IV Therapy Flash Cards

IV Therapy Flash Cards

Lynn D. Phillips, RN, MSN, CRNI®

Butte College Nursing Instructor

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F. A. Davis Company1915 Arch StreetPhiladelphia, PA 19103www.fadavis.com

Copyright © 2009 by F. A. Davis Company

Copyright © 2009 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.

Printed in MexicoLast digit indicates print number: 10 9 8 7 6 5 4 3 2 1

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As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, andmake no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.

ISBN3: 978-0-8036-2141-1ISBN 10: 0-8036-2141-8

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Table of Contents:Section 1: Infection Control Related to IV Therapy 1–27Section 2: Fluid, Electrolytes, and Parenteral Solutions 28–55Section 3: Equipment 56–78Section 4: Technique/Maintenance Peripheral IVs 79–100Section 5: Technique/Maintenance Central IVs 101–113Section 6: Complications 114–136Section 7: Infusion Modalities 137–146Section 8: Transfusion Therapy 147–160Section 9: Nutritional Support 161–165Section 10: IV Therapy Bonus Cards, Illustration Credits 166–170

Guide to Pronunciation: Pronunciations are spelled phonetically; pronunciations, diacritical marks (long and short vowels), and stressses on syllables ( ' for primary and '' for secondary) follow Taber’s Cyclopedic Medical Dictionary.

See “Features and Their Use” in the dictionary for more information.

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DedicationTo my mother, Margie Schuetz, thank you for your unconditional love.

AcknowledgmentsChristina C. Burns, Project EditorThomas A. Ciavarella, Acquisitions EditorInfusion Nurses Society

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ReviewersMichelle Crum, RN, BSNNursing InstructorOzarks Technical Community CollegeSpringfield, Missouri

Debra J. Dichiara, MSN, RNAssociate ProfessorDaytona Beach CollegeDaytona Beach, Florida

Gay Oyco Divinagracia, MA, RN, BCAssociate Professor Indian River Community CollegeFort Pierce, Florida

Shirley Lyon Garcia, RN, BSNAdjunct Faculty, PNE InstructorMcDowell Technical Community CollegeMarion, North Carolina

Mary M. Goetteman, RN, EdDProfessorDaytona Beach CollegeDaytona Beach, Florida

Sung Gwak, MSN, CCRN, BC, RNAssociate ProfessorBorough of Manhattan Community CollegeNew York, New York

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Roxanne Hurley, MS, RNClinical Associate ProfessorUniversity of North DakotaGrand Forks, North Dakota

Mark R. Kucharek, RN, MSNAssistant Director of NursingMohave Community CollegeKingman, Arizona

Cynthia Levering, RN, Med, MS, CNSAssociate ProfessorCentral Ohio Technical CollegeNewark, Ohio

Missy Mohler, MS, RNNursing InstructorHocking CollegeNelsonville, Ohio

Karen Reilly, MSN, ARNPAssociate Professor Daytona Beach CollegeDaytona Beach, Florida

Kay Schwartzwelder, MSN, RNAssociate Director of Nursing and Allied Health Collins Career CenterChesapeake, OhioInstructorOhio UniversityIronton, Ohio

Jill Scott, RN, MSN, CCRNNursing ProfessorSt. Johns River Community CollegePalatka, Florida

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Barbara Tacinelli, RN, MAProfessor of NursingBorough of Manhattan Community CollegeNew York, New York

Mary Tan, PhD, RNAssistant DirectorHolmes Community CollegeRidgeland, Mississippi

Diana C. Tilton, RN, BSN, CRNI®

Assistant ProfessorJohnson Community CollegeOverland Park, Kansas

Judith Valloze, ARNP, MSNProfessor of NursingDaytona Beach CollegeDaytona Beach, Florida

Susan Waltz, RN, DNPNursing Department ChairIvy Tech Community College of Indiana, Columbus CampusColumbus, Indiana

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Getting the Most Out of Your IV Therapy Flash Cards Purpose of Flash CardsYou’re on your way to mastering IV therapy vocabulary! Using these flash cards will developyour ability to focus and achieve deep memory learning. They will help you not only learnthe terminology, but they will help you relate those terms to the nursing content you arestudying. It is important to make a connection between the term, its meaning, and how itfunctions in the language of nursing. So I designed the flash cards to allow you to see theword, read the word (out loud is best), use the word, and associate the word with other related concepts.

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How to Use Flash CardsThis set of flash cards is unique because it gives you opportunities to actively associate eachword or phrase with your studies. Here are some strategies I recommend to get the most outof the time you spend with the cards. But these are not the only ways they can be used; seeif you can think of others that better suit your learning style.1. Write the word on a separate piece of paper and recite the word out loud.2. Work with a partner, take turns saying words out loud to each other, and recite their defi-

nitions. Check your achievement by turning over the cards to see if you provided thecorrect definitions.

3. Draw a picture of the word on a separate piece of paper if you are having trouble remem-bering it. This is called concept mapping—an example is on the back of this card.

4. On the back of each card is a “notes” area that you can use to include associated concepts from a textbook or lecture. Example: ✓Notes: Phlebitis � occurs frequently from mechanical or chemical irritation to the vein.Must anchor IV securely

5. To review for a test, mix up the sections, and use these same strategies as above to testyour understanding of all the words and concepts.

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DavisPlus Web Site: On the DavisPlus Web site , you will find additional terms anddefinitions. Visit http://davisplus.fadavis.com to access this content.

Concept MappingConcept mapping is a thinking tool that reflects externally what is going on in your brain. Each map is unique to the student creating the map. The steps are simple and can be used for any nursing content.1. Write the word on a blank piece of paper.2. Create stems off the word using different colors, and curve the stems leading from the

central word. Note: The brain connects better with free flowing curves rather than straight lines.

3. Write words on the stems that connect ideas to the center word. (Narrow-tip coloredmarking pens work great.)

4. Write one word on each stem and make the stem the length of the word.5. Draw smaller branches coming off each large stem, again the length of the word you

are going to write, and only one word per branch.

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6. Draw pictures if you wish, adding them next to the appropriate stem. Search for imagesonline or create your own drawings. The brain connects to the word or term through pictures.

Lynn Phillips

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Concept Mapping Sample

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1. INFECTION CONTROL

aerobic(er-o'bık)

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DEFINITION:Taking place in the presence of oxygen. Concerning anorganism that lives and reproduces in the presence ofoxygen.

APPLICATION:The physician ordered an aero-

bic culture of the wound.

KEEP IN MIND:Aerobic organisms are generallyfound on the surface of a wound.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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airborne precautions(ar'born pre-ko'shenz)

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DEFINITION:Microorganisms carried bythe air. Precautions usedin addition to standardprecautions for illnessestransmitted by airbornedroplet nuclei.

APPLICATION:The patient with active pul-monary tuberculosis was admit-ted to a private room with nega-tive air pressure with 6–12 airchanges per hour as part of airborne precautions.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

Airborne precautions are used to control the spread of infectionsthat are transmitted on air cur-rents. Airborne infections include tuberculosis, varicella(chickenpox), and rubeola(measles). Airborne precautionsinclude standard and contactprecaution guidelines, along withplacing the patient in a privateroom with a negative air pres-sure. The health-care workers(HCWs) must wear a special N95respirator to care for patientswith pulmonary tuberculosis.Only immune HCWs can care for patients with rubeola or varicella.

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anaerobic(an''er-o'bık)

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DEFINITION:Taking place in the absence of oxygen. Concerning anorganism that lives and reproduces in the absence ofoxygen.

APPLICATION:The nurse collected the woundsample from deep in a tunneledportion of the wound for ananaerobic culture.

KEEP IN MIND:Anaerobic organisms are foundin deep wounds, tunnels, andcavities.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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antibodies(an'tı-bod''ez)

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DEFINITION:A substance produced by B lymphocytes in response toa unique antigen. Antibodies neutralize or destroy antigens.

APPLICATION:Antibodies are proteins that target antigens and destroy themusing the following four methods:phagocytosis, neutralization, agglutination, and activation ofcomplement and inflammation.

KEEP IN MIND:Antibodies also are called im-munoglobulins and are part ofthe body’s plasma proteins.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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antigen(an'tı-jen)

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DEFINITION:A protein marker on the surface of cells that identifiesthe cell as self or nonself; identifies the type of cell andstimulates the production of antibodies.

APPLICATION:The combination of an antigen

with its specific antibody iscalled antigen-antibody reaction.

KEEP IN MIND:Antigens on the body’s own cellsare called autoantigens. Anti-gens on all other cells are calledforeign antigens.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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bacteristatic(bak-ter''e-stat' ık)

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DEFINITION:Inhibiting the growth of bacteria.

APPLICATION:The cephalosporin anti-infectivesare considered bacteristatic.

KEEP IN MIND:Many anti-infective and cleaning/disinfecting agents prevent the growth and repro-duction of some bacteria.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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bactericidal(bak''ter-ı-sı'dal)

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DEFINITION:Capable of killing bacteria.

APPLICATION:Penicillin is considered an anti-infective that is bactericidal.

KEEP IN MIND:Disinfectants destroy pathogensand are bactericidal. Chlorinebleach is capable of killing bac-teria, spores, fungi, and viruseson surfaces. Bactericidal drugsare used for their selective toxic-ity on certain bacterial cells.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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blood borne pathogens(blod born path'o-jenz)

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DEFINITION:Those microorganisms carried in blood and body fluidsthat are capable of infecting other persons.

APPLICATION:Standard precautions are usedfor all hospitalized patients toprevent the spread of blood borne

pathogens.

KEEP IN MIND:The common blood bornepathogens include hepatitis Bvirus, hepatitis C virus, andHIV.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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bloodstream infection (BSI)(blod'strem'' ın-fek'shun)

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DEFINITION:An infection that flows through the circulatory system.

APPLICATION:Bloodstream infections related toplacement of a central venousaccess device (CVAD) in theearly stages are caused by bacte-rial contamination during theinitial catheter insertion.

KEEP IN MIND:The average rate of catheter-related BSIs is 1.5 to 6.8 per1000 catheter days.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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Centers for Disease Controland Prevention (CDC)

(sen'terz for dı-zez' kon-trol' and pre-ven'shun)

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DEFINITION:A division of the U.S. Public Health Service that investi-gates and controls various diseases, especially those thathave epidemic potential. Located in Atlanta, Georgia.

APPLICATION:In 2002, the Centers for Disease

Control and Prevention pub-lished guidelines for preventionof intravascular catheter-relatedinfections.

KEEP IN MIND:The CDC includes Center for Infectious Diseases, Center forEnvironmental Health, Centerfor Health Promotion and Edu-cation, Center for PreventionServices, Center for ProfessionalDevelopment and Training, andCenter for Occupational Safetyand Health.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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chain of infection(chan of ın-fek'shun)

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DEFINITION:The process by which infections spread.

APPLICATION:Health-care workers must eitherclean their hands with analcohol-based solution or washwith soap and water frequently toassist in breaking the chain of

infection.

KEEP IN MIND:Chain of infection is made up of sixlinks, all of which must be presentfor infection to be transmitted fromone individual to another.

1. Infectious agent2. Reservoir3. Portal of exit4. Mode of transmission5. Portal of entry6. Susceptible host

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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colonization(kol''o-nı-za'shun)

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DEFINITION:The growth of microorganisms, especially bacteria, in aparticular body site.

APPLICATION:The culture taken from thenurse’s fingernails showed colo-

nization of Staphylococcus

aureus.

KEEP IN MIND:The microorganisms become resident flora; in this state, themicroorganisms may grow andmultiply but do not cause disease.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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contact precautions(kon'takt'' pre-ko'shenz)

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DEFINITION:Techniques used in addition to standard precautions thatdecrease infection by microorganisms transmittedthrough direct contact with the patient or patient-careitems.

APPLICATION:The patient with a diagnosis ofClostridium difficile (C. difficile)was placed on contact precautions.

KEEP IN MIND:A private room is preferable, butpatients may be placed with others infected with the same organism. Hospital workers mustwear gloves when entering theroom, gowns if close to patient.Stethoscopes and other noncriti-cal patient-care equipmentshould be dedicated to single-patient use.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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droplet precautions(drop'let pre-ko'shenz)

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DEFINITION:Infection due to inhalation of respiratory pathogens suspended in liquid particles exhaled from someone already infected.

APPLICATION:Droplet precautions include the useof a mask and eye protection whenworking within 3 ft of a patient, inaddition to standard and contactprecaution guidelines.

KEEP IN MIND:Droplet precautions are usedwhen the pathogen can bespread via moist droplets (sneezing, coughing, talking).Droplets can spread infection bydirect contact with mucousmembranes or through indirectcontact such as touching a bedside table.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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dissemination(dı-sem'ı-na''shun)

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DEFINITION:Shedding of microorganisms from an individual into theimmediate environment or movement of microorganismsfrom a confined site (skin) to the bloodstream and otherparts of the body.

APPLICATION:The outpatient clinic, with its recent outbreak of staphylococ-cus, cultured all asymptomaticstaff for dissemination of the organism.

