Term
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Definition
IV therapy: is the infusion of a fluid into a vein to prevent or teat fluid or electrolyte imbalance or to deliver medications, nutrition or blood products. the therapeutic goal of IV therapy may be maintenance, replacement, treatment, diagnosis, monitoring, palliation, or a combination.
Iv therapy is prescribed for:
-maintenance and replacement of lfuids for daily fluid requirements
-electrolytes to maintain noremal electrolyte balance
-glucose and nutrients for patient use as an energy source
- an access route to administer meds IV
-venous access to administer blood products
-venous access for emergencies
Principles of IV therapy include the types of IV used, the equipment used for infusion and flow rates. |
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Term
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Definition
crystalloid- Iv fluids that are clear.
can be further classified as isotonic, hypertonic and hypotonic according to how closely the solutions osmolarity matches that of plasma, which is between 275 and 295 mOsm/L. |
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Term
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Definition
| colloid- IV fluids that contain proteins or starch molecules. |
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Term
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Definition
| oslmolarity- refers to the number of particles or solutes that are in a liter of solution. therefore, osmolarity is measures in milliosmoles per liter. specific patient fluid and electrolyte needs determine which solution is prescribes |
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Definition
| Isotonic fluids have an osmolarity of 250-275 mOsm/L, which is the same osmotic pressure as that found within the cell. CAUSE NO FLUID SHIFTS. used to expand the intravascular compartment and this increase the circulating volume. an isotonic solution is helpful for hypotension caused by hypovolemia in dehydration. ex: include normal saline (0.9% NaCl) and Ringer's lactate RL |
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Definition
hypotonic fluids have an osmolarity below 250 mOsm/L or a lower osmotic pressure than the cell. HYPOTONIC SOLUTION MOVES FLUID INTO THE CELLS AND INTERSTITIAL SPACE. USED FOR DEHYDRATION. when a hypotonic solution is infused, it lowers serum osmolarity, causing body fluids to shift out of the blood vessels and into the cell sand interstitial space.
- administeres when a patient needs cellular hydration.
one haLFnormal saline (0.45 NaCl) is an ex. - a solution like D51/2NaCl, although an isotonic solution before administration (in the bad iso), quickly becomes a hypotonic solution once in the body because this small amount of dextrose is quickly metabolized. |
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Definition
hypertonic fluids have and osmolarity of 375 mOsm/liter or higher with a greater osmotic pressure than the cell. DRAW FLUID FORM THE INTERCELLULAR SPACE INTO THE INTRAVASCULAR. USED UNDER CONDITIONS OF INTRAVASCULAR DEHYDRATION WITH INTERSTITIAL AND INTRACELLULAR FLUID OVERLOAD, SEPSIS.
-when a hypertonic solution is infused, serum osmolarity is increased, pulling fluid from the cells and the interstitial tissues into the vascular space.
ex: include 3% saline (NaCl) and 5% saline. they should be administered slowly to rpevent circulatory overload, usually used in the critical care setting.
-considered high risk and should not be stored with other IV solutions on nursing units. |
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Term
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Definition
| parenternal nutrition refers to a nutritional elements supplied through an IV route, usually a central vein. |
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Term
| Total parenteral nutrition (TPN) |
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Definition
| TPN IS A HYPERTONIC SOLUTION CONTAINING 20% TO 50% DEXTROSE, protein, vitamins, and minerals that is administered into the venous system |
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Term
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Definition
| venipuncture is the technique that permits insertion of a needle or catheter into a vein. sterile procedure. most common is insertion of a needle or flexible catheter into a peripheral vein. over the needle iv catheters are the access devices most common used for peripheral IV therapy. |
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Term
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Definition
midline catheter inserted near the antecubital fossa and terminates in the vasculature, just before the axilla. for patients who need moderate-term parenteral therapy or who have limited peripheral access. may not be suited for TPN, hyperosmolar infusions or vesicant therapy, shoudl not be used for routine blood drawing.
