Question Answer

Maintenance, to replace or correct deficits, to

What is the purpose of IV fluid
restore ongoing loss, for meds, nutirtion,
therapy?
phlebotomy, transfusions or blood product therapy.
What is oncotic pressure? Colloids, plasma proteins, albumin
What is hydrostatic pressure? Blood pressure
280 - 295 or approx. twice that of the serum Na
What is normal serum osmo?
level.
What can expand the intravascular
Hypertonic fluids.
compartment?
If done too fast will draw too much fluid into the
What is the problem with using
intravascular, dehydrating intracellular, especially
hypertonic fluids?
the brain?
What is a S/sx of fluids
decreased LOC / Confusion.
administered too fast?
What happend if you expand the
Deplete the intravascular, decreasing BP and
intraCellular compartment too fast?
causing edema.
What are the two basic types of
Crystalloid and Colloid
parenteral fluids?
What is a crystalloid fluid? An Electrolyte containing solution.
What are the three basic types of
Isotonic, HypOtonic and Hypertonic
crystalloid fluids?
Why are crystalloid fluids called Because they can pass through semipermeable
true solutions? membranes.
What is a Colloid fluid? Contains proteins and starches.
Pass between compartments. They draw the fluid to
What can't a Colloid fluid do?
them.
Name three problems with IV fluid
Phlebitis, extravasation and incompatabilities.
therapy.
What three things can and LVN cannot han, flush or change bags on a central line
NOT do? even if certified.
What can an RN NOT do with a Cannot assign to LVN or supervise LVN with
central line. anything to do with a central line.
How do you determine whether it is
Ask the doctor for an x ray order to determine.
a central line or a peripheral line?
Name some isotonic fluids D5W, LR and NS
Why do you need to be careful with It is hard for the renal system to process the
LR and dehydration? elecetrolytes.
What does the liver do to lactate? It metabolizeds the lactate to bi-carbonate which
(LR) buffers acidosis
What are two common uses for To treat hyponatremia and intravascular
Normal Saline (NS)? dehydration.
Name a HypOtonic solution? 0.45 NS ( 1/2 NS)
What is a problem with HypOtonic Use too long and it will lower BP. It is low in solutes
solutions? so fluid will move out of the vascular space.
What makes Hyper tonic fluids
It has moce dissolved particles than bldy fluid.
different than the others?
It moves fluid out of the intracellular and interstitial
What does a hypertonic fluid do?
compartments into the intracascular.
What are hypertonic fluids used
Hydration and nutrition
for?
What is dangerous about
hypertonic dextrose saline they can move fluids very quickly.
solutions?
What is a hypertonic dextrose
TPN and PPN. Nutrition.
saline fluid solution used for?
What type IV line do you use with 10% solutions can go peripheral but all others 20%
Hypertonic dextrose saline? and above must use a central line?
Why must most hypertonic
dextrose saline solutions be used Because the fluids are very irritating to veins.
with a central line?
How do you infuse hypertonic
You must use an infusion pump.
dextrose saline solutions?
Plasma expanders are not
Blood products.
considered what?
What do you NOT have to do with
Type and cross match.
plasma expanders?
Which of the two main categories of
fluids do plasma expanders fall Colloid.
into?
Maintenence of blood volume, hypovolemic shock,
What are Colloids used for?
dialysis.
In which patients do you need to
use colloid product with cautiously? renal insufficiency and CHF