KEEP IN MIND:Cultures of air samples, surfaces,and objects reveal disseminationof microorganisms.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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endogenous(en-doj'e-nus)

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DEFINITION:Produced or originating from within a cell or organism.

APPLICATION:The most common endogenous

organism is Staphylococcus

aureus.

KEEP IN MIND:Nosocomial infections can origi-nate from clients themselves.Most nosocomial infectionscome from endogenous sources.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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exogenous(eks-oj'e-nus)

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DEFINITION:Originating outside an organism.

APPLICATION:The patient acquired a nosoco-mial infection from an exogenous

source, the intensive care nurse’shands.

KEEP IN MIND:Exogenous sources of nosoco-mial infections occur from hospital environment or hospitalpersonnel.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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1. extrinsic contamination(eks-trın'sık kon-tam''ı-na'shun)

2. intrinsic contamination(ın-trın'zık kon-tam''ı-na'shun)

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DEFINITIONS:1. Contamination with bacteria during preparation or

administration.2. Contamination introduced during manufacturing.

APPLICATION:The IV therapy–related BSI wastraced to extrinsic contamination

from improperly administered IVsolution.

KEEP IN MIND:Most BSIs related to contami-nated infusates are related to the duration of uninterrupted infusions through the same administration set and the frequency with which the set is manipulated.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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hand hygiene(hand hı'jen)

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DEFINITION:A general term that applies to hand washing, antiseptichand wash, antiseptic hand rub, or surgical hand antisepsis.

APPLICATION:The transmission of healthcare-associated pathogens from onepatient to another via the hands ofhealth-care workers requires a sequence of events. Hand hygiene

breaks the sequence of events.

KEEP IN MIND:The goal of using specific handhygiene products is to maintainnormal barrier function.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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healthcare-associated infections (HAIs)

(helth'kar a'so-se-a''ted ın-fek'shunz)

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DEFINITION:Infections that patients acquire during the course of receiving treatment for other conditions or that health-care workers (HCWs) acquire while performing their duties within a health-care setting.

APPLICATION:In hospitals alone, healthcare-

associated infections (HAIs) account for an estimated 2 millioninfections, 90,000 deaths, and$4.5 billion in excess health-carecosts annually (CDC, 2006.)

KEEP IN MIND:The term nosocomial infectionshas been replaced with the termhealthcare-associated infections.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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host(host)

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DEFINITION:The organism from which a microorganism obtains itsnourishment.

APPLICATION:The frail, 90-year-old man hadimpaired defenses due to pneu-monia and, therefore, was a com-promised host.

KEEP IN MIND:A susceptible host is any personwho is at risk for infection. Intact skin is the best defenseagainst infection.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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immunosuppression(ım''u-no-su-presh'un)

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DEFINITION:Prevention of or interference with the development ofimmunologic response; may be artificially induced bychemical, biologic, or physical agents, or may be causedby disease.

APPLICATION:Immunosuppression can occur inpatients receiving chemotherapy.

KEEP IN MIND:Persons who acquire an infec-tion because of a deficiency inany of their multifaceted hostdefenses are referred to as com-promised hosts. Persons withmajor defects related to specificimmune responses are referredas immunosuppressed.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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leukopenia(loo''ko-pe'ne-a)

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DEFINITION:Any condition in which the number of leukocytes in thecirculating blood is lower than normal, the lower limit ofwhich is generally regarded as 4000/5000 mm3.

APPLICATION:The immunocompromised patient was admitted with leucopenia and placed on neutropenic precautions.

KEEP IN MIND:Infection, together with neutropenia, is regarded as an emergency situation. Precautionsare usually initiated when the patient’s absolute neutrophilcount (ANC) is lower than 1000.The ANC can be calculated withthe following formula: ANC =total WBC × (% segs + % ofbands).

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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reservoir(rez'er-vwor)

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DEFINITION:Living or nonliving material in or on which an infectiousagent multiplies and develops and is dependent on forits survival in nature.

APPLICATION:The patient with a staphylococ-cus infection in the wound wasthe reservoir for transmission bywound drainage.

KEEP IN MIND:Second link in the chain of infection. The exit site fromreservoir is important in transmission of infection.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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susceptible host(su-sep'tı-bl host)

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DEFINITION:Person with inadequate defenses against an invadingpathogen. The host is the organism from which a parasite obtains its nourishment.

APPLICATION:The client with AIDS is a suscep-

tible host for opportunistic infec-tious organisms.

KEEP IN MIND:Once a pathogen gains entry intoa host, three factors determinewhether the person develops infection. First, the virulence ofthe organism; second, the num-ber of organisms transmitted;and third, the ability of thehost’s defenses to prevent infection.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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transient flora(trans'ze-ent flor'a)

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DEFINITION:Microorganisms that are picked up, usually on the skin,and can be removed fairly easily with hand hygiene.

APPLICATION:The nurse used a 15-second, vigorous scrub to remove transient

skin flora prior to insertion of anintravascular device.

KEEP IN MIND:Alcohol-based products are moreeffective than standard handwashing to remove transient skinflora.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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virulence(vır'u-lens)

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DEFINITION:Relative power and degree of pathogenicity possessed byorganisms to produce disease.

APPLICATION:The microorganism’s ability toproduce disease includes viru-

lence, dose (number of organismsavailable to infect), susceptiblehost, and dissemination.

KEEP IN MIND:The ability of an organism to induce disease is called its viru-lence or invasiveness.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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28. FLUID, ELECTROLYTES, AND PARENTERAL SOLUTIONS

1. acidosis(as''ı-do'sıs)

2. alkalosis(al''ka-lo'sıs)

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DEFINITIONS:1. An actual or relative

increase in the acidityof blood due to an accumulation of acidsor an excessive loss ofbicarbonate. The hydro-gen ion concentration ofthe fluid is increased,lowering the pH. A pHless than 7.35.

2. An actual or relativeincrease in blood alka-linity due to an accu-mulation of alkalies orreduction of acids. ApH above 7.45.

APPLICATION:The body maintains the plasma pH within the narrow normal range of7.35 to 7.45. It does so by means of chemical buffering mechanismsutilized by the kidneys and by the lungs to prevent acidosis or alkalosis.

KEEP IN MIND:

DEA

TH

ACIDOSIS ALKALOSISD

EATHNORMAL

1 part of carbonic acidH CO 1.20 mM/L2 3

20 parts of biocarbonateHCO- 24 mEq/L

pH6.80

pH7.35

pH7.45

pH7.80

3

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active transport(ak'tıv trans''port)

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DEFINITION:The process by which acell membrane movesmolecules against a con-centration or electrochem-ical gradient. Metabolicwork is required.

APPLICATION:The sodium-potassium pump, which is located in the cell membrane,in the presence of adenosine triphosphate (ATP) actively moves sodiumfrom inside the cell into the extracellular fluid (ECF) by active

transport.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Active transport occurs to move other ions (such as calcium or hydro-gen) from areas of lesser concentration to areas of greater concentra-tion. Energy expenditure must occur for the movement to occur.

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1. anion(an'ı-on)

2. cation(kat' ı-on)

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DEFINITIONS:1. An ion (electrolyte) carrying a negative charge; the

opposite of cation. 2. An ion (electrolyte) carrying a positive charge; the

opposite of anion.

APPLICATION:The unit of measure for anions

and cations is milliequivalentsper liter (mEq/L).

KEEP IN MIND:An anion is attracted by andtravels to the anode (positivepole). A cation is attracted byand travels to the cathode (nega-tive pole).

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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Chvostek’s sign(vos'teks sın)

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DEFINITION:A sign elicited by tapping the facial nerve about 2 cmanterior to the earlobe, just below the zygomatic process;the response is a spasm of the muscles supplied by thefacial nerve. A positive Chvostek’s sign is a symptom ofhypocalcemia or hypomagnesemia.

APPLICATION:The patient postoperative forthyroidectomy began to havesigns of hypocalcemia includingnumbness of the fingers, crampsin the muscles of the legs, andpositive Chvostek’s sign.

KEEP IN MIND:Chvostek’s sign also can be observed as unilateral twitching. *NOTE: Refer to Bonus Card170 for picture of Chvostek’ssign.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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colloid(kol'oyd)

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DEFINITION:A substance (e.g., blood, plasma, albumin, dextran) thatdoes not dissolve into a true solution and is not capableof passing through a semipermeable membrane.

APPLICATION:Albumin 25% (a colloid solu-tion) was ordered to maintainblood volume for the 24-year-oldmale, auto accident victim priorto administration of packedcells.

KEEP IN MIND:Colloid solutions contain proteinor starch molecules that remaindistributed in the extracellularspace and do not form “true” solutions.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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crystalloid(kr ı'stal-oyd'')

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DEFINITION:A substance that forms a true solution and is capable ofpassing through a semipermeable membrane.

APPLICATION:Many crystalloid solutions contain dextrose as the carbohy-drate, calorie source.

KEEP IN MIND:Crystalloid solutions, such as5% dextrose in water or 0.9%sodium chloride, move betweenthe three fluid compartments in the body based on osmolalityof the solution.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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extracellular fluid (ECF)(eks''tra-sel'u-lar floo''ıd)

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DEFINITION:Fluid located outside the cell, comprised of interstitialand plasma fluid.

APPLICATION:The patient admitted to the EDafter a gunshot wound to theright shoulder, had extracellular

fluid volume deficit due to theblood loss.

KEEP IN MIND:Extracellular fluid (ECF) is subdivided into intravascularfluid (plasma) and interstitialfluid (fluid lying between thecells or tissue fluid). Also part of the ECF is transcellular fluids.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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1. fluid volume deficit (FVD)(floo'ıd vol'um def ' ı-sıt)

2. fluid volume excess (FVE)(floo' ıd vol'um ek'ses)

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DEFINITIONS:1. A deficiency. Hypov-

olemia. An equal pro-portion of loss of waterand electrolytes fromthe body.

2. The state of exceedingwhat is normal. Hyper-volemia. Retention ofboth water and sodiumin similar proportionsto normal ECF.

APPLICATION:The student nurse created a table identifying the characteristics of fluid

volume deficit and fluid volume excess to study for the examination.

KEEP IN MIND:FVD has defining characteristics such as weight loss over a short period of time, decreased skin and tongue turgor, dry mucous membranes, urine output <30 mL/hr in adults, weak rapid pulse, andslow capillary refill. FVE has defining characteristics such as weightgain over a short period of time, peripheral edema, distended neckveins, slow-emptying peripheral veins, moist rales in lungs, polyuria,and bounding full pulse.

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hydrating solution(hı'dr at-ıng so-lu'shun)

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DEFINITION:A solution of water, car-bohydrate, sodium, andchloride used to deter-mine the adequacy of renal function.

APPLICATION:The client was admitted to the emergency department for intractablevomiting and 3 days of diarrhea. An IV was started with a 5% dextrosein 0.45% sodium chloride, a hydrating solution, to determine kidneystatus and begin hydration before replacement of potassium chloride.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Hydrating solutions are used to assess kidney function. Kidney func-tion must be determined prior to administering potassium infusions.

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1. hypotonic(hı''po-ton'ık)

2. hypertonic(hı''per-ton'ık)

3. isotonic(ı''so-ton'ık)

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DEFINITIONS:1. Solutions that have a

lower osmolality thanbody fluids. Below 250 mOsm.

2. Solutions that have ahigher osmolality thanbody fluids. Above 375 mOsm.

3. Solutions that have thesame osmolality asbody fluids. Between250 and 375 mOsm.

APPLICATION:Intravenous parenteral solutions are classified as either hypotonic,

isotonic, or hypertonic solutions based on the osmolarity of the solution.

KEEP IN MIND:

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1. hypercalcemia(hı''per-kal-se'me-a)

2. hypocalcemia(hı''po-kal-se'me-a)

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DEFINITIONS:1. An excessive amount of

calcium in the blood.2. Abnormally low blood

calcium.

APPLICATION:The patient receiving six unitsof blood post trauma was evalu-ated for hypocalcemia.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

Hypercalcemia is caused by hyperparathyroidism, lithiumtherapy, malignancies includingsolid tumors and hematologicalmalignancies, hyperthyroidism,and milk-alkali syndrome.Hypocalcemia occurs transientlyin patients with severe sepsis, se-vere pancreatitis, burns, and re-nal failure. It also may resultfrom multiple transfusions of cit-rated blood, parathyroidectomy,malabsorption, and medications.

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1. hyperkalemia(hı''per-ka-le'me-a)

2. hypokalemia(hı''po-ka-le'me-a)

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DEFINITION:1. An excessive amount of

potassium in the blood.2. An abnormally low

concentration of potas-sium in the blood.

APPLICATION:Patients receiving diuretics must have laboratory potassium valuesevaluated periodically for hypokalemia due to loss of potassium in theurine.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Hyperkalemia usually is caused by inadequate excretion of potassium orthe shift of potassium from tissues. Hypokalemia results from deficientpotassium intake or excess loss of potassium due to vomiting, diarrhea, orfistulas; metabolic acidosis; diuretic therapy; aldosteronism; excessadrenocortical secretion; renal tubule disease; and alkalosis.

