IV Therapy Flash Cards

IV Therapy Flash Cards

Lynn D. Phillips, RN, MSN, CRNI®

Butte College Nursing Instructor
F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.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 Mexico
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Thomas A. Ciavarella

Director of Content Development: Darlene D. Pedersen
Project Editor: Christina C. Burns
Art and Design Manager: Carolyn O’Brien
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, and
make 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: 978-0-8036-2141-1
ISBN 10: 0-8036-2141-8
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users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly
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Table of Contents:
Section 1: Infection Control Related to IV Therapy 1–27
Section 2: Fluid, Electrolytes, and Parenteral Solutions 28–55
Section 3: Equipment 56–78
Section 4: Technique/Maintenance Peripheral IVs 79–100
Section 5: Technique/Maintenance Central IVs 101–113
Section 6: Complications 114–136
Section 7: Infusion Modalities 137–146
Section 8: Transfusion Therapy 147–160
Section 9: Nutritional Support 161–165
Section 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.
Dedication
To my mother, Margie Schuetz, thank you for your unconditional love.
Acknowledgments
Christina C. Burns, Project Editor
Thomas A. Ciavarella, Acquisitions Editor
Infusion Nurses Society
Reviewers
Michelle Crum, RN, BSN Shirley Lyon Garcia, RN, BSN
Nursing Instructor Adjunct Faculty, PNE Instructor
Ozarks Technical Community College McDowell Technical Community College
Springfield, Missouri Marion, North Carolina
Debra J. Dichiara, MSN, RN Mary M. Goetteman, RN, EdD
Associate Professor Professor
Daytona Beach College Daytona Beach College
Daytona Beach, Florida Daytona Beach, Florida
Gay Oyco Divinagracia, MA, RN, BC Sung Gwak, MSN, CCRN, BC, RN
Associate Professor Associate Professor
Indian River Community College Borough of Manhattan Community College
Fort Pierce, Florida New York, New York
Roxanne Hurley, MS, RN Karen Reilly, MSN, ARNP
Clinical Associate Professor Associate Professor
University of North Dakota Daytona Beach College
Grand Forks, North Dakota Daytona Beach, Florida
Mark R. Kucharek, RN, MSN Kay Schwartzwelder, MSN, RN
Assistant Director of Nursing Associate Director of Nursing and Allied Health
Mohave Community College Collins Career Center
Kingman, Arizona Chesapeake, Ohio
Instructor
Cynthia Levering, RN, Med, MS, CNS
Ohio University
Associate Professor
Ironton, Ohio
Central Ohio Technical College
Newark, Ohio Jill Scott, RN, MSN, CCRN
Nursing Professor
Missy Mohler, MS, RN
St. Johns River Community College
Nursing Instructor
Palatka, Florida
Hocking College
Nelsonville, Ohio
Barbara Tacinelli, RN, MA Judith Valloze, ARNP, MSN
Professor of Nursing Professor of Nursing
Borough of Manhattan Community College Daytona Beach College
New York, New York Daytona Beach, Florida
Mary Tan, PhD, RN
Assistant Director Susan Waltz, RN, DNP
Holmes Community College Nursing Department Chair
Ridgeland, Mississippi Ivy Tech Community College of Indiana,
Columbus Campus
Diana C. Tilton, RN, BSN, CRNI®
Columbus, Indiana
Assistant Professor
Johnson Community College
Overland Park, Kansas
Getting the Most Out of Your IV Therapy Flash Cards
Purpose of Flash Cards
You’re on your way to mastering IV therapy vocabulary! Using these flash cards will develop
your ability to focus and achieve deep memory learning. They will help you not only learn
the terminology, but they will help you relate those terms to the nursing content you are
studying. It is important to make a connection between the term, its meaning, and how it
functions in the language of nursing. So I designed the flash cards to allow you to see the
word, read the word (out loud is best), use the word, and associate the word with other
related concepts.
How to Use Flash Cards
This set of flash cards is unique because it gives you opportunities to actively associate each
word or phrase with your studies. Here are some strategies I recommend to get the most out
of the time you spend with the cards. But these are not the only ways they can be used; see
if 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 the
correct 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 test
your understanding of all the words and concepts.
DavisPlus Web Site: On the DavisPlus Web site , you will find additional terms and
definitions. Visit http://davisplus.fadavis.com to access this content.
Concept Mapping
Concept 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 colored
marking 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.
6. Draw pictures if you wish, adding them next to the appropriate stem. Search for images
online or create your own drawings. The brain connects to the word or term through
pictures.
Lynn Phillips
Concept Mapping Sample
1. INFECTION CONTROL
aerobic
(ĕr-ō'bı̆k)
DEFINITION: KEEP IN MIND:

Taking place in the presence of oxygen. Concerning an Aerobic organisms are generally
organism that lives and reproduces in the presence of found on the surface of a wound.
oxygen.
APPLICATION: NOTES:
The physician ordered an aero- ____________________________________________
bic culture of the wound. ____________________________________________
____________________________________________
____________________________________________
airborne precautions
(ār'born prē-kŏ'shĕnz)
DEFINITION: APPLICATION: KEEP IN MIND:

Microorganisms carried by The patient with active pul- Airborne precautions are used
the air. Precautions used monary tuberculosis was admit- to control the spread of infections
in addition to standard ted to a private room with nega- that are transmitted on air cur-
tive air pressure with 6–12 air rents. Airborne infections
precautions for illnesses
changes per hour as part of include tuberculosis, varicella
transmitted by airborne airborne precautions. (chickenpox), and rubeola
droplet nuclei. (measles). Airborne precautions
include standard and contact
precaution guidelines, along with
placing the patient in a private
room with a negative air pres-
NOTES: sure. The health-care workers
(HCWs) must wear a special N95
____________________________________________ respirator to care for patients
____________________________________________ with pulmonary tuberculosis.
____________________________________________ Only immune HCWs can care for
patients with rubeola or varicella.
____________________________________________
anaerobic
(ăn'' ĕr-ō'bı̆k)

Taking place in the absence of oxygen. Concerning an Anaerobic organisms are found
organism that lives and reproduces in the absence of in deep wounds, tunnels, and
oxygen. cavities.
APPLICATION: NOTES:
The nurse collected the wound ____________________________________________
sample from deep in a tunneled ____________________________________________
portion of the wound for an
anaerobic culture. ____________________________________________
____________________________________________
antibodies
(ăn'tı̆-bŏd''ēz)

A substance produced by B lymphocytes in response to Antibodies also are called im-
a unique antigen. Antibodies neutralize or destroy munoglobulins and are part of
antigens. the body’s plasma proteins.
APPLICATION: NOTES:
Antibodies are proteins that ____________________________________________
target antigens and destroy them ____________________________________________
using the following four methods:
phagocytosis, neutralization, ____________________________________________
agglutination, and activation of ____________________________________________
complement and inflammation.
antigen
(ăn'tı̆-jĕn)

A protein marker on the surface of cells that identifies Antigens on the body’s own cells
the cell as self or nonself; identifies the type of cell and are called autoantigens. Anti-
stimulates the production of antibodies. gens on all other cells are called
foreign antigens.
APPLICATION: NOTES:
The combination of an antigen ____________________________________________
with its specific antibody is ____________________________________________
called antigen-antibody reaction.
____________________________________________
____________________________________________
bacteristatic
(băk-tēr''ē-stăt'ı̆k)

Inhibiting the growth of bacteria. Many anti-infective and
cleaning/disinfecting agents
prevent the growth and repro-
duction of some bacteria.
APPLICATION: NOTES:
The cephalosporin anti-infectives ____________________________________________
are considered bacteristatic. ____________________________________________
____________________________________________
____________________________________________
bactericidal
(băk''tĕr-ı̆-sı̄'dăl)

Capable of killing bacteria. Disinfectants destroy pathogens
and are bactericidal. Chlorine
bleach is capable of killing bac-
teria, spores, fungi, and viruses
on surfaces. Bactericidal drugs
are used for their selective toxic-
ity on certain bacterial cells.
APPLICATION: NOTES:
Penicillin is considered an ____________________________________________
anti-infective that is bactericidal. ____________________________________________
____________________________________________
____________________________________________
blood borne pathogens

(blŏd born păth'ō-jĕnz)

Those microorganisms carried in blood and body fluids The common blood borne
that are capable of infecting other persons. pathogens include hepatitis B
virus, hepatitis C virus, and
HIV.
APPLICATION: NOTES:
Standard precautions are used ____________________________________________
for all hospitalized patients to ____________________________________________
prevent the spread of blood borne
pathogens. ____________________________________________
____________________________________________
bloodstream infection (BSI)

(blŏd'strēm'' ı̆n-f ĕk'shŭn)

An infection that flows through the circulatory system. The average rate of catheter-
related BSIs is 1.5 to 6.8 per
1000 catheter days.
APPLICATION: NOTES:
Bloodstream infections related to ____________________________________________
placement of a central venous ____________________________________________
access device (CVAD) in the
early stages are caused by bacte- ____________________________________________
rial contamination during the ____________________________________________
initial catheter insertion.
Centers for Disease Control

and Prevention (CDC)
(sĕn'tĕrz for dı̆-zēz' kŏn-trōl' and prē-vĕn'shŭn)

A division of the U.S. Public Health Service that investi- The CDC includes Center for
gates and controls various diseases, especially those that Infectious Diseases, Center for
have epidemic potential. Located in Atlanta, Georgia. Environmental Health, Center
for Health Promotion and Edu-
cation, Center for Prevention
Services, Center for Professional
Development and Training, and
Center for Occupational Safety
and Health.
APPLICATION: NOTES:
In 2002, the Centers for Disease ____________________________________________
Control and Prevention pub- ____________________________________________
lished guidelines for prevention
of intravascular catheter-related ____________________________________________
infections. ____________________________________________
chain of infection
(chān of ı̆n-fĕk'shŭn)

The process by which infections spread. Chain of infection is made up of six
links, all of which must be present
for infection to be transmitted from
one individual to another.
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host
APPLICATION: NOTES:
Health-care workers must either ____________________________________________
clean their hands with an ____________________________________________
alcohol-based solution or wash
with soap and water frequently to ____________________________________________
assist in breaking the chain of ____________________________________________
infection.
colonization
(kŏl''ŏ-nı̆-zā'shŭn)

The growth of microorganisms, especially bacteria, in a The microorganisms become
particular body site. resident flora; in this state, the
microorganisms may grow and
multiply but do not cause
disease.
APPLICATION: NOTES:
The culture taken from the ____________________________________________
nurse’s fingernails showed colo- ____________________________________________
nization of Staphylococcus
aureus. ____________________________________________
____________________________________________
contact precautions
(kŏn'tăkt'' prē-kŏ'shĕnz)

Techniques used in addition to standard precautions that A private room is preferable, but
decrease infection by microorganisms transmitted patients may be placed with
through direct contact with the patient or patient-care others infected with the same
organism. Hospital workers must
items.
wear gloves when entering the
room, gowns if close to patient.
Stethoscopes and other noncriti-
cal patient-care equipment
should be dedicated to single-
patient use.
APPLICATION: NOTES:
The patient with a diagnosis of ____________________________________________
Clostridium difficile (C. difficile) ____________________________________________
was placed on contact precautions.
____________________________________________
____________________________________________
droplet precautions
(drŏp'lĕt prē-kŏ'shĕnz)

Infection due to inhalation of respiratory pathogens Droplet precautions are used
suspended in liquid particles exhaled from someone when the pathogen can be
already infected. spread via moist droplets
(sneezing, coughing, talking).
Droplets can spread infection by
direct contact with mucous
membranes or through indirect
contact such as touching a
bedside table.
APPLICATION: NOTES:
Droplet precautions include the use ____________________________________________
of a mask and eye protection when ____________________________________________
working within 3 ft of a patient, in
addition to standard and contact ____________________________________________
precaution guidelines. ____________________________________________
dissemination
(dı̆-sĕm'ı̆-nā''shŭn)

Shedding of microorganisms from an individual into the Cultures of air samples, surfaces,
immediate environment or movement of microorganisms and objects reveal dissemination
from a confined site (skin) to the bloodstream and other of microorganisms.
parts of the body.
APPLICATION: NOTES:
The outpatient clinic, with its ____________________________________________
recent outbreak of staphylococ- ____________________________________________
cus, cultured all asymptomatic
staff for dissemination of the ____________________________________________
organism. ____________________________________________
endogenous
(ĕn-dŏj'ĕ-nŭs)

Produced or originating from within a cell or organism. Nosocomial infections can origi-
nate from clients themselves.
Most nosocomial infections
come from endogenous sources.
APPLICATION: NOTES:
The most common endogenous ____________________________________________
organism is Staphylococcus ____________________________________________
aureus.
____________________________________________
____________________________________________
exogenous
(ĕks-ŏj'ĕ-nŭs)

Originating outside an organism. Exogenous sources of nosoco-
mial infections occur from
hospital environment or hospital
personnel.
APPLICATION: NOTES:
The patient acquired a nosoco- ____________________________________________
mial infection from an exogenous ____________________________________________
source, the intensive care nurse’s
hands. ____________________________________________
____________________________________________
1. extrinsic contamination
(ĕks-trı̆n'sı̆k kŏn-tăm''ı̆-nā'shŭn)
2. intrinsic contamination
(ı̆n-trı̆n'zı̆k kŏn-tăm''ı̆-nā'shŭn)
DEFINITIONS: KEEP IN MIND:

1. Contamination with bacteria during preparation or Most BSIs related to contami-
administration. nated infusates are related to
2. Contamination introduced during manufacturing. the duration of uninterrupted
infusions through the same
administration set and the
frequency with which the set
is manipulated.
APPLICATION: NOTES:
The IV therapy–related BSI was ____________________________________________
traced to extrinsic contamination ____________________________________________
from improperly administered IV
solution. ____________________________________________
____________________________________________
hand hygiene
(hănd hı̄'jēn)

A general term that applies to hand washing, antiseptic The goal of using specific hand
hand wash, antiseptic hand rub, or surgical hand hygiene products is to maintain
antisepsis. normal barrier function.
APPLICATION: NOTES:
The transmission of healthcare- ____________________________________________
associated pathogens from one ____________________________________________
patient to another via the hands of
health-care workers requires a ____________________________________________
sequence of events. Hand hygiene ____________________________________________
breaks the sequence of events.
healthcare-associated
infections (HAIs)
(hĕlth'kār ă'sō-sē-ā''tĕd ı̆n-f ĕk'shŭnz)

Infections that patients acquire during the course of The term nosocomial infections
receiving treatment for other conditions or that health- has been replaced with the term
care workers (HCWs) acquire while performing their healthcare-associated infections.
duties within a health-care setting.
APPLICATION: NOTES:
In hospitals alone, healthcare- ____________________________________________
associated infections (HAIs) ____________________________________________
account for an estimated 2 million
infections, 90,000 deaths, and ____________________________________________
$4.5 billion in excess health-care ____________________________________________
costs annually (CDC, 2006.)
host
(hōst)

The organism from which a microorganism obtains its A susceptible host is any person
nourishment. who is at risk for infection.
Intact skin is the best defense
against infection.
APPLICATION: NOTES:
The frail, 90-year-old man had ____________________________________________
impaired defenses due to pneu- ____________________________________________
monia and, therefore, was a com-
promised host. ____________________________________________
____________________________________________
immunosuppression
(ı̆m''ū-nō-sū-prĕsh'ŭn)

Prevention of or interference with the development of Persons who acquire an infec-
immunologic response; may be artificially induced by tion because of a deficiency in
chemical, biologic, or physical agents, or may be caused any of their multifaceted host
defenses are referred to as com-
by disease.
promised hosts. Persons with
major defects related to specific
immune responses are referred
as immunosuppressed.
APPLICATION: NOTES:
Immunosuppression can occur in ____________________________________________
patients receiving chemotherapy. ____________________________________________
____________________________________________
____________________________________________
leukopenia
(loo''kō-pē'nē-ă)

Any condition in which the number of leukocytes in the Infection, together with
circulating blood is lower than normal, the lower limit of neutropenia, is regarded as an
which is generally regarded as 4000/5000 mm3. emergency situation. Precautions
are usually initiated when the
patient’s absolute neutrophil
count (ANC) is lower than 1000.
The ANC can be calculated with
the following formula: ANC =
total WBC × (% segs + % of
bands).
APPLICATION: NOTES:
The immunocompromised ____________________________________________
patient was admitted with ____________________________________________
leucopenia and placed on
neutropenic precautions. ____________________________________________
____________________________________________
reservoir
(rĕz'ĕr-vwor)

Living or nonliving material in or on which an infectious Second link in the chain of
agent multiplies and develops and is dependent on for infection. The exit site from
its survival in nature. reservoir is important in
transmission of infection.
APPLICATION: NOTES:
The patient with a staphylococ- ____________________________________________
cus infection in the wound was ____________________________________________
the reservoir for transmission by
wound drainage. ____________________________________________
____________________________________________
susceptible host
(sŭ-sĕp'tı̆-bl hōst)

Person with inadequate defenses against an invading Once a pathogen gains entry into
pathogen. The host is the organism from which a parasite a host, three factors determine
obtains its nourishment. whether the person develops
infection. First, the virulence of
the organism; second, the num-
ber of organisms transmitted;
and third, the ability of the
host’s defenses to prevent
infection.
APPLICATION: NOTES:
The client with AIDS is a suscep- ____________________________________________
tible host for opportunistic infec- ____________________________________________
tious organisms.
____________________________________________
____________________________________________
transient flora
(trăns'zē-ĕnt flŏr'ă)

Microorganisms that are picked up, usually on the skin, Alcohol-based products are more
and can be removed fairly easily with hand hygiene. effective than standard hand
washing to remove transient skin
flora.
APPLICATION: NOTES:
The nurse used a 15-second, ____________________________________________
vigorous scrub to remove transient ____________________________________________
skin flora prior to insertion of an
intravascular device. ____________________________________________
____________________________________________
virulence
(vı̆r' ū-lĕns)

Relative power and degree of pathogenicity possessed by The ability of an organism to
organisms to produce disease. induce disease is called its viru-
lence or invasiveness.
APPLICATION: NOTES:
The microorganism’s ability to ____________________________________________
produce disease includes viru- ____________________________________________
lence, dose (number of organisms
available to infect), susceptible ____________________________________________
host, and dissemination. ____________________________________________
28. FLUID, ELECTROLYTES, AND PARENTERAL SOLUTIONS
1. acidosis
(ăs''ı̆-dō'sı̆s)
2. alkalosis
(ăl''kă-lō'sı̆s)

1. An actual or relative
pH pH
increase in the acidity 7.35
7.45
NORMAL ALK
of blood due to an pH 0 D OSI
S ALO
p
7.8 H
0
6.8 ACI SIS
accumulation of acids
DE
AT
or an excessive loss of
AT
DE
H
bicarbonate. The hydro-
gen ion concentration of
1 part of carbonic acid 20 parts of biocarbonate
the fluid is increased, H2CO3 1.20 mM/L HCO3- 24 mEq/L
lowering the pH. A pH
less than 7.35.
APPLICATION:
2. An actual or relative
The body maintains the plasma pH within the narrow normal range of
increase in blood alka-
7.35 to 7.45. It does so by means of chemical buffering mechanisms
linity due to an accu- utilized by the kidneys and by the lungs to prevent acidosis or
mulation of alkalies or alkalosis.
reduction of acids. A
pH above 7.45.
active transport
(ăk'tı̆v trăns''pŏrt)

The process by which a Active transport occurs to move other ions (such as calcium or hydro-
cell membrane moves gen) from areas of lesser concentration to areas of greater concentra-
molecules against a con- tion. Energy expenditure must occur for the movement to occur.
centration or electrochem-
ical gradient. Metabolic
work is required.
APPLICATION: NOTES:
The sodium-potassium pump, which is located in the cell membrane, ____________________
in the presence of adenosine triphosphate (ATP) actively moves sodium ____________________
from inside the cell into the extracellular fluid (ECF) by active
transport. ____________________
____________________
1. anion
(ăn'ı̄-ŏn)
2. cation
(kăt'ı̄-ŏn)

1. An ion (electrolyte) carrying a negative charge; the An anion is attracted by and
opposite of cation. travels to the anode (positive
2. An ion (electrolyte) carrying a positive charge; the pole). A cation is attracted by
and travels to the cathode (nega-
opposite of anion.
tive pole).
APPLICATION: NOTES:
The unit of measure for anions ____________________________________________
and cations is milliequivalents ____________________________________________
per liter (mEq/L).
____________________________________________
____________________________________________
Chvostek’s sign
(vōs'tĕks sı̄n)

A sign elicited by tapping the facial nerve about 2 cm Chvostek’s sign also can be
anterior to the earlobe, just below the zygomatic process; observed as unilateral twitching.
the response is a spasm of the muscles supplied by the *NOTE: Refer to Bonus Card
170 for picture of Chvostek’s
facial nerve. A positive Chvostek’s sign is a symptom of
sign.
hypocalcemia or hypomagnesemia.
APPLICATION: NOTES:
The patient postoperative for ____________________________________________
thyroidectomy began to have ____________________________________________
signs of hypocalcemia including
numbness of the fingers, cramps ____________________________________________
in the muscles of the legs, and ____________________________________________
positive Chvostek’s sign.
colloid
(kŏl'oyd)

A substance (e.g., blood, plasma, albumin, dextran) that Colloid solutions contain protein
does not dissolve into a true solution and is not capable or starch molecules that remain
of passing through a semipermeable membrane. distributed in the extracellular
space and do not form “true”
solutions.
APPLICATION: NOTES:
Albumin 25% (a colloid solu- ____________________________________________
tion) was ordered to maintain ____________________________________________
blood volume for the 24-year-old
male, auto accident victim prior ____________________________________________
to administration of packed ____________________________________________
cells.
crystalloid
(krı̆'stăl-oyd'')

A substance that forms a true solution and is capable of Crystalloid solutions, such as
passing through a semipermeable membrane. 5% dextrose in water or 0.9%
sodium chloride, move between
the three fluid compartments
in the body based on osmolality
of the solution.
APPLICATION: NOTES:
Many crystalloid solutions ____________________________________________
contain dextrose as the carbohy- ____________________________________________
drate, calorie source.
____________________________________________
____________________________________________
extracellular fluid (ECF)

(ĕks''tră-sĕl'ū-lăr floo''ı̆d)

Fluid located outside the cell, comprised of interstitial Extracellular fluid (ECF) is
and plasma fluid. subdivided into intravascular
fluid (plasma) and interstitial
fluid (fluid lying between the
cells or tissue fluid). Also part
of the ECF is transcellular
fluids.
APPLICATION: NOTES:
The patient admitted to the ED ____________________________________________
after a gunshot wound to the ____________________________________________
right shoulder, had extracellular
fluid volume deficit due to the ____________________________________________
blood loss. ____________________________________________
1. fluid volume deficit (FVD)

(floo'ı̆d vŏl' ūm dĕf'ı̆-sı̆t)
2. fluid volume excess (FVE)

(floo'ı̆d vŏl'ūm ĕk'sĕs)

1. A deficiency. Hypov- FVD has defining characteristics such as weight loss over a short
olemia. An equal pro- period of time, decreased skin and tongue turgor, dry mucous
portion of loss of water membranes, urine output <30 mL/hr in adults, weak rapid pulse, and
slow capillary refill. FVE has defining characteristics such as weight
and electrolytes from
gain over a short period of time, peripheral edema, distended neck
the body. veins, slow-emptying peripheral veins, moist rales in lungs, polyuria,
2. The state of exceeding and bounding full pulse.
what is normal. Hyper-
volemia. Retention of
both water and sodium
in similar proportions
APPLICATION:
to normal ECF.
The student nurse created a table identifying the characteristics of fluid
volume deficit and fluid volume excess to study for the examination.
hydrating solution
(hı̄'dr āt-ı̆ng sō-lū'shŭn)

A solution of water, car- Hydrating solutions are used to assess kidney function. Kidney func-
bohydrate, sodium, and tion must be determined prior to administering potassium infusions.
chloride used to deter-
mine the adequacy of
renal function.
APPLICATION: NOTES:
The client was admitted to the emergency department for intractable ____________________
vomiting and 3 days of diarrhea. An IV was started with a 5% dextrose ____________________
in 0.45% sodium chloride, a hydrating solution, to determine kidney
status and begin hydration before replacement of potassium chloride. ____________________
____________________
1. hypotonic
(hı̄''pō-tŏn'ı̆k)
2. hypertonic
(hı̄''p ĕr-tŏn'ı̆k)
3. isotonic
(ı̄''sō-tŏn'ı̆k)

1. Solutions that have a
lower osmolality than
body fluids. Below
250 mOsm.
2. Solutions that have a
higher osmolality than
body fluids. Above
375 mOsm.
3. Solutions that have the
same osmolality as
APPLICATION:
body fluids. Between
Intravenous parenteral solutions are classified as either hypotonic,
250 and 375 mOsm.
isotonic, or hypertonic solutions based on the osmolarity of the solution.
1. hypercalcemia
(hı̄''pĕr-kăl-sē'mē-ă)
2. hypocalcemia
(hı̄''pō-kăl-sē'mē-ă)
DEFINITIONS: APPLICATION: KEEP IN MIND:

1. An excessive amount of The patient receiving six units Hypercalcemia is caused by
calcium in the blood. of blood post trauma was evalu- hyperparathyroidism, lithium
2. Abnormally low blood ated for hypocalcemia. therapy, malignancies including
solid tumors and hematological
calcium.
malignancies, hyperthyroidism,
and milk-alkali syndrome.
Hypocalcemia occurs transiently
in patients with severe sepsis, se-
vere pancreatitis, burns, and re-
nal failure. It also may result
from multiple transfusions of cit-
NOTES: rated blood, parathyroidectomy,
malabsorption, and medications.
____________________________________________
____________________________________________
____________________________________________
____________________________________________
1. hyperkalemia
(hı̄''pĕr-kă-lē'mē-ă)
2. hypokalemia
(hı̄''pō-kă-lē'mē-ă)

1. An excessive amount of Hyperkalemia usually is caused by inadequate excretion of potassium or
potassium in the blood. the shift of potassium from tissues. Hypokalemia results from deficient
2. An abnormally low potassium intake or excess loss of potassium due to vomiting, diarrhea, or
concentration of potas- fistulas; metabolic acidosis; diuretic therapy; aldosteronism; excess
adrenocortical secretion; renal tubule disease; and alkalosis.
sium in the blood.
APPLICATION: NOTES:
Patients receiving diuretics must have laboratory potassium values ____________________
evaluated periodically for hypokalemia due to loss of potassium in the ____________________
urine.
____________________
____________________
1. hypermagnesemia
(hı̄''pĕr-măg''nĕ-sē'mē-ă)
2. hypomagnesemia
(hı̄''pō-măg''n ĕ-sē'mē-ă)

