Chapter 15

resistance when flushing a Heparin or saline lock could mean that

a cloth might be forced into the bloodstream

verify compatibility by checking

a compatibility chart, drug reference book, The pharmacy, the internet, or package insert

5% dextrose contains 5 grams of dextrose how many millimeters

100 mL

which of the following are true about electrolytes

they help correct fluid and chemical imbalances they include calcium potassium chloride phosphorus and magnesium

what are characteristics of KVO/TKO IV fluids

they provide access to the vascular system a commonly used fluid is normal saline

which of the following apply to hypotonic solutions

they result in fluid moving into the cell they are used for dehydrated patients

isotonic IV fluid is also used

to replace intravenous fluid in the patient is hypovolemic does not have enough fluid circulating in the blood vessels

roller clamp/screw clamp

to set or just the flow rate of the IV solution

Odell D5W has an osmolarity similar to intracellular fluid

well it is in the IV bag the dextrose quickly moves into the cell after administration leaving the hypotonic solution in the extracellular fluid D5W is used as a hypotonic solution

IV fluids are sometimes necessary during emergencies because they

work faster than other routes

intermittent peripheral infusion devices

you can administer medication to a patient on a regular basis through not continue, scheduled by using intermittent peripheral infusion device dysport allows you to inject medication directly into the vein by using a syringe refuse medication intermittently physician's orders will list IV push or bolus for medication that is injected into IV line or through a saline or Heparin lock to prevent blockage that device must be flex 2 or 3 times a day or after administering medication a saline lock is flushed irrigated with saline Heparin lock is flushed irrigated with saline mixed with Heparin an anticoagulant that retarts clot formation

if you flush or irrigate an IV catheter that is clogged

you may be pushing a cloth into the circulatory system known as embolism can travel through the bloodstream and block a blood vessel pain and swelling in her IV site may indicate infiltration or phlebitis infiltration occurs when the needle of a catheter is dislodge from the vein or penetrates the skin fluid is in infused into the surrounding tissues signs are infiltration include swelling discomfort coolness at the infiltration site as well as sizable decrease in float rate

find the total time to infuse ordered 750ml LR to infuse at a rate of 125 mL/h started at 11 p.m.

you take 750 ml ÷ 125 ml/h 6 hour total time to infuse 750 ml

use formula to calculate flow rate

F=V/T

KVO/TKO

KVO (keep vein open) fluids or TKO (to keep open) fluids

saline abbreviation

NaCL

HYPERTONIC

Solutions with a higher osmolarity than intracellular fluid are termed hypertonic Hypertonic solutions are concentrated and cause fluid to shift out of the cell

HYPOTONIC

Solutions with a lower osmolarity than intracellular fluid Describes fluids that move across the cell membrane into surrounding cells and tissues, such as 0.45% NS and 0.33% NS. HYPOTONIC are dilute moving fluid into the cell

ISOTONIC

Solutions with approximately the same osmolarity as the fluid within human body cells are termed isotonic

which of the following apply to both and infiltration and phlebitis

The physician should be notified the IV should be removed and start another limb

the formula is used to calculate infusion volume

V=T×F

Port of cath

a device play surgically under the skin in the chest in order to deliver drugs into a large Central vein it is surgically placed under the skin and access through the skin to administer IV medications on an intermittent basis

if a patient has too much fluid in the cell and is in cerebral edema

a hypertonic fluid is ordered

saline solutions with less sodium chloride than normal saline less than 0.9%

a hypotonic examples: 1/2 NS (0.45% NaCl) 1/3 NS (0.3% NS) 1/4 NS (0.225% NaCl)

if the patient is dehydrated and there is not enough fluid within the body cells

a hypotonic fluid is ordered

patients who are dehydrated experience

a lots of fluid from the cell

Flow rate

a measurement of the amount of fluid entering a patient through an intravenous line for a set amount of time

and IV bag is hung about the patient's heart to

allow gravity to draw the fluid

injection ports

allow you to inject medication are compatible fluids into the family line or to attach a second IV line IV bags may have ports for additive injected directly into the solution

macrodrip

allows larger drops to farm before falling into the drip chamber may be used for infusions of 80 ml/h or more and is always use operating room infusions

