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Flashcards in IV Therapy Deck (27)
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1
Q

What is IV therapy?

A

The introduction of medication or solutions into the circulatory system via a peripheral or central vein

2
Q

What is a PVC?

A

peripheral venous cannula

3
Q

What is a CVC?

A

central venous cannula - may also be referred to as CVAD (central venous access device): Hickman, subclavian, jugular, femoral etc

4
Q

What is a PICC?

A

peripherally inserted central catheter

5
Q

What are implantable ports?

A

implanted central line, more common in USA/Australia

6
Q

Give 5 reasons for using IV Therapy?

A
  • When extra vascular route (oral, rectal, etc.) not available/appropriate (e.g. nil by mouth, stroke so can’t swallow, etc)
  • To maintain fluids and electrolytes.
  • To replace previous/concurrent losses.
  • To provide nutrition/vitamin replacement.
  • To administer medications and/or the transfusion of blood and blood products.
7
Q

What are 5 advantages of IV therapy?

A

Immediate therapeutic effect.
100% bioavailability.
(bioavailability describes how much of the drug effects the circulatory system, won’t be broken down in the stomach)
Total absorption allows precise dose calculations and reliable treatment.
Rate of administration can be controlled, maintained and modified.
Avoids the need for sub- cut and/or IM injections.

8
Q

What are 5 disadvantages of IV therapy?

A

Immediate therapeutic effect!!
Inability to recall the drug…..toxicity.
Microbial contamination of access.
Invasive procedure with multiple risks
Drug incompatibilities/interactions if multiple additives given.

9
Q

There are different types of IV therapy. Describe continuous infusion.

A

IV delivery of a medication or fluid at a prescribed rate over a defined period of time ranging from several hours to several days to achieve a controlled therapeutic response.

Used when drug to be administered requires high dilution, when a stable/constant blood level of drug is required and when larger volumes needed.

10
Q

There are different types of IV therapy. Describe intermittent infusion.

A

Intermittent infusion of smaller volumes over short periods. Maybe one-off dose or multi-doses at defined, prescribed times. Used when peak plasma levels of medication are necessary, when drug requires this particular dilution, when the drug given is unstable over longer periods or when the patient is on restricted fluids.

11
Q

There are different types of IV therapy. Describe direct intermittent injection/ bolus injection.

A

Usually involves a medication being administered from a syringe via an injection port or directly into a PVC, CVC or PICC.

Usually administered over several seconds or minutes
depending on clinical situation, characteristics of drug
and patient’s vein integrity (if PVC).

Used to achieve maximum serum concentration to
sustain organ function/life (e.g. adrenaline) or when the drug cannot be diluted or does not need diluted.

Rapid injection also means a greater element of risk.

12
Q

What are some considerations that should be made when picking type of IV therapy?

A

Type of therapy: Fluids, blood, medication, is the agent to be administered avesicant?

Anticipated duration of therapy; Short term=PVC, Longer term=CVAD/PICC

Potential risks of therapy: During “office hours” if high risk of complications, Pre-med may be required, How closely does the patient need monitored?

Available of equipment: Is an infusion device needed/available? Can the patient be given a central line?

Patient-related factors: vein selection, cognitive status, co-morbidity; Does the patient have good peripheral venous access? Are there any co-morbidities such as heart failure? Will the patient tolerate an IV? In-patient versus out-patient therapy.

13
Q

Name 5 potenial risks and complications of IV therapy

A
Over/under infusion
Infection
Phlebitis
Extravasation/infiltration 
Speed shock
14
Q

What 9 groups of patients are at greatest risk of complications?

A

Extremes of age
Patients with compromised organ function (renal, cardiac)
Patients with severe sepsis
Patients in shock
Patients with trauma
Post-operative patients
Patients with endocrine disorders which affect homeostatic controls
Clinically unstable patients/high acuity
Patients receiving multiple medications

15
Q

Descrive over-infusion

A
Accounts for approximately half of IV errors 
80% due to user error 
Over-infusion may lead to; 
-Fluid overload 
-Electrolyte imbalance 
-Over-dose of medication 
-Increased risk of phlebitis
16
Q

Describe under-infusion

A

Associated with

  • Increased risk of dehydration
  • Metabolic disturbance
  • Medicines being administered at sub- therapeutic levels, causing less effective treatment
  • Cannula occlusion/blockage requiring replacement
17
Q

Which treatments puts patients at most at risk of infection?