advantages to midline catheter:
easy to insert and remove
intermediate use
lower infection rates
disadvantages:
thrombosis, phlebitis, air embolism more common than with peripheral veins |
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Term
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Definition
peripheral catheters:
advantages- choice of sites, eay to insert and remove, lower infection rates
disadvantages: short-term use
infiltration and phlebitis more common
inability to infuse hyperosmolar solutions
inability for blood draws |
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Term
| central venous access devices |
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Definition
central venous access therapy involves the placement of a flexible catheter into large veins, with the tip of thecatherter places in either the superior vena cava or the right atrium. when infusing hypertonic solutions or when the patients peripheral venous access is inadequate for the duration of type of IV therapy needed.
- for long term or home IV therapy. access to entral vein for infusion of irritating medications and TPN, when peripheral vein access is not available.
Four main categories of CVC:
-single or multilumen catheters
-PICC
-Tunneled catheter
implanted access port |
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Term
| Catheter related bloodstream infections (CRBSI) |
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Definition
CRBSI- the development of a biofilm formation along the catheters inner lumen. in response the central catheter care bundle made up five basic elements of prevention:
-hand hygeine
-maximum barrier precautions during insertion
-chlorhexidine skin antisepsis
-optimal catheter site selection with subclavian vein preferred.
- daily assessment of catheter necessity. |
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Term
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Definition
cenrtal venous catheters- single-lumen catheter and the multi-lumen catheter, which has either two or three lumens and is made of non-thrombogenic material such as teflon or polyurethane, making it more resistant to adherence of microorganisms. Sterile procedure. catheter tip is placed n the superior vena cava or at the entrance of the right atrium. allows multiple drugs to be administered at once without the risk of incompatibility or solutions. bc of complication risks, used only in hospitals.
-nontunnelled CVC:
advantages-choice of sites,easy to insert and remove, multiple lumens available.
disadvantages-short-term in-hospital use,higher risk of complications.
-tunnelled CVC:
advantages-lower infection rate than non-tunnelled CVC, long-term use, multiple lumens available.
disadvantages- more complex insertion and removal |
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Term
| Peripherally inserted central catheter (PICC) |
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Definition
PICC- Long-line catheter made of soft silicone or silastic material; it is placed peripherally nit delivers medications and solutions centrally. Basilic vein is usually used, but the median cubital and cephalic veins in the antecubital area also can be used. PICC lines are threaded so the catheter tip terminates in either the axillary or subclavian vein or the superior vena cava.
Advantages: easy to insert and remove, long-term and home care use, may be used for blood draws, may infuse all solutions.
Disadvantages: higher thrombosis rates than tunneled or implanted catheters, small diameter limits flow rates, catheter longevity less than tunneled or implanted catheters, greater incidence of malposition. |
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Term
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Definition
Tunneled CVC is implanted during a surgical procedure in which an incision is made in the deltopectoral groove and teh subclavian vein is isolates. the subQ pathway or tunnel is gently formed with a long forceps to a point btwn the nipple and sternum,
Advantages: lower infection rathe than non-tunneled CVC, long term use, multiple lumens available
disadvantages: complex insertion and removal |
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Term
| Implanted vascular acess devices |
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Definition
implanted vascular access devices- system includes the subQ injection port and silastic catheter,which is usually inserted into superior vena cava. self sealing septum port allows repeated use without the risk of air entering the system.
advantages: long-term use, no external catheter: cosmetically attractive, low maintenance, may swim, shower, bathe, lower infection rate than tunneled caths.
