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WVC 2 chpt 15
| Question | Answer |
|---|---|
| Normal serum osmolarity for adults is between | 270 and 300 mOsm/L. These are isotonic |
| Fluids greater than 300 mOsm/L are | hypertonic |
| Fluids less than 270 mOsm/L are | hypotonic. |
| Hypertonic fluids are used to | correct fluid, electrolyte, and acid-base imbalances by moving water out of the body's cells and into the bloodstream. |
| Hypotonic infusates do what | move water into cells to expand them |
| pH of infusates usually ranges from | 3.5 to 6.2 |
| Fluids and medications with a pH value less than _______ and more than __________with an osmolarity more than _______________ should not be infused through a peripheral vein | less than 5 and more than 9 and osmolarity more than 500 mOsm/L |
| IV rotation is every | 72 hours…..label the tubing |
| IV charting of what | site, gage, time, reactions and # of attempts |
| PIGGY BACK tubing IS CHANGED EVERY | 24 HOURS….label the tubing |
| Non-continuous piggy back tubing is | anything less than a 24 hour continuous. Tubing is changed q24 |
| Piggyback Syringe, IV Push (IVP) meds are given in which port | the one closest to the pt. |
| What is extremely important to check prior to giving IVP | solution/medication compatibility |
| Partial Fill or “Piggyback” Solutions rule of thumb | flush, give med and flush again |
| Who publishes guidelines and standards of practice for policy and procedure development in all health care settings | The Infusion Nurses Society. CRNI (Certified registered nurse infusion) |
| Who develops guidelines about chemotherapy and biotherapy administration. | The Oncology Nursing Society (ONS) |
| Who publishes standards for all types of nutrition. | The American Society of Parenteral and Enteral Nutrition (ASPEN) |
| Types of parenteral fluids used | •IV solutions, including parenteral nutrition •Blood and blood components •Drugs |
| Limited Vein Order (LVO) | HCP writes an order allowing to keep the site open indefinitely (dialysis pt’s) |
| “To Keep Open” TKO rate | <15 mL/hour |
| IV solution is classified by (2) | tonicity and pH |
| Isotonic IV’s put the pt at risk for | fluid overload |
| Short Peripheral Catheters dwell time | 72-96 hours (risks are phlebitis/infection) |
| Midline Catheters are 6-8 inches and dwell time is | 1-4 weeks |
| Nontunneled Percutaneous Central Catheters are located | at the tip of the superior vena cava. X-rays used to verify placement. |
| Infiltration | Leakage of a nonvesicant IV solution or medication into the extravascular tissue (cool touch, redness, edema and different from other arm) |
| NIC for infiltration | stop IV, restart in other arm, elevate arm |
| Phlebitis | inflammation of the vein. (redness). There are specific protocals for phlebitis (heat and forms) |
| What does a complete order for IV therapy include | •Specific type of fluid •Rate of administration written in milliliters per hour, or e.g., 125 mL/hr or 1000 mL/8 hr •Drugs and the specific dose to be added to the solution, such as electrolytes or vitamins |
| A drug prescription (for IV use) should include: | •Drug name, preferably by generic name •Specific dose and route •Frequency of administration •Time of administration •Length of time for infusion •Purpose (required in some health care agencies, especially nursing homes) |
| Infection | breach of integument. Risk increases based on procedure during catheterization |
| Local Complications of Intravenous Therapy (4) | Infiltration Phlebitis Infection Catheter Dislodgement |
| What are a RN’s responsibilities prior to administering and IV | determining that the prescription is appropriate for the patient and clarifying any questions before administration. Be sure to check for the accuracy and completeness of the treatment prescription. |
| Speed Shock | systemic response to getting fluids too rapidly (high BP..vascular probs) |
| Circulatory Overload | the speed of infusion is so great that it causes this condition, especially with the elderly (congestive HF) |
| Catheter Embolism | the catheter breaks of and moves in BV |
| Systemic Complications of Intravenous Therapy (5) | Air embolism Speed Shock Circulatory Overload Allergic Reaction Catheter Embolism |
| What is the tx for catheter embolism | Remove the catheter, and apply a tourniquet high on the limb of the catheter site; inspect catheter for any rough edges; an x-ray is taken to determine the presence of any catheter piece; surgical intervention may be necessary. |
| Insertion-Related Complications of Central Venous Catheters | pneumothorax, hemothorax, Chylothorax, Hydrothorax, Air embolism, |
