surgical puncture of a vein to deliver medication or withdraw blood
intravenous or cannulation
two types of intravenous access are?
peripheral and central(rare)
common sites for peripheral venous access are
arms
legs
sometimes neck
rapid fluid admin requires larger veins like the ?
antecubital fossa
external jugular vein is considered a
peripheral vein
7 things that make peripheral venous access fragile and difficult to cannulate
peripheral vein collapse
hypovolemia
circulatory failure
and veins in
geriatrics
peds
peripheral vascular disease
surgical puncture of the internal jugular, subclavian, or femoral vein(veins located deep within the body)
central venous access
will a central vein collapse in shock?
no
central IV lines are placed near the_______for long term use
heart
placed for intravenous pacing or for monitoring central venous pressure
central venous access
line threaded into the central circulation via a peripheral site
peripherally inserted central catheter (PICC)
when is a picc line most often used in
infants
children requiring long term care
central is typically restricted to the hospital setting becuase
high risk complications
such as
arterial puncture
pneumothorax
air embolism
intravenous solutions containing large proteins that cannot pass through capillary membranes
colloids
colloids remain in the circulatory system for a ________time
long
have osmotic properties that attract water into the circulatory system
colloids(mostly for pt with low volume)
4 types of colloids are
plasma protein fraction(plasmanate)
salt poor albumin
dextran
hetastarch(hespan)
COLLOIDS
principal protein albumin is suspended with other proteins in a saline solutions
plasmanate
COLLOIDS
contains only human albumin. each gram of albumin will retain approximately 18 ml of water in the bloodstream
salt poor albumin
COLLOIDS
comes in two molecular weights 40,000 and 70,000 daltons. has 2 to 2 1/2 times the colloid osmotic pressure of albumin. anaphylactic is a common side effect
dextran
is using colloids in the field practical
no
intravenous solution that contain electrolytes but lack the larger proteins associated with colloids
crystalloids
how are crystalloids classified
by their tonicity relative to that of body plasma
three classification of crystalloids are
isotonic=equal to blood plasma
hypertonic=higher solute concentration
hypotonic=lower solute concentration
cause fluid to shift out of the intracellular compartment and into the extracellular compartment
hypertonic solution crystalloid
cause fluid to shift from the extracellular compartment and into the intracellular compartment
hypotonic solution crystalloid
isotonic solution containing sodium chloride, potassium chloride, calcium chloride and sodium lactate in water
lactated ringers
hypotonic glucose solution to keep a vein patent and supply calories needed for cellular metabolism
D5W
fluids used because of their immediate ability to expand the circulating volume
lactated ringers
normal saline
2/3 will be lost in extravascular space within 1 hour
universal blood
o negative
two classes of oxygen carrying solutions
per-fluorocarbons
hemoglobin based oxygen carrying solution(HBOCs)
Oxygen carrying solutions denser than water and have high capacity to dissolve large quantities of gases such as oxygen
liquivent
oxygent
perfluoracarbons
Oxygen carrying solutions contain long chains of polymerized hemoglobin.
