IV Therapy Basics

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Questions and Answers

Which of the following patients might require infusion therapy?

  • A trauma patient in the emergency department (correct)
  • A patient with multiple sclerosis in remission
  • A patient with osteomyelitis receiving IV antibiotics at home (correct)
  • A high school teacher during an annual health appraisal

A licensed healthcare providers order for IV fluids does not need to include the rate of infusion or the total dose.

False (B)

What are the two major types of IV solutions?

crystalloid solutions and colloidal solutions

Solutions containing protein, lipids, and high concentrations of __________ can provide the calories and nutrition needed to sustain life.

<p>dextrose</p> Signup and view all the answers

Which type of IV solution is frequently referred to as a plasma volume expander?

<p>Colloidal solutions (D)</p> Signup and view all the answers

Osmolarity and osmolality are significantly different in human body fluids.

<p>False (B)</p> Signup and view all the answers

Name two examples of colloidal solutions used in infusion therapy.

<p>albumin, dextran, and mannitol</p> Signup and view all the answers

Match the following blood products with their primary use:

<p>Packed Red Blood Cells (RBCs) = Increase oxygen-carrying capacity Platelets = Aid in blood clotting Plasma = Replace clotting factors and volume Albumin = Volume expansion and protein replacement</p> Signup and view all the answers

What color is a 20-gauge catheter?

<p>Pink (D)</p> Signup and view all the answers

Veins in the lower extremities are recommended for infusion therapy in adult patients.

<p>False (B)</p> Signup and view all the answers

What is the recommended action if a more distal site is available and appropriate for short-term IV access?

<p>Use the most distal available and appropriate vein.</p> Signup and view all the answers

A vein selected for short-term infusion therapy should be ________.

<p>soft</p> Signup and view all the answers

Which gauge catheter is most appropriate for trauma, surgery, or blood transfusion?

<p>14 (B)</p> Signup and view all the answers

Midline catheters are appropriate for therapies expected to last between 4 and 8 weeks.

<p>False (B)</p> Signup and view all the answers

Why should veins in areas of flexion such as the wrist and antecubital fossa be avoided for IVAD placement?

<p>It is more difficult to stabilize the IVAD in these areas</p> Signup and view all the answers

Match the catheter gauge with its corresponding color:

<p>16 = Gray 18 = Green 22 = Blue 24 = Yellow</p> Signup and view all the answers

Which resource is commonly utilized in healthcare facilities as a standard for verifying medication compatibility?

<p>IBM Micromedex© (B)</p> Signup and view all the answers

Medication incompatibilities are a rare occurrence in hospitals and do not significantly contribute to intravenous medication errors.

<p>False (B)</p> Signup and view all the answers

Name two potential adverse effects that can result from medication incompatibility during intravenous administration.

<p>IV catheter obstruction, venous irritation</p> Signup and view all the answers

Veins contain structures known as ________ which prevent the backflow of blood, aiding in returning blood to the heart.

<p>valves</p> Signup and view all the answers

What is the anticipated fluid movement when an isotonic intravenous fluid is administered to a patient?

<p>There is no significant net movement of fluid between cells and intravascular space. (A)</p> Signup and view all the answers

Match the layer of the vein wall with its primary description:

<p>Tunica Intima = Outermost layer providing support and containing nerve endings Tunica Media = Innermost layer composed of endothelial cells Tunica Adventitia = Middle layer containing smooth muscles</p> Signup and view all the answers

In older adults, the dermal layer of the skin typically becomes thicker, which simplifies the placement of peripheral intravenous catheters.

<p>False (B)</p> Signup and view all the answers

Due to the increased fragility of blood vessels in older adults, ________ and ________ are potential skin-related complications to monitor for after infusion therapy.

<p>purpura, ecchymoses</p> Signup and view all the answers

The American Heart Association recommends the IO route as the primary route in cardiopulmonary resuscitation.

<p>False (B)</p> Signup and view all the answers

What is the primary purpose of needleless systems in infusion therapy?