| Is this statement a complete medical order, “5% dextrose in water to keep the vein open (TKO or KVO)” | No, does not specify the rate of infusion and is not considered complete |
| What determines whether the infusion can be given safely through peripheral veins or if the large central veins of the chest are needed. | The specific type and purpose of the therapy |
| What are the 7 vascular access device (VAD) | •Short peripheral catheters •Midline catheters •Peripherally inserted central catheters (PICC) •Nontunneled percutaneous central catheters •Tunneled catheters •Implanted ports •Hemodialysis catheters |
| 24 and 26 inch gage is used for | neonates and pediatric and older patients only choice is small-diameter veins |
| 22” gage | blood and blood products rates slightly slower most adults, especially those with small or fragile veins N/A when rapid flow rates are required such as trauma or surgery |
| 20” gage | All injectibles; suitable for minor surgical procedures Most commonly used size |
| 18” gage | trauma and surgery Rapid flow rates Requires a large vein to allow room for blood to flow in the vein around the catheter Irritation to the vein wall and phlebitis result when the catheter is too large for the chosen vein |
| 14-16” GAGE | Used for high-risk surgical procedures and trauma Large volumes and rapid flow Requires a large vein Mechanical irritation and phlebitis are likely |
| If the length of the patient's therapy is expected to be longer than 6 days, what type of cath would you choose | a midline catheter or PICC |
| The most appropriate veins for peripheral catheter placement include the | dorsal venous network basili cephalic median veins, as well as their branches |
| Factors that Affect Stability, Activity and Compatibility of IV Drugs | Number of additives Dilution (stability)Time (stability)Light (sensitivity) Temperature (stability) Order of additives (molec wt) Container (eg. Nitro) |
| What would be required in order to start an IV on the same side as a mastectomy, fistula (ect.) | a doctor’s order |
| Visual impcompatibilies | presents of precipitation (Phenytoin), gas, bubbles |
| Chemical incompatibilites | breakdown causes inactive or toxic solutions |
| Solution Instability incompatibilites | degrades or comes out of solution (temp, lite, time, order,…) |
| Types of IV Drug Incompatibilities … | visual, chemical & solution instability |
| Why should you avoid veins on the palm side of wrist | b/c of the medial nerve (pain) |
| An irritant is | agent causing ahing, tightness & phlebitis along the ein or at the injection site with local inflammatory reaction . NO NECROSIS |
| A vesicant is | high alert drugs that cause tissue and cell damage. NECROSIS |
| Extravasation | Leakage of a vesicant IV solution or medication into the extra vascular tissue. Tissue slough & necrosis may occur |
| Tx for extravasation | Stop infusion & d/c admin set. Aspirate drug. Leave short peripheral catheter or port access needle in place to deliver antidote, if indicated by established policy. If possible, aspirate residual drug from the exit site of a central venous catheter. |
| Flare reaction | LOCAL allergic reaction to an agent manifested by streaking or red blotches along the vein BUT WITHOUT PAIN |
| Hypersensitivity reaction | exaggerated or inappropriate immune response that may be localized or systemic occurring during or w/I hours of drug administration. |
| Short peripheral catheters are allowed to stay in | 72-96 hours but then require removal and insertion at another venous site. |
| If the length of the procedure or stay is >6 days, what IV would you use | PICC |
| The most appropriate veins for peripheral catheter placement include | dorsal venous network, basilic, cephalic, and median veins, as well as their branches |
| Midline catheters are | 6 to 8 inches long and are inserted through the veins of the antecubital fossa. Basilic vein vs cephalic. Therapies lasting 1-4 weeks |
| Indications for midline cath | •Fluids for hydration •Five to 10 days of antibiotics to treat urosepsis or pneumonia•Heparin infusions for deep vein thrombosis •Bronchodilators, such as aminophylline •Steroids |
| Fluids infused w/midline cath require what pH and mOsm/L | 5 and 500 mOsm/L |
| How do you give KCL- in IV | a Central Line not peripherally unless it is REALLY dilute. |
| Normal Mg | 1.3 |
| KNOWWHAT IS IMPORTANT TO MONITOR WITH GENTAMICIN | BUN AND CREATININE (RENAL TOXIC) |
| WHAT IS THE MOST IMPORTANT THING TO ASSESS FOR WHEN ADMIN LASIX | HEARLING LOSS(OTOTOXIC) |
| A peripherally inserted central catheter (PICC) is inserted through a vein of the | antecubital fossa |
| PICC length ranges from | 18 to 29 inches |
