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IV Therapy (ATI Chapter 49)

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Large volume IV infusions are administered on a
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continuous basis
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Advantages of IV therapy
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-rapid absorption -maintains consistent TL -Less irritation to SubQ and muscle tissue
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Disadvantages of IV therapy
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-Circulatory fluid overload is possible -Immediate absorption leaves no time to correct errors -Solution and IV catheter can cause irritation to lining of vein -Failure to maintain surgical asepsis can lead to local infection or septicemia
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A fluid bolus is a large amount of IV fluid given in a
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short period of time, usually less than 1 hr.
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A fluid bolus is given to rapidly
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replace fluid loss that could be caused by dehydration, shock, burns, hemorrhage, or trauma
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To maintain a rapid rate that is necessary to give a fluid bolus to an adult, a size
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18 gauge or larger is needed
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This medication can cause serious adverse reactions and should be infused on an IV pump for accurate dosage control. It should never be administered by IV bolus
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Potassium chloride
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Never administer IV meds through tubing that is infusing
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blood, blood products, or parenteral nutritional supplements
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Special considerations (SC) for older adult clients, clients taking anticoagulants, or clients who have fragile veins
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-avoid tourniquets -use BP cuff instead -do not slap extremity to visualize veins -avoid rigorous friction when cleaning site
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SC for edema
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-apply digital pressure over selected vein to displace edema -apply pressure with swab of cleaning solution -Cannulation must be quick
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Preventing IV infections includes the following
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Change IV sites
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usually 72 hours (according to policy)
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Change continuous infusion tubing no more frequently than every
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96 hours
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Change intermittent infusion tubing every
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24 hours (according to policy)
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Change cath when
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there is any break in surgical aseptic technique (emergency insertions)
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Use a __ needle/cath for each insertion attempt
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Sterile
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Fluids should not be hung for any longer than
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24 hours unless it is a closed system (pressure bags for hemodynamic monitoring)
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Before connecting IV lines or inserting a syringe, you should wipe all ports with
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alcohol or antiseptic swab.
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For trauma clients and rapid fluid volume use
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16 gauge
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For surgical clients and rapid blood admin use
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18 gauge
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For all other clients (children and adults) use
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22-24 gauge
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If hair removal is needed use
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scissors or an electric shaver
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Apply a clean tourniquet or BP cuff__ inches above proposed insertion site to___
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1. 4-6 inches 2. compress only venous blood flow
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Select vein by choosing:
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-distal veins first on nondominant hand -vein that is resilient with a soft, bouncy sensation when palpated
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Additional methods to enhance venous access include:
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-gravity -fist clenching -friction with cleaning solution -heat
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Avoid veins that
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-are permanently dilated and tortuous -are in inner wrist with bifurcations, flexion areas, near valves (appearing as bumps), lower extremities, antecubital fossa -back of hand -sclerosed or hard -in extremity with impaired sensation (scar/paralysis), lymph nodes removed, recent infiltration, PICC line, or arteriovenous fistula/graft
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Allow cleaning agent to ___ after cleaning site
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air dry for 1-2 minutes
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Insert catheter with the bevel
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up at an angle of 10-30
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Flashback of ___ will confirm placement in vein
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blood
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Lower the hub to the cath close to the skin to prepare for ____ it into the ___ approximately ___. Loosen the ___ and ____ slightly so that it no longer ____ past the tip of the cath. Use the thumb and ____ finger to ____ cath into the ___ until the hub ____ ____ the insertion site.
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1. threading, vein, .25 in 2. needle from the catheter, pull back, extends 3. index, advance, vein, rests against
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Now is the time to ___ the IV cath with one hand and remove the ____ with the other.
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1. stabilize 2. Tourniquet or BP cuff
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Apply pressure ____ above insertion site with middle finger and ____ catheter with the index finger
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1. 1.25 inches (3 cm) 2. stabilize
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Avoid _____ with tape, and taping ____
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1. encircling the entire extremity 2. under sterile dressing
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Flush intermittent IV catheters with appropriate solution after every ____ or every ____ when not in use
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1. medication administration 2. 8-12 hours (according to policy)
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Monitor site and infusion rate at least every
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hour
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When DC IV therapy,
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-do not use alcohol to apply pressure to vein -pull catheter straight back from site keeping hub parallel to skin -elevate extremity and apply pressure for 2-3 minutes
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Complications
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Infiltration or extravasation
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-pallor, local swelling at the site, decreased skin temp around site, damp dressing, slowed rate of infusion
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TX
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-stop infusion and remove cath -elevate extremity -apply warm/cold compress (depends on solution) -restart IV proximal to site or in another extremity -Encourage AROM
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Prevention of Infiltration or extravasation
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carefully select site and cath. Secure cath
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Phlebitis/thrombophlebitis findings
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-edema, throbbing/burning or pain at site, increased skin temp, erythema, red line up arm with a palpable band at vein site, slowed rate of infuison
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TX
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-DC promptly and remove cath -elevate extremity -apply warm compresses 3-4 x/day -restart infusion proximal or other extremity -culture site and cath if drainage is present
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Prevention of phlebitis
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-rotate site every 72 hours -avoid lower extremities -use hand hygiene -surgical aseptic technique
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Hematoma findings
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-ecchymosis at site
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TX
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-DO NOT apply alcohol -apply pressure after IV cath removal -Use warm compress and elevate after bleeding stops
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Prevention of hematoma
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-minimize tourniquet times -remove tourniquet before starting infusion -maintain pressure after IV cath removal
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Fluid overload findings
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-distended neck veins -high BP -tachy -SOB -crackles -edema
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TX
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-stop infusion -raise head of bed -Vital signs and O2 sat -adjust rate administer diuretics
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Fluid overload prevention
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-use an infusion pump -Monitor I and O
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Cellulitis findings
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-pain -warmth -edema -induration -red streaking -fever/chills -malaise
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TX
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-DC and remove cath -elevate -apply warm compress 3-4 x/day -obtain specimen for culture Administer: ABX, analgesics, antipyretic
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Cellulitis prevention
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-rotate site q 72 hrs -avoid lower extremities -use hand hygiene use surgical aseptic technique
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Catheter embolus findings
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-missing cath tip severe pain at site w/ migration -absence of findings if no migration
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TX
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-place tourniquet high on extremity to limit venous flow -Prepare for removal under x-ray or via surgery -save cath after removal
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Cath embolus prevention
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-do not reinsert stylet into cath