IV Test 2
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Y-type infusion sets are used for...
PRBC becasue it facilitates primary infusion (NS) and blood bag.
What to inspect before hanging a bag...
Solution clarity, expiration date, puntures
teflon ONC catheters increase risk of...
Peripheral catheter that is 3-8 inches in length is called a
Microaggragate filter is used for
administration of whole blood and packed cells that have been stored more than five days
The size of the clot filter on a standard blood administration set is
what size um filter is used for non lipid fluids that require filtration....
0.2 um filter because it is bacterial/particulate retentive and air eliminating.
What size um filter is used for lipid filtration
What type of tubing and bag should be used to administer cyclosporine and why?
Non-PVC bag and tubing to preven DEHP leaching/toxicity.
What special item is needed when using a volumetric pump?
special cassette tubing
What needs to be considered when selecting venous access devices?
- pH of fluid (above 9 or less than 5 requires PICC), osmolarity (above 600 mOsm requires PICC).
- Patient's understanding and caregiver support.
- Invterventional radiology support.
50mmHg is equivalent to how many psi?
What type of infusion set must be used with closed glass system?
vented set, to allow air into the container
When flushing an intermittent locking device what is the order of the steps the nurse should take?
- Check patency.
- Flush with NS with push-pause method
- Administer medication
- Flush with NS applying positive pressure
Midline catheters are placed where?
Between antecubital fossa and head of clavicle, optimal tip location level with axilla
Which techniques should be used to distend veins prior to IV insertion?
BP cuff inflated to 30 mmHG
Wamr compress over site for 10 minutes
Which peripheral vein is most appropriate for adminstration of anti infective therapy?
Three layers of a vein
Tunica adventitia, tunica media and tunica intima
How often does a peripheral IV site need to be observed?
every 4 hours
Advantagesof ONCs over metal scalp vein needles?
- decreased infiltration risks
- patent longer than scalp vein needles
What technicques should be used to start an IV on a PT taking anticoagulant therapy?
Use alcohol to loosen dressing, avoid excess pressure when cleansing, avoid using tourniquet or apply loosely.
Most central access devices are made of...
when not in use, ports can be flushed how often?
every 4 weeks
long term catheter thatis surgially inserted through and incising in the deltopectoral groove terminating near right atrium is
central venous tunnel catheters
What are the most common complications of a PICC?
bleeding, catheter malposition, and cardiac arrhythmias
Primary advantage of tunnelled catheters is
they can be used for multiple purposes
Purpose of Valsalva maneuver is
to prevent air from entering circulation.
Most common cause of stuck PICC is
Advantages of PICC
- involves less pain and discomfort because of its multiple uses
- cost effective
When changing PICC dressings remove the old dressing from
distal to proximal edge
Technique for removing stuck PICC
apply moist heat or gentle massage to upper arm and reattempt removal in 20-30 minutes.
Which organism is responsible for most cases of catheter related bloodstream infections?
Stages of phlebitis
- 1-erythema at site with or w/o pain
- 2-pain, erythema or edema
- 3-all previous sx with streak and palpable cord
- 4-all previous with palpable cord greater than 1 inch and purulent drainage
What thrombolytic agent is most comonly used to clear an occlusiong by blood clot?
Which declotting agent should be used to clear lipid deposits from a central line?
Venous spasm presents as....
Pain at IV site that travels up arm, caused by piercing stream of fluid that irritates vein wall and slows infusion. Apply warm compress and slow infusion until spasm subsides.
Factors that put PT at risk for phlebitis
catheter materials, insertion in emergency room type of fluid (hypertonic), daily dressing changes, gender (women more), individual biologic vulnerability, and immunosuppression.
Compression of device between clavicle and first rib. Presents as intermittent catheter malfunction, difficulty drawing blood and positional IV.
Speed shock is
Systemic reaction to foreign substance being rapidly introduced into the circulation. Pt will be flushed and have irregular pulse rate, complain of headache and tightness in chest.
How to treat 2+ phlebitis?
remove cannula and apply cold compress for 45 minutes, restart IV in new location.
What are local complications of IV therapy?
phlebitis, venous spasm, hematome
Which patients are at increased risk for phlebitis?
- Multiple IV manipulations
Which complication should be checked for with a newly implanted port?
displacement of the septum
Major complication of central venous device placement?
intravascular and exravascular malpositioning due to catheter tip migrating during insertion.
What is the first sign of a venous spasm?
sharp pain extending from site of infusion
Difficulty withdrawing blood with ability to infuse fluids is most likely caused by....
During IV insertion nurse notices difficulty advancing catheter and ecchymosis over and around insertion site, area is raised and hard, what is causing this?
What are signs and symptoms of air embolus?
Decreased breath sounds, chest pain with inhalation and exhalations, pleural friction rub, cardiac dysrhythmias, hypotension, anxiety, substernal pressure and cogwheel murmur.
Flushing technique for negative displacement devices...
withdraw syring as last 1.5-1 mL is flushed inward, maintain force on syringe plunger as a clamp on the catherter or extension is closed and then disconnect.
How many seconds of hand washing with antimicrobial is recommended before equipment setup and venipuncture?
Preferred site for peripheran infusion in infants less than 9 months old is...
dorsum of the hand
best method for locating veins in dark-skinned people?
Most appropriate cannula size for 2 month old infant?
22 -24 guage ONC
Most appropriate containier for infant recieving IV fluids...
microdrip volume control connected to 250 mL infusate container
Tunica intima is the layer in which..
the endothelial lining is located and where thrombus formation may occur.
Advantage to patients of tunneled catheters...
can be used for more than one purpose
blunt catheter tip with three way valve
Best intervention for flushing a central line to prevent fibrin buildup is the
Standard of practice for implanted port dressings...
- after site has healed dressing is not routinely needed
- after insertion by physicain no dressing is needed at any time.
collecting blood from TPN line requires the nurse to first...
tunr off TPN 3-5 minutes before obtaining sample.
Ways to prevent thrombus formation.
- pumps or controller to manage rate of flow
- avoid placing cannula in places of flexion
- good technique during vein cannulation
Treatment for vasospasm during infusin
Signs of infiltration
swelling, cool skin, blanching, rigid skin and slowed infusion speed
Which syringe barrels should be used on peripheral IV line to prevent damage
3 mL or smaller
Catheter occlusion may cause
- inability to administer essential medications
- permanent loss of access
- increased risk of infection
Which agent would be used to treat non-thrombotic occlusion caused by lipids
70% ethyl alcohol
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