A

Patients with central lines, the immuno-suppressed and patients receiving TPN are particularly at risk and additional measures may be required.

18
Q

Name 6 potential sources of infection

A

Contaminated infusate/additive
Contaminated equipment.
Health care worker: hands, respiratory. (most common in emergency situations)
Patient: skin, contaminated lotions etc.
Non closed-system in operation.
Inadequate skin cleansing.

19
Q

Give 7 measures used to reduce risk of infection

A
  • Aseptic technique is essential.
  • SICPs key to IV therapy are;
  • Hand hygiene, use of appropriate PPE, respiratory hygiene/cough etiquette, management of care equipment and management of blood and body fluid.
  • Optimal skin disinfection.
  • Use of a closed system/minimal manipulations/avoidance of 3-way taps.
  • Transparent dressing/observation of site
  • Phlebitis scale
  • Take it out!
20
Q

What is phlebitis? What causes it(mechanical, chemical and bacterial)? What are signs and symptoms?

A

This is inflammation of the vein.

Mechanical;
-Irritation/injury of vessel wall by cannula.
-Related to cannula size/location/stability.
Chemical;
-Irritation/injury of vessel wall by infusate.
Infective/bacterial;
-Least common cause of phlebitis.
-Related to poor insertion technique,
contaminated equipment and poor maintenance of IV system.

Signs & symptoms;

  • Pain/irritation
  • Erythema
  • Swelling/oedema
  • Induration/venouscord/pyrexia (late stage)
21
Q

What are extravastion and infiltration? What are signs and symptoms/ What causes it? What can extravastion lead to?

A

Leakage of infusate into the surrounding tissues;

  • Extravasation if vesicant
  • Infiltration if non-vesicant

Signs & symptoms;

  • Pain/burning/tenderness
  • Flow occlusion
  • Leakage of fluid
  • Limb becomes pale/cool/swollen

Causes: poor cannulation, poor administration technique, patient-related factors.

Extravasation may lead to irreversible tissue damage/necrosis (Some cytotoxics, TPN, phenytoin, diazepam, KCL, some antibiotics)

22
Q

Describe speed shock, and the signs and symptoms.

A

The body’s reaction to rapid introduction of a foreign agent into the circulation.
Related to speed of delivery causing toxic levels of medication.
Can be fatal.

Signs and symptoms;

  • Flushing of skin
  • Headache and/or dizziness/fainting
  • Rise in HR with fall in BP
  • Shock and cardiovascular collapse
23
Q

Give 7 other potential complications of IV therapy? (not Over/under infusion, Infection, Phlebitis, Extravasation/infiltration, Speed shock)

A
  • Haematoma
  • Bleeding
  • Thrombosis/thrombo-phlebitis
  • Venous spasm/pain
  • Air embolism
  • Cellulitis
  • CVCs–pneumothorax,haemothorax
24
Q

What 6 things should be checked?

A
  • 5 Rs; Right patient, Right infusate, Right route, Right time(rate), Right dose(rate)
  • Patient allergies
  • Prescription
  • Expiry dates
  • Infusate and equipment
  • Vital signs/fluid balance
25
Q

describe the IV therapy process?

A

Patient assessment
Collect and prepare equipment
Perform hand hygiene and don PPE
Using an aseptic non- touch technique remove protective cover from IV fluids and administration set.
Spike the infusion bag
Hang the bag and squeeze the drip chamber until half full
Prime the giving set with compatible fluid;
Holding the end of the tubing up initially loosen the protective cap and release roller clamp.
Gradually lower tubing until solution reaches end;
Ensure end of line is not contaminated
Do not drip onto floor/bed
Ensure there is no air in the set.
Attach to cannula/insert into device.

26
Q

What nursing care is involved in IV therapy?

A
Patient education
Monitoring of site, infusion, patient 
Documentation
Assess ongoing need for cannula – daily review in conjunction with medical staff
Identification of patients at high risk
27
Q

How often should IV infusion systems be changed?

A

72-96 hours