete, consult the doctor. Check for allergies and pertinent lab results

In order to maintain fluid balance, fluid loss will be replaced in order to prevent dehydration (vomiting and diarrhea) and shock (hemorrhage). When the body has lost too much fluid, oral intake will not be adequate for replacement of fluids. Administering fluids intravenously provides a faster way of rehydrating a patient or increasing fluid volume. A patient with severe blood loss will require blood transfusion. The average adult needs 1,500 to 2,000 mL of fluids in each 24-hour period to replace those eliminated by the body. Fluids are lost by: Hemorrhage Severe or prolonged vomiting or diarrhea Excessive wound drainage Wounds (especially burn wounds) Profuse perspiration

Dextrose solutions, saline, and TPN are commonly used but their use depends on the clinical condition of the patient. Isotonic solutions such as 0.9 NS replace fluid lost from extracellular compartment and increase fluid volume for trauma patients. Hypotonic solutions such as 0.45 NS cause a shift in fluids from the vascular compartment. Hypertonic solutions such D5.45 NS shift fluid from intracellular (interstitial space) to extracelluar (intravenous) compartments allowing stabilization of blood pressure, increased urine output, and reducing edema.

Peripheral: veins near the surface of the skin Central: veins near the heart

Primary Administration Sets Consist of a bottle or bag of solution, a tubing set with a spike at one end, drip chamber, the tubing, a flow or regulator clamp, and one or two injection ports Used for delivery of most common IV solutions except for blood products (need special set) Selected by size of drop delivered to drip chamber (10 to 20 drops/mL or 60 drops/mL) New systems use needleless snap-lock devices for medication infusion Secondary Infusion Sets Called piggybacks IV line that is usually shorter than the primary line but is used to superimpose other solutions, such as those containing medications, into the primary line Secondary bags or bottles must be hung higher than the primary bottle for proper infusion Don't clamp primary or secondary during infusion Once the piggyback is completed, the primary line will start to flow independently

Each institution has protocols in place as how to manage IVs, including saline locks. Saline locks should be flushed every eight hours when not in use. The saline lock should be checked for patency before administration of any medications and must be flushed afterwards. IV site care is the same as a flowing IV; site must be changed every 24 hours, or per the institution's policy. Used with patients not needing continuous IVF's but have and IV antibiotic periodically throughout the day Saline lock, heparin lock, or PRN lock Provides constant IV access but solutions are instilled into it intermittently May convert a regular IV line to a lock by use of a hub device or cannula cap Provides freedom of movement and comfort for the patient Must be flushed regularly to maintain patency with saline or heparin solution

Trap particles such as undissolved medication or salts that have precipitated from solution Prevent particles from entering the vein TPN and lipids always require a filter. There are special tubings for these types of IV fluids. Some filters are attached to the tubing, others are separate and must be added to the primary tubing. The Y-tubing for blood administration has a built-in filter. Blood tubing must be flushed with normal saline before and after use and then discarded. Follow the institutions policies regarding blood administration. A 0.22-micron filter used for most solutions A 1.2-micron filter is used for lipids or albumin A special filter is used for blood When medications such as Protonix are being used, the filter should be placed as close to the infusion site as possible to filter possible precipitates.

Infusion pumps should be checked each time the IV site is checked to ensure that it is functioning properly. Malfunctioning pumps should not be used, as they pose a safety problem for the patient. Infusion pumps are used for medications that require precise dose administration such as cardiac drugs. These drugs can not be administered by gravity infusion. Used to regulate the flow of IV fluids but should be checked every 1 on pediatric patients and every 2 hours on adult patients Deliver fluids at a set preprogrammed rate and are almost always used for TPN Can switch rates from secondary to primary automatically when programmed to do so Rate controllers—Operate by gravity but regulate flow using a drop sensor as an electronic feedback mechanism

PCA pumps—used in hospitals to allow patient to regulate administration of IV analgesics Patient receives a preset bolus of medication when the button is pushed and/or a base amount of medication each hour Demerol & Morphine are the typical meds used

May be inserted and left in place for 6 to 8 weeks Positioned in the right atrium or superiorvena cava PICC lines are the first choice in home IV therapy. Correct placement is verified by x-ray before administration of fluids. Midline and PICC line catheters are used primarily in the home care setting for patients who require less than eight weeks of IV therapy. If a patient requires more than eight weeks of IV therapy, then a long-term catheter, such as a Broviac or Hickman, is used. Central line catheters require x-ray verification before use. This is necessary to assure that the catheter is properly placed, and to prevent any adverse events from occurring. Can be used for hand injected contrast dye with diagnostic testing Central Lines Draw up 1000 units of Heparin in 9 ml NS Don gloves Swab port with alcohol pad Flush with 5 - 10 ml NS using push - pause method Flush with 5 ml of Heparin solution Flush after giving meds or once a shift This can be done by RN's or credentialed LPN's

List two causes of infiltration/extravasation, symptoms, and treatment. (dislodged or kinked catheter; IV improperly inserted in vein. Affected area will be swollen, cool to touch. Treatment requires removal of catheter, cool compress to prevent absorption) if infiltrated, restart above the original site Fluid infuses into tissue instead of vein

List two causes of phlebitis, symptoms, and treatment. (infused medication, infection. Symptoms include warm, tender, red, swollen, and hard area. Treatment requires removal of catheter and application of warmth to promote healing.) Chief hazard with long term IV therapy

List two causes of septicemia, symptoms, and treatment. (contaminated IV site, or solution. Symptoms include fever, pain, and swelling to IV site. Remove IV cathete

Pain: mix meds with NS if irritating such as Phenergan

Speed shock Caused by infusing too rapidly (flushing, headache, chest pain, irregular pulse, low BP. Stop infusion, monitor vital signs, and notify physician.)

