-
Why do we use IV therapy?
- Restore and maintain fluid and electrolyte balance.
- Provide IV meds and blood products.
- Provide parenteral nutrition.
-
What is the dwell time for peripheral IV catheters (unless complication arises)?
up to 96 hrs.
-
How many mL can peripheral veins accomodate? How much glucose concentration?
- up to 200mL/hr
- glucose concentrations up to 12%
-
What are common IV sites? What's the one IV site exeption?
Feet- for peds, nonambulatory pts *last resort*
-
What are the different methods of delivery of IV?
- Continous infusion
- Intermittent infusion
- Direct Injection
-
This infusion is administered at a carefully regulated amount of fluid over a prolonged period of time.
Continuous infusion
-
This infusion has a solution that is given at certain intervals. (ex. IV antiobiotic every 8 hrs)
Intermittent infusion
-
This is an IV "PUSH" delivery of a single dose (bolus) of a drug or solution.
Direct Injection
-
When programming the pump what do most pumps ask for?
TVBI "Total Volume to Be Infused" and the rate per hour
-
Who orders IV solutions?
The health care provider
-
How are IV solutions classfified?
Osmolarity
-
What are the different kinds of solutions based on osmolarity?
- Isotonic
- Hypotonic
- Hypertonic
-
List the key ingredients in IV solutions.
- Saline
- Electrolytes
- Dextrose and Water
- Combinations
-
How much is serum usually?
290 mEq
-
This IV solution has osmolarity that is equal to serum.
Isotonic
-
This IV solution stays in the intravascular space, expands the intravascular volume, replaces ECF fluid lossses.
Isotonic
-
This IV solution is a good choice for hypovolemia and treating Na loss.
Isotonic
-
Examples of isotonic solution are:
- 0.9% saline
- Lactated Ringers
-
This IV solution has an osmolarity that's lower than the serum.
Hypotonic
-
In this IV solution it shifts fluid out of the intravascular compartment to hydrate cells and tissue compartments.
Hypotonic
-
What are examples of hypotonic solutions?
-
How many calories a day does an adult on bedrest need?
1600 cal/day
-
This IV solution has an osmolarity that's higher than the serum.
Hypertonic
-
This IV solution draws fluid into the intravascular compartment from the cells and interstitial spaces
Hypertonic solution
-
This IV solution expands intravascular volume so used in post-op pts. to stabilize BP, regulate urine output, decrease risk of edema
hypertonic
-
What are some examples of hypertonic solutions?
5% Dextrose in 0.45% saline
-
What do we check for with an IV order?
- Solution
- rate of infusion
- any additives: Potassium Chloride, MVI (Multivitamin)
-
What can never be pushed in an IV, but you can dilute in an IV bag? Why?
Potassium chloride because of the heart
-
-
D5 1/2NS
Dextrose 5%, 0.5% Normal Saline
-
How is the IV packaged?
Maintain sterility
-
What kind of technique do we use to handle IV equipment?
Aseptic technique
-
What must we do when we use IV equipment?
Maintain a "closed system", no air, no pathogens, think of the IV as an extension of your pt's circulatory system.
-
What does a basic IV setup include?
- Venous access device
- Bag or bottle of solution
- Administration set (IV tubing)
-
What are the venous access devices called?
Butterfly/Angiocath
-
This gauge size is used for major surgery, trauma
16
-
This gauge size is used for blood, blood components
18
-
This gauge size is suitable for most electrolyte/dextrose solutions
20-22
-
This gauge size is used for neonates, children, and some elders.
24-26
-
Why is the gauge size for blood so big?
So we don't destroy RBCs
-
What kind of volume amounts does the IV solution come?
-
What are the different kinds of containers that IV solution comes in?
-
What should we do when an IV solution comes as a glass bottle?
- Requires vented tubing to run
- Comes in 1000, 500 mL volumes
- *Rarely see these
-
What are the two ends of the IV tubing known as?