1. Increase in magnesium Hypermagnesemia is clinically accompanied by a severe decrease in
in the blood. Above neuromuscular transmission and depression of skeletal muscle func-
2.1 mEq/L. tion. The common causes include renal failure and magnesium admin-
istration for therapeutic purposes. Hypomagnesemia is clinically
2. Decreased magnesium accompanied by increased neuromuscular irritability. The common
in the blood. Below causes include gastrointestinal losses, alcoholism, and refeeding after
1.3 mEq/L. starvation.
APPLICATION: NOTES:
The preeclampsia patient in labor and delivery receiving magnesium ____________________
sulfate must be monitored for hypermagnesemia including fetal heart ____________________
tones.
____________________
____________________
1. hypernatremia
(hı̄''pĕr-nă-trē'mē-ă)
2. hyponatremia
(hı̄''pō-nă-trē'mē-ă)

1. An increased concentra- More than 95% of the body’s physiologically active sodium is in the
tion of sodium in the ECF. In contrast, the intracellular concentration of sodium is small.
blood. Above 145 mEq/L. Sodium does not easily cross the cell wall membrane. The primary role
is in controlling water distribution as well as ECF volume. In general,
2. A decreased concentra- a loss or gain of sodium is accompanied by loss or gain of water.
tion of sodium in the
blood. Below 135 mEq/L.
APPLICATION: NOTES:
Hyponatremia is the most frequent electrolyte disorder seen in clinical ____________________
practice. ____________________
____________________
____________________
1. hypervolemia
(hı̄''pĕr-vō-lē'mē-ă)
2. hypovolemia
(hı̄''pō-vō-lē'mē-ă)

1. An increased volume of circulating blood usually due Fluid volume imbalances may
to retention of sodium and water in the ECF. occur alone or in combination
2. A decreased blood volume that may be caused by in- with other imbalances. Fluid
volume excess is also referred to
ternal or external bleeding, fluid losses, or inadequate
as hypervolemia, and fluid
fluid intake. volume deficit is also referred to
as fluid volume deficit.
APPLICATION: NOTES:
Nurses can help to prevent hypovolemia or hypervolemia by identifying ____________________
patients who have the highest risk for developing either fluid volume
____________________
deficit (older adults, infants and children), and conditions associated
with 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.
ions
(ı̄'ŏnz)

An atom or group of In aqueous solution, ions are called electrolytes because they permit
atoms that has lost one or the solution to conduct electricity.
more electrons and has a
positive charge, or has
gained one or more elec-
trons and has a negative
charge.
APPLICATION: NOTES:
The unit of measurement for ions is usually milliequivalents per liter ____________________
(mEq/L), or can be expressed as millimoles per liter (mmol/L) as is ____________________
chemical activity of the electrolytes. Milligrams per 100 mL express
the weight of the solute per unit volume. ____________________
____________________
interstitial fluid
(ı̆n''tĕr-stı̆sh'ăl floo'ı̆d)

Fluid that surrounds the cells. Also called tissue fluid. The
electrolyte content of interstitial
fluid is not measured in clinical
situations; however, it is essen-
tially the same as that of plasma,
except that it contains less
proteinate.
APPLICATION: NOTES:
The extracellular fluid is divided ____________________________________________
into plasma space, approxi- ____________________________________________
mately 5% of total body weight,
and interstitial fluid approxi- ____________________________________________
mately 15% of body weight. ____________________________________________
intracellular fluid (ICF)

(ı̆n''tră-sĕl' ū-lăr floo'ı̆d)

The fluid within the tissue cells. The bulk of body fluid is located
within the body’s intracellular
fluid (ICF); this fluid is con-
tained within the body’s more
than 100 trillion cells.
APPLICATION: NOTES:
Intracellular fluid accounts for ____________________________________________
approximately 40% of total body ____________________________________________
weight.
____________________________________________
____________________________________________
maintenance solution
(mān'tĕ-nănts sō-lū'shŭn)

Fluids that provide all nutrients necessary to meet daily Water has priority in mainte-
patient requirements. Usually, water, glucose, sodium, nance therapy.
and potassium.
APPLICATION: NOTES:
The patient, NPO for laparo- ____________________________________________
scopic cholecystectomy, received ____________________________________________
intravenous maintenance solu-
tions until discharge from the ____________________________________________
outpatient surgery center. ____________________________________________
1. metabolic acidosis
(mĕt''ă-bŏl'ı̆k ăs''ı̆-dō'sı̆s)
2. metabolic alkalosis
(mĕt''ă-bŏl'ı̆k ăl''kă-lō'sı̆s)

1. The clinical disturbance in bicarbonate deficit charac- Metabolic acidosis can be pro-
terized by a low pH and a low plasma bicarbonate duced by a gain of hydrogen ion
concentration. or a loss of bicarbonate. Meta-
bolic alkalosis can be produced
2. The clinical disturbance in bicarbonate excess char- by a gain of bicarbonate or a
acterized by a high pH and a high plasma bicarbonate loss of hydrogen ion.
concentration.
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 blood
gases 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 low
HCO3 level.
oncotic pressure
(ŏng-kŏt'ı̆k prĕsh'ŭr)

The osmotic pressure Also referred to as colloid osmotic pressure. Movement of fluid through
exerted by colloids (pro- the capillary wall into the tissues depends on two forces: hydrostatic
teins), as when albumin pressure and oncotic pressure which is exerted by nondiffusible plasma
exerts oncotic pressure proteins. Oncotic pressure is greater than hydrostatic pressure in the
venous end of the capillary; fluids re-enter the capillary at the venous end.
within the blood vessels
and helps to hold the water
content of the blood in the
intravascular compartment.
APPLICATION: NOTES:
AThe patient with 60% second degree burns has damage to capillary ____________________
beds and decreased plasma proteins to maintain oncotic pressure. ____________________
____________________
____________________
osmosis
(ŏz-mō'sı̆s)

The passage of water from The solvent, usually water, passes through the membrane from the
a lower to higher concen- region of lower concentration of solute to that of higher concentration,
tration through a semiper- thus tending to equalize the concentrations of the two. The rate of
meable membrane that osmosis is dependent primarily upon the difference in osmotic pres-
sures of the solutions on the two sides of a membrane, the permeability
separates solutions of dif-
of the membrane, the electric potential across the membrane, and the
ferent concentrations. charge upon the walls of the pores in it.
APPLICATION: NOTES:
Administration of 0.45% sodium chloride (a hypotonic solution) will ____________________
move by osmosis from the plasma compartment into the interstitial and ____________________
cellular compartments.
____________________
____________________
osmolarity/osmolality
(ŏs''mō-lăr' ı̆-tē/ŏs''mō-lăl'ı̆-tē)

A measure of solute concentration; the concentration of a The normal osmolality of body
solution in terms of osmoles of solutes per liter of solu- fluid is between 285 and
tion. The term osmolarity is used to refer to solutions 295 mOsm (milliosmoles).
outside of the body. Osmolality refers to solutions within
the body.
APPLICATION: NOTES:
The osmolarity of 5% dextrose ____________________________________________
in 0.45 % sodium chloride is ____________________________________________
406 mOsm.
____________________________________________
____________________________________________
pH

A measure of the hydro- pH pH
7.45
7.35
gen ion concentration of a pH 0 OSIS
NORMAL ALK
ALO
p
7.8 H
0
6.8 ACID SIS
solution.
DE
AT
AT
DE
H
1 part of carbonic acid 20 parts of biocarbonate
H2CO3 1.20 mM/L HCO3- 24 mEq/L
Because the pH scale is logarithmic, there is a 10-fold difference

between each unit.
APPLICATION: NOTES:
The blood gas results reflected a pH of 7.48, a alkalotic condition. ____________________
____________________
____________________
____________________
plasma volume expander

(plăz'mă vŏl'ūm ĕk-spăn'dĕr)

A high-molecular weight compound in a solution suit- Examples of plasma volume
able for intravenous use. expanders include Dextran and
Hetastarch. Used to restore
circulatory dynamics and treat
perioperative shock.
APPLICATION: NOTES:
The patient in postanesthesia ____________________________________________
recovery required Dextran 40 in ____________________________________________
0.9% sodium chloride as a
plasma volume expander due to ____________________________________________
blood loss in the operating room. ____________________________________________
replacement therapy
(rē-plās'mĕnt thĕr'ă-pē)

Replenishment of losses when maintenance cannot be Usually patient is in acute dis-
met and patient is in deficient state. tress from loss of gastrointestinal
fluids, hemorrhage, low platelet
count, or starvation. Replace-
ment is calculated over 48 hours.
APPLICATION: NOTES:
The patient receiving chemother- ____________________________________________
apy required replacement ther- ____________________________________________
apy of platelets at the outpatient
infusion center due to a platelet ____________________________________________
count of 50,000. ____________________________________________
1. respiratory acidosis
(rĕs'-pı̆r ă-tōr''ē ăs''ı̆-dō'sı̆s)
2. respiratory alkalosis
(rĕs'-pı̆ră-tōr''ē ăl''kă-lō'sı̆s)

1. A state of excess car- Respiratory acidosis (H2CO3 excess) can be either acute or chronic;
bon dioxide in the body the acute imbalance is particularly dangerous. Respiratory acidosis is
(hypercapnia). always due to inadequate excretion of CO2 resulting in increased
plasma CO2 levels. Respiratory alkalosis (H2C03 deficit) is always due
2. A state of excessive
to hyperventilation, this causes excessive “blowing off” of C02.
loss of carbon dioxide
from the body.
APPLICATION: NOTES:
A patient is hypoventilating because of a respiratory depressant drug ____________________
overdose, with a pH below the normal range (<7.35); therefore this is ____________________
acidosis and the PaCO2 is 80, far above normal. This is uncompensated
respiratory acidosis. ____________________
____________________
Trousseau’s sign
(troo-sōz sı̄n)

A carpopedal attitude of the hand elicited when the To elicit a Trousseau’s sign, use
blood supply to the hand is decreased or the nerves of a blood pressure cuff and place
the hand are stimulated by pressure; elicited within it on the arm, inflate the cuff to
10 mm/Hg for 3 minutes, and
several minutes by applying a blood pressure cuff
observe for carpopedal spasm.
inflated above systolic pressure. Positive Trousseau’s *NOTE: Refer to Bonus Card
indicates hypocalcemia or hypomagnesemia. 170 for picture of Trousseau’s
sign.
APPLICATION: NOTES:
The student nurse taking the postoperative thyroidectomy patient’s ____________________
vital signs noted a carpopedal attitude of the hand and fingers when the
____________________
blood pressure pump was inflated. She reported this to the instructor
who explained the need to report this Trousseau’s sign to the physician. ____________________
____________________
56. EQUIPMENT TERMS
cannula
(kăn' ū-lă)
56. EQUIPMENT TERMS

A flexible tube that may be inserted into a duct, cavity, Also called a catheter. Refer to
or blood vessel to deliver medication or drain fluid. It card 72 for over-the-needle
may be guided by a sharp, pointed instrument (stylet). catheter (cannula) information.
APPLICATION: NOTES:
The infusion nurse chose a #20 ____________________________________________
cannula to begin the infusion of ____________________________________________
5% dextrose and 0.45% sodium
chloride in the cephalic vein. ____________________________________________
____________________________________________
57. EQUIPMENT TERMS
check valve
(chĕk vălv)
57. EQUIPMENT TERMS

A device that functions to prevent retrograde solution Check valves are inline compo-
flow; also called a back check valve. nents of many primary adminis-
tration sets. The check valve is
an important feature when sec-
ondary IV lines are in place for
intermittent infusions.
APPLICATION: NOTES:
The check valve stopped the back ____________________________________________
flow of the secondary infusion of ____________________________________________
gentamicin into the primary 5%
dextrose in 0.45% sodium ____________________________________________
chloride. ____________________________________________
58. EQUIPMENT TERMS
drip chamber
(drı̆p chām'bĕr)
58. EQUIPMENT TERMS

Area of IV administration set usually found under the This chamber is a pliable,
spike where the solution collects and drips into the enlarged clear plastic tube that
tubing. contains the drop orifice. It is
connected to the tubing.
APPLICATION: NOTES:
The drip chamber had a micro- ____________________________________________
drip in the drop orifice deliver- ____________________________________________
ing 60 drops per milliliter.
____________________________________________
____________________________________________
59. EQUIPMENT TERMS
drop factor
(drŏp făk'tŏr)
59. EQUIPMENT TERMS

The number of drops needed to deliver 1 mL of fluid. Drop factors vary per manufac-
turer. Primary macrodrip is 10,
15, and 20 gtt/mL. Pediatric sets
are microdrip at 60 gtt/mL, and
blood sets are 10 gtt/mL.
APPLICATION: NOTES:
The administration set package ____________________________________________
stated that the blood administra- ____________________________________________
tion set drop factor was 60 gtt/mL.
____________________________________________
____________________________________________
60. EQUIPMENT TERMS
elastomeric pump
(ē''lăs-tō'mĕr-ı̆k pŭmp)
60. EQUIPMENT TERMS

A portable infusion device with a balloon made of soft, An elastomeric reservoir or bal-
rubberized material capable of being inflated to a prede- loon works on flow restrictions.
termined volume. When filled, the balloon exerts
positive pressure to administer
the medication with an inte-
grated flow restrictor that con-
trols the flow. Elastomeric pumps
come in a variety of sizes ranging
in volume from 50 to 500 mL.
APPLICATION: NOTES:
The home-care nurse brought ____________________________________________
the 50-mL elastomeric pump ____________________________________________
to the client with instructions
for the family on delivery of the ____________________________________________
medication via the pump every ____________________________________________
6 hours.
61. EQUIPMENT TERMS
electronic infusion device

