IV Therapy & Insertion

What are the gauge sizes of IV needles with their corresponding colors and what their common uses are?

14G- orange; trauma situation 16G- gray; trauma, surgeries, large volume infusions 18G- green; blood transfusions, large volume infusions 20G- pink; multi-purpose, hydration, meds, routine therapies 22G- blue; small veins, elderly/pedi patients 24G- yellow; very fragile veins, elderly/pedi patients

What is ASAS? When do you need to do it?

Aspirate: this is to verify blood return and you only really need to do this with IV's that are saline locked Saline: you flush first before the med to flush and prime the line for the medication Administer: push the med according to the correct amount of time needed to administer it Saline: you'll flush the line one more time after administration (PUSHING THE SAME RATE AS THE MED ADMINISTERED) to ensure all of the medication has gone into the vein and to then saline lock it with positive pressure and keep the line patent

What supplies are needed to insert a IV catheter?

IV catheter IV start kit (skin prep, tegaderm, tourniquet, tape) local anesthetic (lidocaine, EMLA, cold spray) IV tubing and IV solution Saline lock

Who can insert a IV catheter?

It depends on governing boards that set certain standards for the scope of practice for particular roles (Texas Board of Nursing, Nurse Practice Act, Facility Policy and Procedure)

What does KVO mean?

KEEP VEIN OPEN the usual rate for this is at least 15gtt/min

When administering an IV push medication, what should you know beforehand about the medication?

What is the normal dose does it have to be diluted how fast can it be administered compatibility with other medications potential complications, side effects, adverse reactions, nursing implications

Are IV fluids treated as medications?

YES this is because there are different types of fluids for different therapeutic effects for the patient

What would you document after the insertion of an IV catheter?

any assessment findings IV catheter size IV site location IV solution and rate it was started at patient response any teaching provided number of attempts taken to get it

Why do you need to prime tubing before hooking it up to the IV catheter?

because if you do not prime it air will go into the patients veins and can kill the patient

What is circulatory overload in relation to complications of IV fluid therapy? Signs and symptoms?

caused by the rapid administration of fluids or the prolonged administration of fluids which then causes the body to have excess fluid signs and symptoms: dyspnea, adventitious lung sounds (rhonchi), peripheral edema (pitting edema), hypertension, tachycardia

What are the different types of IV fluids?

hypertonic: this pulls water from the cells isotonic: this doesn't remove or push water into the cells and just replenishes the cells (0.9% normal saline) hypotonic: this pushes water into the cells

What can cause infections related to IV therapy? Signs and symptoms?

improper cleaning of the site prior to IV insertion and improper cleaning with med and fluid administration can lease to bacteria to enter the blood stream which can then lead to septicemia signs and symptoms: edema, erythema, and exudate at the site; fever (100.4 or higher), altered mental status, hypotension (late sign)

What is phlebitis in relation to local complications of IV catheters? Signs and symptoms?

inflammation of a vein related to mechanical or chemical irritation signs and symptoms: pain/tenderness, erythema (can be along the vein or around the surrounding tissue), warm to touch, slow flow rate of IV fluids/medications

What can happen if you push a medication too quickly?

it can cause damage related to the vein or other parts of the body dependent of the type of medication

What can happen if you do not dilute a medication?

it can cause vein/tissue damage

What is secondary tubing used for?

it is used for any meds being hanged by gravity or infused with the IV pump (like antibiotics)

What is extravasation in relation to local complications of IV catheters? Signs and symptoms?

leakage of vesicant fluids or meds (such as potassium, dopamine, epinephrine) from the vein due to displacement into the surrounding tissues signs and symptoms: pain, swelling, redness, stinging/burning at the site, if severe enough it can cause tissue death and necrosis

What are some special considerations when selecting a vein when placing an IV?

pedi: will be scared/nervous and you may need support staff or parents to hold the patient still older: loose skin, fragile veins, may need to use smaller IV needle gauge blood thinner patients: may be excess bleeding/ bruising

What can you do if you are having trouble finding a vein for IV insertion?

stroke the extremity from distal to proximal below the proposed site warm the extremity place the extremity in a dependent position

What is IV therapy?

the ability to administer medications, blood products, and fluids with an intravenous catheter

What is infiltration in relation to local complications of IV catheters? Signs and symptoms? How should you respond?

the displacement of the IV catheter from the vein into the patients soft tissues signs and symptoms: edema of affected extremity, cool skin, pain, IV will no longer aspirate blood stop any fluids immediately, must remove the IV, give a hot compress, then elevate the arm to promote the getting rid of excess fluid, determine if another IV will need to be placed

Why is checking the compatibility of medications important?

this is because if you mix any incompatible meds together in an IV it can cause precipitate which crystalizes the vein

What are pulmonary emboli in relation to complications of an IV? Signs and symptoms?

tiny clots can forma to the end of the IV catheter in the vein which can then break off from the catheter and then travel through the blood stream to the lungs there are also different types of clots as well: fibrin sheath (fibrin is a natural byproduct of the blood) intraluminal clot mural thrombosis venous thrombosis (This is why it is important to consistently flush the IV) Signs and symptoms: chest pain, sudden shortness of breath, frequent coughing, hemoptysis (coughing up blood)

What are some goals of IV fluid therapy?

to correct/prevent fluid imbalance to correct/prevent electrolyte imbalance to facilitate the administration of IV medications

What is a Gahart book used for?

to look up information on any specific drug where you can check normal dose, push time, and compatibility with other meds/fluids

What should you look out for when selecting a vein when placing an IV?

try to go on the nondominant hand/arm of a patient straight veins pick a vein that would be undisturbed by joint movement (try not to go in a vein in the AC) a vein that would accommodate the IV gauge you need

What is primary tubing used for?

used for the PRIMARY solution being given to your patient (like saline)

What should you do for your assessment before inserting an IV?

verify the providers order obtain a patient history (especially if they have a fistula/graft, mastectomy, any IV drug use) ask about any tattoos, scars, or burns (no poke tattoo if fresh, and try to avoid them) (do not poke scars/burns if you can avoid them as they're hard to stick through)