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1. hypermagnesemia(hı''per-mag''ne-se'me-a)

2. hypomagnesemia(hı''po-mag''ne-se'me-a)

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DEFINITION:1. Increase in magnesium

in the blood. Above 2.1 mEq/L.

2. Decreased magnesiumin the blood. Below 1.3 mEq/L.

APPLICATION:The preeclampsia patient in labor and delivery receiving magnesiumsulfate must be monitored for hypermagnesemia including fetal hearttones.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Hypermagnesemia is clinically accompanied by a severe decrease inneuromuscular transmission and depression of skeletal muscle func-tion. The common causes include renal failure and magnesium admin-istration for therapeutic purposes. Hypomagnesemia is clinicallyaccompanied by increased neuromuscular irritability. The commoncauses include gastrointestinal losses, alcoholism, and refeeding afterstarvation.

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1. hypernatremia(hı''per-na-tre'me-a)

2. hyponatremia(hı''po-na-tre'me-a)

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DEFINITION:1. An increased concentra-

tion of sodium in theblood. Above 145 mEq/L.

2. A decreased concentra-tion of sodium in theblood. Below 135 mEq/L.

APPLICATION:Hyponatremia is the most frequent electrolyte disorder seen in clinicalpractice.

KEEP IN MIND:

NOTES:________________________________________________________________________________

More than 95% of the body’s physiologically active sodium is in theECF. In contrast, the intracellular concentration of sodium is small.Sodium does not easily cross the cell wall membrane. The primary roleis in controlling water distribution as well as ECF volume. In general,a loss or gain of sodium is accompanied by loss or gain of water.

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1. hypervolemia(hı''per-vo-le'me-a)

2. hypovolemia(hı''po-vo-le'me-a)

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DEFINITIONS:1. An increased volume of circulating blood usually due

to retention of sodium and water in the ECF.2. A decreased blood volume that may be caused by in-

ternal or external bleeding, fluid losses, or inadequatefluid intake.

APPLICATION:Nurses can help to prevent hypovolemia or hypervolemia by identifyingpatients who have the highest risk for developing either fluid volumedeficit (older adults, infants and children), and conditions associatedwith fluid loss (e.g., vomiting, fever); or fluid volume excess by moni-toring intake and output and observing patients for signs and symp-toms of fluid overload.

KEEP IN MIND:Fluid volume imbalances mayoccur alone or in combinationwith other imbalances. Fluidvolume excess is also referred toas hypervolemia, and fluid volume deficit is also referred toas fluid volume deficit.

NOTES:________________________________________________________________________________

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ions(ı'onz)

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DEFINITION:An atom or group ofatoms that has lost one ormore electrons and has apositive charge, or hasgained one or more elec-trons and has a negativecharge.

APPLICATION:The unit of measurement for ions is usually milliequivalents per liter(mEq/L), or can be expressed as millimoles per liter (mmol/L) as ischemical activity of the electrolytes. Milligrams per 100 mL expressthe weight of the solute per unit volume.

KEEP IN MIND:

NOTES:________________________________________________________________________________

In aqueous solution, ions are called electrolytes because they permitthe solution to conduct electricity.

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interstitial fluid(ın''ter-stısh'al floo'ıd)

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DEFINITION:Fluid that surrounds the cells.

APPLICATION:The extracellular fluid is dividedinto plasma space, approxi-mately 5% of total body weight,and interstitial fluid approxi-mately 15% of body weight.

KEEP IN MIND:Also called tissue fluid. Theelectrolyte content of interstitialfluid is not measured in clinicalsituations; however, it is essen-tially the same as that of plasma,except that it contains less proteinate.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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intracellular fluid (ICF)(ın''tra-sel'u-lar f loo' ıd)

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DEFINITION:The fluid within the tissue cells.

APPLICATION:Intracellular fluid accounts forapproximately 40% of total bodyweight.

KEEP IN MIND:The bulk of body fluid is locatedwithin the body’s intracellularfluid (ICF); this fluid is con-tained within the body’s morethan 100 trillion cells.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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maintenance solution(man'te-nants so-lu'shun)

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DEFINITION:Fluids that provide all nutrients necessary to meet dailypatient requirements. Usually, water, glucose, sodium,and potassium.

APPLICATION:The patient, NPO for laparo-scopic cholecystectomy, receivedintravenous maintenance solu-

tions until discharge from theoutpatient surgery center.

KEEP IN MIND:Water has priority in mainte-nance therapy.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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1. metabolic acidosis(met''a-bol' ık as'' ı-do'sıs)

2. metabolic alkalosis(met''a-bol' ık al''ka-lo'sıs)

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DEFINITIONS:1. The clinical disturbance in bicarbonate deficit charac-

terized by a low pH and a low plasma bicarbonateconcentration.

2. The clinical disturbance in bicarbonate excess char-acterized by a high pH and a high plasma bicarbonateconcentration.

APPLICATION:A patient presented to the ED with vomiting for the past three days. His blood gases were pH- 7.56, PaCO2 = 49 mm/Hg, HCO3 = 40 mEq/L. The patient has uncompensated metabolic alkalosis. The following set of bloodgases were found in a young man admitted to the ED wth Kussmaul breathing and an irregular pulse. pH = 7.32,PaCO2 = 15 mm Hg, HCO3 = 6 mEq/L. This patient has uncompensated metabolic acidosis due to the very lowHCO3 level.

KEEP IN MIND:Metabolic acidosis can be pro-duced by a gain of hydrogen ionor a loss of bicarbonate. Meta-bolic alkalosis can be producedby a gain of bicarbonate or aloss of hydrogen ion.

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oncotic pressure(ong-kot' ık presh'ur)

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DEFINITION:The osmotic pressure exerted by colloids (pro-teins), as when albumin exerts oncotic pressurewithin the blood vesselsand helps to hold the watercontent of the blood in theintravascular compartment.

APPLICATION:AThe patient with 60% second degree burns has damage to capillarybeds and decreased plasma proteins to maintain oncotic pressure.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Also referred to as colloid osmotic pressure. Movement of fluid throughthe capillary wall into the tissues depends on two forces: hydrostaticpressure and oncotic pressure which is exerted by nondiffusible plasmaproteins. Oncotic pressure is greater than hydrostatic pressure in thevenous end of the capillary; fluids re-enter the capillary at the venous end.

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osmosis(oz-mo'sıs)

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DEFINITION:The passage of water froma lower to higher concen-tration through a semiper-meable membrane thatseparates solutions of dif-ferent concentrations.

APPLICATION:Administration of 0.45% sodium chloride (a hypotonic solution) willmove by osmosis from the plasma compartment into the interstitial andcellular compartments.

KEEP IN MIND:

NOTES:________________________________________________________________________________

The solvent, usually water, passes through the membrane from the region of lower concentration of solute to that of higher concentration,thus tending to equalize the concentrations of the two. The rate of osmosis is dependent primarily upon the difference in osmotic pres-sures of the solutions on the two sides of a membrane, the permeabilityof the membrane, the electric potential across the membrane, and thecharge upon the walls of the pores in it.

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osmolarity/osmolality(os''mo-lar' ı-te/os''mo-lal' ı-te)

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DEFINITION:A measure of solute concentration; the concentration of asolution in terms of osmoles of solutes per liter of solu-tion. The term osmolarity is used to refer to solutionsoutside of the body. Osmolality refers to solutions withinthe body.

APPLICATION:The osmolarity of 5% dextrose in 0.45 % sodium chloride is406 mOsm.

KEEP IN MIND:The normal osmolality of bodyfluid is between 285 and 295 mOsm (milliosmoles).

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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pH

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DEFINITION:A measure of the hydro-gen ion concentration of asolution.

APPLICATION:The blood gas results reflected a pH of 7.48, a alkalotic condition.

KEEP IN MIND:

NOTES:________________________________________________________________________________

DEA

TH

ACIDOSIS ALKALOSIS

DEATH

NORMAL

1 part of carbonic acidH CO 1.20 mM/L2 3

20 parts of biocarbonateHCO- 24 mEq/L

pH6.80

pH7.35

pH7.45

pH7.80

3

Because the pH scale is logarithmic, there is a 10-fold differencebetween each unit.

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plasma volume expander(plaz'ma vol'um ek-span'der)

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DEFINITION:A high-molecular weight compound in a solution suit-able for intravenous use.

APPLICATION:The patient in postanesthesia recovery required Dextran 40 in0.9% sodium chloride as aplasma volume expander due toblood loss in the operating room.

KEEP IN MIND:Examples of plasma volumeexpanders include Dextran andHetastarch. Used to restorecirculatory dynamics and treatperioperative shock.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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replacement therapy(re-plas'ment ther'a-pe)

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DEFINITION:Replenishment of losses when maintenance cannot bemet and patient is in deficient state.

APPLICATION:The patient receiving chemother-apy required replacement ther-

apy of platelets at the outpatientinfusion center due to a plateletcount of 50,000.

KEEP IN MIND:Usually patient is in acute dis-tress from loss of gastrointestinalfluids, hemorrhage, low plateletcount, or starvation. Replace-ment is calculated over 48 hours.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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1. respiratory acidosis(res'-pıra-tor''e as''ı-do'sıs)

2. respiratory alkalosis(res'-pıra-tor''e al''ka-lo'sıs)

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DEFINITION:1. A state of excess car-

bon dioxide in the body(hypercapnia).

2. A state of excessiveloss of carbon dioxidefrom the body.

APPLICATION:A patient is hypoventilating because of a respiratory depressant drugoverdose, with a pH below the normal range (<7.35); therefore this isacidosis and the PaCO2 is 80, far above normal. This is uncompensatedrespiratory acidosis.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Respiratory acidosis (H2CO3 excess) can be either acute or chronic; the acute imbalance is particularly dangerous. Respiratory acidosis is always due to inadequate excretion of CO2 resulting in increasedplasma CO2 levels. Respiratory alkalosis (H2C03 deficit) is always dueto hyperventilation, this causes excessive “blowing off” of C02.

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Trousseau’s sign(troo-soz sın)

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DEFINITION:A carpopedal attitude of the hand elicited when theblood supply to the hand is decreased or the nerves ofthe hand are stimulated by pressure; elicited within several minutes by applying a blood pressure cuff inflated above systolic pressure. Positive Trousseau’s indicates hypocalcemia or hypomagnesemia.

APPLICATION:The student nurse taking the postoperative thyroidectomy patient’svital signs noted a carpopedal attitude of the hand and fingers when theblood pressure pump was inflated. She reported this to the instructorwho explained the need to report this Trousseau’s sign to the physician.

KEEP IN MIND:To elicit a Trousseau’s sign, usea blood pressure cuff and place it on the arm, inflate the cuff to 10 mm/Hg for 3 minutes, and observe for carpopedal spasm. *NOTE: Refer to Bonus Card170 for picture of Trousseau’ssign.

NOTES:________________________________________________________________________________

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56. EQUIPMENT TERMS

cannula(kan'u-la)

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56. EQUIPMENT TERMS

DEFINITION:A flexible tube that may be inserted into a duct, cavity,or blood vessel to deliver medication or drain fluid. Itmay be guided by a sharp, pointed instrument (stylet).

APPLICATION:The infusion nurse chose a #20cannula to begin the infusion of5% dextrose and 0.45% sodiumchloride in the cephalic vein.

KEEP IN MIND:Also called a catheter. Refer tocard 72 for over-the-needlecatheter (cannula) information.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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57. EQUIPMENT TERMS

check valve(chek valv)

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57. EQUIPMENT TERMS

DEFINITION:A device that functions to prevent retrograde solutionflow; also called a back check valve.

APPLICATION:The check valve stopped the backflow of the secondary infusion ofgentamicin into the primary 5%dextrose in 0.45% sodiumchloride.

KEEP IN MIND:Check valves are inline compo-nents of many primary adminis-tration sets. The check valve isan important feature when sec-ondary IV lines are in place forintermittent infusions.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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58. EQUIPMENT TERMS

drip chamber(dr ıp cham'ber)

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58. EQUIPMENT TERMS

DEFINITION:Area of IV administration set usually found under thespike where the solution collects and drips into the tubing.

APPLICATION:The drip chamber had a micro-drip in the drop orifice deliver-ing 60 drops per milliliter.

KEEP IN MIND:This chamber is a pliable,enlarged clear plastic tube thatcontains the drop orifice. It isconnected to the tubing.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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59. EQUIPMENT TERMS

drop factor(drop fak'tor)

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59. EQUIPMENT TERMS

DEFINITION:The number of drops needed to deliver 1 mL of fluid.

APPLICATION:The administration set packagestated that the blood administra-tion set drop factor was 60 gtt/mL.

