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Terms in this set (45)
Where are PVADs inserted? (very broad answer)
In a peripheral vein
How long are PVADs recommended to stay in situ?
- 72-96 hours
- IH allows for longer time so long as there are no signs and symptoms of infection
PVADs may be used for continuous or intermittent access. If it is being used intermittently, what must be done before using it to infuse a solution?
- Flush with 3-5ml of NS to maintain patency and confirm placement
How often does an intermittent PVAD need to be flushed?
- At least once per shift
What is infiltration?
- Occurs when IV fluids enter surrounding tissues
What are signs and symptoms of infiltration?
- Pallor and coolness
- Sluggish flush
______________ is when the vein used for IV access becomes inflamed
What are signs and symptoms of phlebitis?
- Palpable cord
What are some potential sites for PVAD insertion?
What gauge needle does an orange hub catheter represent and what is it typically used for?
- Trauma, high rate of infusion
What gauge needle does a grey hub represent?
What gauge needle does a green hub represent and what might it be used for?
- Blood transfusions, surgery
A _________ hub on a catheter is a 20 gauge needle and can be used routinely in healthy adults to infuse medications and IV solutions.
A _________ hub on a catheter is a 22 guage needle and can be used for small/fragile veins in adults. It may be used to infuse medications, IV solutions and chemotherapy.
A __________ hub on a catheter is a 24 gauge needle and is typically used for children and neonates
Describe an isotonic IV solution and provide an example
- Same osmolarity as serum, no net loss or gain
- "Stays where I put it"
- Used for electrolyte and fluid replacement
- Ideal for fluid replacement for ECF volume deficiency
- 0.9% NaCl, RL, D5W (hypotonic to the body)
Describe a hypotonic IV solution and provide an example
- Less osmolarity than serum, causing fluid to shift into cells
- Provides more fluid than electrolytes, diluting ECF, osmosis then produces movement from ECF to ICF
- "Travels Out of the blood vessel"
- Increases blood volume
- 0.45% NaCl,
Describe a hypertonic IV solution and provide an example
- Higher osmolarity than serum, causing fluid to shift out of cells
- Initially raises the osmolality of ECF, and expands it
- Useful in the treatment of hypovolemia & hyponatremia
- "Enters blood vessel"
- 3% NaCl, D5NS (isotonic to the body), D5 1/2NS, D5RL, D10W
What are some indications for certain gage PVADs?
- Medication administration (#20)
- Surgical access in a healthy adult (#20)
- Blood transfusion (#16-18)
- Venous access for high volume fluid replacement (#14-16)
- Fragile veins (#22)
- Pediatric neonate (#24)
______________ is when fluid leaks into surrounding tissues
_____________ is inflammation of the vein
___________ is increased blood volume due to excessive fluid infusion
What are some signs and symptoms of hypervolemia?
- Pounding headache
- Jugular vein distention (JVD)
Your patient was in a trauma and is suffering from third degree burns. They are also at risk for increased ICP. A student nurse suggests that you give 0.45% NaCl. What should you say to correct the student nurse?
- 0.45% NaCl is a hypotonic IV fluid
- This should not be given to this patient because it will not replace intravascular fluid loss, instead fluid will just shift into cells
Describe some properties of plasma expanders and provide an example of a plasma expander
- Colloids such as FFP and albumin
- Stays in vascular space and increases osmotic pressure
When packed red blood cells (PRBC) are administered IV what is its effect on hemodynamics?
Increases pressure and pulls fluif into intravascular space
How often should a PVAD be assessed?
Your patient just had a PVAD inserted for a continuous infusion of NS. What should you assess?
- Start at the pt and move outward
- Check tegaderm is intact
- Check for pain at the site
- Check for exudate
- Check for discolouration at the site
- Check temperature
- Check that connections
- Check that tubing is secure
- Check that tubing has not expired
- Check clamps
- Assess pump flow rate
- Ensure pump is plugged in
- Check that drip chamber is at line
- Check bag (med, solution, expiration, etc)
How long is an IV fluid bag good for after being spiked?
How often should primary IV tubing be changed (assume it is for a continuous infusion)?
How often should secondary IV tubing be changed?
You should always label your IV tubing with an ___________ time label
IV site should be assessed ___________ for infiltration and phlebitis
When selecting a site for a PVAd you should always start ___________ and work __________
You patient requires IV access. You miss the vein the first try. How many more attempts do you get?
- Only 2 attempts allowed, then get another nurse
- If the second nurse is unsuccessful, consult the IV team
What should be included in the patient teaching before they get a PVAD inserted?
- Purpose of IV therapy
- Teach to avoid tampering with the IV pump
- Proper positioning of arm
- Avoid kinking IV tubing
- How to mobilize an IV pole
- Showering with IV, keep clean and dry, cover with plastic bag
- Watch for redness, swelling, increased pain and report to HCP
What should you avoid when looking for a site to insert a PVAD?
- Sclerosed veins
- Sites near previous IV site
- Areas below phlebitis
- Inner wrist
- Veins with to many curves
What infection control measures should you use when inserting a PVAD?
- Wear gloves
- Swab with alcohol
If the person is well hydrated, what should a good vein feel like?
- Supple and bouncy
What are some ways that you can engorge a vein and make it easier to see?
- Use gravity
- Warm compress for 10-15 minute
- Pump their hand
When using a tourniquet, do not leave on from more than __________ seconds because of risk for ____________
Describe the overall process for inserting a PVAD?
- Assess and feel vein
- Prep and prime extension tubing with 10ml NS syringe and keep sterile
- Use tourniquet or BP cuff to trap blood flow in lower arm. Should be placed approximately 6 inches above selected site
- Palpate for vein
- Encourage flow path of blood when cleansing with alcohol
- Stabilize vein by pulling skin taut
- Insert directly on top of vein with bevel at a 15 degree angle
- Watch for flash in IV cannula
- Advance catheter at a lower angle
- Remove tourniquet
- Occlude vein
- Remove needle into safety guard
- Connect extension tubing
- Flush with 3ml prior to placement
- Secure with transparent dressing and tap tubing to reduce pulling
If using a BP cuff to occlude a vein, how much should it be inflated?
- Just below diastolic BP level
Why should you feel the vein through ROM?
To ensure it is not a tendon
What should you document after the insertion of a PVAD?
- Date and time of IV initiation
- Gauge of needle
- Location of insertion site
- Number of attempts
- Type and flow rate of solution
- Pt teach and evidence of understanding
- Pt tolerance of the procedure
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