Central line

an IV line that administers large amounts of medications to Major veins

Drip chamber

an area on the IV equipment where the drop of a fluid is visualized during infusion is transparent enclosure through which the drops of IV fluid can be counted in or to estimate the rate of infusion attaches to IV bag

Heprin lock

an infusion Port attached to an already inserted catheter for IV access flushed with heparin

if the patient has a normal fluid balance but can't take fluids and enterally

an isotonic maintenance IV fluid is ordered

saline solutions with more NaCl than normal saline greater than 0.9% of NaCl

are hypertonic 3% NaCl 5% NaCl

IV labels

are labeled with the name and exact amount of components in the solution

examples of isotonic solution

are lactated ringer's, ringers lactate, normal saline and D5W

piggyback

are typically infused buy a mini bags of 50 100 150 200 or 250 ml of fluid

match the following terms to their definitions: drip chamber Heparin lock infusion pump patient controlled analgesia syringe pump

drip chamber in area of an IV equipment where the fluids drops are visual Heparin lock infusion Port attached to an inserted IV catheter infusion pump the device that applies a pressure to maintain the rate of an IV infusion patient controlled analgesia allows the patient to control access to pain medications through an IV syringe pump provides precise control of an IV infusion by syringe

mentally delivered IV fluids are usually administered in

drops per minute

when a saline or Heparin lock is used fluids do not

flow continuously

when a saline or Heparin lock is used for lights do not

flow continuously

A roller or screw clamp is used to set an adjuster of the IV solution

flow rate

may need to be adjusted because counting time and drops is not always precise

flow rates

Maintenance fluids

fluids that help patients maintain fluid and electrolyte balance

Replacements fluids

fluids that replace electrolytes or fluid loss from dehydration, hemorrhage, vomiting, or diarrhea

lactated ringers also known as

hartmann's solution contain sodium chloride as well as sodium lactate, potassium chloride and calcium chloride LR can be mixed with 5% dextrose

patient C is a 50 year old male with cerebral edema

he may require hypotonic solution such as 3% sodium chloride to help draw fluid from cells and tissues

after calculation infusion time is expressed in

hours

microdrip

how smarter drops you into the drip chamber it is used for flow rates of less than 80 ml/h and is often used for kvo infusions especially useful for pediatric and critical care IVs when very small volumes are used in accuracy is extremely important accidentally increases in volume can be fatal in these situations

patient be is an 8 year old female has been vomiting and has diarrhea for 24 hours and is dehydrated she may require

hypotonic solution such as 0.40 5% sodium chloride of 0.3% sodium chloride to restore the proper fluid level in her cells and tissues

KVO/TKO

"keep veins open"or "to keep open" fluids that provide access to the vascular system for an emergency situations

normal saline is 0.9% saline it contains 900 mg or 0.9 g of sodium chloride how many millimeters

100mL

0.40 5% saline or 1/2 NS has 450 mg of sodium chloride how many millimeters

100mL that is one half the amount of normal saline

will identify how much additive to administer

prescribers orders

which of the following apply to hypertonic solutions

they are concentrated they cause fluid to move out of the cell

a patient with normal fluid balance may need an isotonic IV for maintenance because

they are not able to drink

which of the following are true of IV drip Chambers

they are transferring so drops can be counted they allow rate of infusion to be estimated

What is the normal saline per mL

0.9% per 1000 mL

IV solutions

1. 1000 ml D10w 2. 500ml D5 and 1/2 normal saline 3. 250ml D5NS 4. 1000mL D5LR 5. 500ml D5 1/4 NS

0.3% saline is also

1/3 NS

0.225% saline

1/4 NS

find the total time to infuse ordered 1000 ml NS to infuse at a rate of 75 mL / hour

13 hr and 20 min you divide 1000 mm by 75 mL / h equals 13.33 hours second you take the 33 minutes and multiply that by 60 which equals 20 minutes 13 hours and 20 minutes is your answer

order 500 mL D5 1 and 1/2 NS over 3 hours

167 mL/h first no need to convert 3 hours because it's already in hours second divide 500 mL through 3 hours

ordered 500 mg ampicillin in 100 ml NS to infuse over 30 minutes find the flow rate

