3390-Intravenous Therapy- Test 1 Material

18G green:

- 18 holes on a golf course green - antecubital area - blood admin./lots of fluids - unless has big huge veins

What is the treatment of Local Infiltration?

- Remove IV/fluids - discontinue the cath. - go to opposite side or more proximal of arm and re-put in saline lock. - hot/warm compress (towel) and wrap it with a pad to elevate if edema is present. DO NOT microwave causes hotspots.

what are the s/s of an air embolism?

- SOB, anxiety, fluttering (palpations), dysrhythmias, chest pain, & nausea

intraosseous IV access:

- a technique in which the bone marrow cavity is used as a noncollapsible vascular entry point - into the bone - most often used as a last resort in emergencies - physician or flight RN initiated - 24 hr use

Dressing Changes: Peripheral - aseptic simple clear window dressing

- additional tape for secured placement - be careful of tape allergies - want to be able to see insertion site - want j loop to be looped and secured - when u start an IV or change the dressing always include date, time, initials - change every 5-7 days or per policy

Types of needles:

- angio-caths (most common used, one used in class) - butterflys - central catheters - central lines

How to prevent cellulitis?

- by educating IV drug users on a way to get access to clean needles - monitoring and accessing IV site - maintaining asepsis

what is the treatment for an air embolism?

- call HCP - place them flat/trendelenburg and turn them onto their L. side, keeps air embolism in place if it is caught early.

what is the treatment for cellulitis?

- change location - restart IV in other arm - remove saline lock - mark edges, administer antibiotics - warm compress

what gauges are ideal to use for trauma pts?

- 14/16 but are rare used or seen in hospitals - 18 most commonly used (14,16,18)

Documentation example:

9/10/12 1522 18 gauge inserted to R forearm x 2 attempts. Remains a SL for medication needs. Patient tolerated well. Understood the purpose and therapeutics of need of IV cath insertion. Cath secured and labeled. ------------------------Nurse Nellie, RN

How to prevent IV complications for adult patients?

Assess - IV site - Patient - Rate of fluids (are they at prescribed rate?) - Site (site care. Changing primary tubing q. 96 hrs.) (secondary tubing, intermittent med. change q. 24 hrs. or per policy. Some places if not disconnected at all change q. 96 hours.)

CATS PRRR to help remember safety checks for administering IV medications:

C - heck compatibility A - clergies T - ubing S - ite care, q. 72 hours or prn P - ump assessment R - ight rate R - eleased clamps R - eturn / reassess ?????

What is the cause of Local Infiltration?

Fluid gets under skin/ leaks under tissue, swelling occurs. This is non vesicant (non-damaging) - little bodies, big/profound - if really bad, fluid can compress nerves & require a fasciectomy.

what is an air embolism (systemic) and the cause?

It is caused by incorrect priming of tubing/J loop or if fluid runs out in the IV pump. - local - air gets into system by IV pump or syringes - air enters into bloodstream and is carried to the R. ventricle, sit there, pushes out in pulmonary system. (small air bubbles are ok, large ones/big volume not ok)

What is cellulitis and the cause?

It is inflammation/infection of the cells. It a common bacterial skin infection. - It can occur from dressing changes not being done to site. - Not cleaning IV site before injecting - weak immune system - IV drug uses (common)

What is phlebitis and the cause?

It is the inflammation of a vein. - it is caused by not cleaning IV site - contamination of site (bacteria, break of asepsis) - pushing medication too fast. - potentially insertion technique - the chemical itself, high pH of drug causing vein irritation (ex: potassium, promethazine)

What are the s/s of cellulitis?

Redness that spreads out under skin - important to mark edges to make sure redness doesn't spread but decreases. If continues to increase over marked lines, this indicates medication is not working.

What is the cause of Extravasation?

This is infiltration of a vesicant. Vesicant (causes damage) to tissue. Damage such as, necrosis, blisters, sloughing skin - IV. cath slipped out of vein leaking into tissue, and med./fluid damages tissue. (ex: dopamine) - pressure of poorly secured IV's

What does a statlock provide?

a standardized method to prevent Catheter movement

24G yellow:

at age 2 & 4, yellow is for the little fellows, sometimes the elders.

Why is it important to check compatibility when giving an IV?

b/c if incompatible it can crystalize and cause irritation to vein. Resulting in phlebitis. Reference drug book to find compatibility info. out.