(EID)
(ē-lĕk-trŏn'ı̆k ı̆n-f ū'zhŭn dı̆-vı̄s')
61. EQUIPMENT TERMS

An automated system of introducing a fluid into a vein. Often called an IV pump. They
The device may have programmable settings that control allow delivery of drops per
the amount of fluid to be infused, rate, low-volume minute or milliliters per hour.
notification level, and a keep-vein-open rate.
APPLICATION: NOTES:
The electronic infusion device ____________________________________________
was set for 100 milliliters per ____________________________________________
hour as a primary infusion.
____________________________________________
____________________________________________
62. EQUIPMENT TERMS
filter
(f ı̆l't ĕr)
62. EQUIPMENT TERMS

A device for eliminating certain elements, such as parti- A membrane filter is one that is
cles of certain size, in a solution. made up of a thin film of collo-
dion, cellulose acetate, or other
material, available in a wide
range of defined pore sizes; the
smaller pore sizes are capable of
retaining all the known viruses.
APPLICATION: NOTES:
A 0.22 micron filter is used to ____________________________________________
filter microbes and air from a ____________________________________________
primary administration set.
____________________________________________
____________________________________________
63. EQUIPMENT TERMS
gauge
(gāj)
63. EQUIPMENT TERMS

A standard of measurement. The gauge of over-the-needle
catheters is in even numbers
(14, 16, 18, 20, 22, and 24).
Metal needles are odd numbered
(19, 21, 23, and 25). The gauge
of the catheters refers to the
opening size of the bevel.
APPLICATION: NOTES:
The nurse starting an infusion ____________________________________________
used a #20 gauge 1 inch over- ____________________________________________
the-needle catheter placed in the
cephalic vein. ____________________________________________
____________________________________________
64. EQUIPMENT TERMS
hub
(hŭb)
64. EQUIPMENT TERMS

Female connection point of an IV cannula where the All hubs for infusion equipment
tubing or other equipment attaches. should be Luer-Lok design.
The Luer adapter is a device
that makes connections between
syringes and injection ports,
administration sets, and catheters
in a manner that prevents the
threads on the Luer adapter from
slipping.
APPLICATION: NOTES:
The hub of the infusion device ____________________________________________
has threads to lock the syringe in ____________________________________________
place during a flush.
____________________________________________
____________________________________________
65. EQUIPMENT TERMS
infusate
(ı̆n-f ū'zāt)
65. EQUIPMENT TERMS

Any liquid introduced into the body. Infusates include all crystalloids
and colloids, blood and blood
products.
APPLICATION: NOTES:
The infusate of albumin was ____________________________________________
completed within 2 hours. ____________________________________________
____________________________________________
____________________________________________
66. EQUIPMENT TERMS
locking device (PRN device)

(lŏk'ı̆ng dı̆-vı̄s')
66. EQUIPMENT TERMS

A capped resealable diaphragm that may have a Luer- The lock is part of administra-
Lok or Luer-Slip connection. This diaphragm can be tion sets, available as separate
accessed multiple times. Also called PRN device or connectors to convert continuous
infusions to intermittent devices.
saline lock.
APPLICATION: NOTES:
The order from the physician ____________________________________________
stated to convert the continuous ____________________________________________
infusion of 0.9% sodium chloride
to an intermittent infusion using ____________________________________________
a locking device (or saline lock). ____________________________________________
67. EQUIPMENT TERMS
lumen
(lū'mĕn)
67. EQUIPMENT TERMS

The space within a tubular structure, such as an artery Several types of peripheral
or catheter. infusion devices are available
with single- and double-lumen
catheters.
APPLICATION: NOTES:
The dual-lumen peripherally ____________________________________________
inserted central catheter dress- ____________________________________________
ing was scheduled to be changed
24 hours after insertion. ____________________________________________
____________________________________________
68. EQUIPMENT TERMS
macrodrop
(măk'rō-drŏp'')
68. EQUIPMENT TERMS

In IV therapy, an administration device that is used to The size of the drops is con-
deliver measured amounts of IV solution. Large drops of trolled by the fixed diameter of a
fluid. plastic delivery tube. Different
macrodrips deliver 10, 15, or
20 drops per milliliter of solution.
APPLICATION: NOTES:
The outpatient surgicenter rou- ____________________________________________
tinely uses macrodrip adminis- ____________________________________________
tration sets as part of the
presurgery infusion set. ____________________________________________
____________________________________________
69. EQUIPMENT TERMS
microdrop
(mı̄'krō-dr ŏp'')
69. EQUIPMENT TERMS

In IV therapy, an administration device for delivering Also called a pediatric drip, or
small, measured amounts of IV solutions (60 drops = 60-drop tubing. Microdrips
1 mL) at specific flow rates. deliver small amounts of solution
over time.
APPLICATION: NOTES:
The ICU nurse added a micro- ____________________________________________
drip administration set to the ____________________________________________
solution of heparin in order to
titrate the delivery of the ____________________________________________
medication in small amounts. ____________________________________________
70. EQUIPMENT TERMS
multichannel pumps
(mŭl''tı̄-chăn'ĕl pŭmpz)
70. EQUIPMENT TERMS

Electronic infusion device that delivers multiple drugs Multichannel pumps are now
or solutions simultaneously or intermittently from bags, being designed with medication
bottles, or syringes. safety systems.
APPLICATION: NOTES:
Multichannel pumps are used ____________________________________________
in critical care areas for delivery ____________________________________________
of multiple solutions and
medications. ____________________________________________
____________________________________________
71. EQUIPMENT TERMS
needleless systems
(nē'dĕl-lĕs sı̆s'tĕmz)
71. EQUIPMENT TERMS

A device for administering intravenous solutions that These systems were developed
permits intravascular access without the necessity of to reduce the number of needle
handling a needle. stick injuries related to tradi-
tional intravenous administra-
tion of fluids and medications.
APPLICATION: NOTES:
The infusion clinic converted to ____________________________________________
a new needleless system. ____________________________________________
____________________________________________
____________________________________________
72. EQUIPMENT TERMS
over-the-needle catheter
(ō'vĕr nē-dĕl kăth' ĕ-tĕr)
72. EQUIPMENT TERMS

A flexible tube that enables passage of fluid from or into Most common peripheral infu-
a blood vessel. Consists of a needle with a catheter sion device. The point of the
sheath. needle extends beyond the tip of
the catheter. After venipuncture,
the needle (stylet) is withdrawn.
ONCs are sized by even num-
bers.
APPLICATION: NOTES:
A # 20 gauge over-the-needle ____________________________________________
catheter was used to initiate the ____________________________________________
infusion on the adult waiting for
outpatient surgery. ____________________________________________
____________________________________________
73. EQUIPMENT TERMS
patient-controlled analgesia
(PCA)
(pā'shĕnt kŏn-trōl'ed ăn-ăl-jē'zē-ă)
73. EQUIPMENT TERMS

A drug delivery system that dispenses a preset intravas- The device consists of a comput-
cular dose of a narcotic analgesic when the patient erized pump with a chamber
pushes a switch on an electric cord. containing a syringe of drug.
The patient administers a dose
of narcotic when the need for
pain relief arises. A lockout
interval automatically inacti-
vates the system if a patient
tries to increase the amount of
narcotic within a reset period.
APPLICATION: NOTES:
The physician ordered morphine ____________________________________________
via patient-controlled analgesia ____________________________________________
postoperatively for the 62-year-
old client with hip resurfacing. ____________________________________________
____________________________________________
74. EQUIPMENT TERMS
injection port
(ı̆n-jĕk'shŭn pŏrt)
74. EQUIPMENT TERMS

Resealable devices designed to accommodate needleless Injection ports serve as an
access for administration of solutions or medications into access into the tubing and are
the vascular system. located at various points along
the administration of medica-
tion. Needleless systems are
used to access the port. Ports
are located along primary ad-
ministration sets or stand-alone
devices connected as locking
devices.
APPLICATION: NOTES:
The injection port was cleaned ____________________________________________
with an alcohol swab using a ____________________________________________
twisting motion prior to delivery
of the IV medication. ____________________________________________
____________________________________________
75. EQUIPMENT TERMS
primary administration set

(prı̄'mă-rē ad-mı̆n-ı̆-strā'shŭn sĕt)
75. EQUIPMENT TERMS

Device used for delivery of large volume parenterals. Available in microdrip or macro-
drip drop factor. Tubing is long
and used to deliver 500 to
1000 mL infusions over a period
of time.
APPLICATION: NOTES:
The student nurse, gathering ____________________________________________
equipment for the initial intra- ____________________________________________
venous infusion, chose a primary
macrodrip administration set and ____________________________________________
the prescribed solution. ____________________________________________
76. EQUIPMENT TERMS
radiopaque
(rā-dē-ō-pāk')
76. EQUIPMENT TERMS

Material used in IV catheter that can be identified by Most infusion catheters are
radiographic examination. radiopaque to ensure radi-
ographic visibility.
APPLICATION: NOTES:
The catheter embolized after in- ____________________________________________
sertion and was detected on radi- ____________________________________________
ographic examination because of
the radiopaque quality of the ____________________________________________
catheter. ____________________________________________
77. EQUIPMENT TERMS
secondary administration set

(sĕk'ŏn-dăr''ē ăd-mı̆n-ı̆-strā'shŭn sĕt)
77. EQUIPMENT TERMS

Administration set that has short tubing used for Usually 3 to 36 inches in length.
delivery of 50 to 100 mL of infusion attached to Always attached to a needleless
primary administration set for intermittent delivery adapter into an injection port
immediately distal to the back
of medications.
check valve of the primary
tubing.
APPLICATION: NOTES:
The student nurse chose the ____________________________________________
appropriate secondary adminis- ____________________________________________
tration set to administer the
piggyback medication. ____________________________________________
____________________________________________
78. EQUIPMENT TERMS
syringe pumps
(sı̆r-inj' pŭmpz)
78. EQUIPMENT TERMS

Piston-driven infusion pumps that provide precise infu- The system pushes the plunger
sion by controlling the rate by drive speed and syringe to deliver fluid or medication at
size. a rate of 0.1 to 99.9 mL/h. Some
models have program modes
capable of administration in
mg/kg per minute, mcg/min, and
mL/h. The syringe is usually
filled in the pharmacy and
stored until use.
APPLICATION: NOTES:
The syringe pump technology ____________________________________________
was applied to patient-controlled ____________________________________________
analgesia pumps.
____________________________________________
____________________________________________
79. TECHNIQUES/MAINTENANCE PERIPHERAL IVS
basilic vein
(bă-sı̆l' ı̆k vān)

Vein that arises from the The basilic vein, located at the
ulnar side of the dorsal median cubital site, is one vein
venous network of the used for insertion of peripherally
inserted central catheters.
hand; it curves around Cephalic vein Basilic vein
the medial side of the
Accessory Brachial
forearm, communicates cephalic vein artery
with the cephalic vein Median
Radial
through the median cu- artery cubital vein
bital vein and passes up Cephalic Basilic vein

vein
the medial side of the
NOTES: Ulnar artery
arm to join the axillary
vein. ___________________ Median
antebrachial
___________________ vein
___________________
___________________
cannulation
(kăn''ū-lā'shŭn)

Insertion of an over-the-needle catheter. Step number 9 of the 15 Steps.
Actual insertion of the catheter
through the skin and substruc-
tures into the vein.
*NOTE: Refer to Bonus Card
166 (back), Phillips 15 Steps.
APPLICATION: NOTES:
The nurse can use the direct or ____________________________________________
indirect method of cannulation
technique for insertion of over-
____________________________________________
the-needle catheters. ____________________________________________
____________________________________________
cephalic vein
(sĕ-făl'ı̆k vān)

Vein arises at the radial The cephalic vein above the
Image rights not
border of the dorsal radial border above the wrist is
a common site to initiate initial available.
venous area of the hand,
IV therapy.
passes upward in front of
the elbow and along the
lateral side of the arm; it
empties into the upper
part of the axillary vein.
NOTES:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
chlorhexidine
(klor-hĕk'sı̆-dēn)

A bisbiguanide used as a topical disinfectant. As a site prep, 2% chlorhexi-
dine gluconate and 70%
isopropyl alcohol significantly
reduces microbial counts over a
24-hour period.
166 (back), Phillips 15 Steps.
APPLICATION: NOTES:
A skin prep for 20 seconds with ____________________________________________
Chlorhexidine (gluconate) should ____________________________________________
be used prior to insertion of the
peripheral catheter. ____________________________________________
____________________________________________
digital veins
(dı̆j'ı̆-tăl vānz)

Veins that are located on The digital vein of the thumb is
the lateral and dorsal por- a site for initiation of infusion
tions of the fingers. therapy for the elderly when
hydrating fluids are needed
without additives and other Basilic vein
Cephalic vein
access is limited as a result of
dehydration. Dorsal venous
arch
Metacarpal
veins
Digital
NOTES: veins
____________________________________________
____________________________________________
____________________________________________
____________________________________________
distal
(dı̆s'tăl)

Farthest from the center, from a medial line, or from the The fingers are the most distal
trunk. point in the peripheral area for
infusion therapy.
APPLICATION: NOTES:
The IV placed in the lower ____________________________________________
cephalic vein had infiltrated and ____________________________________________
the nurse was aware that she
could not initiate infusion ther- ____________________________________________
apy distal to that site. ____________________________________________
dermis
(dĕr'mı̆s)