| Mid-clavicular tip locations should be used only when | anatomic or pathophysiologic changes prohibit placing the catheter into the SVC. |
| mid-clavicular catheters are associated with much higher rates of | thrombosis than when the tip is located in the SVC |
| Are there any limitations on the pH or osmolarity in using a PICC | no, because meds are diluted by the SVC. (antibiotics, chemotherapy agents, parenteral nutrition formulas, vasopressor agents) |
| Nontunneled percutaneous central catheters, what used for, where and by who | emergent, trauma, critical care & surgery. Dr. inserts in jugular or subclavian. Short term use, but can stay for an unspec time (no home care). Trendelenburg pos. More potential for infection than PICC |
| Tunneled central venous catheters, purpose | to prevent the organisms on the skin from reaching the bloodstream |
| How is a tunneled percutaneous central cath placed | surgical techniques for insertion. (Broviac, Hickman, and Leonard catheters) |
| Why are tunnel caths used | when infusion therapy is frequent and long-term (parenteral nutrition for months, years, or the remainder of their life) |
| Implanted ports consist of | a portal body, a dense septum over a reservoir, and a catheter. No part of the catheter is visible externally; therefore this device has the least impact on body image. |
| Care of an implanted port | flushed after use and at least once a month. |
| What types of caths are dialysis caths | tunneled for long term and non-tunneled for short term. No fluids should be infused in either of these ports |
| Glass infusion containers are considered | an open system. They need to be ventilated |
| Plastic infusion containers are considered | closed systems. They don’t require outside air to move fluid through |
| Plastic containers are incompatible with (drugs) | insulin, nitroglycerin, lorazepam (Ativan), fat emulsions, and lipid-based drugs. |
| Problems with plastic bags | drug incompatibilities and inaccurate measurements when reading the measurements (up to 40%) |
| What are semiridgid containers | no plastic stabilizers or drug interactions. Require air to flow fluids |
| Safety practice for bag inspections | check bag for holes/inconsistencies, turbidity and color changes |
| How often are Intermittent Administration Sets to be changed | every 24 hours |
| How is tip placement confirmed with central lines | xray |
| Tape and gauze dressings should be changed every | 48 hours |
| Transparent membrane dressings are changed at least every | 7 days |
| The initial dressing on a midline catheter or PICC is usually tape and gauze and is changed within | 24 hours after insertion |
| When changing the dressing, remove it by pulling it | laterally from side to side |
| Primary and secondary administration sets are usually changed using sterile technique every | 72 or 96 hrs. (infusions combined w/lipid emulsion, blood products, and drugs such as propofol, changed per directions) |
| Needless connector devises being used for intermittent infusions, the device should be changed at least | once per week. |
| What is the suggested syringe for a central venous cath | 10 mL, it creates less pressure |
| During flushing the cath, always aspirate for | a brisk blood return from the catheter lumen. |
| For short peripheral catheters, usually ______ normal saline is adequate to flush the catheter. | 3 mL |
| For catheters (other than short periph) how much saline is needed | 5 to 10 mL |
| Bacteriostatic normal saline is limited to no more than | 30 mL in a 24-hour period in adults. |
| Short peripheral and midline catheters should or shouldn’t be routinely used for obtaining blood sample | shouldn’t |
| Short peripheral catheters are usually removed | 72 or 96 hours after insertion. |
| Documentation for VAD | date, time, site, number of attempts, type of VAD, pt. response, education & types of dressings used |
| Catheters are placed into arteries are used to obtain | repeated arterial blood samples, to monitor various hemodynamic pressures continuously, and to infuse chemotherapy agents |
| Intraperitoneal (IP) therapy is | the administration of chemotherapy agents into the peritoneal cavity. IP therapy is used to treat intra-abdominal malignancies such as ovarian and gastrointestinal tumors that have moved into the peritoneum after surgery |
| Subcutaneous therapy is used for | infusing many drugs at a time. Usually hospice or palliative care |
| Hypodermoclysis involves the | slow infusion of isotonic fluids into the patient's subcutaneous tissue |
| Intraosseous (IO) therapy allows access to the rich vascular network located in | the long bones. This vascular network is more prominent in children younger than 6 years. |
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