compatible with all types of blood
HBOCs
HBOCs expired donated human blood contains 50 g of hemoglobin per unit.must be refrigerated and has a shelf life of 1 year
polyheme
HBOCs bovine blood(cow)
shelf life of 3 years
hemopure
hollow needle used to puncture the vein
cannula
drip chamber should be about
1/3 full
micro drip
drop former is a hollow metal stylet
60 gtts/ml
macro drip
large circular opening at the top of the drip chamber
10 gtts/ml
medication that is chemically incompatible with regular tubing and require special tubbing
nitro
when possible use the med port nearest to the patient
true
what permits you to void possible air bubbles when using electromechanical pump tubing
bladders and relief points
IV setup that delivers specific volumes of fluid
measured volume administration
calibrated chamber of berutrol IV admin tubing that enables precise measurement and delivery of fluids and medicated solutions
burette chamber
blood tubing cones in 2 configurations
straight
Y=two ports(one for blood one for NS)
fluid that increases the potential for blood coagulation
lactated ringers
three basic types of IV cannulas
over the needle cath
hollow needle cath
plastic cath inserted through a hollow needle
often called angiocatheter
over the needle catheter
easiest to place
used for peds or other patients with tiny delicate veins
hollow needle catheter
metal stylet itself is inserted into the vein and secured there
also called intracatheter
catheter inserted through the needle
for central lines
fragile veins such as those of the elderly or children
22 gauge
average adult who does not need fluid replacement
20 gauge
to increase volume of admin viscous meds such as dextrose
18, 16, 14 gauge
blood can only be admin through a 16 gauge or larger
never leave venous constricting band in place for longer than
2 minutes
inserting cannula at what angle when into the vein
10 to 30 degree angle
once in vein advance the cannula approximately
0.5 cm further
label the intravenous solution bag with the following information
date and time
person initiating the intravenous access
between the angle of the jaw and the middle third of the clavicle and connects into the central circulation subclavian vein
external jugular vein
occurs if you accidentally puncture the vein more than once, thus allowing IV solution and blood to escape from the second puncture and accumulate in the surrounding tissue
extravasation
never flush on IV that has stopped running because of
of a clot
use to minimize pain
1% lidocaine
what occurs if you do not properly cleanse the site
local infection
foreign proteins capable of producing fever
pyrogens
pyrogenic reaction will occur within
and secondary to contaminated intravenous solution
1/2 to 1 hours after you initiate IV
when do allergic reactions most often accompany
the admin of blood or colloids
foreign particle in the blood
embolus
never draw the teflon cath over the metal stylet after you have advanced it
true true
what do should you do if you accidentally puncture a artery
direct pressure to the site for at least 5 mins or
until the hemorrhaging has stopped
occurs if you admin too much fluid for a patient condition
circulatory overload
especially in kidney failure or heart failure who are intolerant of excessive fluid
signs of circulatory overload are
crackles
tachypnea
dyspnea
JVD
inflammation of the vein
thrombophlebitis
terminate the IV and apply a warm compress to the site
blood clot
thrombus
air within the vein
air embolism
most likely in central IV
sloughing off of dead tissue
necrosis
drugs that inhibits blood clotting
anticoagulants
aspirin
coumadin
heparin
2 methods for admin drugs through an IV line
intravenous bolus
intravenous infusion
concentrated dose of drug through the medication admin port of an established IV
IV bolus
18 to 20 gauge needle, 1 to 11/2 inch long is for
IV bolus
heparin lock
deliver a steady continual dose of medication through an existing IV line
IV infusions
(piggyback)
never admin IV infusion as a
primary IV line
peripheral IV port that does not use bag of fluid
heparin lock
long term
IV cannula with a distal medication port use for intermittent fluid or medication infusions.
saline lock.
short term
surgically implanted port that permits repeat access to central venous circulation,
venous access device
placed on the anterior chest neat the third of fourth rib lateral to the sternum. raised circle just beneath the skin
venous access device
needle that has an opening on the side of the shaft instead of the tip
huber needle
venous access device
complication of using a venous access device include
infection
thrombus formation
dislodgment of the catheter tip from the vein
gravity flow device that regulates fluids passage through an electromechanical pump
infusion controller
device that delivers fluids and meds under positive pressure
infusion pump
when should you obtain venous blood
during peripheral
before drug admin
when drug admin may be needed
blood tubes size for adult and peds
adults=5 to 7ml
peds=2 to 3ml
best to obtain venous blood from sturdy veins such as
cephalic
basilic
median
the most convenient way to obtain venous blood is through an
angiocath (over the needle cath)
tube holder is commonly referred to as a
vacutainer
blood tube color and anticoagulant
red=none
blue=citrate
green =heparin
purple =EDTA
gray= fluoride
long exposed needle that screws into the vacutainer and is inserted directly into the vein
luer sampling needle
elevated numbers of red and white blood cells
hemoconcentration
occurs when constrictive band is left in place to long
destruction of red blood cells
hemolysis
vigorously shaking the blood tubes after they are filled using too small of needle
too forcefully aspirating blood into or out of a syringe
generally for critical patients under 5 years old
IO
initiate IO lines only after
90 seconds or three unsuccessful attempts to establish peripheral IV access
most commonly used IO site for peds is
proximal tibia
you can identify the proximal epiphysis by palpating the
condyles
between the condyles, on the top of the anterior tibial crest, is a palpable bump called the