The layer of the skin lying immediately under the The corium dermis is composed
epidermis; the true skin. of fibrous connective tissue
made of collagen and elastin,
and contains numerous capil-
laries, lymphatics, and nerve
endings. In it are hair follicles
and their smooth muscle fibers,
sebaceous glands and sweat
glands, and their ducts.
APPLICATION: NOTES:
The epidermis and dermis of the ____________________________________________
80-year-old woman upon assess- ____________________________________________
ment were very thin; therefore,
the nurse had to use special ____________________________________________
techniques in initiating infusion ____________________________________________
therapy.
drop factor
(drŏp făk'tŏr)

The drop rate of the infu- Drop factors vary depending on the size of the drop orifice. Common
sion administration set to drop factors are: Primary sets: 10, 15, or 20. Pediatric/micro drip
be used is called the drop sets: 60. Blood administration sets: 10.
*NOTE: Refer to the back of Bonus Card 167 for examples of
factor.
rate calculations.
APPLICATION: NOTES:
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 of ____________________
125 mL per hour. A formula was needed to set the drip rate.
____________________
Drop factor × mL/hour = drop per minute
60 (minutes)
____________________
endothelium
(ĕn''dō-thē'lē-ŭm)

A form of squamous epithelium consisting of flat cells Derived from mesoderm.
that line the blood and lymphatic vessels, the heart, and Endothelial cells are metaboli-
various other body cavities. cally active and produce a num-
ber of compounds that affect the
vascular lumen and platelets.
APPLICATION: NOTES:
The intima of the vein is lined ____________________________________________
with endothelium and can be ____________________________________________
damaged with poor venipuncture
technique. ____________________________________________
____________________________________________
epidermis
(ĕp''ı̆-dĕr'mı̆s)

The outermost layer of the skin. The epidermis is less sensitive
than underlying structures. The
epidermis is the first line of
defense against infections.
APPLICATION: NOTES:
The nurse performed a 20-second ____________________________________________
prep with antimicrobial solution ____________________________________________
of the epidermis prior to insertion
of the catheter. ____________________________________________
____________________________________________
flushing
(flŭsh'ı̆ng)

To irrigate with fluid. 0.9% sodium chloride is used for maintenance of intermittent
infusion devices. Flush with 0.9% sodium chloride to ensure and
maintain patency. For peripheral IVs, flushing protocol dictates: flush
with 2–3 mL at least every 12 hours. Flushing should be done prior to
medication administration and post administration of intermittent
devices.
*NOTE: Refer to Bonus Card 169 for Flushing Guidelines.
APPLICATION: NOTES:
The nurse prepared the morphine, 5 mg to be given IV push over ____________________
5 minutes, along with two prefilled flushing solutions—one for prior to ____________________
administration of the medication into the intermittent infusion device
and one for post administration. ____________________
____________________
metacarpal veins
(mĕt''ă-kăr'păl vānz)

Veins located on the dor- The metacarpal vein of the right Image rights not
sum of the hand over the hand was used to initiate infu- available.
five long bones formed by sion of 5% dextrose and 0.45%
sodium chloride without addi-
the union of digital veins. tives for hydration for the client
with gastroenteritis.
NOTES:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
median cubital veins

(mē'dē-ăn kū'bı̆-tăl vānz)

Veins that pass across the The phlebotomist used the Image rights not
anterior aspect of the cephalic portion of the median
available.
elbow from the cephalic cubital veins to withdraw blood
for analysis.
vein to the basilic vein;
commonly, this vein is
replaced by intermediate
basilic and intermediate
cephalic veins.
NOTES:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
These veins are often used for venipuncture for blood withdrawal and in emergency cases for access.
midline catheter
(mı̆d'lı̄n kăth'ĕ-tĕr)

Catheter with tip placement level with the axillary vein, This catheter measures 3.1 to
and distal to the shoulder. 8 inches in length with the distal
tip dwelling in the basilic,
cephalic, or brachial vein.
APPLICATION: NOTES:
The nurse inserted a midline ____________________________________________
catheter to support the infusion ____________________________________________
of the peripheral nutritional sup-
port over a period of 7 days. ____________________________________________
____________________________________________
palpation
(păl-pā'shŭn)

Examination by application of the hands or fingers to Palpate the vein by moving the
the external surface of the body to detect the outline tips of the fingers down the vein
of a vein. to observe how it refills.
*NOTE: Refer to front of
Bonus Card 166, step 5
of Phillips 15 Steps, for pal-
pation of veins to determine
site selection.
APPLICATION: NOTES:
The nurse, prior to venipuncture, ____________________________________________
used palpation of the veins of the ____________________________________________
hand and lower arm to determine
which vein would be most appro- ____________________________________________
priate for infusion therapy. ____________________________________________
prime
(prı̄m)

Process of running the The administration set was Image rights not
fluids in an IV bag primed prior to insertion into the available.
through the tubing so electronic infusion device.
that there is no air in the
tubing.
NOTES:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
proximal
(prŏk'sı̆m-ăl)

Nearest the point of attachment, center of the body; The upper cephalic vein (above
or point of reference. the median cubital) is the most
proximal point of insertion of a
catheter for peripheral infusion
therapy.
APPLICATION: NOTES:
The IV site in the hand appeared
____________________________________________
reddened and the patient com-
plained of pain at the site. The ____________________________________________
nurse discontinued the infusion ____________________________________________
and catheter, and restarted the
infusion proximal to the previous ____________________________________________
infusion site.
skin receptors:
1. mechanoreceptors
(mĕk''ă-nō-rē-sĕp'torz)
2. thermoreceptors
(thĕr''mō-rē-sĕp'torz)
3. nociceptor
(nō''sē-sĕp'tor)
4. chemoreceptors
(kē''mō-rē-sĕp'torz)

1. A receptor that receives mechanical stimuli, such as There are five types of sensory re-
ceptors, four of which affect par-
pressure from sound or touch. enteral therapy. Sensory receptors
2. A free nerve ending that is a receptor for painful stimuli. transmit along afferent fibers.
3. A sensory receptor that is stimulated by a rise in body Mechanoreceptors, palpation of
veins; thermoreceptors, application
temperature. of heat or cold; nociceptors, the
4. A sense organ or sensory nerve ending that is stimu- puncture of vein for insertion of
lated by, and reacts to, certain chemical stimuli and the cannula; chemoreceptors,
decrease circulating blood volume.
that is located outside the central nervous system.
APPLICATION: NOTES:
Application of the physiology of ____________________________________________
nociceptors must be considered ____________________________________________
prior to venipuncture to decrease
the discomfort of initiation of ____________________________________________
infusion therapy. ____________________________________________
tangential lighting
(tăn-jĕn'shŭl lı̄t'ı̆ng)

Indirect lighting used to illuminate the blue of veins. This technique can be used for
dark skinned individuals and
those with altered skin surfaces.
166, step 5 of Precannula-
tion, use tangential lighting
to determine site selection.
APPLICATION: NOTES:
Tangential lighting was used ____________________________________________
with a small flashlight to illumi- ____________________________________________
nate the veins of the lower arm
and, thus, assist with access of ____________________________________________
the vein. ____________________________________________
1. tunica adventitia
(tū'nı̆-kă ăd''vĕn-tı̆sh' ē-ă)
2. tunica media
(tū'nı̆-kă m̆ē'dē-ă)
3. tunica intima
(tū'nı̆-kă ı̆n'tı̆-mă)

Layers of tissue that form the walls of veins and arteries. Tunica adventitia: The outermost
layer consists of connective tis-
sue that surrounds and supports
a vessel. Tunica media: composed
of muscular and elastic tissue
with nerve fibers for vasoconstric-
tion and vasodilation. Tunica
intima: innermost layer has one
thin layer of cells referred to as
the endothelial lining.
APPLICATION: NOTES:
The nurse must keep in mind ____________________________________________
that the intima of the vein is ____________________________________________
fragile and that good venipunc-
ture technique is important to ____________________________________________
prevent damage to this third ____________________________________________
layer of the vein.
transdermal analgesia
(trăns-dĕr'măl ăn-ăl-jē'zē-ă)

Analgesia delivered Use of anesthetics either on the skin or injected into the dermal layer
through the dermis or prior to venipuncture to decrease the pain of venipuncture. Lidocaine
skin. 1% (plain) by intradermal route; transdermal by EMLA cream or ELA
Max cream topically applied 30 minutes prior to venipuncture.
*NOTE: Refer to Bonus Card 166 (back) for step 8 of Phillips
15 Steps. Analagesic is used prior to site preparation, allowed
to take effect, and then the nurse should continue with step 9.
APPLICATION: NOTES:
The nurse provided transdermal analgesia with EMLA cream covered ____________________
with occlusive dressing 30 minutes prior to venipuncture. ____________________
____________________
____________________
transparent semipermeable
membrane dressing (TSM)
(trăns-păr'ĕnt sĕm''ē-per'mē-ă-bl mĕm'brān drĕs-ı̆ng)

A transparent wound covering made of polyurethane that Transparent semipermeable
enables health-care providers to visually inspect the site membrane dressings should be
under the dressing. The dressing allows water vapor to applied aseptically and changed
every 72 hours or when the
escape from the wound but does not permit liquids or
catheter is changed. Do not use
bacteria to enter. ointment of any kind under a
TSM dressing.
166, (back), step 10 of
Phillips 15 Steps.
APPLICATION: NOTES:
After the #20 over-the-needle ____________________________________________
catheter was stabilized, a TSM ____________________________________________
dressing was applied and labeled
with the time of venipuncture, ____________________________________________
date, size catheter, and nurse’s ____________________________________________
initials.
101. TECHNIQUES/MAINTENANCE CENTRAL IVS
central venous catheter

(CVC)
(sĕn'trăl vē'nŭs kăth'ĕ-tĕr)

Catheter inserted into the central circulation for infusion CVCs are indicated for infusion
therapy; the tip located in the superior vena cava. All therapy longer than 7 days.
central lines are central venous catheters (CVCs).
APPLICATION: NOTES:
The new bundles for prevention ____________________________________________
of catheter-related bloodstream ____________________________________________
infections include assessing the
client early for placement of a ____________________________________________
CVC. ____________________________________________
external jugular
(ĕks-tĕr'năl jŭg' ū-lăr)

The vein located on the exterior aspect of the neck. External jugular access can be
used for external jugular periph-
erally inserted central catheters
(EJ PICCs) and external jugular
peripheral intravenous catheters
(EJ PIVs).
APPLICATION: NOTES:
In an acute care setting, nurses ____________________________________________
who are proficient in infusion ____________________________________________
therapy may insert a peripheral
IV by accessing the external ____________________________________________
jugular. ____________________________________________
flushing CVC
(flŭsh'ı̆ng)

To wash out with a full The nurse flushed the peripher- For central catheters the follow-
stream of fluid. ally inserted central catheter ing protocol is recommended.
with 5 mL of preservative-free Central catheters should be
sodium chloride in a 10-mL flushed with a minimum of 5 mL
syringe and followed the flush of sodium chloride using a sin-
with 5 mL of 10 units/mL of gle-use 10-mL syringe. Lock the
heparin using a push-pause device with 5 mL of 10 unit/mL
method. of heparin. For ports use 3–5 mL
of 100 units/mL heparin to lock
device.
NOTES: 169 (back), Flushing Guide-
lines.
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Groshong® valve
(Grō'shŏng vălv)

Flaplike structure resem- Used at the terminal end of central venous catheters and implanted
bling a valve that retards ports to prevent reflux of blood. The Groshong® has a two-way valve
or prevents a reflux of placed near the distal end that restricts backflow of blood, but it can
fluid or blood. be purposefully overridden to obtain venous blood samples. This
valve eliminates the need for flushing with heparin. The valve is open
inward, minimizing the risks of blood backing up the catheter lumen.
APPLICATION: NOTES:
®
The Groshong valve feature is included in many types of central ____________________
lines—PICC, tunneled, and ports. ____________________
____________________
____________________
Hickman catheter
(Hı̆k'măn kăth'ĕ-tĕr)

Long-term, tunneled, Silastic catheter inserted Prototype for a variety of tun-
surgically. neled catheters currently on the
market.
APPLICATION: NOTES:
The Hickman catheter was ____________________________________________
placed so the client could ____________________________________________
receive chemotherapy over the
next 8 months. ____________________________________________
____________________________________________
implanted port
(ı̆m'plănt- ĕd pŏrt)

Catheter surgically placed into a vessel, body cavity, or Implanted ports must be
organ and attached to a reservoir, which is placed under accessed with special needles
the skin. that are noncoring.
169 (back) for picture of
port.
APPLICATION: NOTES:
The implanted port was accessed ____________________________________________
with a safety needle that uses a ____________________________________________
noncoring needle.
____________________________________________
____________________________________________
infraclavicular
(ı̆n''fră-klă-vik'ū-lăr)

Positioned below the clavicle. This site on the right or left is
used for insertion of implanted
ports or percutaneous catheters.
APPLICATION: NOTES:
The infraclavicular insertion site ____________________________________________
was inspected for redness and ____________________________________________
drainage per shift with docu-
mentation of visual inspection. ____________________________________________
____________________________________________
ports (injection):
1. distal port
(dı̆s'tăl pŏrt)
2. medial port
(mē'dē-ăl pŏrt)
3. proximal port
(prŏk'sı̆m-ăl pŏrt)
DEFINITIONS: APPLICATION: KEEP IN MIND:

