IV Tubing Changes & Central Line Risks PDF

1. Differentiate between hypo/iso/hypertonic solution types and uses/contraindications *hypotonic: lower concentration or tonicity of solutes, osomolality equal to or less than 250 mOsm/L, lowers the osmolality w/i the vascular space and causes fluid to shift to the intracellular and interstiti...

1. Differentiate between hypo/iso/hypertonic solution types and uses/contraindications *hypotonic: lower concentration or tonicity of solutes, osomolality equal to or less than 250 mOsm/L, lowers the osmolality w/i the vascular space and causes fluid to shift to the intracellular and interstitial space, cells will swell but also may delete fluid w/i the vascular space (examples: 0.45% sodium chloride, 0.33% sodium chloride, 2.5% dextrose in water, and 0.2% sodium chloride) monitor for hypovolemia and hypotension, do not administer to pts w/ ICP (can exacerbate cerebral edema), use w/ caution in pts w/ burns, liver failure, and traumas *isotonic: osomolality of 250-375 mOsm/L, has the same osmotic pressure as plasma creating constant pressure inside and outside the cells and causes the cells to remain the same (dont shrink or swell), does not cause any fluid shifts w/i compartments, useful to increase intravascular volume, treats v/d, shock, and metabolic acidosis and resuscitation purposes and administation of blood and blood products (examples: 0.9% solium chloride (normal saline), lactated ringer’s solution, 5% dextrose in water (D5W), and ringer’s solution), monitor pts for fluid volume overload (hypervolemia) *hypertonic: higher concentration or tonicity of solutes, osomolality equal to or greater than 375 mOsm/L, osmotic pressure draws water out of the intracellular space into the extracellular space (examples: D5W, 0.45% sodium chloride, D10W, 3% sodium chloride), may cause intravascular fluid volume overload and pulmonary edema, should not be used for an extended period of time, should not be used in patients w/ heart or renal disease who are dehydrated *notes: all examples of crystalloid solutions 2. Micro vs macro tubing administration sets *micro tubing: 60 gtts/min, most common in pediatric or neonatal care when small amounts of fluids are administered over a long period of time *macro tubing: 10, 15, or 20 gtts/min, used for routine primary infusions 3. When to change IV tubing (primary, secondary/intermittent, blood products, fat emulsion *primary: every 72-96 hours *secondary/intermittent: every 24 hours *blood products: 4 hours or 4 units (whichever comes first or between products) *fat emulsion: every 24 hours *note: all IV tubing must be changed using sterile technique. IV tubing is changed based on the type of tubing, time used, and the type of solution. If possible, coordinate IV tubing changes w/ IV solution changes 4. Central line risks *pain: pain or discomfort during or after CVC is placed *bleeding: bleeding or bruising around the area the cvc was placed, goes away in a few days *infection: increase of infection, wash hands or sanitize before touching cvc, notify team if dressing is loose or change yourself if you’ve been taught, notify team of any s/s like fever or chills *blockage: can be blocked by clotted blood, flush to prevent clots, meds can be used to unclog it *blood clots: can for in the vein where cvc is, can cause redness or swelling in the hands, arms, shoulder, or neck, notify tream immediately of any new swelling or redness *migration or kinking: can migrate or move, twist, or become kinked inside the vein, needs repositioning *accidental removal: can be accidentally pulled out, team will use tape or bandages to secure cvc, be careful around children or pets *collaped lung: very rarely a lung can collapse (pneumothorax)- develops when the lung is punctured and air collects in the chest outside the lung, doctors use tools like ultrasound and fluoroscopy to see veins and lungs during placement 5. Types of peripheral IV vs central lines *IVs: peripheral IV, central venous catheter, midline catheter *central lines: implanted ports, tunneled catheters, PICCs