🤲 Intravenous Therapy & Blood Administration
What filter is used for most solutions?
0.22 micron filter
What are the STEPS to Dressing an infusion site?
1) Take a 3 inch piece of tape and rip it in half lengthwise 2) Put 1 piece on the back of your glove 3) Place the tape under the extension tubing and criss cross the tubing Remove the backing of the transparent off 2) Apply one edge of the dressing then smooth the remaining over the IV site 3) Smooth the edges around the IV site 4) Place 1 inch piece of tape over the Luer lock under the transparent dressing
what should you do if you suspect that a patient has an air embolism?
1) clamp the tubing 2) turn the patient on the left side with the head of the bed lowered (Trendelenburg position) 3) Notify the RN and/or HCP
For solutions containing lipids or albumin what filter is used?
1.2 micron filter
How often should the Venipuncture site be changed ?
Every 72 to 96 hours
Which drip chamber is used if the solution is thick or sticky fluids such as blood and needs to be infused rapidly and drops 10 to 20 drops per mL?
Macrodrip Chamber
Which drip chamber is used if the fluid needs to be infused out of slow rate less than 50mL per hour , or if the solution contains a potent medication & delivers about 60 drops per mL?
Microdrip Chamber
While assessing for a vein and you began to feel it pulsate should you still stick?
No if it's pulsating then it is an artery not a vein
How do you assess the veins?
Palpate the vein it should feel bouncy
An inflammation of the vein that can occur from mechanical or chemical trauma from medication or a local infection is called
Phlebitis
Taut means to
Pull tight or stretch
If the secondary or piggyback IV set is positioned properly , what should you expect to happen?
The primary bag will began to flow as soon the secondary or piggyback IV is finished
It is mandatory to use an infusion pump when patients are receiving
Total Parenteral Nutrition (TPN) or critical care meds
What supplies are needed for dressing an infusion site?
Waterproof pad or towel tape Transparent dressing 2 × 2-inch gauze pads Clean gloves
———————-When should the IV dressing be changed ?
When wet or containmented
After inserting the vascular access device, how do you know if the bevel of the needle has entered the vein?
You'll see a blood return in the flashback chamber
A bolus of air that enters the vein through an inadequately primed IV line, loose connection, changing the tube, or removing the tube
air embolism
What are the s/s of hematoma?
blood at the site hard and painful lump at the site ecchymosis
A large vein in your neck bulges visible is called
distended neck veins
Whenever a prescribed IV rate is increased what should the nurse monitor for?
increased HR, RR, or lung congestion that can indicate fluid overload
an entry of microorganisms into the the body via IV
infection
what happens if you rub an infiltration?
it cause a hematoma
small dose of medication administered by IV is
bolus
If an IV infusion is running behind schedule what should you do?
collaborate with the PHCP to determine the patient's ability to tolerate an increased flow rate, especially if the patient has cardiac, pulmonary, renal, or neurological condition NEVER increase the rate of an IV infusion to catch up if the infusion is running behind schedule
discoloration of an area of the skin or membrane cause by blood seeping into the tissue as a result of a contusion
ecchymosis
what are the s/s of circulatory overload?
elevated BP distended neck veins dyspnea wet cough crackles
What prevent particles from entering the vein such as undissolved medication or salts that have precipitated from solution?
filter
When a secondary or piggyback IV set is being used, the primary infusion is interrupted to?
give medications such as antibiotics and antineoplastic
What are the s/s of phlebitis?
heat, redness, tenderness at the site Low flow of IV
Where should a secondary or piggyback IV set be hung?
higher than the level of fluid in the primary bag so that gravity forces it to empty first
what patients are at greater risk of infection through an IV?
immunocompromised patients chemotherapy patients Older adult patients diabetic patients
What are the s/s of infiltration?
pain , swelling, coolness, numbness at the site no blood return
Because there is no solution continuously infusing through the saline lock in an intermittent infusion device what must be used to flush the device to maintaining patency by keeping a clot from forming at the tip of the catheter ?
saline or diluted heparin on rare occasions
what are the s/s of infection via IV?
tachycardia redness swelling fever malaise n/v
What are the s/s of air embolism?
tachycardia angina hypotension LOC (level of consciousness) cyanosis
IV drugs must be pushed slowly over
1 minute or over
What are the 5 steps to spiking an IV tubing?
