1. surgical puncture of a vein to deliver medication or withdraw blood
    intravenous or cannulation
  2. two types of intravenous access are?
    peripheral and central(rare)
  3. common sites for peripheral venous access are
    • arms
    • legs
    • sometimes neck
  4. rapid fluid admin requires larger veins like the ?
    antecubital fossa
  5. external jugular vein is considered a
    peripheral vein
  6. 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
  7. surgical puncture of the internal jugular, subclavian, or femoral vein(veins located deep within the body)
    central venous access
  8. will a central vein collapse in shock?
  9. central IV lines are placed near the_______for long term use
  10. placed for intravenous pacing or for monitoring central venous pressure
    central venous access
  11. line threaded into the central circulation via a peripheral site
    peripherally inserted central catheter (PICC)
  12. when is a picc line most often used in
    • infants
    • children requiring long term care
  13. central is typically restricted to the hospital setting becuase
    • high risk complications
    • such as
    • arterial puncture
    • pneumothorax
    • air embolism
  14. intravenous solutions containing large proteins that cannot pass through capillary membranes
  15. colloids remain in the circulatory system for a ________time
  16. have osmotic properties that attract water into the circulatory system
    colloids(mostly for pt with low volume)
  17. 4 types of colloids are
    • plasma protein fraction(plasmanate)
    • salt poor albumin
    • dextran
    • hetastarch(hespan)
    principal protein albumin is suspended with other proteins in a saline solutions
    contains only human albumin. each gram of albumin will retain approximately 18 ml of water in the bloodstream
    salt poor albumin
    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
  21. is using colloids in the field practical
  22. intravenous solution that contain electrolytes but lack the larger proteins associated with colloids
  23. how are crystalloids classified
    by their tonicity relative to that of body plasma
  24. three classification of crystalloids are
    • isotonic=equal to blood plasma
    • hypertonic=higher solute concentration
    • hypotonic=lower solute concentration
  25. cause fluid to shift out of the intracellular compartment and into the extracellular compartment
    hypertonic solution crystalloid
  26. cause fluid to shift from the extracellular compartment and into the intracellular compartment
    hypotonic solution crystalloid
  27. isotonic solution containing sodium chloride, potassium chloride, calcium chloride and sodium lactate in water
    lactated ringers
  28. hypotonic glucose solution to keep a vein patent and supply calories needed for cellular metabolism
  29. 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
  30. universal blood
    o negative
  31. two classes of oxygen carrying solutions
    • per-fluorocarbons
    • hemoglobin based oxygen carrying solution(HBOCs)
  32. Oxygen carrying solutions
    denser than water and have high capacity to dissolve large quantities of gases such as oxygen
  33. Oxygen carrying solutions
    contain long chains of polymerized hemoglobin.
    compatible with all types of blood
  34. HBOCs
    expired donated human blood contains 50 g of hemoglobin per unit.must be refrigerated and has a shelf life of 1 year
  35. HBOCs
    bovine blood(cow)
    shelf life of 3 years
  36. hollow needle used to puncture the vein
  37. drip chamber should be about
    1/3 full
  38. micro drip
    • drop former is a hollow metal stylet
    • 60 gtts/ml
  39. macro drip
    • large circular opening at the top of the drip chamber
    • 10 gtts/ml
  40. medication that is chemically incompatible with regular tubing and require special tubbing
  41. when possible use the med port nearest to the patient
  42. what permits you to void possible air bubbles when using electromechanical pump tubing
    bladders and relief points
  43. IV setup that delivers specific volumes of fluid
    measured volume administration
  44. calibrated chamber of berutrol IV admin tubing that enables precise measurement and delivery of fluids and medicated solutions
    burette chamber
  45. blood tubing cones in 2 configurations
    • straight
    • Y=two ports(one for blood one for NS)
  46. fluid that increases the potential for blood coagulation
    lactated ringers
  47. three basic types of IV cannulas
    • over the needle cath
    • hollow needle cath
    • plastic cath inserted through a hollow needle
  48. often called angiocatheter
    • over the needle catheter
    • easiest to place
  49. used for peds or other patients with tiny delicate veins
    • hollow needle catheter
    • metal stylet itself is inserted into the vein and secured there
  50. also called intracatheter
    • catheter inserted through the needle
    • for central lines
  51. fragile veins such as those of the elderly or children
    22 gauge
  52. average adult who does not need fluid replacement
    20 gauge
  53. 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
  54. never leave venous constricting band in place for longer than
    2 minutes
  55. inserting cannula at what angle when into the vein
    10 to 30 degree angle
  56. once in vein advance the cannula approximately
    0.5 cm further
  57. label the intravenous solution bag with the following information
    • date and time
    • person initiating the intravenous access
  58. between the angle of the jaw and the middle third of the clavicle and connects into the central circulation subclavian vein
    external jugular vein
  59. 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
  60. never flush on IV that has stopped running because of
    of a clot
  61. use to minimize pain
    1% lidocaine
  62. what occurs if you do not properly cleanse the site
    local infection
  63. foreign proteins capable of producing fever
  64. pyrogenic reaction will occur within
    and secondary to contaminated intravenous solution
    1/2 to 1 hours after you initiate IV
  65. when do allergic reactions most often accompany
    the admin of blood or colloids
  66. foreign particle in the blood
  67. never draw the teflon cath over the metal stylet after you have advanced it
    true true
  68. 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
  69. 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
  70. signs of circulatory overload are
    • crackles
    • tachypnea
    • dyspnea
    • JVD
  71. inflammation of the vein
    • thrombophlebitis
    • terminate the IV and apply a warm compress to the site
  72. blood clot
  73. air within the vein
    air embolism