1. The lumen located far- The proximal port of the central
ther from the catheter line triple lumen was labeled
tip. “use for blood sampling only.”
2. The center lumen of a
triple lumen catheter.
3. Lumen nearest the tip. Slide clamp
Proximal
lumen port
(18-gauge
NOTES: lumen)
____________________________________________ Distal Medial

lumen port
lumen port
____________________________________________ (16-gauge (18-gauge
lumen)
lumen)
____________________________________________
____________________________________________
peripherally inserted central

catheter (PICC)
(pĕr-ı̆f'ĕr-ăl-lē' ı̆n-sĕr'tĕd sĕn'trăl kăth'ĕ-tĕr)

Catheter inserted into the The PICC is a percutaneous line that may have single or multiple
superior vena cava through lumens with a range in lengths from 33 to 60 cm and diameters of 14
a peripheral vein; usually to 25 gauges. The PICC is placed by a nurse certified in PICC place-
cephalic and basilic at the ment. X-ray verification of placement is required before the line can
be used.
median cubital area. *NOTE: Refer to Bonus Card 169 (back) to see a picture of
PICC placement.
APPLICATION: NOTES:
The IV team placed the PICC in the right cephalic vein and verified ____________________
confirmation of the tip in the superior vena cava prior to starting the ____________________
client on total parenteral nutrition.
____________________
____________________
polyurethane
(pŏl''ē-yŭr'ĕ-thān)

Medical grade resins, widely varying in flexibility, used A polyurethane catheter is
in chemical-resistant coatings and adhesives used to commonly used because of the
make catheters for venous access. material’s versatility, malleabil-
ity (tensile strength and elonga-
tion characteristics), and
biocompatibility.
APPLICATION: NOTES:
The polyurethane catheter was ____________________________________________
also coated with chlorhexidine/ ____________________________________________
silver sulfadiazine on the internal
and external luminal surfaces as a ____________________________________________
means of reducing catheter-related ____________________________________________
bloodstream infections (CRBSI).
pulsatile flushing
(push-pause)
(pŭl'să-tı̆l flŭsh'ı̆ng) (poosh-păwz)

Rapid succession of pulsatile push-pause–push-pause Use this technique for flushing
movements that create turbulence within the catheter central lines with preservative-
lumen that causes a swirling effect to move any debris. free sodium chloride. This tech-
nique is not used for locking the
device with heparin.
APPLICATION: NOTES:
The nurse administered the ____________________________________________
medication into the PICC and ____________________________________________
flushed the catheter with 5 mL
of preservative-free sodium chlo- ____________________________________________
ride in a 10-mL syringe using a ____________________________________________
push-pause technique.
silicone elastomer
(sı̆l'ı̆-kōn ē''lăs-tō'mĕr)

A polymer of organic silicon oxides, which may be a Some VADs are made of silicone
liquid, gel, or solid depending on the extent of polymer- elastomer (Silastic), which is
ization; used in surgical implants and as a coating on the soft and pliable. This material is
biocompatible. Silicone has a
inside of glass vessels for blood collection.
high degree of thrombogenicity
because of surface tackiness.
Fibrin sheath formation can
occur when particulate matter
is present.
APPLICATION: NOTES:
The peripherally inserted central ____________________________________________
catheter was made of silicone ____________________________________________
elastomer.
____________________________________________
____________________________________________
vascular access device

(VAD)
(văs'kū-lăr ăk'sĕs dē'vı̄s)

Access device inserted into a main vein or artery, or VADs are all access devices
bone marrow and used primarily to administer fluids and (peripheral catheters, central
medication, monitor pressures, and collect blood. venous catheters, arterial lines,
and intraosseous access devices)
that have access to the circula-
tory system.
APPLICATION: NOTES:
The hospital distributed a memo ____________________________________________
requesting that those nurses ____________________________________________
interested in being on the VAD
committee contact the infusion ____________________________________________
therapy department. ____________________________________________
114. COMPLICATIONS
acute hemolytic transfusion

reaction
(ă-kūt' hē''mō-lı̆t'ı̆k trăns-fū'zhŭn rē-ăk'shŭn)
114. COMPLICATIONS

Blood transfusion reaction Cause of this complication is usually clerical error or breakdown in
in which an antigen- identification of matching blood component with recipient. ABO
antibody reaction in the incompatibility.
recipient is caused by an
incompatibility between
red blood cell antigens
and antibodies causing
the destruction of red
blood cells, resulting in
liberation of hemoglobin.
APPLICATION:
The nurse hung the unit of red blood cells and per protocol stayed with
the patient for the first 5 minutes. The patient complained immediately of
flank pain and burning sensation along vein. The nurse stopped the infu-
sion, disconnected the infusion, and hung fresh tubing and saline while
calling for assistance. The physician determined that the patient had an
acute hemolytic transfusion reaction due to clerical error in the laboratory.
115. COMPLICATIONS
air embolism
(ār ĕm'bō-lı̆zm)
115. COMPLICATIONS

A sudden obstruction of a blood vessel caused by air Rare but lethal complication.
introduced into the circulation. Especially involving VADs.
Causes include: Allowing solu-
tion container to run dry and
then adding a new bag without
clearing air from the administra-
tion set. Loose connections that
allow air to enter the system.
Poor technique in dressing and
administration set changes.
APPLICATION: NOTES:
The nurse, following protocol ____________________________________________
for the central line dressing and ____________________________________________
administration cap change, had
the patient hold his breath while ____________________________________________
disconnecting the cap in order to ____________________________________________
prevent air embolism.
116. COMPLICATIONS
catheter malposition
(kăth'ĕ-tĕr măl-pō-zı̆'shŭn)
116. COMPLICATIONS

Position of the central Refer to central line term catheter malpositioning where tip of catheter
line catheter outside the advances into a venous tributary or does not reach the superior vena
superior vena cava. cava.
APPLICATION: NOTES:
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.
____________________
____________________
117. COMPLICATIONS
circulatory overload (fluid

overload)
(sı̆r''kū-lă-tōr'ē ō'vĕr-lōd)
117. COMPLICATIONS

Increased blood volume, This can result in heart failure, pulmonary edema, and cyanosis. Also
usually caused by transfu- called hypervolemia.
sions or excessive fluid
infusions that increase the
venous pressure.
APPLICATION: NOTES:
The nurse noted that the patient was short of breath with wet lung ____________________
sounds and increased peripheral edema; upon inspection of IV solu- ____________________
tion, she noted that 0.9% sodium chloride was infusing and the order
had read 0.45% sodium chloride. The nurse immediately slowed the ____________________
infusion and contacted the physician for new solution order to prevent ____________________
further circulatory overload.
118. COMPLICATIONS
extravasation
(ĕks-trăv''ă-sā'shŭn)
118. COMPLICATIONS

The escape of fluid from its physiologic contained space Extravasation is often referred
into surrounding fluid. to as infiltration of irritating or
vesicant substances into the
surrounding tissue. A vesicant
causes the formation of blisters,
with subsequent sloughing of
tissues.
APPLICATION: NOTES:
The antidote for extravasation of ____________________________________________
dopamine is 5 to 10 mg phento- ____________________________________________
lamine mesylate by intradermal
administration. ____________________________________________
____________________________________________
119. COMPLICATIONS
fibrin sheath
(fı̄'brı̆n shēth)
119. COMPLICATIONS

Covering on the end of a The nurse had difficulty aspirat-
ing blood from the central line
catheter with a whitish,
and suspected a fibrin sheath
filamentous protein formed covering the Hickman catheter.
by the action of thrombin
on fibrinogen. The fibrin
is deposited as fine inter-
lacing filaments which
entangle red and white
blood cells and latelets
forming a clot.
NOTES:
____________________
____________________
____________________
Also called a fibrin sleeve.
____________________
120. COMPLICATIONS
graft-versus-host disease
(GVHD)
(grăft vĕr'sŭs hōst dı̆-zēz')
120. COMPLICATIONS

Immunological injury suffered by an immunosuppressed GVHD occurs in about 50% of
recipient of a bone marrow transplant. The donated lym- allogeneic bone marrow trans-
phoid cells (the “graft”) attack the recipient (the “host”), plants. It may develop in the
first 60 days after transplanta-
causing damage, especially to the skin, liver, and gas-
tion or many months later
trointestinal tract. (chronic GVHD). Creates
scleroderma-like changes on
skin and organs.
APPLICATION: NOTES:
The immunocompromised client ____________________________________________
was at risk for graft-versus-host ____________________________________________
disease.
____________________________________________
____________________________________________
121. COMPLICATIONS
hematoma
(hē''mă-tō'mă)
121. COMPLICATIONS

A swelling comprising a mass of extravasated blood con- Symptoms include ecchymoses,
fined to subcutaneous tissue caused by break in a blood swelling, inability to advance
vessel. catheter, and resistance during
flushing.
APPLICATION: NOTES:
The nurse inserted the #20 over- ____________________________________________
the-needle catheter into the vein ____________________________________________
of an elderly 80-year-old female
with the immediate formation of ____________________________________________
a hematoma. ____________________________________________
122. COMPLICATIONS
hemothorax
(hē''mō-thō'răks)
122. COMPLICATIONS

Blood in the pleural cavity caused by a rupture of blood Complication during insertion of
vessels. central line.
APPLICATION: NOTES:
The physician inserted the central ____________________________________________
line and upon x-ray verification of ____________________________________________
placement noted the patient had
developed a hemothorax. ____________________________________________
____________________________________________
123. COMPLICATIONS
hypothermia
(hı̄''pō-thĕr'mē-ă)
123. COMPLICATIONS

A low core body temperature. Hypothermia can occur from
rapid transfusion of cold blood.
Blood warmers can be used for
rapid or massive transfusions.
Guidelines from the manufactur-
ers of specific fluid/blood warm-
ers should be adhered to when
using any warmer.
APPLICATION: NOTES:
The nurse in post-anesthesia ____________________________________________
recovery (PAR) set up the blood ____________________________________________
warmer in anticipation of infu-
sion of additional blood compo- ____________________________________________
nents to the trauma patient to ____________________________________________
prevent hypothermia.
124. COMPLICATIONS
infiltration
(ı̆n''fı̆l-trā'shŭn)
124. COMPLICATIONS

The accumulation of an external substance within tissue. Infiltration is usually due to
solutions seeping from vessel
into the tissue space causing
swelling.
*Note: Refer to Bonus Card
168 (back) for Infiltration
Rating Scale.
APPLICATION: NOTES:
Upon inspection of the IV site, ____________________________________________
the nurse noted edema and the ____________________________________________
site was cool to touch; the infil-
tration was rated at a grade 2. ____________________________________________
____________________________________________
125. COMPLICATIONS
local infection
(lō'kăl ı̆n-fĕk'shŭn)
125. COMPLICATIONS

An invasion of microor- Local infections are usually related to contamination of the hands of
ganisms that penetrate the the health-care practitioner while starting the infusion, a contaminated
tissues of a specific bodily catheter or infusate. Symptoms include redness and swelling at the
area, then grow and exert site, possible exudate of purulent material, and elevated temperature.
their effect there.
APPLICATION: NOTES:
The catheter site was not rotated for more than 96 hours and it was noted ____________________
that there was purulent material under the transparent dressing. The ____________________
nurse cultured the site and catheter in anticipation of a local infection.
____________________
____________________
126. COMPLICATIONS
phlebitis
(flĕ-bı̄'tı̆s)
126. COMPLICATIONS

Inflammation of a vein. *Note: Refer to Bonus Card 168 for Phlebitis Rating Scale.
Common causes include
chemical or mechanical
irritation of vein.
APPLICATION: NOTES:
Upon assessment of the infusion site, the patient complained of pain at ____________________
the access site, and it was noted that there was a red streak extending up ____________________
the vein and the nurse felt a palpable cord along the vein. The catheter
was discontinued and a 3+ phlebitis was reported to the physician. ____________________
____________________
127. COMPLICATIONS
pinch-off syndrome
(pı̆nch ŏff sı̆n'drōm)
127. COMPLICATIONS

CVC compressed by the Can result in complete or partial catheter transection and emboliza-
clavicle and the first rib; tion. Infraclavicular pain or swelling is present.
results in mechanical
occlusion.
APPLICATION: NOTES:
The nurse encountered difficulty in aspiration of blood and resistance ____________________
when the subclavian catheter was flushed, along with the patient com- ____________________
plaining of infraclavicular pain. The nurse suspected pinch-off
syndrome. ____________________
____________________
128. COMPLICATIONS
pneumothorax
(nū-mō-thō'răks)
128. COMPLICATIONS

The presence of air or gas in the pleural cavity between Caused during insertion of cen-
the lung and chest wall. tral catheter by puncturing the
pleural covering of the lung;
often treated by insertion of
chest tube.
APPLICATION: NOTES:
Upon insertion of the central line ____________________________________________
the patient complained of chest ____________________________________________
pain and dyspnea; a crunching
sound on auscultation was heard. ____________________________________________
X-ray confirmed a pneumothorax ____________________________________________
post central line insertion.
129. COMPLICATIONS
pulmonary edema
(pŭl'mō-nĕ-rē ĕ-dē'mă)
129. COMPLICATIONS

