IV Therapy Lecture ❤️

3 main purposes of IV therapy

hydration, nutrition, medication

what is peripheral IV? when is it used?

in extremities (ex arm, foot, head). more short term (usually 2-4 days).

when can peripheral IV not be used

certain medications are too damaging to veins in those areas (ex no vasopressors and parenteral nutrition through periph IV)

general rule for a good locations for peripheral IV

places that do not bend. places that are not damaged (ex fistula). more sanitary places (ex avoid foot)

if a needle is a 26 guage is the hole bigger or smaller than a needle with a 14 guage?

smaller. (bigger number smaller the hole)

how many attempts should you try starting an IV before taking a break/having someone else do it

2

how long do you scrub the hub

15 seconds

best disinfectant for scrubbing the hub?

Chlorhexidine

how often should you check a peripheral IV site?

about site check every 4 hours. (maybe more often depending on circumstances)

if you have a client with an IV in, what is the first thing you should do when starting your shift?

flush the IV to make sure it is working!

(peripheral IV dont usually get great blood return because of small veins.

for central lines you should get good blood return. no blood return=problem.)

never leave tubing

uncapped

continious tubing should be changed every

96 hours (4 days)

tpn tubing should be changed every

24 hours

how often should you change the tubing that is delivring blood products?

after every unit

what are central lines

more long term. end in superior vena cava

what is an extended dwell

 inbetween a peripheral and midline. bit longer and put in through ultrasound. left in for week.

if you remove an IV, what should you be mindful of

have a good reason to remove IV. make sure paitent has another access that is working or that they absolutely do not need it anymore.

midline catheters

longer peripheral lines. Terminates in the area of the axillae. Dwell time is up to 4 weeks and they are good for longterm antibiotics.

midline catheters are usually in which veins

Basilic, cephalic veins

how does the length of a line contribute to infection control?

longer lines (ex central lines) decrease risk of infection because bacteria has to travel further

what is a PICC line? what is the dwell time?

• peripherally inserted central catheter

• dwell time 6-12 months

• has multiple ports at end so you can give multiple meds at same time

indications for a PICC line

can be used to give long term antibiotics, chemo

and TPN. can be used in clients with

• INFECTION

• ENDOCARDITIS

• HYPEREMESIS

• OSTEOMYLITIS

• CANCER

• PANCREATITIS

• BOWEL OBSTRUCTION

• NUTRITIONAL SUPPORT

care of a PICC line

• verify placement with xray.

• put pink band on this extremity. make sure you dont use that limb for other things like checking BP and other IVs

• encourage client to avoid using the limb a ton. avoid lifting weights and stuff

• mark length of tubing so you know if the line gets pulled out some

• push pause method of flushing. creates turbulent flow inside tube to prevent any blockage in tube. (only do push pause in central lines bc turbulence too strong for peripheral lines)

what are the benefits of having multiple lumens in an IV line?

• helpful for delivering multiple medications at once 

• can give incompatible medications at the same time 

• multiple lumens allows you to push medications at different rates 

• decreasing number of accesses the patient needs. instead of 3 IVs only need one 

tunneled vs non tunneled catheters

Tunneled catheters are designed for long-term use (weeks to months, even years). longer line tunneled under skin to decrease ability of bacteria to travel

Non-tunneled catheters are for short-term or emergency use (days to a few weeks) and are removed more frequently to reduce infection risk

implanted ports are often used for

cancer pts and people requiring continious infusions

breif overveiw of implanted ports

• port is tunneled under skin in pocket. access port with needle when needed 

• decrease infection risk

• can stay in for years

how often should you change the dressing of a central line

change dressing about every week (unless soiled or falling off)

unstable paitents should not receive what kinds of IV acess

tunneled central lines and implanted ports because they are surgical procedures. unstable paitents may not be in condition to undergo procedure

clabsi

central line associated bloodstream infection

do peripheral or central lines have less complications

peripheral

how much air does it take to kill somone

only 8cc. ALWAYS make sure to properly prime lines

extravasion vs infiltration

• infiltration- cather going through vessel and fluid leaks into tissue. cool to touch

• extravasation - fluid leaked into tissue starts causing tissue damage 

signs and symptoms of infiltration

• EDEMA/SWELLING

• BLANCHING

• COOL

• TENDERNESS

• DISCOMFORT

infiltration interventions

• STOP INFUSION

• ASSESSMENT

• REMOVE CATHETER

• ELEVATE EXTREMITY

• ISOTONIC- WARM COMPRESS

• IRRITATING- COOL COMPRESS

how can you prevent infiltration

properly flushing lines, using preferred location (avoiding bends), stabilization of device, proper assessment

what is a vesicant

any liquid that causes damage or necrosis to tissue if it escapes from venous pathway

common examples of vesciants

potassium, vasopressors, antibiotics, chemo

signs and symptoms of phlebitis

redness, tenderness, heat, edema, pain, palpable cord

phlebitis interventions

• remove IV

• assess

• apply heat

• elevate limb

how to prevent phelbitis

dilute medications. stabilize catheter

what is an occlusion

fibrin builds up in tube. need to have good flushing to avoid this

how to use clot busting medications to clear occlusion from tubing

because clot busting medications can increase a clients risk of bleeding, you don’t want to flush the clot buster into the client’s bloodstream. to use it: measure the clot buster and pull it out after sitting. dont flush clot buster into stream. just let it sit in tube

first line choice for fluid resuscitation

crystalloids

Isotonic solutions are used to

increase the EXTRACELLULAR fluid volume due to blood loss, surgery, dehydration, fluid loss that has been loss extracellularly. used to replace plasma volume, not cause shifts 

lactated ringers is often used for

• LR has more electrolytes. better match for what our plasma is.

• better for giving large volumes because it matches our plasma makeup better. ex severe burns.  

isotonic fluids run the risk of

fluid volume overload

HYPOtonic crystalloids causes water to

shift from ECF to ICF compartment -> out of the blood into the cells and tissue spaces.

what do HYPERtonic solutions do

HYPER - increase extracellular volume and decrease intracellular volume -> out of the cells and into blood

hypotonic solution uses

for patients in DKA and hypernatremia.

hypotonic solutions risks

risk- hemolysis (cells burst) and intracranial pressure

hypertonic solution uses

hyponatremia

people with increased intracranial pressure.

hypertonic solution risks and considerations

risk- hypernatremia

• hypertonic saline you only need a small amount. shrivles cells. 200-300cc MAX. 

Colloid solutions contain

large insoluble molecules, generally proteins

colloid solution pros

colloids remain in the intravascular space longer than crystalloids, so less volume is needed for the same effect, reducing the risk for fluid overload

colloid solution cons

Colloids are more expensive than crystalloids and are associated with a slightly greater risk of adverse reactions, including allergic reactions. 

albumin and sodium relationship

albumin besties with sodium. where albumin goes, sodium follows, water follows 

colloids are good for people with

good for people with CHF and kidney disease that can’t tolerate lots of extra volume because colloids can replace more volume with less volume