89 terms

Basic IV therapy

i did not include every single thing. I tried not to put little petty things on here we already know
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what are the most commonly used IV administration sets?
primary
secondary(piggyback)
y-set
what are the characteristics of a primary admin set?
hooked from person to the primary fluid container
vented or nonvented
macrodrip-10-20drops/min
microdrip-60drops/min, pediatric set
check valve-prevent secondary set from flowing into main solution
1-3 access ports
what are the characteristics of a secondary admin set?
piggyback or volume controlled set
must be above the primary solution container
drip rate 10-20drops/min
delivers 50-100ml of infusate
volume controlled for intermintent
how often should primary and secondary continuous sets be changed?
every 72 hours
how often should primary and secondary intermittent sets be changed?
every 24 hours
what are the characteristics of a primary Y admin set?
for rapid infusion
more than one solution at a time
2 separate spikes and drip chambers
large bore tubing
used for blood components
how often do you change an admin set for blood components?
after each unit or after 4 hrs, which ever comes first
what would a patients site look like if was infiltrated?
coolness of skin around site
taunt skin
edema at, above, or below site
absence of blood backflow
pinkish blood return
infusion rate slow but the fluid continues to infuse
What do we do if the pt has infiltration?
discontinue line
use warm or cold compress
elevate limb
if grade 2 or higher contact pcp
calculate infiltration rate= #of incidents/#of caths*100=%
how can we prevent infiltration?
avoid areas of joint flexion
dont rely on blood backflow to check blood return
do not use veins w/previous punctures
turn pt carefully
choose the smallest iv catheter
make sure catheter is stabilized w/devices
what is the most accurate way to check for infiltration?
apply pressure 3 inches above cath site infront of the tip
if infusion continues to run, its most likely infiltrate
what are the characteristics of grade 1 infiltrate?
skin blanched
edema <1 inch
cool to touch
may be pain
what are the characteristics of grade 2 infiltrate?
skin blanched
edema 1-6 inches
cool to touch
may be pain
what are the characteristics of grade 3 infiltrate?
skin blanched and translucent
edema >6 inches
cool to touch
mild to moderate ain
possible numbness
what are the characteristics of grade 4 infiltrate?
skin blanched and translucent
skin tight and leaking
edema > 6 inches
deep pitting tissue edema
circulatory impairment
moderate to sever pain
what does a patients site look like if there is phlebitis?
redness at site
site warm to touch
local swelling
palpable cord along vein
sluggish infusion rate
increased temp of 1celcius or more
what do we do if phlebitis occurs?
discontinue infusion or may be infusion rate is to fast
warm or cold compress
cold is best
if 2 or > grade call pcp
how can we prevent phlebitis from happening?
determine duration of iv therapy to choose correct site
use smallest cannula
rotate infusion site every 72-96hrs
stabilize cath
use a .22 mcron filter
hand hygiene
add a buffer to known irritating meds and hypertonic solutions
change solution containers q24hrs
what are the characteristics of grade 1 phlebitis scale?
erythema at site
possible pain
what are the characteristics of grade 2 phlebitis?
pain at site
erythema
and or edema
what are the characteristics of grade 3 phlebitis?
pain, erythema and or edema
streak formation
palpable venous cord
what are the characteristics of grade 4 phlebitis
pain, erythema and or edema, streak, palpable venous cord > 1 inch, purulent drainage
what does a patients site look like if there is a hematoma?
discoloration of the skin-ecchymoses
swelling and discomfort
inability to advance cannula all the way during insertion
resistance to + pressure during the lock flushing procedure
what do we do if a patient has a hematoma?
remove cath and apply light pressure with gauze for 2-3 minutes
elevate extremity on pillow
apply ice
how can we prevent hematoma?
use direct method of insertion
apply tourniquet just before venipuncture
use a small needle 20 or 22 on elderly, pt taking corticosteroids or pts with paper thin skin. use a b/p cuff for better control of the pressure on the vein
what would a pts site look like with thormbophlebitis?
sluggish flow rate
edema in the limbs
tender and cordlike vein
site warm to touch
visible red line above site
what do we do if a patient has thrombophlebitis?
remove entire iv cath retart in opposite arm
contact pcp
apply warm most compress to area for 20 minutes
how can we prevent thrombophlebitis from happening?
use forearm for site
monitor for redness, swelling and pain q4hrs
infuse solution at prescribed rate
use smallest cath
dilute irritating meds
what does a patients site look like if there is a local infection?
red, swollen or indurated
temp change
drainage from site
exudite or purulent material
increase WBC
elevated temp--no chills
what do we do if the patient has a local infection?
