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