IV Therapy Study Guide Can LPN’s administer IV’s? They can not start IV’s If an LPN is IV certified what can they not do with IV? They can not give IV’s with meds What should you look for as you are obtaining a bag/bottle of IV fluids Check for leaking, discoloration, crystals What special equipment is needed if your IV comes in a glass bottle? Vented tubing Identify what the following abbreviations mean: NS: Normal Saline D: Dextrose LR: Lactate Ringer What IV fluids are isotonic? 0.9 NS D5W LR Isotonic fluids are used for: Bleeding, hypotension, after surgery, regulate sugar with D5W Where do isotonic fluids go when infused? No fluids shift Monitor patients receiving isotonic fluids for what and what are the symptoms: Fluid overload, SOB, crackles, dry cough, edema, increased RR, HR and BP. What IV fluids are hypotonic? .45 NS .33 NS Where do hypotonic fluids go when infused? They leave the vessel and go into the cells Hypotonic fluids are used for: Cellular dehydration and high sodium Which patients should the nurse question administering hypotonic fluids? A PT with head trauma or hypotensive What IV fluids are hypertonic? 3 % NS Mannitol D10W Parenteral Nutrition What occurs to the fluids shifts when hypertonic IVs are infused? Pulls more fluid into the vessels Hypertonic fluids are used for: Low blood sugar, low sodium levels, swelling/fluid retention Monitor patients receiving hypertonic fluids for what and what are the symptoms: Fluid overload, SOB, coughing, edema, increased BP, RR, and HR What labels are required with IV set up? 1. Date time itital, gauge 2. Change date 3. Meds that are added to IV bags (Time tape- may be used with gravity fed) When would you use primary tubing? When setting up a singular bag of fluids When would you use secondary tubing? When attaching a IVPB When would you use and extension tubing? When needing veins access a lot How often do you change primary IV tubing if your patient is getting continuous IV fluids? 3-4 days How often do you change IV tubing if your patient is getting only intermittent IV medications through a sealed IV? Every 24 hours How often does the cap on a saline lock be changed? Every 7 days How full should the drip chamber be filled to? 1/3 or 1/2 What is the first thing that should be done when you open a new package of IV tubing? Close the clamp What is sterile on the IV tubing and can never be touched? What color hub are the following IV catheters and when would each size be used? 14 g: orange 16g: grey 18g: green 20g: pink 22g: blue 24g: yellow When will you use a winged needles? When needing blood samples What calculation is required to regulate the IV when using an IV pump? ml per hour What calculation is required to regulate the IV when it is flowing by gravity? ml per minute What can cause a hematoma when pt get IV therapy? When the vein is punctured or busts What will prevent hematomas Don’t tie tourniquet too tight, avoid areas of flexion What is infiltration and what are the symptoms? Infiltration is when the catheter pokes through the veins and the fluids leak out into the tissues. The skin will become shiny, tight, swollen and cold. What is the treatment for infiltration? D/C cath and notify MD What is extravasation and what are the symptoms? This is when medication is leaked from the IV and into the tissues and causes tissue death. The symptoms are discoloration and tissue necrosis What is the treatment for extravasation? It depend on the med. Sometimes you will leave the IV in and insert the antidote What is Thrombosis and what are the symptoms? Is a blood clot, red swollen irritated looking vein, cant flush cath What is the treatment for thrombois? D/C and restart What is phlebitis and what are the symptoms? It is vein inflammation What does the nurse do to prevent phlebitis? Use a bigger vein and small gauge and length needle, use aseptic technique What can cause Fluid Overload and who is at higher risk? Fluid overload can be caused by water retention, sodium retention, kidney failure, or receiving too many IV fluids. PT’s with HF, kidney failure and the very young and old. What are symptoms of fluid overload? Edema, SOB, decreased HCT, decreased urine specific gravity, crackles, dry cough, increased BUN What are systemic symptoms of infection that can be seen if pt has developed septicemia secondary to IV therapy? How do you position the patient if you suspect an air or catheter embolism? In trend Ellen burg on their left side How do you prevent an air embolism? Prime tubing before connecting to PT What is speed shock, what are the symptoms and how do you prevent it? Too much fluid too fast. Pounding headache, syncope, increased HR, apprehension, chills, back pain, dyspnea. Using correct flow of administration What conditions prevent you from selecting that extremity for IV insertion? Breast removal, lymphoid removal, Fistulas or shunts from dialysis, paralysis What are the common veins that are used to start peripheral IV’s? Cephalic Why should the wrist be avoid if possible? Because it is a area of flexion and it also have lots of nerves What are strategies to help you find a vein 1. 2. 3. 4. 5. 6. Tourniquet Lightly tap Warm compress Hang below heart Some devices help you find veins How do you clean and prepare the insertion site? You tourniquet, find the veins, release the tourniquet, clean with alcohol first in circles smallest the largest for 20 seconds, then let dry and repeat with iodine and retie tourniquet At what angle do you insert the VAD? 10 to 30 degrees Where can the nurse touch the transparent dressing? Anywhere that wont be touching the PT skins What will the nurse monitor for a pt. receiving IV therapy? 1. 2. 3. 4. 5. 6. Phlebitis Infiltration Necrosis Infection How often is the following changed? IV site: 4-7 days Transparent dressing: when dirty or when iv is changed IV cap on saline locks: 7 days Continuous IV tubing: 4-7 days Intermittent IV tubing: every 24 hours IV bag: every 24 hours What do you need to document when you insert an IV? Date time initial site gauge What do you need to document when you discontinue an IVa Reason for D/C and site of D/C