notify pcp immediately
get order to culture site
apply sterile dressing over site
apply warm moist compresses if ordered
give meds as ordered
monitor site
how can we prevent infection?
hand hygiene
disinfect pts skin before insertion
change dressing when needed
no topical ointments on site
do not submerge cath in water
replace cath q72hrs
use alcohol twisting motino for 10 times and let dry before each access
how can we tell if a pt has a venous spasm?
sharp pain at site that travels up the arm
slowing of infusion
what do we do if a pt is having a venous spasm?
apply warm compress and decrease flow rate to subsides
if not relieved, remove and restart
how can we prevent a venous spasm from happening?
dilute med additive adequately
iv solution at room temp
use prescribed rate
fluid warmer for rapid infusion of cold agglutinins
parenteral solutions at room temp
what is a patients site like if extravasation has occured?
pain, tenderness or discomfort
edema at, above or below site
blanching around site
temp change at site
buringing at site or along pathway
feeling of tightness below site
slow or stopped infusion
what do we do if extravasation has occured?
stop flow, disconnect and attach empty 3-5ml syringe and attempt to aspirate solution
contact pcp
photograph site
discontinue and use dry gauze to control bleeding
manipulate temp of skin for 24-72 hrs
apply compress 15-30 minutes q4-6hrs for 24-48 hrs
elevate arm
give written instruction to pt
complete occurrence form
plastic surgeon is recommended in some cases
when extravasation has occured, cold applications cannot be used if what type of med was being used?
vinca alkaloids, vincristine, or ipipodophylotoxins
heat and cold can bed used for what type of solutions if extravasation has occured?
hypotonic or isotonic
how many seconds should you rub the access port with alcohol wipe before accessing it?
15
steps to convert primary to intermittent
remove NAP from package(luer-lok needless access port)
flush the lock with saline syringe
place adapter on sterile package
remove dressing
close roller clamp
apply pressure just above the site
disengage old tubing
insert lock adapter
cleanse injection port of adapter for 15 seconds
flush lock
apply fresh dressing
steps to flushing peripheral short iv cath
determine whether the needle-less injection cap is neg or poss displacement or neutral displacement
cleans port with alcohol wipe for 15 seconds
attach ns syringe
irrigate line using a push pause method
negative displacement device '+pressure technique' steps for flushing
as last 0.5-1ml of solution is flushed inward, withdraw the syringe to allow solution to fill the dead space
flush all solution into cath lumen, maintain force on the plunger as a clamp on cath or extension set is closed
disconnect syringe
positive displacement device '- pressure technique' steps for flushing
flush cath gently with solution
disconnect syringe,
allow time for positive displacement
close the catheter clamp
catheter to be clamped before disconnection of syringe
how to discontinue a catheter
2x2 gauze on site
slowly remove without pressure on site
then apply pressure for 2-3 minutes
if pt has been given aspirin or warferin, apply pressure for 5-10 minutes
secure site with gauze and tape and change q24hrs
how often do you flush intermittent infusion device?
before and after meds
q12hrs
how often should a primary or secondary continuous admin set be changed
no more frequently than 96 hours and up to 7 days
what are the types of iv solutions?
hypertonic
hypotonic
isotonic
what are the 3 ways to administer meds
large volume
bolus or small volume
piggyback
steps to adding medications to iv containers
locate correct port and wipe with alcohol wipe
inject medication into port- using a 19-21 gauge
mix by turning gently end to end
label pt name, dose of med, date, time, and ur initials
spike and prime tube if a new one is needed
attach to pt
steps to adding meds to a running iv bag
close off clamp
check volume on drug label to ensure adequate amount of solution to dilute the med
wipe off med port
inject med
lower bag from pole and gently mix
lable
steps to med administration via bolus
determine compatibility if pushing into iv line
check allergies-rapid infusion of meds
check expiration date on vial
continued bolus steps for IV push-existing line
clean off injection port, allow to dry
attach syringe to port
pinch iv line above port
pull back to aspirate blood
release tubing and inject med w/amount of time prescribed
continued bolus steps for IV push-iv lock
need 2 saline syringes to flush before and after med admin
clean injection port
insert saline syringe, pull back to aspirate blood
flush lock slowly, remove and clean port again
insert med and inject for prescribed amount of time
remove and clean port again
flush w/saline
how does a piggyback med admin work?
