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ATI SKILL MODULE: IV THERAPY

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TERMINOLOGY
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butterfly needle
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a small winged tip needle used to initiate IV access
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cannula
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tube inserted into a vessel, duct, or cavity
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central venous catheter
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a blood-vessel access device usually inserted into the subclavian or jugular vein with the distal tip resting in the superior vena cava just above the right atrium; used for long-term intravenous therapy or parenteral nutrition
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flash chamber
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the portion of an over the needle catheter that allows observation of a blood return when the catheter enters a vein
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fluid volume deficit
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loss of both ager and electrolytes from the extracellular fluid aka hypovolemia
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PICC line
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a catheter used for long-term intravenous access and inserted in the basilic or cephalic vein just above or below the antecubital space with the tip of the catheter resting in the superior vena cava
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thrombus
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stationary blood clot
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venipuncture
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inserting a needle into a vein to withdraw blood samples or to establish ongoing access to a vein
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viscosity
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resistance to flow; a physical property of a substance that varies with the friction of its component molecules as they slide past one another
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INITIATING IV THERAPY
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veins most commonly used are
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basilic vein cephalic vein dorsal venous arch metacarpal vein -dt them being easier to access and less limey to rupture
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-to initiate IV access
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-place torique 4-6 inches above the anticipated site -if patient has excessive hair or fragile skin, place tourniquet over the sleeve of the gown to protect skin -if tourniquet not avail, use a BP cuff . inflate it just under the normal diastolic pressure -begin looking at the most distal part and move proximal
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-if you have trouble finding the vein, place a warm blanket or towel or stroke from distal to proximal. do not flick or rub because it can cause vasoconstriction -avoid using ext with compromised circulation and those that are distal to previous IV sites -also avoid sclerosed/ hardened veins, bruised area and areas where there are valves or bifurcations -if there is excessive hair, DO NOT shave the hair, just clip with scissors -shaving causes micro abrasions that increases risk for infection
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IV gauge for adults
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20-24 gauge
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IV gauge for child, older adults and anyone who has small or fragile veins
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22-24 gauge
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if patient will receive large quantities of fluids at a rapid rate or blood products use a large catheter like
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18 gauge
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if you are adding any med to the IV solution , make sure to put …
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amount of added med date time initials
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saline/heparin lock usually get flushed with how many ml
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5-10ml before and after admin of med
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when cleansing site, make sure to let air dry completey
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to decrease the microbial count effectively at insertion site
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some patients may require 1% lidocaine to numb the area so it can be more comfortable
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-inject 0.1-0.2 mL Intradermal so that a wheal appears -use a 25-26 gauge 5/8 inch needle -inject on the side of vein, not into the vein
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two methods of inserting an IV
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direct and indirect method
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direct method =
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piercing the skin immediately over the vein and approx 1/2 in below the proposed iv site
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indirect method =
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piercing the skin along the side of the vein and then angling the catheter toward the vein
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pediatric patients
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-ask parents or another nurse to help -use a topical anesthetic such as LMX (lidocaine) or EMLA( mix of lidocaine and prilocaine) – can use all the veins as an adult plus foot or scalp -use 22-26 gauge
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older patients
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PRIMARY IV TUBING
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macro drip
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10-15 drops/ml
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micro drip
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60 drops a ml
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most IV fluids are available in plastic bags that collapse as the fluid infuses=
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vented tubing is unnecessary
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if you are using a glass bottle, be sure to use tubing with a
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air vent above the drip chamber = allows air to enter the bottle and the fluid to infuse
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SECONDARY TUBING
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piggyback
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-hang the PB higher than the larger bag of fluid. -when using the PB set up, leave both the primary and secondary lines open -to adjust flow rate, open the roller clamp on the secondary tubing completely and use the roller clamp on the primary tubing to adjust flow rate -when secondary infusion is complete, primary infusion resumes
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IV SOLUTIONS
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are infused to..
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-maintain fluid balance -replace loss of fluids -tx electrolyte imbalances
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iv fluids are organized into three categories
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isotonic, hypotonic and hypertonic
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isotonic solutions=
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-electrolyte content of 300mEq -used to replace fluid losses (exrtracellular losses) -expand the intravascular volume
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hypotonic solutions=
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-electrolyte equiv. of 250 mEq/L -expand intracellular space -infused to dilute extracellular fluid and rehydrate the cells of patients who have hypertonic fluid imbalances and to treat gastric fluid loss and dehydration from excessive diureses
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hypertonic solutions=
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-375 mEq or more -tx hyponatremia -can be irritating to the patients veins = some must be infused through central line
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SECURING AN IV CATHETER
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-apply a transparent dressing over the vein so that it extends to the lip of the hub catheter
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-leave the connection between the hub catheter and the IV tubing uncovered to facilitate changing the tubing
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when securing the catheter, place the tape only over the hub, and not over the insertion site
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keep the insertion site visible
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to protect the patients skin, place a small piece of gauze under the hub of IV catheter to elevate it and keep it from exerting pressure on the patients skin.
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replace if it becomes wet or soiled
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if patient is an infant, young child or restless/ confused
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use an arm board to protect IV -try to avoid when ever possible -use the shortest one possible
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ASSESSING AND MANAGING AND IV SITE
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assess and document the condition of the IV site, solution and tubing and flow rate at the beginning of your shift
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-this helps establish baseline at that point in time so you can compare your ongoing assessments throughout your shift
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when assessing the IV site, assess
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-inspect site for redness, swelling -next, palpate the area around the site and along the vein for any pain, firmness or swelling -while palpating, make sure to note the skin temperature near the site and along the vein
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for phlebitis, document using the phlebitis scale..
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-when determining the degree, use the most severe symptom
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when removing an IV catheter, inspect the tip and make sure it is intact . if not intact, embolus might occur and do the following
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-apply tourniquet high on the extremity where the IV line was located and follow facility protocol
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in addition, when removing an IV catheter, look at the insertion side for pain, redness, swelling and drainage
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PREPARING IV SOLUTIONS
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gather supplies
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-primary tubing -extension tub -time tape -tubing label -solution itself (compare to MAR)
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-always look at IV solution bag for leakage -look at color, clarity and exp date
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DOCUMENTATION OF IV THERAPY
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Inserting a peripheral IV catheter
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the date and time the IV catheter was inserted the type, length, and gauge of the catheter inserted the location where the IV catheter was inserted the number and location of attempts to insert the catheter the IV solution and any additives infused the flow rate the condition of the IV site the name of the person starting the IV
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Discontinuing a peripheral IV infusion
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the date and time the IV infusion was discontinued whether or not the IV catheter was intact the condition of the IV site the type of dressing applied (such as a pressure dressing) the amount of fluid infused the name of the person discontinuing the IV infusion