Ch. 4: Intravenous Therapy (Pharm ATI) – Flashcards
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What time of catheter should be used for a fluid bolus?
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Large-gauge (18 gauge or larger)
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Ways to give IV medications:
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-Mixed in a large volume of fluid (500 to 1000 mL) and given continuously -Premixed solution bags or added to the IV bag by a pharmacist -Volume controlled infusions -IV bolus dose administration
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Volume-controlled infusion
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Given intermittently in a small amount of solution (25 to 250 mL) through a saline lock system; They infuse for short periods of time and are given on a scheduled basis; Can be administered by IV bag or bottle or tandem setup, volume-controlled administration set, or mini-infusion pump; Ex= antibiotics
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IV bolus dose administration
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Usually small amounts of solution, concentrated or diluted, that can be injected over a short time (1-5 min) in emergent and non-emergent situations; Ex= Pain medications are given directly into a peripheral IV (central line) or access port; Make sure medications are prepared according to recommended concentration and at the recommended ratel Use extreme caution and observe for complications (redness, burning, swelling, or increasing pain) that may indicate phlebitis, infiltration, or extravasation
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Central venous access devises can be inserted how?
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-Peripherally (PICC line) -Directly into the jugular or subclavian vein through venipuncture or surgical intervention with implantation of access ports for long-term use
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Potassium chloride should only be given how?
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Electronic infusion pump; NEVER IV BOLUS; Always double-check the prescribed dose and correct dilution or amount of fluid
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Medications should only be added to which container?
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A new container, not an IV container that is already hanging
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Never administer medications through tubing that is infusing what?
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Never administer mediations through tubing that is infusing blood, blood products, or parenteral nutritional solutions
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What should you verify before infusion medications through tubing that is infusing another medication?
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Verify compatibility
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Special considerations for older adult clients, clients taking anticoagulants, or clients who have fragile veins:
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-Avoid tourniquets; use a BP cuff -Do not slap the extremity to visualize veins -Instruct the client to hold his hand below the level of his heart -Avoid using the back of the client's hand
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Special considerations for edema in extremities:
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-Apply gentle pressure over the selected vein to displace edema -Apply pressure with an alcohol pad -Cannulation must be quick
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Special considerations for obese clients:
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-Require the use of anatomical landmarks to find veins
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Special considerations for preventing IV infections:
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-Use standard precautions -Change IV sites according to facility policy (usually 72 hrs) -Remove catheters as soon as they are no longer needed -Change catheter if any break in surgical aseptic technique is suspected, such as emergency insertions -Use sterile needle/catheter for each insertion attempt -Avoid writing on IV bags with tens or markers -Change tubing immediately if contamination is known or suspected -Fluids should not hang more than 24 hrs unless it is a closed system -Wipe all ports with alcohol or an antiseptic swab before connecting IV lines or inserting a syringe -Never disconnect tubing for convenience or to position the client -No not allow ports to remain exposed to air -Perform hand hygiene before and after handling the IV system
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16 gauge used for who?
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Trauma clients, rapid fluid volume
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18 gauge used for who?
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Surgical clients, rapid blood administration
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22-24 gauge use for who?
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All other adult clients
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Equipment for IV insertion:
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Correct size catheter, correct tubing, infusion pump, clean gloves, scissors or electric shaver for hair removal
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Nursing actions for IV insertion:
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Check prescription; Assess for allergies; Rights of administration; Hand hygiene; Examine the solution for clarity, leaks, and expiration date; Prime the tubing; Don clean gloves before insertion; Assess extremities and veins
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Select vein by choosing?
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-Distal veins first on the non dominant hand -Site that is not painful or bruised and will not interfere with activity -Vein that is resilient with a soft, bouncy feeling
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What to document is the record:
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-Date and time of insertion -Insertion site and appearance -Catheter size -Type of dressing -IV fluid and rate -Number, locations and conditions of site-attempted cannulations -Client response
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How to maintain potency of IV access:
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-Do not stop a continuous infusion or allow blood to back up into the catheter -Instruct the client not to manipulate flow rate device, change setting on IV pump, or lie on the tubing -Make sure IV site dressing is not too tight -Flush intermittent catheters after every medication administration or every 8 to 12 hours when not in use -Monitor site and infusion rate at least every hour
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Infiltration Sx
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Pallor, local swelling at the site, decreased skin temp around the site, damp dressing, allowed infusion
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Infiltration Tx
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-Stop the infusion and remove catheter -Elevate the extremity -Encourage active range of motion -Apply cold or warm compress based on the type of solution that infiltrated the tissue -Check with the provider to determine whether IV therapy is still needed
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Infiltration prevention
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-Carefully select site and catheter -Secure the catheter
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Extravasation Sx
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Pain, burning, redness, swelling
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Extravasation Tx
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-Stop infusion and notify provider -Follow facility protocol which may include infusing an antidote before removal
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Extravasation prevention
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-Closely monitor site and dressing -Always use infusion pump
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Hematoma Sx
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Ecchymosis at site
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Hematoma Tx
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-Do not apply alcohol -Apply pressure after IV catheter removal -Use warm compress and elevation after bleeding stops
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Hematoma prevention
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-Minimize tourniquet time -Remove the tourniquet before starting the IV infusion -Maintain pressure after IV catheter removal
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Catheter Embolus Sx
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Missing catheter tip; severe pain at site with migration; or no symptoms if no migration
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Catheter Embolus prevention
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-Do not reinsert the stylet into the catheter -Check to be sure the catheter is intact at time of catheter removal
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Phlebitis/Thrombophlebitis Sx
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Edema, throbbing, burning, or pain at the site; increased skin temp; erythema; a red line up the arm with a palpable and at the vein site; slowed infusion
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Phlebitis/Thrombophlebitis Tx
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-Promptly discontinue the infusion and remove the catheter -Elevate the extremity -Document the size of the infiltrated area, estimate the amount of fluid present and monitor the site -Apply cold compress to minimize the flow of blood, then apply a warm compress to increase circulation -Check with provider to determine whether IV therapy is still needed; if so, use different extremity -Culture the site and catheter is drainage is present
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Phlebitis/Thrombophlebitis prevention
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-Rotate sites at least every 72 hrs -Assess IV site using a phlebitis scale -Avoid the lower extremities -Use hand hygiene -Use surgical aseptic technique
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Cellulitis Sx
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Pain, warmth, edema, induration, red streaking, fever, chills, and malaise
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Cellulitis Tx
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-Promptly discontinue the infusion and remove the catheter -Elevate the extremity -Apply warm compress three to four times/day -Culture the site and cannula is drainage is present -Administer antibiotics, analgesics, and antipyretics
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Cellulitis prevention
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-Rotate sites at least every 72 hrs -Avoid the lower extremities -Use hand hygiene -Use surgical aseptic technique
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Fluid overlad Sx
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Distended neck veins, increase BP, tachycardia, shortness of breath, crackles in the lungs, edema
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Fluid overload Tx
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-Slow IV rate to keep the vein open -Raise the head of the bed -Assess vital signs -Adjust rate as prescribed -Anticipate administration of diuretics
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Fluid overload prevention
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-Use infusion pump -Monitor I&O
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