Glossary of I.V. therapy
- prime volume
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- What is an advantage of I.V. route?
- rapidly absorbed
- What is a disadvantage to I.V. therapy?
- limited to highly soluble drugs
drug distribution is limited by poor circulation.
- Several reasons for intravenous therapy.
- rapid effect is required
medications are too irritating to tissues by other routes
when i.v. line is already established, avoids discomfort of other parenteral routes
- What should the nurse assess before beginning an I.V. line?
- signs of infection, infiltration, or a dislocated catheter
inspect surrounding skin for redness, pallor or swelling
palpate for coldness edema
take vital signs
check compatibility of medications
- What is Phlebitis
- infection of a vein due to mechanical or chemical injury
- Clinical signs of phlebitis
- redness, warmth, swelling, at the intravenous site and burning and pain along the course of the vein.
- What is infiltration?
- when an I.V. needle becomes dislodged from the vein and fluid flows into the interstitial space causing swelling
- What are signs of infiltration?
- swelling, pallor, coolness, and discomfort, at the I.V. site.
- Large volume infusions.
- is the safest way to administer drug by I.V.
diluted in volumes of 1000ml-500ml.
normal saline and ringer's lactate often used.
commonly added drugs are potassium chloride and vitamins.
- The main danger when infusing large volumes of I.V. fluids.
- can cause circulatory overload=hypervolemia
- intermittent intravenous infusions
- medication mixed in small amount of solution 100mL - 50mL.
administer every 4 hours or regular intervals for short period of time.
setup by piggy back or tandem
can also be in a syringe, via mini infuser
- volume control infusion
- way to administer intermittent medications.
small fluid containers 100ml-150ml
attached below primary infusion into I.V. line
commonly used for children/older adults
volume must be carefully monitored.
- Intravenous push
- is an undiluted drug directly into the systemic circulation. used in an emergency or when a medication cannot be diluted. can be introduced directly into a vein by venipuncture or into an existing line w/in port or IV lock
- Two major disadvantages to intravenous push methods.
- errors cannot be corrected after drug is introduced
drug may cause irritation to the vein lining.
- intermittent injection port
- resealabel latex injection site for needle access or a port that allows a syringe or a needleless adapter to be connected for administering medications.
- Advantage to a intermittent infusion port
- allows a closed system to be maintained
long term use
can be implanted under the skin
eliminates repeated needle sticks
- Two secondary IV lines.
- Piggy back IV
- used solely for intermittent drug administration.
connected to the primary tubing at the upper port of the primary container
- a second container is connected to the primary container at the lower, seconday port.
used with intermittently or simultaneously with the primary solution
- isotonic solutions
- same concentration of solutes in the blood plasma. most i.v. solutions are isotonic
- Examples of Isotonic solution
- 0.9% NaCL normal saline
5% dextrose in H2O
- Client's on isotonic solutions should be assessed for ?
- Why should 5% dextrose in H2O (D5W) be avoided in clients with intracranial pressure?
- can increase cerebral edema
- Hypertonic solutions
- > concentration of solute or higher osmolality than body fluids
draws fluid out of intercellular & interstitial spaces into the vascular compartments
- Examples of hypertonic solutions.
- 5% dextrose in normal saline(DSNS)
5% dextrose in 0.45% NaCl(D51/2NS)
5% dextrose in lactated ringers (D5LR)
- Who should not receive hypertonic solutions ?
- clients w. heart disease
clients w. kidney disease
clients who are dehydrated
- With hypertonic solution a nurse should assess the client for ?
- Hypertonic solutions used to treat?
- < concentrations of solute or lower osmolality than body fluids.
provides free H2O and treats cellular dehydration
promotes waste elimination by the kidneys
- Examples of hypotonic solutions.
- 0.45% NaCL (1/2 normal saline)
0.33% NaCL (1/3 normal saline)
- hypotonic solutions should not be used for clients DX with?
- IICP Increased Intracranial Pressure
third space shift
- location for
IV push (bolus)
- basilic and median cubital veins in the antecubital space
- locations for intermittent or continuous infusions
- hand, basilic, cephalic, metacarpal veins
- Sites used for long term IV therapy, parenteral nutrition, or medications that are damaging
- central venous catheters- inserted into subclavian or jugular vein w/ catheter superior to the vena cava.