<p>To reduce the number of needle-stick injuries and exposure to blood-borne pathogens. (C)</p> Signup and view all the answers

According to The Joint Commission's recommendations, how long should a nurse scrub a needleless system surface with alcohol?

<p>10-15 seconds</p> Signup and view all the answers

All needleless connectors are activated by ______ in the syringe Luer.

<p>pressure</p> Signup and view all the answers

What feature is present in some Luer access valve systems to prevent blood from backflowing into the IV catheter?

<p>Positive displacement feature (B)</p> Signup and view all the answers

Disinfection/alcohol caps negate the need to clean a needleless system with an alcohol wipe before use.

<p>False (B)</p> Signup and view all the answers

What was identified as a potential contributing factor to increased bloodstream infections associated with needleless connectors in a 2018 study?

<p>Healthcare worker noncompliance with infection control policies and manufacturer instructions (C)</p> Signup and view all the answers

Match the following actions with their purpose in maintaining needleless system safety:

<p>Disinfecting the needleless system surface = Preventing microorganisms from entering the bloodstream Using disinfection/alcohol caps = Providing continuous disinfectant contact Ongoing nursing education = Addressing lack of knowledge about needleless connectors Following manufacturer instructions = Ensuring proper use of the connector</p> Signup and view all the answers

Which of the following is a limitation of midline catheters?

<p>They should not be used for solutions with osmolarity greater than 600 mOsm/L. (A)</p> Signup and view all the answers

Central venous catheters terminate in the peripheral vasculature.

<p>False (B)</p> Signup and view all the answers

What is the primary difference between a midline catheter and a central venous catheter in terms of catheter tip placement?

<p>The tip of a midline catheter is placed in the peripheral vasculature, while the tip of a central venous catheter is placed in the central vasculature (superior or inferior vena cava).</p> Signup and view all the answers

Central venous access is defined as when the tip of the IVAD terminates in the central vasculature at the level of the superior vena cava or the ______ vena cava.

<p>inferior</p> Signup and view all the answers

Match the following catheter types with their descriptions:

<p>Midline Catheter = Longer than peripheral catheter, but not a central catheter Central Venous Catheter = Tip terminates in the superior or inferior vena cava Peripheral Catheter = Shorter catheter for short-term IV access</p> Signup and view all the answers

Which of the following is a characteristic of multiple-lumen central venous catheters?

<p>They have separate fluid pathways allowing for simultaneous administration of incompatible solutions. (A)</p> Signup and view all the answers

A 22-gauge steel-winged device is the most appropriate IVAD for a patient requiring 3-4 weeks of IV antibiotics for osteomyelitis.

<p>False (B)</p> Signup and view all the answers

Name three types of solutions that should not be administered through a midline catheter.

<p>Vesicant solutions, parenteral nutrition solutions, and solutions with a pH less than 5 or greater than 9 or osmolarity greater than 600 mOsm/L.</p> Signup and view all the answers

Which of the following is NOT a primary purpose of modern blood collection practices?

<p>Increasing the overall volume of blood available for transfusion (B)</p> Signup and view all the answers

Transfusion of whole blood is a very common practice in modern medicine.

<p>False (B)</p> Signup and view all the answers

What is the potential consequence of transfusing blood with incompatible ABO antigens?

<p>hemolytic transfusion reaction</p> Signup and view all the answers

Recipients who are Rh-______ should receive only Rh-negative blood.

<p>negative</p> Signup and view all the answers

Match the following blood components with their descriptions:

<p>RBCs = Carry oxygen to the body's tissues Fresh Frozen Plasma = Contains clotting factors and proteins Platelets = Help with blood clotting to stop bleeding Albumin = Maintains blood volume and pressure</p> Signup and view all the answers

What is the purpose of HLA testing before blood transfusions and organ transplants?

<p>To assess the patient's immune response to foreign substances and prevent transfusion reactions or organ rejection (A)</p> Signup and view all the answers

According to protocol, only one healthcare provider needs to confirm patient identification and specimen labeling of blood samples.