22G blue:

blue 22 bid a due or just won't do, try to AVOID w/ blood admin. but can if needle, has the potential to destroy RBC b/c size.

You go into a room, to assess a patient with an angiocath. You observe redness, swelling, pain and edema at the insertion site and along the vein. What is this?

phlebitis

20G pink:

pretty in pink at age 20 (common one grabbed)

DO NOT DO OF IV THERAPY. What are Contraindications of IV Placements?

- do not start on side where there is an av fistula - never stick where there is a shunt, can cause clot formation, infection, and rupture - do not stick on same side of mastectomy, lymph nodes are impaired/damaged infection risk increased - do not stick on impaired side/impairment due to decreased feeling (try not to, last resort) - away from edema, infection, blood clot, and infiltration (try not to) - not legs b/c increase risk for thromboembolism (try not to) - do not put IV where restraint is

What are the s/s of Extravasation?

- edema - pain - BLISTERS - NECROSIS - SLOUGHING OF SKIN (IV pump should be alarming b/c it being slower to get med. in)

what are the s/s of fluid overload

- edema (LAST SIGN) - HTN - Tachycardia - increased RR - O2 decreased - crackles in lungs - distended neck veins

what are the s/s of phlebitis?

- edema @ insertion site -redness localized then travels up to vein - pain - purulent drainage - palpable venous cord

Angiocaths (short peripheral) most common:

- goes in the peripheral system - for intermediate use, short term duration, not long term - go for: IV, Meds, Blood transfusions

Implanted: Huber (central vascular access device)

- implanted under skin of the chest via subclavian vein, requires surgery for implant - long term use - usually seen with cancer pts. - can draw blood from

What are some IV Complications?

- infiltration or extravasation (Scales) - phlebitis or thrombophlebitis (Scales) - Air embolism - Fluid overload - Cellulitis - Dislodgment

Peripherally Inserted Central Catheter: (central vascular access device)

- inserted into the vein of the arm - inserted in antecubial fossa of upper arm where the cephalic vein is located - advance up and into until SVC is reached - help in place w/ sutures/cuff to prevent infection - most used - long term antibiotic use - pt. can go home w/ these

Central Venous Catheter: (central vascular access device)

- inserted w/ intent that is is needed for several weeks - put in by HCP, done at bedside - short term venous access w/ a peripheral line is not easily used - sutured against chest

How to prevent phlebitis?

- monitor and assess - avoid flexion areas - learn high pH meds. - rotate sites every 72 hrs. or per policy - ensure cath. is secured - maintain aseptic technique

How to prevent Extravasation?

- monitor and assess site - if cath. is not stabilize and wiggles, fluid will leak out & cause this, so want to ensure stabilization of cath. - watch out for joints, this can cause wiggle out/ and avoid areas of flexion. - educate patient if it feels tight/swelling to call nurse - do not do BP on arm with IV pressure

How to prevent Local Infiltration?

- monitor and assess site - if cath. is not stabilize and wiggles, fluid will leak out & cause this, so want to ensure stabilization of cath. - watch out for joints, this can cause wiggle out/ and avoid areas of flexion. - educate patient if it feels tight/swelling to call nurse - do not do BP on arm with IV pressure

External Tunneled (Hickman, Broviac, Groshong): (central vascular access device)

- permanent, long term - surgery required insertion - can give fluids, meds., nutrition - in through subclavian or jugular - external & its tunneled

14G (orange) + 16G (grey):

- rarely used - but when you see used, these will be used on pts. that need large amounts of fluids and blood - trauma patients - at age 14/16 you thought you were the biggest/baddest

what are the s/s of Local Infiltration?

- redness - irritation - COOL TO TOUCH - edema - tender/spongy feeling - burins sensation

what is the treatment of phlebitis?

- remove IV - warm compress - restart IV proximal / other arm

How to prevent an air embolism?

- remove air in tubing - follow proper dressing changes - making sure tubing is tight, twist/lock cap - do NOT let fluids run dry, catch it before. Program pump to leave 50 ml so it does not run dry and pump air. - filters on IV tubing

what is the treatment for fluid overload?

- stop the infusion - raise HOB - O2 stat. / V.S give oxygen - give diuretics - monitor I&O - weight them daily - continue to assess/monitor

What is the treatment of Extravasation?

