| Nursing responsibilities for IV sites | assess site whenever in room, document at least every 8 hours, site CDI (clean, dry, intact), sterile technique, changine tubing and solution, awareness of complications, awareness of fluid types, 5 rights |
| Complications of IV therapy | Pain and irritation, infiltration and exravasion, occlusion, loss of patency, phlebitis, fluid overload |
| Infliltration | seepage of IV fluids into tissue when IV cath penetrates vein |
| Extravasion and Infiltration Assessment | swelling, pain, cool to touch, decreased flow, wet dressing, no back flow. |
| Causes of Infiltration and Extravasion | catheter permeates vein, poor taping of site, over manipulation |
| Intervention for Infiltration and Extravasion | Remove IV, cool compress |
| Occlusion causes | kinked tubing, patient lying on tubing, infusion too slow |
| Occlusion assessment | IV stops dripping |
| Occlusion intervention | milk IV, aspirate, irrigate (if no resistance OK, if resistance may be clot> |
| Occlusion Prevention | don't let IV run dry, flush periodically with 1-5 cc of NSS and before and after any intermittent IV therapy. |
| Phlebitis Causes | bacterial, chemical, mechanical |
| Phelebitis Intervention | remove IV, cool compress |
| Phlebitis Assessment | erythemia, pain or burning, warmth, edema, cordlike vein. |
| Phlebitis possible causes: | IV left in too long, irritating fluids, clot at tip of cannula, cath too large for vein |
| Crystalloids | clear fluids, dextrose or saline, can be Iso, Hypo or Hyper tonic |
| Colloids | cloudy, yellowish, used to raise osmotic pressure, Dextran is clearish |
| Isotonic IV | same tonicity as body 0.9% NSS |
| Reasons to give an Isotonic IV | Hypotension (increases BP), Hypovolemia |
| Complications of Isotonic IV | fluid overload |
| Examples of Isotonic Solutions | 0,9% NSS, D5W(isotonic in bottle, hypotonic in body), Lactated Ringers |
| Reasons to give a Hypotonic IV | Will cause fluid to shift from intravascular to intracellular space. |
| Indications for Hypotonic IV | dehydration |
| Hypotonic Solutions | .45% sodium chloride, 5%dextrose water (becomes hypotonic in body) |
| Complications of hypotonic solution | May cause edema |
| Reasons to give a hypertonic IV | low bp, slight edema but not w/CHF, pulls fluid from intracellular space to intravascular space |
| Hypertonic IV Solution | Not as strong as Albumin, 10% Dextrose in Water D10W, 5% normal saline, D5 Ringers Lactate |
| Complications of Hypertonic IV | more fluid in bloodstream can cause circulatory overload. |
| PCA stands for: | Patient Controlled Analgesia |
| 3 settings of PCA | drug dosage, lockout period, basal rate |
| Central Venous Therapy Indications | inadequate vascular access, complex treatment regimes, hyperosmolar infustions ie parenteral nutrition, irritating or vesicant druges, (ie. dopamine cancause necrosis) rapid absorption, long term therapy. |
| Contraindications for Central venous therapy | altered skin integrity, anomalies of central vasculature, cancer in area, coagulopathies, fractured clavicle, septicemia, radiation to insertion site |
| Common insertion pathways for Central Venous Therapy | subclavian, jugular, femoral vein, cephalic vein(is peripheral but the line runs to central area) |
| Risks and Complications of Central Venous Therapy | Air embolism, pneumothorax, sepsis,chest pain, confusion, hypotension, dyspnea, pallor, tachycardia, tachypnea, unresponsiveness |
| Components of Intravenous Nutritional Support | amino acids, carbohydrates, electrolytes, minerals, vitamins, lipids, other (ie insulin) |
| Lipids in Intravenous Nutritional Support | lipids are administered via Piggy back. (white, thin liquid) |
| Cautions for IV nutritional support | not refrigerated, observe for spoilage (fat on top, discoloration), expiration dateNo filter. , must be infused on IV pump, glucose monitored, gradual weaning. Daily weights, |
| Complications for IV nutritional support | hypoglycemia, hyperglycemia, dehydration, infection |
| Reasons to give IV Nutritional Support | bowel surgery, chronic weight loss, bowel rest, coma, excess nitrogen loss, hepatic or renal failure, malnutrition, low serum albumin, hypermetabolic states |
