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What are FOUR reasons we might use IVs?
- Fluid and electrolyte maintenance and balance
- Medication/blood administration
- Nutritional support for NPO status
- Administer diagnostic reagents
What is an affect of hydration using an IV?
Expands intravascular volume
What are THREE reasons we might use a PICC line?
- Put them in for long term IV therapy.
- Less likely to get infection.
- Also good for antibiotics especially on long term therapy.
Why don't we use lower extremity veins?
- Thromboses and varicosities
- Blood becomes stagnant
What sites should we avoid when inserting an IV?
- Legs, feet and ankles
- Below a previous IV infiltration
- Below a phlebitic area
- Sclerosed or thrombosed veins
- Areas of skin inflammation, disease, bruising or breakdown
- Arm affected by a radical mastectomy, edema, blood clot or infection
- Arm with an AV shunt or fistula
- Areas of Flexion
- Below a PICC or midline
What are things to consider in assessing a site for an IV?
- Is the vein straight
- Distal to proximal
- Firm, round in appearance or feel when palpated
- Avoid crossing joints
What are the two main types of IVF?
What is crystalloid IVF?
- Crystalloid-cross semipermeable membrane bc small
- Mostly give crystalloid
What is a colloid IVF?
Colloid-usually proteins, so large, don’t cross membrane (blood, albumin)
What are the FOUR types of infusions?
What is a bolus infusion?
- large amt of fluid all at once.
- Can increase vascular volume before surgery
What is a push?
- Push-medication over a short period of time.
- Usually is diluted.
- Need to know how long to push it.
- Check drug reference book to see how fast to push it. Usually 2-4 minutes**********
Where do you apply the tourniquet?
6-12 inches above IV site
What do you document following an IV?
- Date and time of insertion
- Gauge and type of catheter
- Number of attempts
- Blood return in catheter; whether the IV flushes.
- Method of securing or stabilizing
- Type and rate of the IV fluid
- Patient's tolerance
- Patient education
What should you do if you are unsuccessful after 2-3 sticks?
- Take off the tourniquet
- Cover the site with gauze
What are common mistakes in IV insertion?
- Improper tourniquet placement
- Failure to release the tourniquet
- A tentative “stop and start” approach
- Inadequate vein stabilization
- Failure to recognize that the cannula has gone “through” the vein
- Stopping too soon after insertion
- Inserting the cannula too deep
- Failure to penetrate the vein wall
How often do you change the site or tubing?
- Most facilities the site needs to be changed every 72 hours – or when no longer patent
- Tubing every 72-96 hours – check the policy
What do you do if there isn't any fluid hooked up to site?
- The site may be temporarily not hooked up to fluid
- A “buff cap” is applied – may be called a hep lock
What is best practice in monitoring the site and cath site?
- Monitor catheter site
- Check for signs or symptoms of infiltration or infection
- Change catheter site and tubing Q 72 hours or per hospital policy
- Change IV fluid bags Q 24 hours or per hospital policy
When do you flush catheters?
- Always flush catheters before and after medication administration
- If incompatible, looks like snow. Pushing crystals into patient.
What do you do if there are complications with the IV site?
- Caused by catheter not placed properly or dislodged. Stop IV fluids.
- Put on a cool or warm compress.
- Elevate heart bc of edema.
- Check pulses for peripheral vascular damage.
- Start IV in other arm
What do you do if phlebitis occurs?
- People can have allergic rx to cathrter
- Can be allergic to whatever you’re injecting
- Long red chord
- Maybe introduced bacteria
- Stop IV
- Send iv tip to lab to culture to see what happened
What is pulmonary edema?
Pulmonary edema=fine crackles->coarse crackles->foaming
What is my responsibility in IV insertion as a nurse?
What do you do when you discontinue the IV?
- Utilize standard precautions
- Peel tape towards IV site
- Stabilize catheter and remove remaining tape
- Place gauze over site and slide catheter out
- Use direct pressure as you are pulling out the catheter
- You will document the dressing applied and the time you applied pressure