- spike
- male adaptor end
- Both have covers to maintain sterility of the set
-
What are all the parts to the administration set or IV tubing?
- spike
- male adaptor end
- drip chamber
- clamps
- injection ports
-
This part of the IV tubing maintains prime and set rate
Drip chamber
-
This part of the IV adjusts the flow rate
Clamps
-
This part of the IV tubing is where you add meds or additional tubings.
Injection ports
-
What will an IV package state on it?
- Tubing type (primary/secondary set)
- Length
- Drop Factor
- Vented or not
-
Primary set has a...
longer IV and it regulates the drip
-
Secondary set is...
shorter because its for piggy back
-
What do we do before connecting IV pt to tubing?
Priming
-
What is considered a slow flow rate?
30mL/hr
-
List the factors affecting flow rate.
- Ordered rate is "slow"
- Tubing drop factor
- Height of fluid container
- IV site location: flexion points at wrist (ex. antecubital site = a "positional" IV)
- Position of extremity
- Kinked tubing
-
60 drops/mL is a...
Micro
-
15 drops/mL is a...
Macro (most common)
-
Needle is drip chamber means...
smaller drops
-
No needle in drip chamber means...
Larger drops and goes faster
-
List the steps to setting up infusion.
- Verify MD order
- Wash hands
- Gather appropriate solution and equipment
- Prepare solution
- Prepare tubing
- Set up infusion (attach tubing to bag) using aseptic technique
-
List the steps in preparing the solution.
- VERIFY the solution against the MD order
- INSPECT it for expiration date, leaks, signs of contamination
- LABEL it: pt name, date & time, rate per hour, initials and title
-
How high should the IV bag be placed on the pole?
30" above the IV site
-
What are the steps to priming the tubing?
- Squeeze drip chamber so fills half full
- Remove distal adaptor end cover, keeping ends sterile
- Open roller clamp slowly
- Adjust flow rate so that fluid fills tubing and expels all air...still keeping distal end of tubing sterile
- Invert tubing at injection ports prn
- Recap distal adaptor end once all air bubbles are expelled
-
List the steps to starting the infusion.
- Identify the pt, explain procedure
- Don gloves and assess IV site
- Flush access device and reassess site
- Attach adaptor end (clave adaptor) of tubing securely to access device
- Open roller clamp and adjust to ordered rate
- Reassess in 5 min
-
What do we document with IV?
- Date and time IV hung
- Solution type, any additives (added to IV)
- Ordered rate
- IV site location and assessment data
-
When do we monitor infusions?
Baseline and at least every 2 hrs after
-
What do we teach our pt about the IV?
- Leaking, pain?
- Keep site dry
- Don't touch
- Use other arm for talking on phone etc.
-
When assessing the infusion we remember SDTSDT:
- Solution: ordered? date hung? amount left?
- Drip chamber: half full? rate correct?
- Tubing: dated? kinked? dependent loops?
- Site: skin color, temp, any edema, leaking, pain?
- Dressing: is it dry? intact?
- Talk to pt: pain? other probs?
-
Why do we make sure drip chamber is half full?
Prevents too many pockets of air
-
When is the arm board used now?
Only for peds
-
How do we estimate the volume infused?
Measure amt of solution hanging (amt "up") and subtract from amt hanging when you came on shift.
-
What must we remember to do to estimate the volume infused?
- Bag: Grasp bag with both thumbs about an inch above the fluid level and pull taut
- Bottle: Measure at meniscus of fluid level
-
How do we prevent IV site infection?
- Peripheral IV sites restarted and rotated every 72-96hrs or sooner if pain, tenderness or leaking occur
- IV solutions replaced Q24h
- Tubings changed every 72-96hrs (check agency policy)
- Replace site dsg whenever loose, soiled, or damp
-
When there's no pump what do we do to make sure the right bag is running?
The bag you want to run should be higher than the other bag.
-
Where do labels on the IV bag?
On the back
|
|