200 mL/h first convert 30 minutes to an hour taking 30 / 60 equals 0.5 second you divide 100 mL by 0.5 equals to 200 mL/h that's the answer

find the flow rate 75 mL/h when you're using 20 gtt / ml macrodrip tubing

25 gtt/min 75×20/60

dextrose is

5%

What is the dextrose per mL

5% per 500 mL

find the total volume infused in 5 hour if the infusion rate is 35 ml / h

5× 35ml/h 175mL/h

micro tubing

60 gtts/mL

Normal saline

A commonly used KVO fluid is 0.9% sodium chloride, also called normal saline (NS)

volume control sets such as

Buretrol Soluset Volutro are used with manual IV setups and electronical rate controllers to improve accuracy, especially for small violins in medication or fluid are calibrated in 1 mL increments with volume capacity range from 100- 150 ml

Burrette

a chamber that houses smaller control amount of fluid an exact amount of IV fluid is added as a diluted to the chamber where's mix the fluid is delivered to the patient in micro drips burrette are often used in critical care pediatric at least because of their accuracy

In abbreviations for IV solutions, letters identify the component and numbers identify the concentration.

An order for 5% dextrose in lactated Ringer's solution might be abbreviated in any of the following ways: D5LR D5LR 5%D/LR D5%LR

what can be added to chemically balance an IV solution ?

Calcium, potassium, chloride, phosphorus, and magnesium are electrolytes that can be added to an IV solution to help correct a fluid or chemical imbalance. The concentration of these electrolytes determines the osmolarity of the solution.

a port-a-cath is used to deliver medication to an vein

Central

Central IV therapy

Central IV therapy provides direct access to Major veins Central lines can be inserted using a catheter through the chest wall or by threading a catheter through a peripheral vein a newborn infant to central line can be inserted into the umbilical vein or artery PICC is inserted in arm vein and throw it into a central vein

identifying the components in concentrations of IV solutions

D is dextrose W is water D5W is dextrose 5% in water IV solutions order for: replacement fluid-replace fluids and electrolytes lost due to the hemorrhage, illness, surgery maintenance fluids-maintain normal fluid and electrolyte balance kvo fluids-fluids delivered at a very slow rate to keep vein open therapeutic fluids-delivered medication

Table of common used abbreviations

D10W 10% dextrose in water D5W 5% dextrose in water W, H2O Water NS, NSS Normal saline (0.9% NaCl) LR Lactated Ringer's RL Ringer's lactate D5LR, D5LR, 5%D/LR, D5%LR 5% dextrose in lactated Ringer's solution NS, NSS One-half normal saline solution (0.45% NaCl) 1/2 NS, NSS One-third normal saline solution (0.3% NaCl) 1/3 NS, NSS One-fourth normal saline solution (0.225% NaCl) 1/4

a clogged IV catheter should not be irrigated because can be pushed into the circulatory system

a clot

Intravenous (IV)

Fluids are solutions including medications that's are delivery directly into bloodstream through a vein Blood is a suspension is also delivered IV Fluids delivered directly into the bloodstream have rapid effect which is necessary during emergencies or other critical care situations when medications are needed The guidelines typically outline recommended dosages, infusion rates, compatibility and patient monitoring Some medications can not be combined with others or must be administered over specific lenght of time

Maintenance fluid

Fluids that help patients maintain fluid and electrolyte balance. help patients maintain normal electrolyte and fluid balance. They include IV fluids such as normal saline given during and after surgery.

Replacement fluid

Fluids that replace electrolytes or fluids lost from dehydration, hemorrhage, vomiting, or diarrhea. replace electrolytes and fluids lost or depleted due to hemorrhage, vomiting, or diarrhea. Examples include whole blood, nutrient solutions, or fluids administered to treat dehydration

fluids are solutions that are delivered into the bloodstream through vein

IV

IV equipment

IV BAG different sizes often five hundred or a thousand mL of solution that should be marked at regular time intervals to help keep track of the amount of solution that is being infused

Therapeutic fluids

IV fluids that deliver medication to patients

peripherally inserted central catheter (PICC)

IV line that is inserted in an arm vein and threaded into a central vein often by a special train nurse

IV solutions

IV solutions fall into four functional categories replacement fluids, maintenance fluids, KVO or TKO fluids, and therapeutic fluids REPLACEMENT FLUIDS INCLUDEwhole blood, nutrient solutions, or fluid administered to treat dehydration MAINTENANCE FLUIDS normal saline given during and after surgery KVO/TKO FLUIDS are prescribed very slow rate to maintain open vein access commonly used fluid is 0.9% sodium chloride also called normal saline THERAPEUTIC FLUIDS deliver medication to the patient