KEEP IN MIND:Drop factors vary per manufac-turer. Primary macrodrip is 10,15, and 20 gtt/mL. Pediatric setsare microdrip at 60 gtt/mL, andblood sets are 10 gtt/mL.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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60. EQUIPMENT TERMS

elastomeric pump(e''las-to'mer-ık pump)

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60. EQUIPMENT TERMS

DEFINITION:A portable infusion device with a balloon made of soft,rubberized material capable of being inflated to a prede-termined volume.

APPLICATION:The home-care nurse broughtthe 50-mL elastomeric pump

to the client with instructionsfor the family on delivery of themedication via the pump every6 hours.

KEEP IN MIND:An elastomeric reservoir or bal-loon works on flow restrictions.When filled, the balloon exertspositive pressure to administerthe medication with an inte-grated flow restrictor that con-trols the flow. Elastomeric pumpscome in a variety of sizes rangingin volume from 50 to 500 mL.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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61. EQUIPMENT TERMS

electronic infusion device(EID)

(e-lek-tron'ık ın-fu'zhun dı-vıs' )

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61. EQUIPMENT TERMS

DEFINITION:An automated system of introducing a fluid into a vein.The device may have programmable settings that controlthe amount of fluid to be infused, rate, low-volume notification level, and a keep-vein-open rate.

APPLICATION:The electronic infusion device

was set for 100 milliliters perhour as a primary infusion.

KEEP IN MIND:Often called an IV pump. Theyallow delivery of drops perminute or milliliters per hour.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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62. EQUIPMENT TERMS

filter(f ıl't er)

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62. EQUIPMENT TERMS

DEFINITION:A device for eliminating certain elements, such as parti-cles of certain size, in a solution.

APPLICATION:A 0.22 micron filter is used tofilter microbes and air from aprimary administration set.

KEEP IN MIND:A membrane filter is one that ismade up of a thin film of collo-dion, cellulose acetate, or othermaterial, available in a widerange of defined pore sizes; thesmaller pore sizes are capable ofretaining all the known viruses.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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63. EQUIPMENT TERMS

gauge(gaj)

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63. EQUIPMENT TERMS

DEFINITION:A standard of measurement.

APPLICATION:The nurse starting an infusionused a #20 gauge 1 inch over-the-needle catheter placed in thecephalic vein.

KEEP IN MIND:The gauge of over-the-needlecatheters is in even numbers(14, 16, 18, 20, 22, and 24).Metal needles are odd numbered(19, 21, 23, and 25). The gaugeof the catheters refers to theopening size of the bevel.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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64. EQUIPMENT TERMS

hub(hub)

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64. EQUIPMENT TERMS

DEFINITION:Female connection point of an IV cannula where thetubing or other equipment attaches.

APPLICATION:The hub of the infusion devicehas threads to lock the syringe inplace during a flush.

KEEP IN MIND:All hubs for infusion equipmentshould be Luer-Lok design. The Luer adapter is a devicethat makes connections betweensyringes and injection ports,administration sets, and cathetersin a manner that prevents thethreads on the Luer adapter fromslipping.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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65. EQUIPMENT TERMS

infusate(ın-fu'zat)

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65. EQUIPMENT TERMS

DEFINITION:Any liquid introduced into the body.

APPLICATION:The infusate of albumin wascompleted within 2 hours.

KEEP IN MIND:Infusates include all crystalloidsand colloids, blood and bloodproducts.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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66. EQUIPMENT TERMS

locking device (PRN device)(lok'ıng dı-vıs')

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66. EQUIPMENT TERMS

DEFINITION:A capped resealable diaphragm that may have a Luer-Lok or Luer-Slip connection. This diaphragm can be accessed multiple times. Also called PRN device orsaline lock.

APPLICATION:The order from the physicianstated to convert the continuousinfusion of 0.9% sodium chlorideto an intermittent infusion usinga locking device (or saline lock).

KEEP IN MIND:The lock is part of administra-tion sets, available as separateconnectors to convert continuousinfusions to intermittent devices.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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67. EQUIPMENT TERMS

lumen(lu'men)

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67. EQUIPMENT TERMS

DEFINITION:The space within a tubular structure, such as an arteryor catheter.

APPLICATION:The dual-lumen peripherally inserted central catheter dress-ing was scheduled to be changed 24 hours after insertion.

KEEP IN MIND:Several types of peripheralinfusion devices are availablewith single- and double-lumencatheters.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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68. EQUIPMENT TERMS

macrodrop(mak'ro-drop'')

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68. EQUIPMENT TERMS

DEFINITION:In IV therapy, an administration device that is used todeliver measured amounts of IV solution. Large drops offluid.

APPLICATION:The outpatient surgicenter rou-tinely uses macrodrip adminis-tration sets as part of thepresurgery infusion set.

KEEP IN MIND:The size of the drops is con-trolled by the fixed diameter of aplastic delivery tube. Differentmacrodrips deliver 10, 15, or 20 drops per milliliter of solution.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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69. EQUIPMENT TERMS

microdrop(mı'kro-drop'')

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69. EQUIPMENT TERMS

DEFINITION:In IV therapy, an administration device for deliveringsmall, measured amounts of IV solutions (60 drops =1 mL) at specific flow rates.

APPLICATION:The ICU nurse added a micro-

drip administration set to thesolution of heparin in order totitrate the delivery of themedication in small amounts.

KEEP IN MIND:Also called a pediatric drip, or60-drop tubing. Microdripsdeliver small amounts of solutionover time.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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70. EQUIPMENT TERMS

multichannel pumps(mul''tı-chan'el pumpz)

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70. EQUIPMENT TERMS

DEFINITION:Electronic infusion device that delivers multiple drugsor solutions simultaneously or intermittently from bags,bottles, or syringes.

APPLICATION:Multichannel pumps are used in critical care areas for deliveryof multiple solutions andmedications.

KEEP IN MIND:Multichannel pumps are nowbeing designed with medicationsafety systems.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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71. EQUIPMENT TERMS

needleless systems(ne'del-les sıs'temz)

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71. EQUIPMENT TERMS

DEFINITION:A device for administering intravenous solutions thatpermits intravascular access without the necessity ofhandling a needle.

APPLICATION:The infusion clinic converted toa new needleless system.

KEEP IN MIND:These systems were developedto reduce the number of needlestick injuries related to tradi-tional intravenous administra-tion of fluids and medications.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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72. EQUIPMENT TERMS

over-the-needle catheter(o'ver ne-del kath'e-ter)

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72. EQUIPMENT TERMS

DEFINITION:A flexible tube that enables passage of fluid from or intoa blood vessel. Consists of a needle with a cathetersheath.

APPLICATION:A # 20 gauge over-the-needle

catheter was used to initiate theinfusion on the adult waiting foroutpatient surgery.

KEEP IN MIND:Most common peripheral infu-sion device. The point of theneedle extends beyond the tip ofthe catheter. After venipuncture,the needle (stylet) is withdrawn.ONCs are sized by even num-bers.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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73. EQUIPMENT TERMS

patient-controlled analgesia (PCA)

(pa'shent kon-trol'ed an-al-je'ze-a)

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73. EQUIPMENT TERMS

DEFINITION:A drug delivery system that dispenses a preset intravas-cular dose of a narcotic analgesic when the patientpushes a switch on an electric cord.

APPLICATION:The physician ordered morphinevia patient-controlled analgesia

postoperatively for the 62-year-old client with hip resurfacing.

KEEP IN MIND:The device consists of a comput-erized pump with a chambercontaining a syringe of drug.The patient administers a doseof narcotic when the need forpain relief arises. A lockoutinterval automatically inacti-vates the system if a patienttries to increase the amount ofnarcotic within a reset period.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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74. EQUIPMENT TERMS

injection port (ın-jek'shun port)

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74. EQUIPMENT TERMS

DEFINITION:Resealable devices designed to accommodate needlelessaccess for administration of solutions or medications intothe vascular system.

APPLICATION:The injection port was cleanedwith an alcohol swab using atwisting motion prior to deliveryof the IV medication.

KEEP IN MIND:Injection ports serve as anaccess into the tubing and arelocated at various points alongthe administration of medica-tion. Needleless systems areused to access the port. Portsare located along primary ad-ministration sets or stand-alonedevices connected as lockingdevices.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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75. EQUIPMENT TERMS

primary administration set(pr ı'ma-re ad-mın-ı-stra' shun set)

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75. EQUIPMENT TERMS

DEFINITION:Device used for delivery of large volume parenterals.

APPLICATION:The student nurse, gatheringequipment for the initial intra-venous infusion, chose a primary

macrodrip administration set andthe prescribed solution.

KEEP IN MIND:Available in microdrip or macro-drip drop factor. Tubing is longand used to deliver 500 to 1000 mL infusions over a periodof time.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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76. EQUIPMENT TERMS

radiopaque(ra-de-o-pak')

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76. EQUIPMENT TERMS

DEFINITION:Material used in IV catheter that can be identified by radiographic examination.

APPLICATION:The catheter embolized after in-sertion and was detected on radi-ographic examination because ofthe radiopaque quality of thecatheter.

KEEP IN MIND:Most infusion catheters areradiopaque to ensure radi-ographic visibility.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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77. EQUIPMENT TERMS

secondary administration set(sek'on-dar''e ad-mın-ı-stra'shun set)

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77. EQUIPMENT TERMS

DEFINITION:Administration set that has short tubing used for delivery of 50 to 100 mL of infusion attached to primary administration set for intermittent delivery of medications.

APPLICATION:The student nurse chose the appropriate secondary adminis-

tration set to administer the piggyback medication.

KEEP IN MIND:Usually 3 to 36 inches in length.Always attached to a needlelessadapter into an injection portimmediately distal to the backcheck valve of the primarytubing.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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78. EQUIPMENT TERMS

syringe pumps(sır-inj' pumpz)

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78. EQUIPMENT TERMS

DEFINITION:Piston-driven infusion pumps that provide precise infu-sion by controlling the rate by drive speed and syringesize.

APPLICATION:The syringe pump technologywas applied to patient-controlledanalgesia pumps.

KEEP IN MIND:The system pushes the plungerto deliver fluid or medication ata rate of 0.1 to 99.9 mL/h. Somemodels have program modescapable of administration inmg/kg per minute, mcg/min, andmL/h. The syringe is usuallyfilled in the pharmacy andstored until use.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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79. TECHNIQUES/MAINTENANCE PERIPHERAL IVS

basilic vein(ba-sıl' ık van)

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DEFINITION:Vein that arises from theulnar side of the dorsalvenous network of thehand; it curves aroundthe medial side of theforearm, communicateswith the cephalic veinthrough the median cu-bital vein and passes upthe medial side of thearm to join the axillaryvein.

APPLICATION:The basilic vein, located at themedian cubital site, is one veinused for insertion of peripherallyinserted central catheters.

KEEP IN MIND:

NOTES:____________________________________________________________________________

Basilic vein

Basilic vein

Cephalic vein

Accessorycephalic vein

Brachialartery

Median cubital vein

Ulnar artery

Medianantebrachialvein

Cephalic vein

Radialartery

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cannulation(kan''u-la'shun)

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DEFINITION:Insertion of an over-the-needle catheter.

APPLICATION:The nurse can use the direct orindirect method of cannulation

technique for insertion of over-the-needle catheters.

KEEP IN MIND:Step number 9 of the 15 Steps.Actual insertion of the catheterthrough the skin and substruc-tures into the vein. *NOTE: Refer to Bonus Card166 (back), Phillips 15 Steps.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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cephalic vein(se-fal' ık van)

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DEFINITION:Vein arises at the radialborder of the dorsal venous area of the hand,passes upward in front ofthe elbow and along thelateral side of the arm; itempties into the upperpart of the axillary vein.

APPLICATION:The cephalic vein above the radial border above the wrist isa common site to initiate initialIV therapy.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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Image rights not available.


chlorhexidine(klor-hek'sı-den)

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DEFINITION:A bisbiguanide used as a topical disinfectant.

APPLICATION:A skin prep for 20 seconds withChlorhexidine (gluconate) shouldbe used prior to insertion of theperipheral catheter.

KEEP IN MIND:As a site prep, 2% chlorhexi-dine gluconate and 70% isopropyl alcohol significantly reduces microbial counts over a24-hour period.*NOTE: Refer to Bonus Card166 (back), Phillips 15 Steps.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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digital veins(dıj'ı-tal vanz)

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DEFINITION:Veins that are located onthe lateral and dorsal por-tions of the fingers.

APPLICATION:The digital vein of the thumb isa site for initiation of infusiontherapy for the elderly when hydrating fluids are neededwithout additives and other access is limited as a result ofdehydration.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

Cephalic veinBasilic vein

Dorsal venous arch

Metacarpal veins

Digital veins

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distal(dıs'tal)

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DEFINITION:Farthest from the center, from a medial line, or from thetrunk.

APPLICATION:The IV placed in the lowercephalic vein had infiltrated andthe nurse was aware that shecould not initiate infusion ther-apy distal to that site.

KEEP IN MIND:The fingers are the most distalpoint in the peripheral area forinfusion therapy.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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dermis(der'mıs)

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DEFINITION:The layer of the skin lying immediately under the epidermis; the true skin.