PICC- inserted in the basilic or cephalic vein above or below the antecubital space of the RIGHT arm.
- What is the height of the IV pole to facilitate flow?
- about 1 m= 3 ft.
- Why is the tubing primed when beginning an IV?
- to prevent air from entering the client
- Unless contraindicated which arm should be used when starting an IV?
- the client's non dominate arm.
- Why is if necessary to dilate the veins before starting an IV?
- makes it easier to insert the needle properly.
- What should the nurse do or have the client do if it is difficult to dilate the vein?
- massage or stoke the vein
have client clench and unclench fist
lightly tap the vein
if these steps fail, remove tourniquet and apply heat to the entire extremity for 15 minutes
- If using a anti-infective solutions such as providone-iodine or betaine, what should the nurse assess for before applying the anti-infective to the skin?
- allergies to shell fish
- Why should the nurse pull the skin tight below the injection site when starting an IV?
- stabilizes the vein
makes the penetration less painful
- At what angle does the nurse use when beginning the IV?
- 15 to 30 degree angle
almost parallel when you feel a lack of resistance
- Once blood appears in the lumen during IV insertion how much further should the nurse advance the needle?
- 0.5 to 1 cm= 1/4 inch.
- What information is labeled on the IV site?
- date and time of insertion.
type and gauge of needle or catheter used.
and nurse's initials
- How far does the nurse advance the catheter when inserting an IV?
- until the hub is at the venipuncture site.
- The larger the gauge
- the smaller the needle
- IV insertion
- used for frail, elderly
rarely last more than 1 or 2 infusions
- IV insertion
- used for standard adult infusions
- IV insertion
- used for standard infusions
allows for higher rate of infusion than #20.
- IV insertion
- used in surgical clients, major surgery of trauma
- IV insertion
- wants to make sure blood stays whole.
- What is the best vein for IV insertion?
- distal of arm first
naturally splinted by bone
large enough for adequate circulation around catheter.
- What veins should be avoided when selecting an IV insertion site?
- areas of flexion
damaged by previous use
continually distended with blood or knotted or torturous.
in a compromised extremity
- How long should the nurse clean the injection site before insertion?
- 30 sec.
- signs of hypervolemia
- dyspnea=rapid labored breathing
cough=crackles in the lung bases
- Complications associated with hypervolemia.
- pulmonary edema
- What does a rapid flow of solution into the drip chamber indicate ?
- a patency of the IV line.
- How often is IV tubing changed?
- every 48 to 96 hours
- Serum osmolatlity
- is a measure of solutes concentration of the blood. Values are used primarily to evaluate fluid balance
- normal osmolatlity values
- An increased serum osmolatlity indicates?
- fluid volume deficit
- a decrease in serum osmolatlity indicates?
- fluid volume excess
- hypotonic solutions
- lesser concentration of solute than plasma
- examples of isotonic solutions
- 0.9% NaCl (normal saline)
Lactated Ringer's =a balanced electrolyte solution.
5% dextrose in water (D5W)
- examples of hypotonic solutions?
- 0.45% NaCl (one- half normal saline)
0.33% NaCl ( one-third normal saline)
- examples of hypertonic solutions?
- 5% dextrose in normal saline (D5NS)
5% dextrose in 0.45% NaCl (D5 1/2 NS)
5% dextrose in Lactated Ringer's (D5LR)
- Why does a nurse prime an I.V. tube before beginning IV therapy?
- to prevent air from entering the client.
- For tubing with air vents, the nurse knows ?
- she should not remove the cap, the fluid will stop as soon as liquid enters the cap.
- Intermittent or continuous infusion sites?
- What risk are associated with CENTRAL VENOUS CATHETER?
- pneumothorax on catheter insertion.
- The client with a CENTRAL VENOUS CATHETER should be closely monitored for?
- shortness of breath
- Reasons for a PICC
- reduced risk of pneumothorax
long term intravenous access when the client will be managing IV therapy at home.
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