(elevated BP, wide variance b/t intake & output, distended neck veins, rapid breathing, SOB, dyspnea, moist cough, crackles. Elevating the head of the bed will help breathing. Decrease IV fluid rate and notify the physician.)

entry of air in the circulatory system. Symptoms include a sudden drop in blood pressure and increased heart rate. Place patient on left side and lower head of bed to improve oxygenation.

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Palpate insertion site daily for tenderness through the intact dressing. Perform hand hygiene before and after palpating, inserting, replacing, or dressing any IV device. Cleanse skin site before venipuncture with an appropriate antiseptic. Do not palpate insertion site after skin has been cleansed with antiseptic Use transparent or sterile gauze dressing to cover a catheter site. Change the dressing every 48 hours. Don't cover with a roller bandage. Change IV site dressing every 48 hours or if it becomes damp, loosened, or soiled; don't cover with a roller bandage. Label dressing. Change IV tubing every 96 hours for continuous infusions and every 24 hours for intermittent infusions. Label tubing. Change IV insertion sites every 72 - 96 hours unless showing signs of phlebitis or infections. Label dressing. Replace tubing used to administer blood, blood products, or lipid emulsions after each unit Clean injection ports with antiseptic agent before accessing system.

Verify order Wash hands Gather equipment Choose the cannula Identify patient Explain the procedure Choose the vein Dilate the vein Clean the site Insert the cannula Stabilize the cannula Dispose of equipment Label tubing and dressing then document

Patient teaching: why IV therapy is needed, how long it will last, procedure, what to report to nurse (s/s of infiltration, phlebitis, and inflammation, flow stops, blood in tubing)

Cannula Tourniquet Tape Alcohol Clean gloves IV solution Tubing set or injection cap Arm board IV pole

Needles are sized in gauges Choose the smallest size needle that will work for the intended purpose Smaller gauge needles (20-24 G) are used for fluids and slow infusion rates Larger gauge needles (18 G) are used for blood, rapid infusion rates, or diagnostic imaging with contrast dye Refer to the vein size when selecting a needle

Use a tourniquet placing it 6-7 in above the insertion site If it is too close it will cause the vein to burst from all of the pressure Don't leave on for more than 3 minutes Place the arm in a dependant position causing venous pooling and dilation of the vessel Place a warm rag on the hand to dilate the vessel Opening and closing the fist will pump blood to the extremity

Clean with an antimicrobial solution If the skin is dirty wash it with soap and water before applying the antimicrobial solution Solutions are often Alcohol or iodine based products (ChlorPrep) Apply the solution starting at the point of insertion and work your way out in a circular motion until you have cleaned a 2-3 in diameter If alcohol is used clean for at least 30 seconds Do not remove excess solution after cleaning

Insert the IV device bevel up at a 10 - 15 degree angle Assess for blood return in the flashback chamber Advance the catheter Remove the tourniquet Remove the needle while applying pressure to the point of insertion over the catheter Attach infusion set, apply dressing and label with date, time, catheter size, and nurses initials Program pump or Dial-a-flow extension set Document procedure including number of sticks, size of catheter, location, fluid type, flow rate, pump/dial-a-flow used, and patient response

LPN's can push IV medications when properly credentialed

Saline flush all peripheral "Hep locks" Done gloves Swab port with alcohol pad Flush with 5 ml NS Flush before and after giving medication or each shift

Verify order Verify patient using 2 identifiers Wash hands Explain procedure Turn off IV pump and clamp tubing Remove tape, dressing, and cannula Apply pressure to site with sterile gauze for 1 minute or longer if needed Apply dressing to site and dispose of tubing and soiled dressing Remove gloves and wash hands Document the date, time, condition of site, condition of catheter, and patient's respose

When administering blood or blood products, the nurse must adhere to the institution's policy regarding blood administration. General guidelines include a signed consent by the patient or legal representative. Two nurses must check and verify the blood type, Key Transfusion number, unit number, medical record, expiration date, and order for administration. Frequent monitoring of vital signs is mandatory during blood administration. Consent must be signed within 72 hours of infusion Verify IV site and get VS prior to obtaining blood which must be given within 15 minutes from the time it leaves the blood bank. An RN must start the blood and stay with the patient the first 15 minutes of the infusion. Run at 150 ml/hr and must be infused within 4 hours VS are obtained every 30 min during infusion and 1 hour after infusion is finished Keep the blood slip with the blood at all times and return it to the blood bank after the infusion is completed. Never remove the red arm band No medications are ever administered through the blood tubing s/s of reaction: fever, chills, back pain, SOB With reaction stop transfusion and start NS, don't remove tubing from bag r/t cultures may be drawn Jehovah Witness, Christian Science, and Seventh Day Adventist will not take blood products

Initial and ongoing assessment Monitor blood glucose Monitor signs and symptoms of infection Initiate and discontinue slowly