APPLICATION:The epidermis and dermis of the80-year-old woman upon assess-ment were very thin; therefore,the nurse had to use specialtechniques in initiating infusiontherapy.

KEEP IN MIND:The corium dermis is composedof fibrous connective tissuemade of collagen and elastin,and contains numerous capil-laries, lymphatics, and nerveendings. In it are hair folliclesand their smooth muscle fibers, sebaceous glands and sweatglands, and their ducts.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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drop factor(drop fak'tor)

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DEFINITION:The drop rate of the infu-sion administration set tobe used is called the dropfactor.

APPLICATION:The nurse in the rural clinic needed to set up an infusion to gravity us-ing a primary administration set with a drop factor of 15 at a rate of125 mL per hour. A formula was needed to set the drip rate.

Drop factor × mL/hour = drop per minute60 (minutes)

KEEP IN MIND:

NOTES:________________________________________________________________________________

Drop factors vary depending on the size of the drop orifice. Commondrop factors are: Primary sets: 10, 15, or 20. Pediatric/micro drip sets: 60. Blood administration sets: 10. *NOTE: Refer to the back of Bonus Card 167 for examples ofrate calculations.

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endothelium(en''do-the'le-um)

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DEFINITION:A form of squamous epithelium consisting of flat cellsthat line the blood and lymphatic vessels, the heart, andvarious other body cavities.

APPLICATION:The intima of the vein is linedwith endothelium and can bedamaged with poor venipuncturetechnique.

KEEP IN MIND:Derived from mesoderm. Endothelial cells are metaboli-cally active and produce a num-ber of compounds that affect thevascular lumen and platelets.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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epidermis(ep'' ı-der'mıs)

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DEFINITION:The outermost layer of the skin.

APPLICATION:The nurse performed a 20-secondprep with antimicrobial solutionof the epidermis prior to insertionof the catheter.

KEEP IN MIND:The epidermis is less sensitivethan underlying structures. Theepidermis is the first line of defense against infections.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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flushing (flush' ıng)

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DEFINITION:To irrigate with fluid.

APPLICATION:The nurse prepared the morphine, 5 mg to be given IV push over 5 minutes, along with two prefilled flushing solutions—one for prior toadministration of the medication into the intermittent infusion deviceand one for post administration.

KEEP IN MIND:0.9% sodium chloride is used for maintenance of intermittent infusion devices. Flush with 0.9% sodium chloride to ensure andmaintain patency. For peripheral IVs, flushing protocol dictates: flushwith 2–3 mL at least every 12 hours. Flushing should be done prior tomedication administration and post administration of intermittent devices. *NOTE: Refer to Bonus Card 169 for Flushing Guidelines.

NOTES:________________________________________________________________________________

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metacarpal veins(met''a-kar'pal vanz)

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DEFINITION:Veins located on the dor-sum of the hand over thefive long bones formed bythe union of digital veins.

APPLICATION:The metacarpal vein of the righthand was used to initiate infu-sion of 5% dextrose and 0.45%sodium chloride without addi-tives for hydration for the clientwith gastroenteritis.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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median cubital veins(me'de-an ku'bı-tal vanz)

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DEFINITION:Veins that pass across theanterior aspect of the elbow from the cephalicvein to the basilic vein;commonly, this vein is replaced by intermediatebasilic and intermediatecephalic veins.

APPLICATION:The phlebotomist used thecephalic portion of the median

cubital veins to withdraw bloodfor analysis.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

These veins are often used for venipuncture for blood withdrawal and in emergency cases for access.

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midline catheter(mıd'lın kath'e-ter)

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DEFINITION:Catheter with tip placement level with the axillary vein,and distal to the shoulder.

APPLICATION:The nurse inserted a midline

catheter to support the infusionof the peripheral nutritional sup-port over a period of 7 days.

KEEP IN MIND:This catheter measures 3.1 to 8 inches in length with the distaltip dwelling in the basilic,cephalic, or brachial vein.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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palpation(pal-pa'shun)

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DEFINITION:Examination by application of the hands or fingers to the external surface of the body to detect the outline of a vein.

APPLICATION:The nurse, prior to venipuncture,used palpation of the veins of thehand and lower arm to determinewhich vein would be most appro-priate for infusion therapy.

KEEP IN MIND:Palpate the vein by moving thetips of the fingers down the veinto observe how it refills. *NOTE: Refer to front ofBonus Card 166, step 5 of Phillips 15 Steps, for pal-pation of veins to determinesite selection.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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prime(prım)

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DEFINITION:Process of running the fluids in an IV bagthrough the tubing so that there is no air in thetubing.

APPLICATION:The administration set wasprimed prior to insertion into theelectronic infusion device.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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proximal(prok'sım-al)

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DEFINITION:Nearest the point of attachment, center of the body; or point of reference.

APPLICATION:The IV site in the hand appearedreddened and the patient com-plained of pain at the site. Thenurse discontinued the infusionand catheter, and restarted the infusion proximal to the previousinfusion site.

KEEP IN MIND:The upper cephalic vein (abovethe median cubital) is the mostproximal point of insertion of acatheter for peripheral infusiontherapy.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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skin receptors:1. mechanoreceptors

(mek''a-no-re-sep'torz)

2. thermoreceptors(ther''mo-re-sep'torz)

3. nociceptor(no''se-sep'tor)

4. chemoreceptors(ke''mo-re-sep'torz)

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DEFINITIONS:1. A receptor that receives mechanical stimuli, such as

pressure from sound or touch.2. A free nerve ending that is a receptor for painful stimuli.3. A sensory receptor that is stimulated by a rise in body

temperature.4. A sense organ or sensory nerve ending that is stimu-

lated by, and reacts to, certain chemical stimuli andthat is located outside the central nervous system.

APPLICATION:Application of the physiology ofnociceptors must be consideredprior to venipuncture to decreasethe discomfort of initiation of infusion therapy.

KEEP IN MIND:There are five types of sensory re-ceptors, four of which affect par-enteral therapy. Sensory receptorstransmit along afferent fibers.Mechanoreceptors, palpation ofveins; thermoreceptors, applicationof heat or cold; nociceptors, thepuncture of vein for insertion ofthe cannula; chemoreceptors, decrease circulating blood volume.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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tangential lighting(tan-jen'shul lıt' ıng)

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DEFINITION:Indirect lighting used to illuminate the blue of veins.

APPLICATION:Tangential lighting was usedwith a small flashlight to illumi-nate the veins of the lower armand, thus, assist with access ofthe vein.

KEEP IN MIND:This technique can be used fordark skinned individuals andthose with altered skin surfaces. *NOTE: Refer to Bonus Card166, step 5 of Precannula-tion, use tangential lightingto determine site selection.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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1. tunica adventitia(tu'nı-ka ad''ven-tısh'e-a)

2. tunica media(tu'nı-ka me'de-a)

3. tunica intima(tu'nı-ka ın'tı-ma)

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DEFINITION:Layers of tissue that form the walls of veins and arteries.

APPLICATION:The nurse must keep in mindthat the intima of the vein isfragile and that good venipunc-ture technique is important toprevent damage to this thirdlayer of the vein.

KEEP IN MIND:Tunica adventitia: The outermostlayer consists of connective tis-sue that surrounds and supportsa vessel. Tunica media: composedof muscular and elastic tissuewith nerve fibers for vasoconstric-tion and vasodilation. Tunica intima: innermost layer has onethin layer of cells referred to asthe endothelial lining.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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transdermal analgesia(trans-der'mal an-al-je'ze-a)

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DEFINITION:Analgesia deliveredthrough the dermis orskin.

APPLICATION:The nurse provided transdermal analgesia with EMLA cream coveredwith occlusive dressing 30 minutes prior to venipuncture.

KEEP IN MIND:Use of anesthetics either on the skin or injected into the dermal layerprior to venipuncture to decrease the pain of venipuncture. Lidocaine1% (plain) by intradermal route; transdermal by EMLA cream or ELAMax cream topically applied 30 minutes prior to venipuncture.*NOTE: Refer to Bonus Card 166 (back) for step 8 of Phillips15 Steps. Analagesic is used prior to site preparation, allowedto take effect, and then the nurse should continue with step 9.

NOTES:________________________________________________________________________________

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transparent semipermeablemembrane dressing (TSM)

(trans-par'ent sem''e-per'me-a-bl mem'bran dres-ıng)

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DEFINITION:A transparent wound covering made of polyurethane thatenables health-care providers to visually inspect the siteunder the dressing. The dressing allows water vapor toescape from the wound but does not permit liquids orbacteria to enter.

APPLICATION:After the #20 over-the-needlecatheter was stabilized, a TSM

dressing was applied and labeledwith the time of venipuncture,date, size catheter, and nurse’sinitials.

KEEP IN MIND:Transparent semipermeablemembrane dressings should beapplied aseptically and changedevery 72 hours or when thecatheter is changed. Do not useointment of any kind under aTSM dressing.*NOTE: Refer to Bonus Card166, (back), step 10 ofPhillips 15 Steps.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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101. TECHNIQUES/MAINTENANCE CENTRAL IVS

central venous catheter (CVC)

(sen'tral ve'nus kath'e-ter)

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DEFINITION:Catheter inserted into the central circulation for infusiontherapy; the tip located in the superior vena cava. Allcentral lines are central venous catheters (CVCs).

APPLICATION:The new bundles for preventionof catheter-related bloodstreaminfections include assessing theclient early for placement of aCVC.

KEEP IN MIND:CVCs are indicated for infusiontherapy longer than 7 days.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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external jugular (eks-ter'nal jug'u-lar)

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DEFINITION:The vein located on the exterior aspect of the neck.

APPLICATION:In an acute care setting, nurseswho are proficient in infusiontherapy may insert a peripheralIV by accessing the external

jugular.

KEEP IN MIND:External jugular access can beused for external jugular periph-erally inserted central catheters(EJ PICCs) and external jugularperipheral intravenous catheters(EJ PIVs).

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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flushing CVC(flush'ıng)

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DEFINITION:To wash out with a fullstream of fluid.

APPLICATION:The nurse flushed the peripher-ally inserted central catheterwith 5 mL of preservative-freesodium chloride in a 10-mL syringe and followed the flushwith 5 mL of 10 units/mL of heparin using a push-pausemethod.

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

For central catheters the follow-ing protocol is recommended.Central catheters should beflushed with a minimum of 5 mLof sodium chloride using a sin-gle-use 10-mL syringe. Lock thedevice with 5 mL of 10 unit/mLof heparin. For ports use 3–5 mLof 100 units/mL heparin to lockdevice. *NOTE: Refer to Bonus Card169 (back), Flushing Guide-lines.

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Groshong® valve(Gro'shong valv)

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DEFINITION:Flaplike structure resem-bling a valve that retardsor prevents a reflux offluid or blood.

APPLICATION:The Groshong® valve feature is included in many types of centrallines—PICC, tunneled, and ports.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Used at the terminal end of central venous catheters and implantedports to prevent reflux of blood. The Groshong® has a two-way valveplaced near the distal end that restricts backflow of blood, but it canbe purposefully overridden to obtain venous blood samples. This valve eliminates the need for flushing with heparin. The valve is openinward, minimizing the risks of blood backing up the catheter lumen.

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Hickman catheter(Hık'man kath'e-ter)

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DEFINITION:Long-term, tunneled, Silastic catheter inserted surgically.

APPLICATION:The Hickman catheter wasplaced so the client could receive chemotherapy over thenext 8 months.

KEEP IN MIND:Prototype for a variety of tun-neled catheters currently on themarket.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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implanted port(ım'plant-ed port)

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DEFINITION:Catheter surgically placed into a vessel, body cavity, ororgan and attached to a reservoir, which is placed underthe skin.

APPLICATION:The implanted port was accessedwith a safety needle that uses anoncoring needle.

KEEP IN MIND:Implanted ports must be accessed with special needlesthat are noncoring. *NOTE: Refer to Bonus Card169 (back) for picture ofport.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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infraclavicular(ın''fra-kla-vik'u-lar)

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DEFINITION:Positioned below the clavicle.

APPLICATION:The infraclavicular insertion sitewas inspected for redness anddrainage per shift with docu-mentation of visual inspection.

KEEP IN MIND:This site on the right or left isused for insertion of implantedports or percutaneous catheters.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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ports (injection):1. distal port

(dıs'tal port)

2. medial port(me'de-al port)

3. proximal port(prok'sım-al port)

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DEFINITIONS:1. The lumen located far-

ther from the cathetertip.

2. The center lumen of atriple lumen catheter.

3. Lumen nearest the tip.

APPLICATION:The proximal port of the centralline triple lumen was labeled“use for blood sampling only.”

KEEP IN MIND:

NOTES:________________________________________________________________________________________________________________________________________________________________________________

Medial lumen port (18-gaugelumen)

Distal lumen port (16-gaugelumen)

Slide clamp

Proximallumen port(18-gaugelumen)

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peripherally inserted centralcatheter (PICC)

(per-ıf 'er-al-le' ın-ser'ted sen'tral kath'e-ter)

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DEFINITION:Catheter inserted into thesuperior vena cava througha peripheral vein; usuallycephalic and basilic at themedian cubital area.