1) Hold the IV bag in your non dominant hand upside down 2) Remove the sheath from the IV tubing port on the IV bag or bottle 3) Remove the protective cap from the IV tubing spike 4) Without Contaminating insert the IV tubing spike into the IV tube port on the IV bag or bottle and twist it on 5) Invert the IV bag or bottle and hang it on the IV pole
What supplies do you need for setting up an infusion site , IV tubing, & solution?
1) IV starter kit : tourniquet 🎀, 2 x 2 inch gauze pads, tape, transparent dressing , cleansing agents such as alcohol wipes or Chloraprep , label, drape 2) IV extension tubing with needleless adapter 3) Luer lock hub for extension tubing * if needed * 4) 20 or 22 gauge ; 1 inch IV catheter 5) Prefilled 0.9% NS syringe (pigtail ) 6) Curos cap for extension tubing 7) IV administration set 8) IV solution bag or bottle with label 9) Saline lock or IV plug 10) gloves
What are the 3 STEPS to priming an IV tubing?
1) Lightly squeeze the IV drip chamber to fill about 1/3 to halfway 2) Use the roller clamp to open to allow the solution to travel from the drip chamber down to the entire length of the tubing 3. Ensure that all of the air has been removed
What should you do if you suspect that the patient has an IV infection?
1) Notify the RN or HCP 2) Remove the IV 3) Place the venipuncture device in a sterile container for possible culture 4) Restart the IV in the opposite arm to prevent sepsis
What are the 5 STEPS to Preparing the IV Tubing & Solution?
1) Open all of your supplies and keep in package : a- prime prefilled syringe and attach to IV extension tubing and flush b- loosen the cap of the IV extension tubing c- attach Luer lock onto extension tubing * if needed* 2) Assess the IV solution for tears or leaks (for 3rd time to ensure the 6 rights of medication administration) 3) Open the IV administration set using aseptic technique 4) Fill out the label and attach just below the drip chamber 4) Close the roller clamp 5) Spike the IV bag & Prime the IV tubing
1. What are the 11 STEPS to Preparing an infusion site?
1) Perform Hand Hygiene 2) Provide privacy 3) Explain the procedure to the patient 4) Raise the bed to comfortable height 5) Place the patient in seated position 6) Ask the patient which arm is non dominant & place a drape under the selected arm 7) Perform Hand Hygiene & Don gloves 8) Put on the tourniquet & Assess the veins 9) Check the radial pulse & select a well dilated vein 10) Remove gloves & Perform Hand Hygiene 11) Prepare the IV Tubing & Solution
2. What are STEPS 1 - 14 to performing a Venipuncture?
1) Put on gloves 2) Apply the tourniquet and assess the veins 3) Once you locate the insertion site & remove the tourniquet 4) Clean the insertion site with alcohol pad or Chloraprep for 30 seconds and let it dry 5) Reapply the tourniquet 6) Use your non dominant hand to taut the skin to stabilize the vein 7) Let the patient know that you will warn them when you are to going to stick 8) Place the IV catheter on top of the vein at an 10 to 15 degree angle 9) Tell the patient to relax their arm and that you're going to stick 10) Insert and puncture the skin with the vascular access device and watch 👀 for a blood return in the flashback chamber 11) Lower the catheter until it's flush with the skin 12) Advance the catheter about 1/4 inch into the vein until the catheter hub rests on the vein 13) Loosen the stylet (needle) 14) Apply gentle pressure above the insertion site with non dominant hand
what should you do to discontinue an IV?
1) Remove the IV 2) Elevate the extremity 3) Apply pressure to the site for 2 - 3 mins or longer for patients with bleeding disorders or patient taking anticoagulants & ice
What should you do if you suspect that the patient has an phlebitis?
1) Remove the IV 2) Notify the HCP 3)Restart the IV in the opposite arm
What should you do if you suspect that the patient has an infiltration?
1) Remove the IV immediately 2) Elevate the extremity 3) Apply a warm or cool compress over the affected area
What should you do if you suspect that the patient has an circulatory overload?
1) decrease the flow rate at a keep-vein-open-rate 2) Elevate the head of the bed 3) Keep the patient warm 4) Check lung sounds 5) Assess for edema 6) Notify the HCP
The intravenous prescription is 1000 mL of 0.9% NaCl (normal saline) to run over 12 hours. The drop factor is 15 gtts/ 1 mL . The nurse plans to adjust the flow rate to how many gtts/minute?
1000 mL x 15 gtt / 720 minutes = 15,000 mL / 720 minutes = 20.8 or 21 gtts/ minute
2b. What are STEPS 15 - 22 to performing a Venipuncture?