IV Solutions

IV solutions fall into four functional categories: replacement fluids, maintenance fluids, KVO or TKO fluids, and therapeutic fluids.

a secondary line is also known as a piggyback or

IVPB

are typically infused buy a mini bags of fluid

IVPBs

Syringe pumps

bumps that provide precise control of IV infusions by a syringe inside of a pump let's arrange can deliver medications of fluid that cannot be combined with other medications and solutions are useful for pediatric medication as well as for medications that must be administered by precisely controlled rate are used when a medication must be administered over half an hour or less however they can also be used for longer time periods

solutions to help correct a fluid or chemical imbalances

calcium, potassium, chloride, phosphorus and magnesium are electrolytes it can be added to an IV solution to help correct a fluid or chemical imbalance the concentration of these electrolytes

intermittent IV infusions

can be delivered through an IV secondary line or saline or Heparin lock patient is receiving continuous IV therapy can also be delivered through saline or Heparin lock when the patient does not require continuous or replacement fluids

match the following terms central line peripheral line port-a-cath primary line secondary line

central line IV line that administers large amounts of medication to Major veins peripheral line IV line inserted in the arm been going to a central vein port-a-cath device placed under the skin in the chest that delivers drugs into a central vein primary line main tubing that delivers an IV infusion secondary line line used to add medications to an existing IV port

which of the following are important to remember with IV compatibility

compatibility should be verified using resources not checking compatibility will be harmful for the patient

Therapeutic fluid

deliver medication to the patient

Infiltration

delivery of fluid from an IV infusion outside of a blood vessel into the surrounding tissue

Isotonic

describes fluid that do not affect the fluid balance of the surrounding cells or tissues such as D5W and NS and lactated ringers solution with approximately the same as morality as the fluid within the human body cells

Hypertonic

describes fluids that draw fluid from cells and tissues across the cell membrane into the bloodstream such as 3% saline solutions with a higher osmolarity than intracellular fluid are concentrated in cause fluid to shift out of the cells

Hypotonic

describes fluids that move across the cell membrane into surrounding cells and tissues such as 0.45% NS and 0.33% NS solutions with a lower osmolarity than intracellular fluid

Rate controller

device that controls the rate of an IV infusion by using in pincher and censor the infusion relies on gravity

infusion pump

devices that apply pressure to maintain the rate of an IV infusion using a sensor to monitor both the right and when the bag is empty they can introduce liquid into a central vein where pressure is much higher than peripheral vein the desire floor traders said in milliliters per hour or by dosage the rate is too slow May indicate too much resistance in the vein suggestion of blockage a kink in the tubing or the IV catheter has come out of the vein when you use an infusion pump you must monitor the patient's infusion site regularly for signs of inflirtation(swelling, cooling or discomfort

infusion time and volume

in order me a call for certain amount of fluid to infuse at a specific right without specifying the duration and they skate you need to calculate the duration of the amount of the IV will take to infuse so that you can monitor IV properly

match the following terms infiltration intravenous phlebitis

infiltration delivery of fluid from an IV into surrounding tissue intravenous medication delivered directly into the bloodstream through vein phlebitis inflammation of a vein

Phlebtitis

inflammation of a vein with can be caused by an irritated IV site

phlebtitis

inflammation of the vein can be developed when the vein is irritated by IV additives by movement of the needle or catheter during long-term IV therapy patient complains of pain or near sight other signs include heat redness swelling of the injection site stop the IV infusion restart another notify patient-physician

Saline lock

infusion Port attached to an already inserted catheter for IV access flushed with saline

tubing

is available in two sizes microdrip or macrodrip

patient AIDS 35 years old healthy female who will have an IV infusion during the diagnostic said she will require an

isotonic solution such as NS or lactated ringers

Secondary line

lime used to add medications or other additives to an exciting IV or infusion Port also known as a piggyback IVPB can be used to infuse medication or other compatible fluids on an intermittent basis such as q6h IV bags are usually smaller often holding fifty, a hundred, or 150 ml to fluid some medications require a larger amount of fluid as diluted such as 250 ml

which unit of measurement are most electronical devices expressed in

mL/h

compatibility

medication electrolytes and nutrients are additives that can be combined with an IV solution potassium chloride vitamin b and C and antibiotics are common additives while additives are often pre-packaged in the solution you may need to mix additive and IV solution yourself physician's order will tell you how much additive to administer the amount of type of basic IV solution to use, and the length of time over which additive makes you should infuse