<p>False (B)</p> Signup and view all the answers

Besides ABO and Rh testing, what other type of testing is performed to ensure compatibility between the blood component and the patient's blood?

<p>HLA testing</p> Signup and view all the answers

Flashcards

Infusion Therapy

A method of delivering nutrients or medications directly into the bloodstream via IV.

IV Solutions

Special fluids ordered for infusion include crystalloid and colloidal solutions.

Crystalloid Solutions

Electrolyte solutions in water, used for rehydration and nutrient delivery.

Colloidal Solutions

Fluid containing larger molecules that draw fluid into the bloodstream.

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Osmolarity

Concentration measure of a solution, defined as osmoles per liter (mOsm/L).

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Osmolality

Measure of the number of particles in a kilogram of solution (mOsm/kg).

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Infusion Order

A healthcare provider's directive specifying IV fluids and additives for a patient.

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Blood Products

IV-administered components like RBCs, platelets, and plasma.

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Medication Compatibility

The degree to which two or more medications can be safely used together without causing adverse reactions.

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IV Medication Errors

Mistakes related to intravenous medication administration, often due to incompatibilities, with a 25% incidence rate.

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Isotonic IV Fluid Effects

Isotonic IV fluids cause no significant fluid movement into or out of cells, maintaining balance.

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Vein Structure

Veins consist of three layers: tunica intima, tunica media, and tunica adventitia, supporting vital functions.

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Vein Function in Infusion

Veins return deoxygenated blood to the heart, aided by valves that prevent backflow and skeletal muscle compression.

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Challenges in Older Adults

Older adults may face issues with infusion therapy due to skin and vein changes affecting catheter use.

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Peripheral Catheter Placement

Placement can be affected by changes in skin thickness and decreased pain perception in older adults.

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Purpura and Ecchymoses

Skin conditions in older adults resulting from fragile blood vessels, leading to bruising and discoloration.

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Peripheral Catheter

A device inserted into a vein using a needle, then the needle is removed, leaving the catheter in place.

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Flashback Chamber

A feature that fills with blood when a vein is accessed, confirming the catheter is in the correct place.

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Needle Safety Chamber

Protects against accidental needle sticks once the catheter is inserted.

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Catheter Gauge Color

System of color coding to identify different gauges of catheters, such as gray for 16 gauge and yellow for 24 gauge.

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Gauge 18

A catheter gauge suitable for trauma, surgery, and rapid fluid administration.

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Gauge 20

Used for continuous or intermittent infusions and blood transfusions.

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Midline Catheter

A peripheral catheter ending distal to the shoulder used for therapies lasting 1-4 weeks.

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Recommended Veins for IV

Best peripheral veins for infusion include metacarpal, cephalic, basilic, and median veins.

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Indications for Midline Catheter

Not suitable for certain irritating solutions and pH extremes.

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Central Venous Access (CVA)

When the IVAD tip ends in the central vasculature at the superior/inferior vena cava.

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Multiple-Lumen Catheters

Catheters with several separate fluid pathways for simultaneous infusion.

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Proximal, Medial, Distal Lumens

Terms for the locations of different lumens on a multi-lumen catheter.

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Tourniquet Use

A device used to occlude venous blood flow during venipuncture.

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Venipuncture Steps

Process includes verifying orders, cleaning, and puncturing a vein.

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IVAD for Osteomyelitis

Most appropriate IVAD for prolonged antibiotic therapy in osteomyelitis patients.

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Blood Donation Screening

Multiple tests ensure the blood is safe from diseases.

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Components of Blood

Blood can be separated into RBCs, plasma, platelets, etc.

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ABO Blood Type

Blood type determined by antigens on RBC surface.

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Rh Factor

Determines if blood is Rh-positive or Rh-negative.

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Hemolytic Reaction

Occurs when incompatible blood types are transfused.

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HLA System

Proteins on white blood cells important for immune response.

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Patient Identification Process

Requires careful labeling and dual identification for blood samples.

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Blood Compatibility Testing

Matching blood components to patient's blood before transfusion.