APPLICATION:The IV team placed the PICC in the right cephalic vein and verifiedconfirmation of the tip in the superior vena cava prior to starting theclient on total parenteral nutrition.

KEEP IN MIND:

NOTES:________________________________________________________________________________

The PICC is a percutaneous line that may have single or multiple lumens with a range in lengths from 33 to 60 cm and diameters of 14to 25 gauges. The PICC is placed by a nurse certified in PICC place-ment. X-ray verification of placement is required before the line canbe used.*NOTE: Refer to Bonus Card 169 (back) to see a picture ofPICC placement.

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polyurethane(pol''e-yur'e-than)

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DEFINITION:Medical grade resins, widely varying in flexibility, usedin chemical-resistant coatings and adhesives used tomake catheters for venous access.

APPLICATION:The polyurethane catheter wasalso coated with chlorhexidine/silver sulfadiazine on the internaland external luminal surfaces as ameans of reducing catheter-relatedbloodstream infections (CRBSI).

KEEP IN MIND:A polyurethane catheter is commonly used because of thematerial’s versatility, malleabil-ity (tensile strength and elonga-tion characteristics), and biocompatibility.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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pulsatile flushing (push-pause)(pul'sa-tıl flush'ıng) (poosh-pawz)

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DEFINITION:Rapid succession of pulsatile push-pause–push-pausemovements that create turbulence within the catheter lumen that causes a swirling effect to move any debris.

APPLICATION:The nurse administered the medication into the PICC andflushed the catheter with 5 mLof preservative-free sodium chlo-ride in a 10-mL syringe using apush-pause technique.

KEEP IN MIND:Use this technique for flushingcentral lines with preservative-free sodium chloride. This tech-nique is not used for locking thedevice with heparin.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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silicone elastomer(sıl'ı-kon e''las-to'mer)

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DEFINITION:A polymer of organic silicon oxides, which may be a liquid, gel, or solid depending on the extent of polymer-ization; used in surgical implants and as a coating on theinside of glass vessels for blood collection.

APPLICATION:The peripherally inserted centralcatheter was made of silicone

elastomer.

KEEP IN MIND:Some VADs are made of siliconeelastomer (Silastic), which issoft and pliable. This material isbiocompatible. Silicone has ahigh degree of thrombogenicity because of surface tackiness.Fibrin sheath formation can occur when particulate matter is present.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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vascular access device (VAD)

(vas'ku-lar ak'ses de'vıs)

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DEFINITION:Access device inserted into a main vein or artery, orbone marrow and used primarily to administer fluids andmedication, monitor pressures, and collect blood.

APPLICATION:The hospital distributed a memorequesting that those nurses interested in being on the VAD

committee contact the infusiontherapy department.

KEEP IN MIND:VADs are all access devices (peripheral catheters, central venous catheters, arterial lines,and intraosseous access devices)that have access to the circula-tory system.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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114. COMPLICATIONS

acute hemolytic transfusionreaction

(a-kut' he''mo-lıt' ık trans-fu'zhun re-ak'shun)

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114. COMPLICATIONS

DEFINITION:Blood transfusion reactionin which an antigen-antibody reaction in therecipient is caused by anincompatibility betweenred blood cell antigensand antibodies causingthe destruction of redblood cells, resulting inliberation of hemoglobin.

APPLICATION:The nurse hung the unit of red blood cells and per protocol stayed withthe patient for the first 5 minutes. The patient complained immediately offlank pain and burning sensation along vein. The nurse stopped the infu-sion, disconnected the infusion, and hung fresh tubing and saline whilecalling for assistance. The physician determined that the patient had anacute hemolytic transfusion reaction due to clerical error in the laboratory.

KEEP IN MIND:Cause of this complication is usually clerical error or breakdown inidentification of matching blood component with recipient. ABOincompatibility.

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115. COMPLICATIONS

air embolism(ar em'bo-lızm)

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115. COMPLICATIONS

DEFINITION:A sudden obstruction of a blood vessel caused by air introduced into the circulation.

APPLICATION:The nurse, following protocol for the central line dressing and administration cap change, hadthe patient hold his breath whiledisconnecting the cap in order toprevent air embolism.

KEEP IN MIND:Rare but lethal complication.Especially involving VADs.Causes include: Allowing solu-tion container to run dry andthen adding a new bag withoutclearing air from the administra-tion set. Loose connections thatallow air to enter the system.Poor technique in dressing andadministration set changes.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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116. COMPLICATIONS

catheter malposition(kath'e-ter mal-po-zı'shun)

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116. COMPLICATIONS

DEFINITION:Position of the centralline catheter outside thesuperior vena cava.

APPLICATION:The advanced practice infusion nurse read the x-ray to verify place-ment and noted that the catheter was malpositioned in the right atrium.The radiologist confirmed that the catheter needed to be repositioned.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Refer to central line term catheter malpositioning where tip of catheteradvances into a venous tributary or does not reach the superior venacava.

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117. COMPLICATIONS

circulatory overload (fluidoverload)

(sır''ku-la-tor'e o'ver-lod)

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117. COMPLICATIONS

DEFINITION:Increased blood volume,usually caused by transfu-sions or excessive fluidinfusions that increase thevenous pressure.

APPLICATION:The nurse noted that the patient was short of breath with wet lungsounds and increased peripheral edema; upon inspection of IV solu-tion, she noted that 0.9% sodium chloride was infusing and the orderhad read 0.45% sodium chloride. The nurse immediately slowed theinfusion and contacted the physician for new solution order to preventfurther circulatory overload.

KEEP IN MIND:

NOTES:________________________________________________________________________________

This can result in heart failure, pulmonary edema, and cyanosis. Alsocalled hypervolemia.

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118. COMPLICATIONS

extravasation(eks-trav''a-sa'shun)

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118. COMPLICATIONS

DEFINITION:The escape of fluid from its physiologic contained spaceinto surrounding fluid.

APPLICATION:The antidote for extravasation ofdopamine is 5 to 10 mg phento-lamine mesylate by intradermaladministration.

KEEP IN MIND:Extravasation is often referred to as infiltration of irritating orvesicant substances into the surrounding tissue. A vesicantcauses the formation of blisters,with subsequent sloughing oftissues.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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119. COMPLICATIONS

fibrin sheath(fı'brın sheth)

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119. COMPLICATIONS

DEFINITION:Covering on the end of acatheter with a whitish, filamentous protein formedby the action of thrombinon fibrinogen. The fibrinis deposited as fine inter-lacing filaments which entangle red and whiteblood cells and lateletsforming a clot.

APPLICATION:The nurse had difficulty aspirat-ing blood from the central lineand suspected a fibrin sheath

covering the Hickman catheter.

KEEP IN MIND:

NOTES:________________________________________________________________________________ Also called a fibrin sleeve.

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120. COMPLICATIONS

graft-versus-host disease(GVHD)

(graft ver'sus host dı-zez')

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120. COMPLICATIONS

DEFINITION:Immunological injury suffered by an immunosuppressedrecipient of a bone marrow transplant. The donated lym-phoid cells (the “graft”) attack the recipient (the “host”),causing damage, especially to the skin, liver, and gas-trointestinal tract.

APPLICATION:The immunocompromised clientwas at risk for graft-versus-host

disease.

KEEP IN MIND:GVHD occurs in about 50% ofallogeneic bone marrow trans-plants. It may develop in thefirst 60 days after transplanta-tion or many months later(chronic GVHD). Creates scleroderma-like changes onskin and organs.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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121. COMPLICATIONS

hematoma(he''ma-to'ma)

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121. COMPLICATIONS

DEFINITION:A swelling comprising a mass of extravasated blood con-fined to subcutaneous tissue caused by break in a bloodvessel.

APPLICATION:The nurse inserted the #20 over-the-needle catheter into the veinof an elderly 80-year-old femalewith the immediate formation ofa hematoma.

KEEP IN MIND:Symptoms include ecchymoses,swelling, inability to advancecatheter, and resistance duringflushing.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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122. COMPLICATIONS

hemothorax(he''mo-tho'raks)

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122. COMPLICATIONS

DEFINITION:Blood in the pleural cavity caused by a rupture of bloodvessels.

APPLICATION:The physician inserted the centralline and upon x-ray verification ofplacement noted the patient haddeveloped a hemothorax.

KEEP IN MIND:Complication during insertion ofcentral line.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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123. COMPLICATIONS

hypothermia(hı''po-ther'me-a)

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123. COMPLICATIONS

DEFINITION:A low core body temperature.

APPLICATION:The nurse in post-anesthesiarecovery (PAR) set up the bloodwarmer in anticipation of infu-sion of additional blood compo-nents to the trauma patient toprevent hypothermia.

KEEP IN MIND:Hypothermia can occur fromrapid transfusion of cold blood.Blood warmers can be used forrapid or massive transfusions.Guidelines from the manufactur-ers of specific fluid/blood warm-ers should be adhered to whenusing any warmer.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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124. COMPLICATIONS

infiltration(ın''f ıl-tra'shun)

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124. COMPLICATIONS

DEFINITION:The accumulation of an external substance within tissue.

APPLICATION:Upon inspection of the IV site,the nurse noted edema and thesite was cool to touch; the infil-

tration was rated at a grade 2.

KEEP IN MIND:Infiltration is usually due to solutions seeping from vesselinto the tissue space causingswelling. *Note: Refer to Bonus Card168 (back) for InfiltrationRating Scale.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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125. COMPLICATIONS

local infection(lo'kal ın-fek'shun)

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125. COMPLICATIONS

DEFINITION:An invasion of microor-ganisms that penetrate thetissues of a specific bodilyarea, then grow and exerttheir effect there.

APPLICATION:The catheter site was not rotated for more than 96 hours and it was notedthat there was purulent material under the transparent dressing. Thenurse cultured the site and catheter in anticipation of a local infection.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Local infections are usually related to contamination of the hands ofthe health-care practitioner while starting the infusion, a contaminatedcatheter or infusate. Symptoms include redness and swelling at thesite, possible exudate of purulent material, and elevated temperature.

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126. COMPLICATIONS

phlebitis(fle-bı'tıs)

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126. COMPLICATIONS

DEFINITION:Inflammation of a vein.Common causes includechemical or mechanicalirritation of vein.

APPLICATION:Upon assessment of the infusion site, the patient complained of pain atthe access site, and it was noted that there was a red streak extending upthe vein and the nurse felt a palpable cord along the vein. The catheterwas discontinued and a 3+ phlebitis was reported to the physician.

KEEP IN MIND:

NOTES:________________________________________________________________________________

*Note: Refer to Bonus Card 168 for Phlebitis Rating Scale.

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127. COMPLICATIONS

pinch-off syndrome(pınch off sın'drom)

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127. COMPLICATIONS

DEFINITION:CVC compressed by theclavicle and the first rib;results in mechanical occlusion.

APPLICATION:The nurse encountered difficulty in aspiration of blood and resistancewhen the subclavian catheter was flushed, along with the patient com-plaining of infraclavicular pain. The nurse suspected pinch-off

syndrome.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Can result in complete or partial catheter transection and emboliza-tion. Infraclavicular pain or swelling is present.

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128. COMPLICATIONS

pneumothorax(nu-mo-tho'raks)

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128. COMPLICATIONS

DEFINITION:The presence of air or gas in the pleural cavity betweenthe lung and chest wall.

APPLICATION:Upon insertion of the central linethe patient complained of chestpain and dyspnea; a crunchingsound on auscultation was heard.X-ray confirmed a pneumothorax

post central line insertion.

KEEP IN MIND:Caused during insertion of cen-tral catheter by puncturing thepleural covering of the lung; often treated by insertion ofchest tube.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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129. COMPLICATIONS

pulmonary edema(pul'mo-ne-re e-de'ma)

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129. COMPLICATIONS

DEFINITION:Accumulation of extravascular fluid in lung tissues, usually in the alveoli.

APPLICATION:The patient presented with signsof pulmonary edema includingshortness of breath, 3+ pittingedema of the extremities, andmoist lung sounds.

KEEP IN MIND:Often caused by administrationof high percentages of sodiumchloride or fluid overload. Thetreatment would include: de-crease IV flow rate, place patientin high Fowler’s position, keepwarm, monitor vital signs, andadminister oxygen as ordered.Consideration should be given toa microdrip administration set.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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130. COMPLICATIONS

refeeding syndrome(re-fed'ıng sın'drom)

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130. COMPLICATIONS

DEFINITION:The potentially fatal metabolic response of a starved individual to feeding, either enteral or parenteral. The correction of electrolyte imbalances is imperative beforegradual refeeding to prevent hypophosphatemia, rhab-domyolysis, and other life-threatening complications.

APPLICATION:Refeeding syndrome can beavoided by initiating TPNslowly, then gradually increasingthe rate while carefully monitor-ing the patient’s response andserum electrolyte levels.