PPN is used in what type of line? Peripheral

TPN is used in what type of line? Central
What are the components of TPN?
H2O, PRO, CHO, fat, vitamins, trace minerals.
TPN usually come in a _____hour
24 hour supply
supply.
Non-function GI, Bowel obstruct., acute inflam,
Name some indications for TPN. colitis, Crohns, malabsorption, chemo, burns,
sepsis, ooncology, pancreatitis.
How do you know TPN is working?
By weighing daily.
Must use the appropriate IV access for
What is the consideration with IVs concentration of glucose, must use pump, don't play
and glucose? catch up, taper TPN, accu-checks, used micron
filters
What should you monitor with I & O, weight, liver and renal function and
TPN? electrolytes.
Why do you monitor liver and renal
To make sure that they are excreting electrolytes.
function with TPN?
Why do you use a micron filter with
to filter out bacterial growth.
TPN?
To avoid hypOglycemic shock from cutting of the
Why do you taper TPN?
sugar.
Can you run other things in the TPn
No, don't mix with anything else.
IV tubing?
What is an important consideration
May cause anaphylaxis
with albumin?
What are some potential Fluid imbalances, metabolic acidosis, liver
complications with TPN? dysfunction, hyperglycemia and infection.
What lab can you use to monitor
BUN
liver function?
What is the first thing that you
the IV
assess wtih a patient?
What type line, correct solution according to MAR,
What are some items of IV that you
what time hung, how much left to infuse, correct
should assess?
rate, everything current?
How long is the IV bag good for? 24 hours
How long is IV tubing good for? 72-96 hours depending on hosp
How long is a peripheral site good
72 - 96 hours depending on hosp
for?
Why do you want to know how So you can be prepared and have the next bag
much infusion time is left? order from pharm and ready.
Why inspect for blood return? Good indicatino of patent IV but not alwyas.
When you look up an IV drug what
Y siet compatibility with other drugs you may be
is an important item that you will
administering.
check?
If you add another drung in and it
It is incompatible and you stop it and throw away the
becomes cloudy what is happening
tubing.
and what do you do?
What happens if you see crystals? Incompatibility. Stop IV and throw away the tube.
Who do you determine what is
Use the drug book, call the pharmacy
compatible in an IV?
How long do you continue a
"continous or maintenance" Until the Dr has ordered it stopped.
infusion?
How is an IV push administered? Usually by syringe.
Where can you find the drip factor?
Printed on the bag.
How is gravity or free flow
By roller clamp or clip.
regulated?
Does the IVPB hang higher or
Higher
lower or equal to the regular IV?
Name an important act you must do
with continous infusion ( it's a Time tape the bag.
competency)
Continous infusion limits what and It limits mobility because you have to take it with you
is what type of risk? and it is a fall risk.
What method of infusion should
Gravity or free flow.
you not use with a central line?
What anti-biotic can you NOT use
Vancomycin
with gravity/free flow infusion?
Name three things you cannot use
TPN, peripheral line and medication administration.
gravity free flow with..
What does primary rate mean with
the running rate of the IV
a pump?
What does secondary rate mean
running the medications or antibiotics.
with a pump?
What is the standard mix for
25,000 units in 250 ml of D5W
Heparin with an IV?
One ml of Heparin for IV contains
100 units.
how many heparin units?
What is an important check that
You check the dose with a second person.
you do with Heparin?
what must you be careful about You must check to make sure that the rate has been
with the secondary rate of an changed back to the primary rate when the
IVPB? secondary has finished.
What is positive pressure
closing slide clamp at the same time as flush.
technique?
Infusion time on an IVPB is
The roller clamp of the primary bag.
regulated by what?
PCA administration can be
intermittent (PCA), continous ( basal) or both rates.
programed for what three things?
dose/ml, delay time, lockout, patient administered
What does the Dr order for PCAs?
does, basak rate and loading or PRN dose.
Peripheral, central, HICKMAN® catheter, quinton,
Name six types of IV access?
implanted ports and PICC.
What is an important intervention Catheter management. Check site of inserting but
with epidural IV? do not change, pull dressing.
What is the routine flush times for a
Q8hr and before and after meds.
peripheral line?
Why do you flush a line before
To check patency.
giving the medication?
How much is a routine flush of NS
2-3 ml.
for a peripheral line?
Where is the central line placed? Superior vena Cava.
A Quinton catheter is used for Short term dialysis, longer and a shunt is placed
what? instead.
Implanted ports are put in place
Put in and taken out in the OR
where?
You need to be certified to access
implanted port.
what type of port?
Implanted ports are used in what
Oncology
population?
A right angled needle that you must be certified to
What is a Huber Needle?
use and accesses an implanted port.
What is a PICC? Peripherally Inserted Central Catheter
Is a PICC used for short or long
Both
term therapy?
How many lunmens does a PICC
One or two, two is preferred
have?
Before placement of a PICC what
Informed Consent
do you need to have?
You need to flush a PICC if there is
Continous infusion. Flush Q8hr.
no...what?
Who inserts a PICC. Speciality trained RN and dc'd by same.
What is the amount of NS used to
5 ml flush
flush a PICC?
What sixze syringe do you used to
10 ml syringe
flush a PICC?
What approached is used for a
The brachial approach.
PICC?
It is easliy occluded when they bend their arm
What is the problem with a PICC
(because it is so flexible)and DVTs are becoming
line and the brachial approach?
more common as a result.
What are the seven complication of Infiltration, extravasation, phlebitis, air embolism,
IV therapy? speed shock, fluid overload, infection.
administration of a non vesicant into tissue
What is infiltration?
surrounding the vein or collapse or vein dissolving.
Not much except extravasation is infiltration that
What is the difference between
results in tissue damage and necrosis from the
infiltration and extravasation?
product administered
swelling, Coolness, pain, tigh, hard, blanch or red,
S/Sx of infiltration?
maybe leaking due to pressure
What may be a first indication of
Slow or sluggish IV rate
infiltration?
Infiltration causes: loss of vein integrity , catheter dislodgement
dc IV, warm soaks, elevate, check pulse and cap
Tx for infiltration..
refill,
Tape IV site well, special attention if on a pump, and
Prevention of Infiltration..
educate pt to watch for signs.
Patient education for infiltration? Watch for cool, swollen hard or painful site.
administratino of a vesicant ( blistering) solution into
Extrasavation is..
surround tissue.