disadvantages: surgical insertion and removal, more difficult for frequent repeated access |
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Term
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Definition
| needleless connector- provide access to secondary ports on IV tubing or for flushing access. reduce the risk of injury from contaminating sharps during IV procedures |
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Term
| electric infusion device (EID) |
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Definition
| EID: accurately regulated the infusion rate warranted by patient's age, condition, setting and prescribed therapy. EID pump uses positive pressure to deliver the prescribed fluid volume, whereas the controller senses the drops infusing to maintain a precise flow. |
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Term
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Definition
| smart pumps are enhanced EID that has an embedded computer safety software program, aka "dose error reduction system". configured to match specialty patient populations within org, safety features such as concentration, predetermined dose limits, and administration guidelines. |
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Term
| Factors effecting flow rates |
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Definition
factors effecting flow rates:
-height of IV bag
-position of extremity
-tubing obstruction
-position of the IV access
-Iv Patency
-clogged airvents |
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Term
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Definition
| positional IV the position of the needle or catheter within the vein can affect rate of flow. |
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| Role of Nurse in IV Therapy |
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Definition
| Responsible for initiating, monitoring, maintaining, and discontinuing the IV infusion and for patient teaching related to the infusion |
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Definition
Initiating IV Therapy:
-prepare patient
-select site
-prepare site
-perform venipuncture
-secure venipuncture device |
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Definition
Maintinaing IV Infusions:
-monitoring and documentation
-dressing changes
-changing IV solutions and t
-intermittent flushing of an infusions lockubing |
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Term
| Assessing for complication |
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Definition
Assessing for complication:
-infiltration
-phlebitis
-infection
-fluid overload
-air embolism
-pneumothorax
-catheter breakage or damage |
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Term
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Definition
Infiltration: when an IV solution inadvertently leaks into the SQ tissues - patient may complain of pain, swelling around infiltration site, which is cool to the touch. IV infusion slows bc of increased pressure in SubQ tissue.
Extravasations is caustic can cause tissue necrosis
-take iv out , warm soap and water, find new IV site. |
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Term
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Definition
| Extravasation is infiltration (IV fluid inadvertently leaks into SQ tissue) when solution or medication is vesicant (highly irritating) |
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Term
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Definition
| Vesicant- highly irritating and IV solution or medication that can cause extensive tissue damage when they leak into SQ tissue |
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Term
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Definition
phlebitis- inflammation of the vascular endothelial wall.
factors that contribute to the development of phlebitis include catheter gauge, size, and material; length of time the catheter is in a vein; type and pH of solution administered; and use of small veins or veins of lower extremities. |
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Term
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Definition
| thrombophlebitis- inflammation of the vascular endothelial wall accompanies by a blood clot. factors that contribute to the development of phlebitis include catheter gauge, size, and material; length of time the catheter is in a vein; type and pH of solution administered; and use of small veins or veins of lower extremities. |
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Term
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Definition
| Fluid overload: may occur if the patient receives IV fluid too rapidly: very young, the elderly and patients with cardiac or renal impairment are particularly vulnerable. assessments such as increased weight, decreased urine output compared to intakes, and crackles (rales) upon lung auscultation often indicate fluid overload. |
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Term
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Definition
| Air embolism: entry of air into the patient's circulatory system. more common when central venous catheters are used; air entry i due tot he change in intrathoracic pressures during respiration. a significant amount of air poses a significant health risk. smaller amounts of air are significant when a central venous catheter is used for IV therapy. symptoms include complaints of chest, shoulder, or back pain; dypnea, hypotension, cyanosis, thready pulse, and loss of consciousness. position patient on left side in trendelenburg position to allow the air to rise into the right ventricle and allow blood to pass into the lungs. can be life threatening |
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Term
| Complications of IV Catheters |
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Definition
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Definition
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Term
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Definition
Peripheral-
-short catheter- arm, hands
-midline 4-6 inches
Central-
-multilumen
-peripherally inserted central line (PICC)
-Tunneled catheters (Hickman, Broviac)
-Implantable access devices (infusaport, Poratacath) |
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Term
| Nursing responsibilities in IV therapy |
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Definition
Nursing Responsibilities IV therapy:
-Administer Fluid as /order
-monitor insertion site
-maintain IV tubing, Bags, sites (change/hospital policy)
-Monitor infusion rates (Gravity, EID)
-Assess patients response to therapy (labs)
-Assess and monitor fluid status closely (weight)
-Assess for IV complications |
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