KEEP IN MIND:Occurs in initial phases of TPN.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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131. COMPLICATIONS

septicemia(sep-tı-se'me-a)

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131. COMPLICATIONS

DEFINITION:The presence of pathologic microorganisms in the blood.

APPLICATION:The patient was transferred fromthe medical-surgical unit tointensive care with septicemia,

unknown source.

KEEP IN MIND:Signs and symptoms are dra-matic and include fluctuatingfever, profuse sweating, nauseaand vomiting, diarrdea, abdomi-nal pain, tachycardia, hypoten-sion, and altered mental status.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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132. COMPLICATIONS

speed shock(sped shok)

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132. COMPLICATIONS

DEFINITION:A severe disturbance of hemodynamics in which the cir-culatory system fails to maintain adequate perfusion ofvital organs due to sudden flooding of vital organs withmedication.

APPLICATION:The nurse drew up the meperidineand administered the medicationrapidly through the patient’s injec-tion port; the patient respondedwith syncope and shock symp-toms from the speed shock.

KEEP IN MIND:Speed shock is caused by rapidly administering IV pushsubstances, causing the concen-tration of medication in theplasma to reach toxic propor-tions, flooding the organs rich in blood (heart and brain). Syn-cope, shock, and cardiac arrestmay result.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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133. COMPLICATIONS

superior vena cava (SVC) syndrome

(soo-pe're-or ve'na ka'va sın'drom)

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133. COMPLICATIONS

DEFINITION:Obstruction of the supe-rior vena cava or its maintributaries causing edemaand engorgement of thevessels.

APPLICATION:The client with an implanted port upper chest was peppered with abluish venous star-shaped design; the nurse suspected superior vena

cava syndrome.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Symptoms include progressive edema of the face, neck, arms; nonpro-ductive cough and dyspnea; bluish looking venous stars may be foundin the early phases, overlying the large veins to which they are tribu-tary, but they tend to diminish in size and disappear after collateralcirculation has been established. Interventions include: Notification of physician, radiographic confirmation of SVC syndrome, and may include anticoagulant therapy. Catheter may or may not be removed.

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134. COMPLICATIONS

thrombosis(throm-bo'sıs)

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134. COMPLICATIONS

DEFINITION:Clotting within a blood vessel that may cause interrup-tion of blood flow.

APPLICATION:Thrombosis can develop withinor around the catheter or in thesurrounding vessel.

KEEP IN MIND:The clot may cause obstructionor become attached to the vesselwithout obstructing the lumen.The thrombosis can result frommechanical or nonthromboticobstructions (42%). Interven-tions would be to discontinuethe catheter, apply cold com-presses to site, and assess forcirculatory impairment.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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135. COMPLICATIONS

thrombophlebitis(throm''bo-f le-bı'tıs)

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135. COMPLICATIONS

DEFINITION:Venous inflammation withthrombus (clot) formation.

APPLICATION:The patient received 20 mg of potassium chloride via secondary infu-sion over 3 hours; the nurse assessed the vein for thrombophlebitis for-mation post infusion.

KEEP IN MIND:

NOTES:________________________________________________________________________________

Denotes a twofold injury; thrombosis and inflammation. Throm-bophlebitis is related to: use of veins in legs for infusion therapy; useof hypertonic or highly acidic infusion solutions. Symptoms includesluggish flow rate, edema in the limbs, tender and cordlike vein, sitewarm to touch, visible red line above venipuncture site. Interventionswould include discontinuation of catheter, physician consultation, andcomfort provided by application of warm compresses.

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136. COMPLICATIONS

venospasm(ve'no-spazm)

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136. COMPLICATIONS

DEFINITION:Sudden constriction of the vein.

APPLICATION:The nurse began the transfusionand the patient almost immedi-ately complained of severe painat the infusion site. The nursesuspected venospasm.

KEEP IN MIND:Usually caused by infusion ofcold or irritating substances intothe vein. Flow rate decreases,patient complains of pain at in-fusion site. Apply warm com-presses, slow infusion.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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137. INFUSION MODALITIES

bolus(bo'lus)

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DEFINITION:Concentrated medication or solution given rapidly over ashort period of time; may be given by direct IV injectionor IV drip.

APPLICATION:The physician ordered a bolus of10 mEq of potassium chloride,which needed to be administeredover a minimum of 1 hour accord-ing to the drug reference and di-luted in 50 to 100 mL of infusate.

KEEP IN MIND:The term bolus or IV push doesnot indicate an appropriate injection rate. Consult reliabledrug references or confer with apharmacist to obtain protocol forthe length of time needed toadminister the ordered dose.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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chemical incompatibility(kem'ık-al ın''kom-pat-ı-bıl'ı-te)

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DEFINITION:Not suitable chemically to be combined or mixed with aanother chemical.

APPLICATION:The medication was reconstitutedwith the wrong solution resultingin a chemical incompatibility.

KEEP IN MIND:Alteration in integrity or potencyof the active ingredient in themedication. The most commoncause of chemical incompatibilityis the reaction between acidicand alkaline drugs resulting in apH level that is unstable for oneof the drugs.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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epidural(ep'' ı-dur'al)

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DEFINITION:On or outside the dura mater.

APPLICATION:The epidural route for adjunctpain management was started inthe operating room for postopera-tive patient pain control postpancreatic tumor resection.

KEEP IN MIND:Area used for regional medica-tion administration, produced byinjection of local anesthetic ormedication into the periduralspace.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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intermittent drug infusion(ın''ter-met'eent drug ın-fu'zhun)

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DEFINITION:Delivery of therapeutic agent at specific intervals.

APPLICATION:Ceftazidime (Fortaz) 1 gram in 100 mL of 0.9% NaCl was administered by intermittent

drug infusion preoperatively.

KEEP IN MIND:Delivery of medications such as antibiotics at intervals tomaintain blood levels. Usuallyadministered in 50 to 150 mL ofsolution by secondary infusion,or through a locking intermittentdevice over 15 minutes to 1 hour.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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intraperitoneal (IP)(ın''tra-per'' ı-to-ne'al)

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DEFINITION:Route by which medica-tion is administered directly into the peri-toneal cavity.

APPLICATION:The purpose of intraperitoneal therapy for the patient with ovarian can-cer was to increase the concentration of an antineoplastic agent at thetumor site and enhance its penetration and cell kill while limiting sys-temic effects.

KEEP IN MIND:One intracavitary drug administration route that involves the adminis-tration of therapeutic agents directly into the peritoneal cavity.

NOTES:________________________________________________________________________________

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intraspinal(ın''tra-spı'nal)

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DEFINITION:Within the spinal canal.

APPLICATION:Intraspinal medication deliveryvia the epidural route can beused for acute, chronic, or can-cer pain management.

KEEP IN MIND:Intraspinal is the term used toencompass both epidural andintrathecal spaces surroundingthe spinal cord.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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intrathecal (IT)(ın''tra-the'kal)

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DEFINITION:Within the subarachnoid or subdural space.

APPLICATION:The anesthesiologist set up theintrathecal opioid infusion byimplanted infusion pump for thecancer patient to provide ade-quate pain relief.

KEEP IN MIND:The intrathecal space is sur-rounded by the epidural spaceand separated from it by thedura mater; the intrathecalspace contains cerebrospinalfluid. The epidural and intrathe-cal spaces share a common cen-ter, the spinal cord.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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intravenous push (IVP)(ın-tra-ve'nus poosh)

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DEFINITION:Medication delivered rapidly within the vein.

APPLICATION:The nurse administered the mor-phine sulfate 5 mg by IV push

over 5 minutes.

KEEP IN MIND:Direct administration of medica-tion or solution via syringe. Thepurpose is to achieve rapidserum concentrations of themedications. Follow guidelinesfrom the manufacturer when administering medication by IV push.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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physical incompatibility(fız'ı-kal ın''kom-pa''tı-bıl' ı-te)

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DEFINITION:An undesirable change that is visually observed.

APPLICATION:Calcium in a drug or solutionmay cause physical incompatibility

with some added medications.

KEEP IN MIND:Also called pharmaceutical incompatibility. Can occur whenone drug is mixed in a syringeor bag with another agent to produce a product that is unsafefor administration. Precipitationmay be visible as haze, gas bubbles, or cloudiness.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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therapeutic incompatibility(ther-a-pu'tık ın''kom-pa''tı-bıl'ı-te)

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DEFINITION:Undesirable effect occur-ring within a patient as aresult of two or more drugsbeing given concurrently.

APPLICATION:The peak blood level drawn for chloramphenicol did not show a thera-peutic response. Due to the administration of an additional antibiotic,the physician concluded there was therapeutic incompatibility betweenthe two drugs and one was discontinued.

KEEP IN MIND:Occurs most frequently when two drugs are administered and one antagonizes the effect of the second. Response to medication may gounnoticed until patient fails to show the expected clinical response tothe drug.

NOTES:________________________________________________________________________________

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147. TRANSFUSION THERAPY

ABO system(a-be-o sıs'tem)

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DEFINITION:Blood group of antigens that reside on structurally related carbohydrate molecules.

APPLICATION:The patient was typed and cross-matched for ABO and Rh type.

KEEP IN MIND:The ABO antigens and antibod-ies are the most significant fortransfusion practice.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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agglutinin(a-gloo'tı-nın)

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DEFINITION:An antibody that causes clumping or agglutination of thecells that stimulate the formation of the agglutinin.

APPLICATION:In the test tube, the laboratorytechnician mixed blood to cross-match and assess for any agglu-

tinin formation.

KEEP IN MIND:An antibody has the same nameas the antigen with which it reacts. For example, anti-A reacts to antigen A.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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agglutinogen(a-gloo-tın'o-jen)

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DEFINITION:An antigenic substance that stimulates the formation ofspecific agglutinin, which, under certain conditions,causes agglutination of cells.

APPLICATION:The ABO system is the most important agglutinogen locatedon the red blood cell (RBC)membranes.

KEEP IN MIND:Also referred to as antigens.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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antibody(an'tı-bod''e)

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DEFINITION:A substance produced by B lymphocytes in response toa unique antigen. Each antibody (Ab) molecule com-bines with a specific antigen to destroy or control it.

APPLICATION:Antibodies, also called agglu-tinins, within the blood systemare proteins that react with anantigen.

KEEP IN MIND:All antibodies except natural antibodies are made by B cellsstimulated by a foreign antigen,typically a foreign protein polysaccharide.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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antigen(an'tı-jen)

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DEFINITION:A protein or oligosaccharide marker on the surface ofcells that identifies the cell as self or nonself; identifiesthe type of cell and stimulates the production of antibodiesby B lymphocytes.

APPLICATION:Antigens, also called agglutino-gens, are located on the RBCmembranes.

KEEP IN MIND:Antigens on the body’s own cellsare called autoantigens. Anti-gens on all other cells are calledforeign antigens.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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autologous donor(aw-tol'o-gus do'nor)

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DEFINITION:Originating within an individual, especially a factorpresent in tissues or fluids.

APPLICATION:The patient called the bloodbank to set up an appointmentfor autologous donation of a unitof blood 1 month prior to sched-uled surgery.

KEEP IN MIND:Donation of a unit of blood to bereinfused to the individual donating the blood. Recipientreceives his or her own bloodback postoperatively.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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designated donor(de'zıg-nat'ed do'nor)

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DEFINITION:Use of blood or compo-nents from a specific donorfor a specific patient.

APPLICATION:The 6-year-old boy received a unit of blood donated by his father, who

was blood type identical; the unit was designated to the specific childafter surgery.

KEEP IN MIND:Examples of a designated donor would include: The patient with anantibody to a high-incidence antigen or a combination of antibodiesthat makes it difficult to find compatible blood; the patient awaiting akidney transplant from a living donor, or the multitransfused patientwhose family members can provide components.

NOTES:________________________________________________________________________________

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fresh frozen plasma(fresh fro'zen plaz'ma)

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DEFINITION:Collection of the fluid portion of the circulating blood byseparation and freezing the plasma within 8 hours of collection.

APPLICATION:The fresh frozen plasma wasthawed and transfused into thepatient with dilutional coagu-lopathy within 6 hours.

KEEP IN MIND:It is an aqueous solution of 91%water that contains protein, car-bohydrates, and serum. Plasmadoes not contain red blood cells.May be stored up to 1 year at180C.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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homologous donor(ho-mol'o-gus do'nor)

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DEFINITION:Blood donation of serum or tissue derived from membersof a single species.

APPLICATION:The blood drive on campus wasto increase the pool of homolo-

gous donors.

KEEP IN MIND:Blood donated by someone otherthan the recipient. Most transfu-sions depend on homologoussources and are provided by vol-unteer donors.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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human leukocyte antigen(HLA)

(hyu'man loo'ko-sıt an'tı-jen)

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DEFINITION:Any of several members of a system consisting of thegene products of at least four linked loci and a numberof sub loci on the sixth human chromosome that havebeen shown to have a strong influence on human allo-transplantation, transfusion in refractory patients, andcertain disease associations.