- stop the med. going in, disconnect everything, leave saline lock in and aspirate as much as you can out to prevent further damage. - give antidote if one available, want to stop tissue eating, then discontinue saline lock - apply cold therapy (constricts) prevents spread out of med., keeps it localized.

Important things to notes about the butterfly needle:

- this can be used for a one time med. administration, rarely ever seen for this use though b/c has an increased risk for phlebitis (inflammation of a vein) and can lead to extravasation of the vein (where med. passes out of the vessel into the tissue itself, causing damage) - typically use for phlebotomy - pinch up butterfly wings to inset

Procedure for angiocath continued:

- we always like to start distal then proximal, so low then move up as needed 1. apply tourniquet & locate vein - sometimes dangling hand off bed/warmth helps find vein - palpate vein, they are spongy - tendons will move as joint moves - if hard/moves = tendon - veins can harden over time, avoid. - avoid dominant hand/wrist if u can 2. release tourniquet 3. Don gloves & eye protection if necessary 4. place towel or pad under area 5. scrub site with alcohol - don't touch after clean site, clean in a circle 6. reapply tourniquet - 10 to 15 cm above cleansed area 7. stabilize vein & instruct pt. prior to stick & spread skin taught 8. insert needle BEVEL UP 15-30 deg. angle (eases transition into skin) 9. observe flashback & advance 1/4 in 10. thread cannula into vein 11. release tourniquet & stabilize hub & apply pressure 12. connect IV tubing or j-loop to hub of cannula while stabilizing the device & flush **some place a 2x2 under the hub in this process to catch any potential blood with the connection process. If used, the 2x2 is removed prior to dressing change.** 13. Secure site w/ tape and dressing - transparent dressing over hub (not j loop) with insertion site covered and visible - label: date, time, initials - statlock securement device or tape 16. documentS

what gauge is most ideal for blood administration?

-20G (pink) - but 20G & are good for adults w/ continuous or intermediate infusions

How to prevent IV complications for Infants & children?

-Assess more frequently - infiltrations can be more profound in the little ones.

what is fluid overload and the cause?

-It is an IV complication that occurs from giving too fast of a drip rate. - an electrolyte imbalance can cause this. - immobility - kidney problem patients.

How to prevent fluid overload?

-Monitor infusion and assess ur patient -Know cardiovascular/renal history - Do NOT "catch up" fluids - and understand elderly are at risk

Procedure: Angiocath as a Saline lock

1. Verify the order 2. Gather equipment -. angiocath (determine size needed) - trauma: 18G (or for a child 22/24G) - Grab start kit (tourniquet, tape, transparent dressing, antiseptic chlorhexidine sln, 2x2 gauze, label) - clean gloves - J loop w/ needless connection - drape for under arm - 5 to 10 ml profiled syringe (NS) - stat. lock (stabilization device) if available & policy 3. Prepare equipment w/ saline infused ready for connection with access 4. Identify and prepare patient/educate - purpose of VAD (meds, IVF, procedures) - notify nurse w/ s/s/ of complications (redness, pain, tenderness, swelling, bleeding, drainage/leaking)

Dressing change procedure:

1. hand hygiene 2. ID patient 3. remove old IV site while securing device w/ nondominant hand 4. assess securement device's need to be changed 5. clean site and allow to dry (30 secs) 6. apply new op-site dressing (Transparent Semipermeable membrane-TSM) 7. secure hub and tubing with tape 8. label dressing change

what gauge is most ideal for elderly/children with small veins?

22G (blue) 24G (yellow) 26G (violate)

What gauges are ideal to use on neonates?

24G (yellow) 26 (violet)

what is dislodgment?

This is when the needle/cath. pops out of place. Make sure it is secured good. Always assess! Use arm board, or gauze netting to cover to help prevent!

You go into a room, to assess a patient wit an angiocath. You observe edema, skin blanching, skin coolness, leakage at the puncture site, and absent back flow of blood. What is this?

infiltration

What is phlebotomy?

it is the art of drawing blood labs & evaluation

How often should TPN tubing be changed?

q 24 hrs - this is nutrition and is high in sugar. bacteria proliferates through central line.

How often should secondary tubing be changed?

q. 24 hours or per policy

How often should Primary tubing be change?

q. 96 hours or per policy used for intermittent meds.

When choosing IV gauge remember:

smaller the # = larger the needle diameter (gauge)