A Vesicant is..
An irritant is..
Phlebitis is..
S/Sx of Phlebitis..
When phlebitis damages a vein it is
permanent or temporary?
If the phlebitis shows erythema
where is it usually?
Causes of Phlebitis?
What is the Tx for Phlebitis?
Infection causes:
S/Sx of infected IV
Infected Iv Tx?
S/Sx of FVE
Tx of FVE
Prevention of FVE with IV
What is a positional IV
Who is the at risk population for
FVE with IV?
S/Sx of air embolism
Air Embolism is a problem with
what type line and not with what
type line?
Tx for Air Embolism?
Prevention of Air Embolism?
Speed Shock is..
S/sx of speed shock?
Prevention of speed shock?
agent capable of causing tissue damage or necrosis
to surrounding tissue
an agent capable of producing pain at site
Inflammation of the vein
Pain, erythema, dedma, streak formation, hardness
of vein, increased temp.
Permanent
localized, at tip of catheter and on.
Poor blood flow around cath, friction, iv left in too
long, clotting.
d/c IV faster is better, always apply warm compress,
watch for infection.
Sever phlebitis, equipment contamination, outdated
solutions, poor technique
pain, tenderness, warmth, redness, elevated temp,
chills, purulent drainage, elevated WBC
d/c IV, culture tip, call Dr
HTN, JVD, Dyspnea, SOB, Rales, cough
HOB high Fowlers, decrease EV rate temporarily,
call Dr.
Montior rate, know risk population, watch out if you
have a position IV
One that has multiple positions for drip rate on it.
Check all positions for the drip rate to avoid FVE
CHF, valve replacement surg, new valves, bad
valves
weak, rapid pulse, chest pain, SOB, cyanosis,
decease in blood pressure, anxiety
Problem with Central line, very hard to geton a
peripheral line as you need lots of air.
Clam IV, Place with right side up to trap air in right
atrium, ( left side down,) trendelenburg, give O2, call
Dr.
#1 is careful priming of IV tubing, dc central lines
properly, careful clamping during tube changes,
valsalva manuever during changes.
sudden increase in plasman level of a drug after
administration
syncope( transient sudden loss of conciousness
with inability to maintain upright posture) cardiac
arrest and shock
Know what you are giving and how fast you can
administer it, rate of administration
Name a drug that speed shock can
Vancomyacin
come with
Home care considerations with IV careplan, clean house, safe, support, family, who do
therapy are? you teach.
Most common line for home
PICC line
therapy?