IV solutions are label with the in the solution

name and exact amount of components

never flush

never flush a sluggish IV with the syringe

grade 0

no symptoms

abbreviations for IV solutions identify the concentration

numbers

distinguish basic types of IV equipment

primary line-Archer IV bag connects to longer tubing with a drip chamber (drop counter),roller clamp(rate controller) and injection ports (medicine, fluid,attached to a secondary line) secondary line-smaller IV bag connected shorter tubing with similar to main components is primary line AKA IVPB because it hangs higher than the primary line or confuse are piggyback an intermittent infusion into the primary line rate controller- CONTROLS FLOW RATE infusion pump-DEVICE THAT DELIVERS A SET VOLUME PER MINUTE OR PER HOUR EQUIPPED WITH A LINE TO INDICATE TUBING BLOCKAGE EMPTY BAG syringe pump-INFUSION DEVICE TO WHICH A SYRINGE IS ATTACHED FOR DELIVERY OF INTRAVENOUS MEDICATION PCA pump -PUMPING WHICH THE PATIENT PRESSES THE BUTTON TO THE LIVER PAIN MEDICATION WITH IMPRESS HIS LIMITS FOR ORDER OF AUTHORIZED PRESCRIBER volume control-b u r e t t e chamber calibrated in 1 ml increments with an injection ports which up to 150 mL and meds added peripheral line - central line - PICC line- peripheral and started threaded into Central vein port of the cast-device implanted under the skin connected to a central vein used for long-term intermittent medication administration

match the following terms kvo maintenance fluid replacement fluids therapeutic fluids

provide access to the vascular system help maintain electrolyte balance replace fluids lost from dehydration deliver medications to patients

IV medication can be delivered through saline or Heparin locks intermittently

push

electronic devices

rate controllers, infusion pumps, syringe pumps and patient-controlled analesgia can be used to regulate the flow of IV infusions

an example of an intermittent peripheral infusion device

saline lock

an example of an intermittent peripheral infusion device is

saline lock

slide clamp

sets off the IV solution flow completely without disturbing the floor racing at the roller or screw clamp

grade 1

skin blanched edema less than 1 inch around site cool to touch with or without pain

grade 2

skin blanched edema less than 6in around site cool to touch with or without pain

grade 4

skin blanched translucent skin tight leaking skin discolored bruised swollen gross edema greater than 6 in around site deep pitting tissue edema circulatory impaired moderate-to-severe pain infiltration of any amount of blood product irritated or vesicant

some incompatible attitudes may cause

solution can become cloudy or crystallized if you mix an IV base with a additive that is not compatible you can place the patience help a serious risk

Patient-controlled analgesia (PCA)

technique that allows the patient to control the amount of pain medication delivered through the IV within limits set by the authorized prescriber devices are used by patients in pain, including pain from cancer surgery allows monitor the effectiveness of the pain relief prescription, recording the number of times a patient uses device

find the flow rate in drops per minute 35 ml / h when you're using 60 gtt/ ml microdrip tubing

that's an eyeball 35 gtt/min anything that says 60 it's the same

regulating intravenous infusions

the bag is hung 36 in the patient's heart to allow gravity to draw the fluid through the tubing into a vascular system Weber administers the monitors IV adjust the flow rate using rollers or screw clamps manually delivered IV fluids are usually adjusted in drops per minute

Primary line

the main tubing that delivers an IV infusion usually consisting of a drip chamber clamp and injection ports

peripheral IV therapy

the peripheral IV therapy excessive the circulatory system through a peripheral vein sites are located in hand forearm foot and leg for premature infants the furfrou IV line maybe set up using a vein in the scalp

grade 3

the skin blanched and translucent gross edema greater than 6 in around site cool to touch mild to moderate pain possible numbness

which of the following are functional categories of IV solutions

therapeutic fluids KVO/TKO fluids

which of the following is true of patient-controlled analgesia pumps

they allow patients to control their own medications there are present medications limits according to the prescriber