    most likely in central IV
  74. sloughing off of dead tissue
  75. drugs that inhibits blood clotting

    • aspirin
    • coumadin
    • heparin
  76. 2 methods for admin drugs through an IV line
    • intravenous bolus
    • intravenous infusion
  77. concentrated dose of drug through the medication admin port of an established IV
    IV bolus
  78. 18 to 20 gauge needle, 1 to 11/2 inch long is for
    • IV bolus
    • heparin lock
  79. deliver a steady continual dose of medication through an existing IV line
    • IV infusions
    • (piggyback)
  80. never admin IV infusion as a
    primary IV line
  81. peripheral IV port that does not use bag of fluid
    • heparin lock
    • long term
  82. IV cannula with a distal medication port use for intermittent fluid or medication infusions.
    • saline lock.
    • short term
  83. surgically implanted port that permits repeat access to central venous circulation,
    venous access device
  84. placed on the anterior chest neat the third of fourth rib lateral to the sternum. raised circle just beneath the skin
    venous access device
  85. needle that has an opening on the side of the shaft instead of the tip
    • huber needle
    • venous access device
  86. complication of using a venous access device include
    • infection
    • thrombus formation
    • dislodgment of the catheter tip from the vein
  87. gravity flow device that regulates fluids passage through an electromechanical pump
    infusion controller
  88. device that delivers fluids and meds under positive pressure
    infusion pump
  89. when should you obtain venous blood
    • during peripheral
    • before drug admin
    • when drug admin may be needed
  90. blood tubes size for adult and peds
    • adults=5 to 7ml
    • peds=2 to 3ml
  91. best to obtain venous blood from sturdy veins such as
    • cephalic
    • basilic
    • median
  92. the most convenient way to obtain venous blood is through an
    angiocath (over the needle cath)
  93. tube holder is commonly referred to as a
  94. blood tube color and anticoagulant
    • red=none
    • blue=citrate
    • green =heparin
    • purple =EDTA
    • gray= fluoride
  95. long exposed needle that screws into the vacutainer and is inserted directly into the vein
    luer sampling needle
  96. elevated numbers of red and white blood cells

    occurs when constrictive band is left in place to long
  97. destruction of red blood cells

    • vigorously shaking the blood tubes after they are filled using too small of needle
    • too forcefully aspirating blood into or out of a syringe
  98. generally for critical patients under 5 years old
  99. initiate IO lines only after
    90 seconds or three unsuccessful attempts to establish peripheral IV access
  100. most commonly used IO site for peds is
    proximal tibia
  101. you can identify the proximal epiphysis by palpating the
  102. between the condyles, on the top of the anterior tibial crest, is a palpable bump called the
    tibial tuberosity

    lies at the level of the epiphyseal plates
  103. IO site for adults is
    • distal end of the leg
    • lateral malleolus/medial malleolus
  104. for adults and geriatrics place IO needle
    1 to 2 finger above the medial malleolus
  105. IO needle is
    14 to 18 gauge needle
  106. sharp pointed instrument
  107. contraindications for IO placement
    • fracture to the tibia or femur
    • osteogenesis imperfecta
    • osteoporosis
    • establishment of a peripheral IV line
Card Set
part 2