connected to upper y port and hung above the large volume
the main line doesnt infuse while the piggyback is infusing
back check valve stops the flow of piggyback when its done and large volume starts again
steps to administering meds via piggyback
prepare meds and bring all to bedside
connect tube to med bag, allow to fill tubing by opening the flow clamp. close when done
hang piggyback above lg volume or tandem at the same level
connect tubing to appropriate port, wipe off port first
steps to administering meds via volume control set
fill volutrol with fluid needed by opening clamp
close clamp
make sure air vent is open
clean port
inject med and gently rotate volutorl between hands to mix
lable- med, dosage, volume w/diluent, and time
steps to administering meds via miniinfusion set
connect prefilled syringe to tubing
gentle pressure on syringe to fill tube with med
secure syringe into pump
connect tub to main line
hang pump and tube on an iv pole along side the main bag
set rate and check to make sure primary line started infusing again
how do we administer small amount of meds less than 1ml?
dilute them in 5-10ml ns so med doesnt collect in the dead spaces
what do we do if blood is not returned during aspiration?
if there are no signs of infiltration and iv is infusing w/out difficulty, proceed with pushing med
what do i do if the medication if incompatible with iv fluid?
stop iv fluid, clamp line, flush w/10mlns and give the iv bolus. flush again at same rate med was administered. restart infusion at proper rate
what do i do if the med is incompatible with iv fluid with meds already in it?
diconnect iv and administer as an iv push bolus
what if i cant disconnect the infusion with the incompatible fluid?
start a new iv set and administer meds using the iv lock method
what kind of tubing do we NOT administer meds in?
blood or parenteral
how do i access for patency of a saline lock?
2-3 ml of ns flush
how do i regulate the flow of fluids with out a pump?
count drips per minute or per 15 seconds and x4.
use roller clamp to adjust rate
volume control device goes between insert of spike and iv bag
no more than 2 hrs of fluid at a time
assess hourly
where do i hang a fluid if i use gravity?
36 inches above iv site
how do i check for patency when changing a iv solution?
adjust the roller clamp
what do i do if the flow rate does not increase after adjusting the roller clamp all the way open?
check iv system staring at iv site all the way up to container.
check catheter and dressing integrity, tubing kinks, secure connections, inadvertent clamps, tubing punctures, tubing spike connected right, and distance between iv site and container for adequate gravity
steps to changing iv solution
prepare solution 1 hr before administer
determine compatibility
check date, precipitation, color, and leakage
drip chamber half full
close roller clamp and turn of pump
remove old bag and insert new one
check for bubbles
what do i do if there are bubbles in the line after i have just changed the solution?
close clamp below bubbles
stretch tubing downward, and tap tub w/finger
what do i do if i have a large amount of air in the tube after i just changed the solution?
wipe of the port
use needless syringe and aspirate air
steps to changing infusion tubing-continuous infusion
new iv tube roller clamp off
slow rate to keep vein open rate
compress drip chamber of old tub and fill it
remove solution from pole and invert container-do not contaminate old spike till new one is connected
place new spike into old solution and hang
fill drip chamber1/2full
slowly open roller clap and flush new tube with solution
stop infusion
turn roller clamp off on old tub
apply pressure just above the site, disconnect old insert new
open roller clamp and run rapidly for 30-60 seconds then at regular rate
how do i take off the transparent dressing from the site?
hold cannula hub and tubing and remove tape toward the insertion site
how do i clean an insertion site?
stabilize cannula with one hand
use swab with friction
go horizontal first-cleaning side to side
then vertical-up and down
last swab in a circular motion around site to outer skin
allow to dry completely
how do i know if my solution and drug have a physical incompatibility?
precipitation, haze, gas bubbles and clouidness
how can i tell if my solution and drug have a chemical incompatibility?
pH value
how do i prevent therapeutic incompatibility?
give antibiotics individually
what should be on the label of my solution, insertion site, and tubing/
date and time
type, size and length of cath, my initials
label solution with a time strip
how long can i leave the tourniquet on for
4-6 minutes
how long can lipid containing solutions hang?
24 hrs
how long can lipid only emulsions hang?
12 hrs
how long can blood hang?
4 hrs
when do i replace the tubing of blood or lipid containing products?
q24hrs
when do i replace tubing w/solutions of dextrose and amino acids w/out lipids?
q72 hrs
should i use an alcohol pad when disconnecting an iv?
no, it can cause vasodilation and be painful
what are the dextrose in water solutions?
1. d5w- isotonic
2. d10w- hypertonic
what are the saline solutions?
1. 0.45% or 1/2 saline- hypotonic
2. 0.33% or 1/3 ns- hypotonic
3. 0.9% or NS- isotonic
4. 3-5% sodium chloride or 3-5%NS or 3-5% NaCl-hypertonic
what are the dextrose in saline solutions?
1. D5% in 0.9 NaCl- hypertonic
2. D5% in 0.45 NaCl- hypertonic
what are the multiple electrolytes solutions?
1. lactated ringer's or LR- isotonic and contains na, k, ca, cl, and lactate
2. D5% in lactated ringer's or D5LR- hypertonic