Accumulation of extravascular fluid in lung tissues, Often caused by administration
usually in the alveoli. of high percentages of sodium
chloride or fluid overload. The
treatment would include: de-
crease IV flow rate, place patient
in high Fowler’s position, keep
warm, monitor vital signs, and
administer oxygen as ordered.
Consideration should be given to
a microdrip administration set.
APPLICATION: NOTES:
The patient presented with signs ____________________________________________
of pulmonary edema including ____________________________________________
shortness of breath, 3+ pitting
edema of the extremities, and ____________________________________________
moist lung sounds. ____________________________________________
130. COMPLICATIONS
refeeding syndrome
(rē-fēd'ı̆ng sı̆n'drōm)
130. COMPLICATIONS

The potentially fatal metabolic response of a starved Occurs in initial phases of TPN.
individual to feeding, either enteral or parenteral. The
correction of electrolyte imbalances is imperative before
gradual refeeding to prevent hypophosphatemia, rhab-
domyolysis, and other life-threatening complications.
APPLICATION: NOTES:
Refeeding syndrome can be ____________________________________________
avoided by initiating TPN ____________________________________________
slowly, then gradually increasing
the rate while carefully monitor- ____________________________________________
ing the patient’s response and ____________________________________________
serum electrolyte levels.
131. COMPLICATIONS
septicemia
(sĕp-tı̆-sē'mē-ă)
131. COMPLICATIONS

The presence of pathologic microorganisms in the blood. Signs and symptoms are dra-
matic and include fluctuating
fever, profuse sweating, nausea
and vomiting, diarrdea, abdomi-
nal pain, tachycardia, hypoten-
sion, and altered mental status.
APPLICATION: NOTES:
The patient was transferred from ____________________________________________
the medical-surgical unit to ____________________________________________
intensive care with septicemia,
unknown source. ____________________________________________
____________________________________________
132. COMPLICATIONS
speed shock
(spēd shŏk)
132. COMPLICATIONS

A severe disturbance of hemodynamics in which the cir- Speed shock is caused by
culatory system fails to maintain adequate perfusion of rapidly administering IV push
vital organs due to sudden flooding of vital organs with substances, causing the concen-
tration of medication in the
medication.
plasma to reach toxic propor-
tions, flooding the organs rich
in blood (heart and brain). Syn-
cope, shock, and cardiac arrest
may result.
APPLICATION: NOTES:
The nurse drew up the meperidine ____________________________________________
and administered the medication ____________________________________________
rapidly through the patient’s injec-
tion port; the patient responded ____________________________________________
with syncope and shock symp- ____________________________________________
toms from the speed shock.
133. COMPLICATIONS
superior vena cava

(SVC) syndrome
(soo-pē'rē-or vē'nă kā'vă sı̆n'drōm)
133. COMPLICATIONS

Obstruction of the supe- Symptoms include progressive edema of the face, neck, arms; nonpro-
rior vena cava or its main ductive cough and dyspnea; bluish looking venous stars may be found
tributaries causing edema in the early phases, overlying the large veins to which they are tribu-
tary, but they tend to diminish in size and disappear after collateral
and engorgement of the
circulation has been established. Interventions include: Notification
vessels. of physician, radiographic confirmation of SVC syndrome, and may
include anticoagulant therapy. Catheter may or may not be removed.
APPLICATION: NOTES:
The client with an implanted port upper chest was peppered with a ____________________
bluish venous star-shaped design; the nurse suspected superior vena ____________________
cava syndrome.
____________________
____________________
134. COMPLICATIONS
thrombosis
(thrŏm-bō'sı̆s)
134. COMPLICATIONS

Clotting within a blood vessel that may cause interrup- The clot may cause obstruction
tion of blood flow. or become attached to the vessel
without obstructing the lumen.
The thrombosis can result from
mechanical or nonthrombotic
obstructions (42%). Interven-
tions would be to discontinue
the catheter, apply cold com-
presses to site, and assess for
circulatory impairment.
APPLICATION: NOTES:
Thrombosis can develop within ____________________________________________
or around the catheter or in the ____________________________________________
surrounding vessel.
____________________________________________
____________________________________________
135. COMPLICATIONS
thrombophlebitis
(thrŏm''bō-flē-bı̄'tı̆s)
135. COMPLICATIONS

Venous inflammation with Denotes a twofold injury; thrombosis and inflammation. Throm-
thrombus (clot) formation. bophlebitis is related to: use of veins in legs for infusion therapy; use
of hypertonic or highly acidic infusion solutions. Symptoms include
sluggish flow rate, edema in the limbs, tender and cordlike vein, site
warm to touch, visible red line above venipuncture site. Interventions
would include discontinuation of catheter, physician consultation, and
comfort provided by application of warm compresses.
APPLICATION: NOTES:
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.
____________________
____________________
136. COMPLICATIONS
venospasm
(vē'nō-spăzm)
136. COMPLICATIONS

Sudden constriction of the vein. Usually caused by infusion of
cold or irritating substances into
the vein. Flow rate decreases,
patient complains of pain at in-
fusion site. Apply warm com-
presses, slow infusion.
APPLICATION: NOTES:
The nurse began the transfusion ____________________________________________
and the patient almost immedi- ____________________________________________
ately complained of severe pain
at the infusion site. The nurse ____________________________________________
suspected venospasm. ____________________________________________
137. INFUSION MODALITIES
bolus
(bō'lŭs)

Concentrated medication or solution given rapidly over a The term bolus or IV push does
short period of time; may be given by direct IV injection not indicate an appropriate
or IV drip. injection rate. Consult reliable
drug references or confer with a
pharmacist to obtain protocol for
the length of time needed to
administer the ordered dose.
APPLICATION: NOTES:
The physician ordered a bolus of ____________________________________________
10 mEq of potassium chloride, ____________________________________________
which needed to be administered
over a minimum of 1 hour accord- ____________________________________________
ing to the drug reference and di- ____________________________________________
luted in 50 to 100 mL of infusate.
chemical incompatibility
(kĕm'ı̆k-ăl ı̆n''kŏm-păt-ı̆-bı̆l'ı̆-tē)

Not suitable chemically to be combined or mixed with a Alteration in integrity or potency
another chemical. of the active ingredient in the
medication. The most common
cause of chemical incompatibility
is the reaction between acidic
and alkaline drugs resulting in a
pH level that is unstable for one
of the drugs.
APPLICATION: NOTES:
The medication was reconstituted ____________________________________________
with the wrong solution resulting ____________________________________________
in a chemical incompatibility.
____________________________________________
____________________________________________
epidural
(ĕp''ı̆-dūr'ăl)

On or outside the dura mater. Area used for regional medica-
tion administration, produced by
injection of local anesthetic or
medication into the peridural
space.
APPLICATION: NOTES:
The epidural route for adjunct ____________________________________________
pain management was started in ____________________________________________
the operating room for postopera-
tive patient pain control post ____________________________________________
pancreatic tumor resection. ____________________________________________
intermittent drug infusion

(ı̆n''tĕr-mĕt'ĕent drŭg ı̆n-fu'zhŭn)

Delivery of therapeutic agent at specific intervals. Delivery of medications such
as antibiotics at intervals to
maintain blood levels. Usually
administered in 50 to 150 mL of
solution by secondary infusion,
or through a locking intermittent
device over 15 minutes to
1 hour.
APPLICATION: NOTES:
Ceftazidime (Fortaz) 1 gram ____________________________________________
in 100 mL of 0.9% NaCl was ____________________________________________
administered by intermittent
drug infusion preoperatively. ____________________________________________
____________________________________________
intraperitoneal (IP)
(ı̆n''tră-pĕr''ı̆-tō-nē'ăl)

Route by which medica- One intracavitary drug administration route that involves the adminis-
tion is administered tration of therapeutic agents directly into the peritoneal cavity.
directly into the peri-
toneal cavity.
APPLICATION: NOTES:
The purpose of intraperitoneal therapy for the patient with ovarian can- ____________________
cer was to increase the concentration of an antineoplastic agent at the ____________________
tumor site and enhance its penetration and cell kill while limiting sys-
temic effects. ____________________
____________________
intraspinal
(ı̆n''tră-spı̄'năl)

Within the spinal canal. Intraspinal is the term used to
encompass both epidural and
intrathecal spaces surrounding
the spinal cord.
APPLICATION: NOTES:
Intraspinal medication delivery ____________________________________________
via the epidural route can be ____________________________________________
used for acute, chronic, or can-
cer pain management. ____________________________________________
____________________________________________
intrathecal (IT)
(ı̆n''tră-thē'kăl)

Within the subarachnoid or subdural space. The intrathecal space is sur-
rounded by the epidural space
and separated from it by the
dura mater; the intrathecal
space contains cerebrospinal
fluid. The epidural and intrathe-
cal spaces share a common cen-
ter, the spinal cord.
APPLICATION: NOTES:
The anesthesiologist set up the ____________________________________________
intrathecal opioid infusion by ____________________________________________
implanted infusion pump for the
cancer patient to provide ade- ____________________________________________
quate pain relief. ____________________________________________
intravenous push (IVP)

(ı̆n-tră-vē'nŭs poosh)

Medication delivered rapidly within the vein. Direct administration of medica-
tion or solution via syringe. The
purpose is to achieve rapid
serum concentrations of the
medications. Follow guidelines
from the manufacturer when
administering medication by
IV push.
APPLICATION: NOTES:
The nurse administered the mor- ____________________________________________
phine sulfate 5 mg by IV push ____________________________________________
over 5 minutes.
____________________________________________
____________________________________________
physical incompatibility
(fı̆z'ı̆-kăl ı̆n''kŏm-pă''tı̆-bı̆l'ı̆-tē)

An undesirable change that is visually observed. Also called pharmaceutical
incompatibility. Can occur when
one drug is mixed in a syringe
or bag with another agent to
produce a product that is unsafe
for administration. Precipitation
may be visible as haze, gas
bubbles, or cloudiness.
APPLICATION: NOTES:
Calcium in a drug or solution ____________________________________________
may cause physical incompatibility ____________________________________________
with some added medications.
____________________________________________
____________________________________________
therapeutic incompatibility
(thĕr-ă-pū'tı̆k ı̆n''kŏm-pă''tı̆-bı̆l'ı̆-tē)

Undesirable effect occur- Occurs most frequently when two drugs are administered and one
ring within a patient as a antagonizes the effect of the second. Response to medication may go
result of two or more drugs unnoticed until patient fails to show the expected clinical response to
the drug.
being given concurrently.
APPLICATION: NOTES:
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 between
the two drugs and one was discontinued. ____________________
____________________
147. TRANSFUSION THERAPY
ABO system
(ā-bē-ō sı̆s'tĕm)

Blood group of antigens that reside on structurally The ABO antigens and antibod-
related carbohydrate molecules. ies are the most significant for
transfusion practice.
APPLICATION: NOTES:
The patient was typed and cross- ____________________________________________
matched for ABO and Rh type. ____________________________________________
____________________________________________
____________________________________________
agglutinin
(ă-gloo'tı̆-nı̆n)

An antibody that causes clumping or agglutination of the An antibody has the same name
cells that stimulate the formation of the agglutinin. as the antigen with which it
reacts. For example, anti-A
reacts to antigen A.
APPLICATION: NOTES:
In the test tube, the laboratory ____________________________________________
technician mixed blood to cross- ____________________________________________
match and assess for any agglu-
tinin formation. ____________________________________________
____________________________________________
agglutinogen
(ă-gloo-tı̆n'ō-jĕn)

An antigenic substance that stimulates the formation of Also referred to as antigens.
specific agglutinin, which, under certain conditions,
causes agglutination of cells.
APPLICATION: NOTES:
The ABO system is the most ____________________________________________
important agglutinogen located ____________________________________________
on the red blood cell (RBC)
membranes. ____________________________________________
____________________________________________
antibody
(ăn'tı̆-bŏd''ē)

A substance produced by B lymphocytes in response to All antibodies except natural
a unique antigen. Each antibody (Ab) molecule com- antibodies are made by B cells
bines with a specific antigen to destroy or control it. stimulated by a foreign antigen,
typically a foreign protein
polysaccharide.
APPLICATION: NOTES:
Antibodies, also called agglu- ____________________________________________
tinins, within the blood system ____________________________________________
are proteins that react with an
antigen. ____________________________________________
____________________________________________
antigen
(ăn'tı̆-jĕn)

A protein or oligosaccharide marker on the surface of Antigens on the body’s own cells
cells that identifies the cell as self or nonself; identifies are called autoantigens. Anti-
the type of cell and stimulates the production of antibodies gens on all other cells are called
foreign antigens.
by B lymphocytes.
APPLICATION: NOTES:
Antigens, also called agglutino- ____________________________________________
gens, are located on the RBC ____________________________________________
membranes.
____________________________________________
____________________________________________
autologous donor
(aw-tŏl'ō-gŭs dō'nŏr)

Originating within an individual, especially a factor Donation of a unit of blood to be
present in tissues or fluids. reinfused to the individual
donating the blood. Recipient
receives his or her own blood
back postoperatively.
APPLICATION: NOTES:
The patient called the blood ____________________________________________
bank to set up an appointment ____________________________________________
for autologous donation of a unit
of blood 1 month prior to sched- ____________________________________________
uled surgery. ____________________________________________
designated donor
(dĕ'zı̆g-nāt'ĕd dō'nŏr)

Use of blood or compo- Examples of a designated donor would include: The patient with an
nents from a specific donor antibody to a high-incidence antigen or a combination of antibodies
for a specific patient. that makes it difficult to find compatible blood; the patient awaiting a
kidney transplant from a living donor, or the multitransfused patient
whose family members can provide components.
APPLICATION: NOTES:
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 child ____________________
after surgery.
____________________
____________________
fresh frozen plasma

(fresh frō'zen plăz'mă)