APPLICATION:HLA matching and leukocyte de-pletion of the donor unit help todecrease HLA alloimmunization.

KEEP IN MIND:Important in transfusion therapybecause HLA antigens of thedonor unit can induce alloim-munization in the recipient.HLA incompatibility is a possi-ble cause of hemolytic transfu-sion reactions.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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packed red blood cells(pakt red blud selz)

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DEFINITION:A blood product consisting of concentrated cells, most ofthe plasma having been removed.

APPLICATION:The patient was typed and cross-matched for 4 units of packed

red blood cells.

KEEP IN MIND:Given to the patient who needsred blood cells but not increasedfluid volume. Volume approxi-mately 250 mL, and raises hemoglobin 1 gram/unit, andhematocrit 3%, same as wholeblood.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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platelets(plat'letz)

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DEFINITION:An irregularly shaped, disc-like cell that functions inclotting.

APPLICATION:The patient received a singlepheresis unit of random donorplatelets.

KEEP IN MIND:Platelets live up to 12 days inthe blood, do not have a nuclei,and are unable to reproduce.Normal platelet counts are150,000 to 300,000 mcg/L.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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Rh factor(Rh fak'tor)

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DEFINITION:An antigen present on the surface of erythrocytes. WhenRh factor is present, also called (D), an individual’sblood type is designated Rh+ (Rh positive); when the Rhantigen is absent, the blood type is Rh– (Rh negative).

APPLICATION:A pregnant woman who has anRh factor of Rh– delivered a Rh+fetus, therefore she receivedRhoGAM to prevent Rh antibodyproduction after delivery.

KEEP IN MIND:An individual with Rh– bloodreceives a transfusion of Rh+blood, anti-Rh antibodies form.Subsequent transfusions of Rh+blood result in serious transfu-sion reactions.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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whole blood(hol blud)

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DEFINITION:That drawn from a selected donor under aseptic precautions.

APPLICATION:The patient with massive bloodloss from a crushing injury to hislower body received type O neg-ative whole blood initially uponadmission to the ED.

KEEP IN MIND:Whole blood is composed ofRBCs, plasma, white blood cells(WBCs), and platelets. The volume of each unit is approxi-mately 500 mL and consists of200 mL of RBCs and 300 mL ofplasma. Whole blood is never apreferred treatment, but is avail-able for consideration.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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161. NUTRITIONAL SUPPORT

cyclic therapy(sı'klık ther'a-pe)

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DEFINITION:A regimen of delivery of dextrose, amino acids, and fatover a reduced time frame, usually 12 to 18 hours versusa 24-hour infusion.

APPLICATION:The quality of life for theteenager who needed total par-enteral nutrition was achievedby use of cyclic therapy.

KEEP IN MIND:Patients requiring long-term parenteral nutrition use thismode of delivery during theirsleep so they can be free of infusion during the day.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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fat emulsion(fat e-mul'shun)

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DEFINITION:A combination of liquid, lipid, and an emulsifying sys-tem suitable for intravenous use because the lipid hasbeen broken into small droplets that can be suspendedin water. Solution has limited ability to be mixed withother solutions.

APPLICATION:The 500-mL glass container offat emulsion (lipids) was admin-istered over 12 hours by second-ary infusion on a daily basis.

KEEP IN MIND:Also called lipids. Linoleic, D-linolenic, and arachidonicacid are necessary for formationof other products in the body,and because the body does notsynthesize them, they are classedas essential fatty acids.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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peripheral parenteral nutrition (PPN)(per-ıf 'er-al par-en'ter-al nu-trı'shun)

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DEFINITION:Intravenous support supplied via the peripheral veins topatients whose nutritional requirements cannot be fullymet via the enteral route.

APPLICATION:The home care client was placedon 7 days of peripheral par-

enteral nutrition while awaitingbowel resection.

KEEP IN MIND:An amino acid–dextrose solution(usually 10%) and a lipid emul-sion (10% to 20%) are deliveredinto a peripheral vein through acatheter.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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total parenteral nutrition(TPN)

(to'tal par-en'ter-al nu-trı'shun)

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DEFINITION:The intravenous provision of dextrose, amino acids,emulsified fats, trace elements, vitamins, and minerals topatients who are unable to assimilate adequate nutritionby mouth.

APPLICATION:The client with 30% burns overthe head and chest area wasplaced on total parenteral nutri-

tion by central line to maintaincalories for healing.

KEEP IN MIND:TPN must be delivered by cen-tral line because of the osmolar-ity of the solution.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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total nutrient admixture (TNA)

(to'tal nu''tre-ent ad'mıks-tu'r)

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DEFINITION:Combination of amino acids, dextrose, and fats in onecontainer.

APPLICATION:The home care client re-ceived total nutrient admix-

ture with careful monitoringfor bloodstream infections.

KEEP IN MIND:Also called all-in-one solutionsor three-in-one solutions, ortrimix solutions. The formula isprovided in a large (banana)container that infuses over 24 hours.

NOTES:________________________________________________________________________________________________________________________________________________________________________________

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PHILLIPS 15 STEPS166. IV THERAPY BONUS CARD

PRECANNULATION

Step 1: Obtain authorized prescriber’s order orreview standardized procedure

Step 2: Hand hygiene–15 to 20 seconds Alcohol-based hand rubIf hand visibly dirty or contaminated, use soap,

water, and vigorous scrub

Step 3: Gather equipment and preparation Check integrity of solutionCheck integrity of administration setGather venipuncture and dressing supplies

Step 4: Patient assessment, psychologicalpreparation and patient identificationProvide privacyEvaluate the patient’s preparedness for

IV procedureCheck patient identification, using two

identifers

Things to know—AssessmentPatient’s medical diagnosisHistory of chronic diseaseHistory of vasovagal reaction during venipuncturePrevious experiences with vascular access

devicesCultural considerationsAssess both arms and hands prior to choosing

appropriate veinChoose the lowest best vein Identify allergies

Step 5: Apply tourniquet, site selection, and vein dilationFactors to consider:Patient receiving anticoagulation therapyPresence of disease or previous surgery

(poor venous return)Presence of shunt for dialysis

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CANNULATION

Step 6: Needle selection16 gauge: Trauma18–20 gauge: Infusion of hypertonic or isotonic

solutions, or blood products22–24 gauge: Pediatric patients22 gauge: Fragile veins in elderly

Step 7: GlovingStandard precaution requires gloves to be worn

during placement of an IV catheter

Step 8: Site preparationRecommended to use 2% chlorhexidine

gluconate; use 15–20 second scrub with friction;allow to dry

Step 9: Vein entry: Direct or indirect Direct: One-step methodIndirect: Two-step method

Step 10: Catheter stabilization and dressing managementCatheter should be stabilized in a manner

that does not interfere with visualization of site

Dressing: Transparent semipermeable mem-brane dressing (TSM)

Use stabilization device that is recommended by INS and CDC

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POSTCANNULATION

Step 11: Labeling of site, and administration setInsertion site: Venipuncture site should be

labeled withDate and timeType and length of catheterNurse’s initials

Administration setLabel according to agency policy: Date on

which administration set must be changedSolution container

Place a time strip on parenteral solutionsAny additive must have a clear label applied

to bag

Step 12: Equipment disposalStandard of practice: Needles and stylets shall

be disposed of in nonpermeable tamper-proof containers

Dispose of all paper and plastic equipment inbiohazard container

Step 13: Patient educationPatient must receive information on all aspects

of their care Inform regarding any limitations of movement

or mobilityExplain all alarms if EID is usedInstruct to call for assistance

Step 14: Rate calculationSee Rate Calculation Bonus Card 167.

Step 15: Monitoring and documentationDocument all aspects of procedure Document routine assessments of site every

4 hoursFollow flush protocol if intermittent locking

device in placeChange IV site along with administration set

every 72 hoursIV solutions may only hang 24 hours

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RATE CALCULATION167. IV THERAPY BONUS CARD

COMMON DROP FACTORS

10 gtt = 1 mL15 gtt = 1 mL} Macrodrops20 gtt = 1 mL

60 mcgtt = 1 mL } Microdrops

1. To calculate volume/hour

Total volume � Administration time = mL (volume) � hour

Example: 1000 mL � 8 hours = 125mL/hour

2. To calculate drops/minute (gravity)—Macrodrop infusion

X gtt/min =hourly volume × gtt factor of tubing

Time in minutes (60)

Example:125 mL/hour × 15 (gtt factor)

� 31 gtt/min60 (minutes)

3. To calculate drops/minute microdrop infusion(note: EIDs are microdrip mL/hour versus gtt/min

hourly volume × 60 mcgtt tubing = mL/hour

60 (time in minutes)

Example: 100 mL/hr × 60 = 100 mL/hour60 (minute)

4. To calculate secondary infusion (infusions less than 1 hour)

mL/hour × microdrop set (60) = mL/hourhours volume (varies)

Example: 50 mL × 60 = 30,000 = 200 mL/hour5 minutes 15(will deliver the ordered 50 mL in 15 minutes)

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PHLEBITIS RATING SCALE168. IV THERAPY BONUS CARD

Grade Clinical Criteria0 No clinical symptoms

1 Erythema at access site with or without pain

2 Pain at access site, with erythema and/or edema

3 Pain at access site with erythema and/or edema, streak formation, and palpable venous cord

4 Pain at access site with erythema and/or edema, streak formation, palpable venous cord >1 inchin length, purulent drainage

Source: Revised Standards of Practice. (2006). Cambridge, MA: Infusion Nurses Society; with permission.

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Grade 0 Grade 1 Grade 2 Grade 3 Grade 4

INFILTRATION RATING SCALE168. IV THERAPY BONUS CARD

Skin blanched and translucent

Skin blanched Skin blanched and translucent

No symptoms

INFILTRATION SCALE

Source: Revised Standards of Practice (2006). Cambridge, MA: Infusion Nurses Society; with permission.

Edema <1 inch

With or without pain

Gross edema >6 inches

Mild to moderate pain

Deep, pitting tissue edema

Cool to touch

Skin blanched

Edema 1 to6 inches

Cool to touch


Cool to touch

Skin tight, leaking

Gross edema >6 inches

Circulatory impairment Possible numbness

Infiltration of any amount of blood product, irritant, or vesicant

Moderate to severe pain


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FLUSHING GUIDELINES169. IV THERAPY BONUS CARD

Blood Blood Flushing with Heparin Device Intermittent Administration Draw NO Therapy LockingPeripheral Minimum 2 mL Preadmin 2 mL NA At least q12 hours NACatheters (PIV) Postadmin 10 mL

Midline Minimum 3 mL Preadmin 3 mL NA At least q12 hours 3 mL Postadmin 10 mL 10 units/

mL heparin

Peripherally Minimum 5 mL Preadmin 5 mL Predraw 5 mL Nonvalved–at least 5 mL Inserted Postadmin 10 mL Postdraw q 24 hours 10 units/Central 10 mL Valved–at least weekly mL heparinCatheter (PICC)

Nontunnelled Minimum 5 mL Preadmin 5 mL Predraw 5 mL Nonvalved–at least 5 mLPostadmin 10 mL Postdraw q 24 hours 10 units/

10 mL Valved–at least weekly mL heparin

Tunnelled Minimum 5 mL Preadmin 5 mL Predraw 5 mL Nonvalved–at least 5 mLPostadmin 10 mL Postdraw 1–2 times per week 10 units/

10 mL Valved at least weekly mL heparin

Port Minimum 5 mL Preadmin 5 mL Predraw 5 mL Accessed Nonvalved–at 3–5 mL Postadmin 10 mL Postdraw least 1–2 times per week 10 units/

10 mL Valved–at least weekly mL heparinDeaccessed–at leastmonthly

Source: Infusion Nurses Society. (2008). Flushing Protocols, with permission.

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PICC, TUNNELED CATHETER, AND PORT PLACEMENTS169. IV THERAPY BONUS CARD

1. Subclavian vein(Infusion of other solutions)

Axillary vein

Cephalic vein

Median basilicvein

Median cephalicvein

Basilic vein

2. Superior vena cava(TPN infusion)

Internal jugular vein

Brachiocephalic vein

Example of peripherally inserted central catheter (PICC).

Example of tunneled catheter placement.

Example of port placement.

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CHVOSTEK’S SIGN AND TROUSSEAU’S SIGN170. IV THERAPY BONUS CARD

Example of positive Chvostek’s sign. Example of positive Trousseau’s sign.

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ILLUSTRATION CREDITS170. IV THERAPY BONUS CARD

Illustrations that appear on cards 28, 37, 51, 94, 108, and170 from Phillips, L.D. (2005). Manual of IV Therapeutics(4th ed.). Philadelphia: F.A. Davis; cards 79, 81, 83, 90,and 91: Courtesy and © Becton, Dickinson and Company;card 169 courtesy of Medivisuals, Dallas, TX and courtesyof BARD Access Systems. Tables on cards 168 and 169with permission from the Infusion Nursing Society.

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