15) Pull the catheter off the stylet (needle ) until the catheter hub rests at the insertion site alone 16) Quickly release the tourniquet with dominant hand 17) Attach the IV extension tubing with the prefilled syringe and release pressure off the vein 18) Aspirate for blood return then slowly flush while assessing for infiltration at the site 20) Place tape across the catheter hub 21) Cleanse the needleless adapter and connect the IV tubing 22) Slowly open the roller clamp to start infusing
For standard IV fluid infusion and clear liquid IV medications, what gauge needle is used?
20 or 22 gauge
If the patient has very small veins what gauge needle is used?
24 or 25 gauge
The intravenous prescription is 3000 mL of 5% dextrose in water (D5W) to run over a 24-hour-period. The drop factor is 10 gtts/ 1 mL. The nurse plans to adjust the flow rate to how many gtts/ minute?
30,000 mL x 10 gtt/ 1440 minutes = 30,000 mL/ 1440 minutes = 20.8 or 21 gtts/minute
Medications added through secondary or piggyback must be diluted in how many mL?
50 - 150 mL of solution
Phlebitis can cause the development of
A clot - thrombophlebitis
IV drugs must be pushed rapidly over
A few seconds
How can you easily identify the difference between a macrodrip or microdrip chamber?
A microdrip chamber has a short vertical stylet where the drop forms and the macrodrip doesn't
When picking an insertion site, you want to make sure that it won't interfere with
ADLs The use of an assistive device Planned procedures
How should you apply a tourniquet on a patient?
Apply the tourniquet 4 - 6 inches above the insertion site into a quick release loop * tie into a one eared bunny*
When selecting a vein, you should avoid areas where
Areas that is red, tender , rash, pain, or infection Any extremity that is affected by paralysis, shunt, CVA or mastectomy Areas that are distal to a previous venipuncture Veins that are sclerosed, hardened, or phlebitic
What may be prescribed when the Venipuncture site is located in the area of a flexion?
Arm board
Fluid overload from the administration of fluids too rapidly and/or in a patient that is at risk for fluid overload
Circulatory Overload
How do you prepare an IV solution that is in a bottle?
Clean the rubber stopper with alcohol swabs
How do you prep the skin with an alcohol swab?
Clean, the skin horizontally , vertically , then in a circle on and around the site and let it dry
What should you do if you suspect that the patient has an hematoma via IV?
Discontinue the IV
Which infusions device is used to control the amount of fluid or medication infusing via infusion pump or controller, syringe pump, or patient controlled analgesia (PCA) & needs to be checked frequently ?
Electronic infusion device
Fluid overload or electrolyte imbalance can occur from?
Excessive IV fluids Rapid infusion of IV fluids
Patients who receive IV fluids must be monitored for s/s of ?
Fluid Overload such as sudden weight gain crackles in the lungs peripheral edema
What areas should you search for when assessing the veins ?
Hand Antecubital area for basilic and cephalic
The collection of blood in the tissues after an unsuccessful or discontinued venipuncture ?
Hematoma
What labs should you monitor for when a patient receiving IV fluids?
I&O electrolytes blood urea nitrogen (BUN) Serum Creatinine
What should you assess the IV solution bag or bottle for?
IV Bag: 1) Check for tears 2) Squeeze the bag for intactness IV Bottle: 1) Check for cracks Check the solution for cloudiness or discoloration
IV drugs must be given by
IV piggyback
Seepage of IV fluid out of the vein and into the surrounding tissues that occurs from an IV device being dislodged or perforating the wall of the vein
Infiltration
Any IV fluid administered has to be included in portion of the assessment?
Intake
Which infusion device is used when intravascular accessibility is desired for medications by IV push or piggyback And requires periodic flushing?
Intermittent Infusion Device
A drug that needs to enter the bloodstream quickly or a large dose of a drug must be given
Intravenous (IV) route is injected directly into the vein
What allergy contraindicates IV therapy?
Latex
How should you use chloraprep ?
Pinch the wings until it cracks to release the antiseptic and proceed to cleanse the insertion site as usual
How do you prep & prime a prefilled normal saline syringe?
Pull down on the plunger to release pressure Push plunger in until saline comes out
What veins should be used for infants when administering an IV?
Scalp Feet
What should you do if air bubbles appear while priming an IV tube?
Slightly tap the tubing
Where should you never put an insertion site on a patient?
The inner wrist because it has a lot of nerves
How long should you scrub the cathether hub?
at least 15 seconds