Collection of the fluid portion of the circulating blood by It is an aqueous solution of 91%
separation and freezing the plasma within 8 hours of water that contains protein, car-
collection. bohydrates, and serum. Plasma
does not contain red blood cells.
May be stored up to 1 year at
180C.
APPLICATION: NOTES:
The fresh frozen plasma was ____________________________________________
thawed and transfused into the ____________________________________________
patient with dilutional coagu-
lopathy within 6 hours. ____________________________________________
____________________________________________
homologous donor
(hō-mŏl'ō-gŭs dō'nŏr)

Blood donation of serum or tissue derived from members Blood donated by someone other
of a single species. than the recipient. Most transfu-
sions depend on homologous
sources and are provided by vol-
unteer donors.
APPLICATION: NOTES:
The blood drive on campus was ____________________________________________
to increase the pool of homolo- ____________________________________________
gous donors.
____________________________________________
____________________________________________
human leukocyte antigen

(HLA)
(hyū'măn loo'kō-sı̄t ăn'tı̆-jĕn)

Any of several members of a system consisting of the Important in transfusion therapy
gene products of at least four linked loci and a number because HLA antigens of the
of sub loci on the sixth human chromosome that have donor unit can induce alloim-
munization in the recipient.
been shown to have a strong influence on human allo-
HLA incompatibility is a possi-
transplantation, transfusion in refractory patients, and ble cause of hemolytic transfu-
certain disease associations. sion reactions.
APPLICATION: NOTES:
HLA matching and leukocyte de- ____________________________________________
pletion of the donor unit help to ____________________________________________
decrease HLA alloimmunization.
____________________________________________
____________________________________________
packed red blood cells

(păkt rĕd blŭd sĕlz)

A blood product consisting of concentrated cells, most of Given to the patient who needs
the plasma having been removed. red blood cells but not increased
fluid volume. Volume approxi-
mately 250 mL, and raises
hemoglobin 1 gram/unit, and
hematocrit 3%, same as whole
blood.
APPLICATION: NOTES:
The patient was typed and cross- ____________________________________________
matched for 4 units of packed ____________________________________________
red blood cells.
____________________________________________
____________________________________________
platelets
(plāt'lĕtz)

An irregularly shaped, disc-like cell that functions in Platelets live up to 12 days in
clotting. the blood, do not have a nuclei,
and are unable to reproduce.
Normal platelet counts are
150,000 to 300,000 mcg/L.
APPLICATION: NOTES:
The patient received a single ____________________________________________
pheresis unit of random donor ____________________________________________
platelets.
____________________________________________
____________________________________________
Rh factor
(Rh făk'tŏr)

An antigen present on the surface of erythrocytes. When An individual with Rh– blood
Rh factor is present, also called (D), an individual’s receives a transfusion of Rh+
blood type is designated Rh+ (Rh positive); when the Rh blood, anti-Rh antibodies form.
Subsequent transfusions of Rh+
antigen is absent, the blood type is Rh– (Rh negative).
blood result in serious transfu-
sion reactions.
APPLICATION: NOTES:
A pregnant woman who has an ____________________________________________
Rh factor of Rh– delivered a Rh+ ____________________________________________
fetus, therefore she received
RhoGAM to prevent Rh antibody ____________________________________________
production after delivery. ____________________________________________
whole blood
(hōl blŭd)

That drawn from a selected donor under aseptic Whole blood is composed of
precautions. RBCs, plasma, white blood cells
(WBCs), and platelets. The
volume of each unit is approxi-
mately 500 mL and consists of
200 mL of RBCs and 300 mL of
plasma. Whole blood is never a
preferred treatment, but is avail-
able for consideration.
APPLICATION: NOTES:
The patient with massive blood ____________________________________________
loss from a crushing injury to his ____________________________________________
lower body received type O neg-
ative whole blood initially upon ____________________________________________
admission to the ED. ____________________________________________
161. NUTRITIONAL SUPPORT
cyclic therapy
(sı̄'klı̆k thĕr'ă-pē)

A regimen of delivery of dextrose, amino acids, and fat Patients requiring long-term
over a reduced time frame, usually 12 to 18 hours versus parenteral nutrition use this
a 24-hour infusion. mode of delivery during their
sleep so they can be free of
infusion during the day.
APPLICATION: NOTES:
The quality of life for the ____________________________________________
teenager who needed total par- ____________________________________________
enteral nutrition was achieved
by use of cyclic therapy. ____________________________________________
____________________________________________
fat emulsion
(făt ē-mŭl'shŭn)

A combination of liquid, lipid, and an emulsifying sys- Also called lipids. Linoleic,
tem suitable for intravenous use because the lipid has D-linolenic, and arachidonic
been broken into small droplets that can be suspended acid are necessary for formation
of other products in the body,
in water. Solution has limited ability to be mixed with
and because the body does not
other solutions. synthesize them, they are classed
as essential fatty acids.
APPLICATION: NOTES:
The 500-mL glass container of ____________________________________________
fat emulsion (lipids) was admin- ____________________________________________
istered over 12 hours by second-
ary infusion on a daily basis. ____________________________________________
____________________________________________
peripheral parenteral
nutrition (PPN)
(pĕr-ı̆f'ĕr-ăl păr-ĕn'tĕr-ăl nū-trı̆'shŭn)

Intravenous support supplied via the peripheral veins to An amino acid–dextrose solution
patients whose nutritional requirements cannot be fully (usually 10%) and a lipid emul-
met via the enteral route. sion (10% to 20%) are delivered
into a peripheral vein through a
catheter.
APPLICATION: NOTES:
The home care client was placed ____________________________________________
on 7 days of peripheral par- ____________________________________________
enteral nutrition while awaiting
bowel resection. ____________________________________________
____________________________________________
total parenteral nutrition

(TPN)
(tō'tăl păr-ĕn'tĕr-ăl nū-trı̆'shŭn)

The intravenous provision of dextrose, amino acids, TPN must be delivered by cen-
emulsified fats, trace elements, vitamins, and minerals to tral line because of the osmolar-
patients who are unable to assimilate adequate nutrition ity of the solution.
by mouth.
APPLICATION: NOTES:
The client with 30% burns over ____________________________________________
the head and chest area was ____________________________________________
placed on total parenteral nutri-
tion by central line to maintain ____________________________________________
calories for healing. ____________________________________________
total nutrient admixture

(TNA)
(tō'tăl nū''trē-ĕnt ăd'mı̆ks-tū'r)

Combination of amino acids, dextrose, and fats in one Also called all-in-one solutions
container. or three-in-one solutions, or
trimix solutions. The formula is
provided in a large (banana)
container that infuses over
24 hours.
APPLICATION: NOTES:
The home care client re- ____________________________________________
ceived total nutrient admix- ____________________________________________
ture with careful monitoring
for bloodstream infections. ____________________________________________
____________________________________________
166. IV THERAPY BONUS CARD PHILLIPS 15 STEPS
PRECANNULATION
Step 1: Obtain authorized prescriber’s order or Things to know—Assessment
review standardized procedure Patient’s medical diagnosis
History of chronic disease
Step 2: Hand hygiene–15 to 20 seconds History of vasovagal reaction during venipuncture
Alcohol-based hand rub
Previous experiences with vascular access
If hand visibly dirty or contaminated, use soap,
devices
water, and vigorous scrub
Cultural considerations
Step 3: Gather equipment and preparation Assess both arms and hands prior to choosing
Check integrity of solution appropriate vein
Check integrity of administration set Choose the lowest best vein
Gather venipuncture and dressing supplies Identify allergies
Step 4: Patient assessment, psychological Step 5: Apply tourniquet, site selection, and
preparation and patient identification vein dilation
Provide privacy Factors to consider:
Evaluate the patient’s preparedness for Patient receiving anticoagulation therapy
IV procedure Presence of disease or previous surgery
Check patient identification, using two (poor venous return)
identifers Presence of shunt for dialysis
CANNULATION
Step 6: Needle selection Step 9: Vein entry: Direct or indirect
16 gauge: Trauma Direct: One-step method
18–20 gauge: Infusion of hypertonic or isotonic Indirect: Two-step method
solutions, or blood products
22–24 gauge: Pediatric patients Step 10: Catheter stabilization and dressing
22 gauge: Fragile veins in elderly management
Catheter should be stabilized in a manner
Step 7: Gloving that does not interfere with visualization
Standard precaution requires gloves to be worn of site
during placement of an IV catheter Dressing: Transparent semipermeable mem-
brane dressing (TSM)
Step 8: Site preparation
Use stabilization device that is recommended
Recommended to use 2% chlorhexidine
by INS and CDC
gluconate; use 15–20 second scrub with friction;
allow to dry
POSTCANNULATION
Step 11: Labeling of site, and administration set Step 13: Patient education
Insertion site: Venipuncture site should be Patient must receive information on all aspects
labeled with of their care
Date and time Inform regarding any limitations of movement
Type and length of catheter or mobility
Nurse’s initials Explain all alarms if EID is used
Administration set Instruct to call for assistance
Label according to agency policy: Date on
which administration set must be changed Step 14: Rate calculation
Solution container See Rate Calculation Bonus Card 167.
Place a time strip on parenteral solutions Step 15: Monitoring and documentation
Any additive must have a clear label applied Document all aspects of procedure
to bag Document routine assessments of site every
Step 12: Equipment disposal 4 hours
Standard of practice: Needles and stylets shall Follow flush protocol if intermittent locking
be disposed of in nonpermeable device in place
tamper-proof containers Change IV site along with administration set
Dispose of all paper and plastic equipment in every 72 hours
biohazard container IV solutions may only hang 24 hours
167. IV THERAPY BONUS CARD RATE CALCULATION
COMMON DROP FACTORS
10 gtt = 1 mL
15 gtt = 1 mL
20 gtt = 1 mL } Macrodrops
60 mcgtt = 1 mL } Microdrops
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)
1. To calculate volume/hour Example: 100 mL/hr × 60

= 100 mL/hour
60 (minute)
Total volume Administration time = mL (volume) hour
4. To calculate secondary infusion (infusions less than
Example: 1000 mL 8 hours = 125mL/hour 1 hour)
2. To calculate drops/minute (gravity)—Macrodrop infusion mL/hour × microdrop set (60)
= mL/hour
hourly volume × gtt factor of tubing hours volume (varies)
X gtt/min =
Time in minutes (60) Example: 50 mL × 60 = 30,000
= 200 mL/hour
125 mL/hour × 15 (gtt factor) 5 minutes 15
Example: 31 gtt/min (will deliver the ordered 50 mL in 15 minutes)
60 (minutes)
168. IV THERAPY BONUS CARD PHLEBITIS RATING SCALE
Grade Clinical Criteria

0 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 inch
in length, purulent drainage
Source: Revised Standards of Practice. (2006). Cambridge, MA: Infusion Nurses Society; with permission.
168. IV THERAPY BONUS CARD INFILTRATION RATING SCALE
INFILTRATION SCALE
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4

No symptoms Skin blanched Skin blanched Skin blanched Skin blanched and
and translucent translucent
Edema <1 inch Edema 1 to Gross edema Skin tight, leaking
6 inches >6 inches
Cool to touch Cool to touch Cool to touch Gross edema >6 inches
With or without With or without pain Mild to moderate Deep, pitting tissue edema
pain pain
Possible numbness Circulatory impairment
With or without pain
Moderate to severe pain
Infiltration of any amount

of blood product, irritant,
or vesicant
Source: Revised Standards of Practice (2006). Cambridge, MA: Infusion Nurses Society; with permission.
169. IV THERAPY BONUS CARD FLUSHING GUIDELINES
Blood Blood Flushing with Heparin

Device Intermittent Administration Draw NO Therapy Locking
Peripheral Minimum 2 mL Preadmin 2 mL NA At least q12 hours NA
Catheters (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 heparin
Catheter (PICC)
Nontunnelled Minimum 5 mL Preadmin 5 mL Predraw 5 mL Nonvalved–at least 5 mL

Postadmin 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 mL
Postadmin 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 heparin
Deaccessed–at least
monthly
Source: Infusion Nurses Society. (2008). Flushing Protocols, with permission.

PICC, TUNNELED CATHETER,
169. IV THERAPY BONUS CARD AND PORT PLACEMENTS
1. Subclavian vein
(Infusion of other solutions)
Median basilic
vein Axillary vein
Median cephalic Cephalic vein Internal jugular vein
vein
Brachiocephalic vein
Example of tunneled catheter placement.
Basilic vein
2. Superior vena cava

(TPN infusion)
Example of peripherally inserted

central catheter (PICC).
Example of port placement.

CHVOSTEK’S SIGN AND
170. IV THERAPY BONUS CARD TROUSSEAU’S SIGN
Example of positive Chvostek’s sign. Example of positive Trousseau’s sign.

170. IV THERAPY BONUS CARD ILLUSTRATION CREDITS
Illustrations that appear on cards 28, 37, 51, 94, 108, and
170 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 courtesy
of BARD Access Systems. Tables on cards 168 and 169
with permission from the Infusion Nursing Society.

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Lynn D. Phillips, RN, MSN, CRNI®

Acquisitions Editor: Thomas A. Ciavarella

DEFINITION: KEEP IN MIND:

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blood borne pathogens

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bloodstream infection (BSI)

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Centers for Disease Control

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extracellular ﬂuid (ECF)

DEFINITION: KEEP IN MIND:

1. ﬂuid volume deﬁcit (FVD)

2. ﬂuid volume excess (FVE)

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intracellular ﬂuid (ICF)

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