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I.V. therapy


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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
determine allergies
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
lactate ringers
5% dextrose in H2O
Client's on isotonic solutions should be assessed for ?

bounding pulse

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
blood draws
IV push (bolus)
central catheter
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

#22 gauge
used for frail, elderly

rarely last more than 1 or 2 infusions
IV insertion

#20 gauge
used for standard adult infusions
IV insertion
#18 gauge
used for standard infusions
some irritation
allows for higher rate of infusion than #20.
IV insertion

#16 gauge
used in surgical clients, major surgery of trauma
IV insertion

#14 gauge
wants to make sure blood stays whole.
What is the best vein for IV insertion?
distal of arm first
non-dominate arm
easily palpated
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
rolling veins
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
bounding pulses
Complications associated with hypervolemia.
pulmonary edema
cardiac failure
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
chest pain
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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