ATI IV Therapy

Primary tubing- how full should the drip chamber be?

1/2 full at least to keep air from entering the tubing

How do you secure an IV?

Apply a transparent dressing to protect the IV site from contamination while still allowing visibility. Position the dressing over the vein so that it extends to the lip of the hub of the catheter. Leave the connection between the catheter hub and the IV tubing uncovered to facilitate changing the tubing. When securing the catheter, place the tape only over the hub and not over the insertion site. For easy assessment, keep the insertion site visible. Do not wrap the tape around the patient's arm either, since this can impair circulation if the arm swells. To protect the patient's skin, place a small gauze pad under the hub of the IV catheter to elevate it and keep it from exerting pressure on the patient's skin. Replace the gauze pad if it becomes wet or soiled.

Where should you avoid inserting an IV?

Avoid using veins in an extremity with compromised circulation and those that are distal to previous IV sites. Also avoid sclerosed or hardened veins, bruised areas, and areas where there are valves or bifurcations. If the patient has excessive body hair, do not shave the area; instead, clip the hair with scissors. Shaving can cause microabrasions that increase the risk for infection.

A tube inserted into a vessel, duct, or cavity

Cannula

When is an IV piggyback used?

If an infusion device is not available to ensure standardized delivery of the medication

What should you do if you are having problems finding a well-dilated vein?

If you are having problems finding a well-dilated vein, you can try gently stroking the extremity below the intended IV site from distal to proximal or place a warm blanket or towel on the extremity for a couple of minutes. Avoid rubbing the extremity vigorously or flicking the vein as this can cause the vein to constrict or a hematoma to form.

Device that delivers IV fluid via positive pressure at a specific preset rate

Infusion pump

How should we specialize our IV insertion for pediatric patients?

Minimize pain with topic anesthetic Have another nurse help you to immobilize the extremity You can use infants' scalp and foot veins Use the smallest catheter available- usually a 22 to 26 gauge Secure the catheter and tubing well

a catheter used for long-term intravenous access and inserted in the basilic or cephalic vein just above or below the antecubital space with the tip of the catheter resting in the superior vena cava

PICC- peripherally inserted central catheter

IV access insertion preparation procedure

Pt's extremity in dependent position Apply tourniquet around pt's arm above antecubital fossa (or approx 4-6 inches above anticipated site).

How should we specialize our IV insertion for older adult patients?

Use a tourniquet sparingly to avoid tearing their fragile skin. When inserting the catheter, be sure to pull the skin below the insertion site taut to stabilize the vein Use a lower angle of insertion to avoid puncturing the vein's posterior wall Avoid veins in hand that can interfere with ADLs Use small catheter such as 22-gauge Use minimal tape to secure catheter, if possible use a mesh dressing

IV access insertion procedure

When inspecting the patient's hand and arm for an IV site, begin by looking at the most distal part and move proximally. Select a vein that is well-dilated and one that feels soft with palpation and bounces back when you release the pressure. Once you have found a vein, make sure that placing the IV catheter in that location will not interfere with any planned procedures or with the patient's ability to perform activities of daily living.

Describe an IV piggyback setup.

With a piggyback setup, you'll hang the smaller bag of fluid, the secondary infusion, higher than the larger bag of fluid, the primary infusion. To do this, use the plastic hook, or extension hanger, that is packaged with the secondary tubing. When using the piggyback setup, leave both the primary and the secondary lines open. To regulate the flow rate of the secondary infusion, open the roller clamp on the secondary tubing completely and use the roller clamp on the primary tubing to adjust the flow rate.

4 most common IV insertion veins in hand/forearm (describe location in 2-3 words)

basilic vein- medial side of arm cephalic vein- distal side of arm metacarpal veins- travel to fingers Dorsal venous arch- middle vein leading to metacarpal veins

The slanted surface at the tip of a needle

bevel

Division into two branches; fork

bifurcation

A small, wing-tipped needle used to initiate intravenous access

butterfly needle

The "handle" of an intravenous catheter, the part that allows access to the catheter's lumen

catheter hub

A blood-vessel access device usually inserted into the subclavian or jugular vein with the distal tip resting in the superior vena cava just above the right atrium; used for long-term IV therapy or parenteral nutrition

central venous catheter

Implantation and growth of a micro-organism on or in a host

colonization

the portion of an intravenous administration set that lies just below the tubing insertion spike and allows visualization of the individual drops of solution being infused

drip chamber

the portion squeezed and released to begin the flow of solution immediately after insertion of the spike into the solution bag or bottle when preparing an intravenous infusion set

drip chamber

the calibration or number of drops per mL of solution delivered for a particular drip chamber

drip factor/ drop factor

a blood clot or bolus of air developed in or introduced into a blood vessel that moves from its place of origin and is capable of obstructing blood circulation

embolus

How often should the nurse change primary tubing?

every 96 hours

the portion of an over-the-needle catheter that allows observation of a blood return

flash chamber

loss of both water and electrolytes from the extracellular fluid, AKA hypovolemia

fluid-volume deficit

An IV catheter inserted into a vein and left in place for the intermittent administration of medication into its port or as an open line for emergency situations and intermittently flushed with heparin solution to maintain patency

heparin lock

Referring to a solution that has a higher osmolarity than body fluids have

hypertonic

Referring to a solution that has a lower osmolarity than body fluids have

hypotonic

Seepage or introduction of fluid, such as IV fluid, into the tissues surrounding a blood vessel, similar to extravasation

infiltration

Slow, intentional introduction of fluid into a vein

infusion

A rubber cap attached to the end of an IV catheter or extension tubing to allow access to the blood vessel for injecting fluid

injection cap

the needle inside an over-the-needle catheter used to pierce the wall of a vein to initiate intravenous access that is withdrawn and discarded after the catheter is properly positioned within the vein

introducer needle

referring to a solution that has the same osmolarity as body fluids

isotonic

a plastic catheter that fits over a needle and is used to pierce the wall of a vein to initiate IV access

over-the-needle catheter

open and unobstructed

patent

performed through the skin

percutaneous

inflammation of a vein

phlebitis

device with intravenous tubing threaded through it that acts as a valve when turned (rolled) to increase, decrease, or stop the flow of fluid through the tubing

roller clamp

an intravenous catheter inserted into a vein and left in place for the intermittent administration of medication through its port or as an open line for emergency situations and intermittently flushed with normal saline solution to maintain patency

saline loc

a short piece of plastic tubing that connects into the primary IV tubing for administering medications.

secondary tubing

the formation or presence of a stationary blood clot within a blood vessel

thrombosis

self-adhesive, coated tape used for labeling an intravenous infusion, for example, with the time it was started

time tape

an umbrella term that includes a variety of catheters, cannulas, and infusion ports that allow intermittent or continuous access to a blood vessel

vascular access device (VAD)

inserting a needle into a vein to withdraw blood samples or to establish ongoing access to a vein

venipuncture

resistance to flow; a physical property of a substance that varies with the friction of its component molecules as they slide past one another; refers to thickness of fluid such as blood

viscosity

Intravascular

within a blood vessel