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IO Route

A method for rapid central venous access during emergencies.

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Needleless Systems

Devices designed to prevent needle-stick injuries and exposure to pathogens.

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Luer Lock

A mechanism used to connect syringes and IV sets securely.

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Backflow Prevention

A feature in certain connectors that stops blood from returning into IV catheters.

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Disinfection Importance

Crucial step to prevent infections before using needleless systems.

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Alcohol Caps

Caps used to maintain disinfectant contact on needleless systems.

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Scrubbing Technique

Recommended 10-15 seconds cleaning before accessing a needleless connector.

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Education on Connectors

Ongoing training for nurses regarding needleless connector usage is essential.

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Study Notes

Introduction

  • Infusion therapy is given across various care settings, including hospitals, extended care facilities, and outpatient clinics.
  • Specialized "IV resource teams" improve patient outcomes and reduce costs.
  • Infusion Nurses Society (INS) provides evidence-based standards for infusion therapy delivery.
  • Certified Registered Nurse Infusion (CRNI) certification requires a rigorous examination and practical experience.

Patient Needs for Infusion Therapy

  • Patients may require infusion therapy for fluid and electrolyte replacement, medication administration, blood product administration, or nutritional support.
  • Duration varies from hours/days to lifelong.

Solutions Used in Infusion Therapy

  • Crystalloid solutions: electrolytes dissolved in water (e.g., dextrose, sodium chloride, balanced electrolyte solutions)
  • Colloidal solutions: larger molecules (e.g., protein or starch) suspended in fluid—often used for plasma volume expansion.
  • Osmolarity/Osmolality: Measures concentration of solution in terms of particles per liter/kilogram of solution; normal range for serum osmolality is 270 to 300 mOsm/L.
  • Isotonic solutions: have similar osmolarity to plasma, causing minimal fluid movement in/out of cells (250-375 mOsm/L)
  • Hypotonic solutions: lower osmolarity than plasma, causing fluid to move from intravascular to intracellular/interstitial spaces.
  • Hypertonic solutions: higher osmolarity than plasma, causing fluid to move from cells to intravascular space.

Blood Products in Infusion Therapy

  • Blood products (packed red blood cells, platelets, plasma, albumin, clotting factors) require special precautions for administration and patient safety.
  • Blood products are administered intravenously.

Veins Used in Infusion Therapy

  • Veins are low-pressure vessels returning deoxygenated blood to the heart.
  • Consist of three layers: intima, media, and adventitia.
  • Venipuncture sites should be avoided if possible due to difficulty stabilizing, or risk of mechanical irritation.
  • Veins in lower extremities and arms on sides with prior mastectomy and dialysis are unfavorable.

Types of Intravenous Access Devices

  • Peripheral venous access (over-the-needle catheter, midline catheter, butterfly/steel-winged catheter)
  • Central venous access (nontunneled percutaneous central catheters, tunneled catheters, implanted ports, peripherally inserted central catheters [PICCs]).
  • Appropriate catheter selection depends on patient needs, therapy duration, and volume of fluids.

Medication Incompatibilities

  • Physical incompatibility: visible changes in solution (color, cloudiness).
  • Chemical incompatibility: breakdown of medication; not always visible.
  • Therapeutic incompatibility: undesirable changes in therapeutic response.

Complications of Infusion Therapy

  • Phlebitis: inflammation of the vein (pain, erythema, induration)
  • Infiltration: leakage of solution into surrounding tissue (pain, swelling, blanching)
  • Occlusion: blockage of the catheter (slowed or stopped infusion).
  • Air embolism: air introduced into the venous system.
  • Infection: possible with any IVAD.

Nursing Management of Infusion Therapy

  • Monitoring: Evaluate fluid status (intake/output, weights, electrolyte levels) and monitor for complications.
  • Preventing complications: Proper insertion technique, using appropriate site care, and infection control measures.

Infusion Therapy Standards of Practice

  • The current infusion therapy standards emphasize the importance of maintaining sterile technique, using appropriate dressing changes, and recognizing signs and symptoms of complications.

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