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Lecturek 1 k-kCorrectkAnswer-Injections Whatkiskaksmallkbottlekthatkcontainskakdrug?k-kCorrectkAnswer-ampulle Whatkiskthekdiameterkorkbarrelksizekofkakneedlekcalled?k-kCorrectkAnswer-Gauge Thekhigherktheknumberktheksmallerkthekgauge Whatkiskthekenlargedkbasekbykwhichkakhollowkneedlekmaykbekattachedktokakdevice?k- kCorrectkAnswer-hub Whatkiskakcylindricalkcontainerkthatkholdskliquids?k-kCorrectkAnswer-barrel whatkiskaksmallkcontainer,kusuallykw/kclosure,kthatkiskusedkespkforkliquids?k- kCorrectkAnswer-vial (TQ?)kWhatkiskthekZ-trackkmethodkusedkfor?k-kCorrectkAnswer- tokpreventkleakagekofkirritatingk(vistaril)kandkdiscoloringkmedicationk(e.g.kironkdextran)kintokt hekSQktissue Itkmaykalsokbekusedkinkelderlykw/kdecreasedkmmkmass InkthekZ-trackkmethod,kwhichkwaykdokyoukdisplacekthekskin:kLaterallykorkMedially?k- kCorrectkAnswer- usekULNARksidekofknondominentkhandktokpullkskinkLATERALLYk(displacesktissuekABOVEk thekmm) Whatksizekneedleklengthkiskusedkforkak 200 klbskperson?k 100 klb?k-kCorrectkAnswer- 200 k- k 2 kinchkneedle 100 k-k1.25-1.5kinchkneedle whatkarekthekindicationskforkinjections?k-kCorrectkAnswer- (1)kdrugkiskpoorlykabsorbedkorkdegradedkinkGIktract (2)kpredictablekandkrapidkdrugkresponsekduringkankemergency (3)kptkiskuncooperative,kunconscious,korkunablektoktakekdrugkthroughkenteralkroute (4)klocalizedkdrugktherapykiskdesired Whatkareksomekreasonskofk"whyknot"ktokperformkankinjection?k-kCorrectkAnswer- morekexpensive mustkbeksterile
takeskskilled/trainedkpersonel maykbekdifficultktokremovekdosekifktoxic/AE Whatkdoeskparentalkreferkto?k-kCorrectkAnswer- anykroutekotherkthankthekalimentarykcanal...sokIM/ID/SQ/IV Howkdokyoukmeasurektheklengthkofkakneedle?k-kCorrectkAnswer-fromkthekhubktokthektip Namekthekneedlekgaugekthatkiskusedkforkthekfollowingkscenarios: BloodkWithdrawal? IMkinjection? SQkinjection? IDkinjection?k-kCorrectkAnswer-Bloodkwithdrawal:k18g IMkinjection:k 22 kgauge SQkinjection:k 25 - 27 kgauge IDkinjection:k 27 kgauge rememberktheksmallerkthekgaugektheklargerkthekneedlekdiameter WhatkmustkyoukrememberkNEVERktokdo,kwithkregardsktokneedles?k-kCorrectkAnswer- NEVERkRECAP!k(orkstickkyourself) Ak 4 kmonthkoldkptkpresentskforkhiskvaccinationsk(IM),kwhatkiskthekperferredklocationkforkthekinj ectionkandkwhatkneedleklengthkandkgaugekwouldkyoukuse?k-kCorrectkAnswer- Location:kAnteriorlateralkthigh Lengh:k5/8k-k 1 kinch Gauge:k 25 - 27 Ifkaktoddler/olderkchildkpresentskforkhiskroutinekvaccinationk(IM),kwhatkiskthekperferredklocati onkforkthekinjectionkandkwhatkneedleklengthkandkgaugekwouldkyoukuse?k-kCorrectkAnswer- Location:kDeltoid/Anterlateralkthigh Length:k5/8k-k 1 kinch Gauge:k 22 k-k 27 IMkinjectionskarek(faster/slower)kthankSQkandk(faster/slower)kthankIVk-kCorrectkAnswer- FasterkthankSQkandkSlowerkthankIV WhatkarekthekindicationskforkIMkinjections?k-kCorrectkAnswer- drugsknotkeasilykabsorbedkorally immediatekratekofkonsetkandkdurationkofkactionkperferred whenkparentalkdeliveryknecessary
WhatkiskthekPERFERREDkroutekforkIMkinjectionskinkptsk>k 2 ky/o?k-kCorrectkAnswer- GluteuskMaximus LargerkvolumeskOK,knotkusedkforkvaccinations WherekshouldkthekneedlekbekplacedkinkakglutealkIMkinjection?k-kCorrectkAnswer- UPPER/OUTERkQUADRANTkOFkBUTTOX Inkakglutealkinjection,kwhatkyoukbekcarefulkofknotktokinjure?k-kCorrectkAnswer- sciaticknervekandksuperiorkglutealkmm Inkadults,kthekneedlekiskinserted: A.kAnteriorly B.kPerpendicular C.kInferiorly D.kLaterallyk-kCorrectkAnswer-A.kAnteriorly Whatkgaugekneedlekiskusedktokdrawkupkmedicationkfromkthekvial?k-kCorrectkAnswer- 18 - 22 kgauge Howkmuchkairkshouldkbekpulledkintoktheksyringekafterkyourkhavekdrawnkthekappropriatekamo untkofkmediationkfromkthekvialkusingkascepticktechnique?k-kCorrectkAnswer- 2 kcckofkair Whatkmethodkshouldkyoukusekwhenkcleaningkthekinjectionksitekwithkankalcoholkwipe?k- kCorrectkAnswer-bulls-eye Whatkiskthekanglekthatkyoukholdktheksyringekinkreferencektokthekinjectionksite?k- kCorrectkAnswer- 90 kdegreesk(likekakdart) Oncekneedlekiskinjectedkintokthekskin,kwhatkmustkyoukdo?k-kCorrectkAnswer- AspiratekbackktokmakeksurekyoukarekNOTkinkakvesselk- kifkbloodkiskencounteredkwithrawkneedle,kprepareknewksyringe,ktryknewksite WhatkiskthekMAXkthatkcankbekinjectedkinkankIMkinjection?k-kCorrectkAnswer- 0.5kcckmaxkinkinfants 2.0kcckmaxkinkchildren Dokyoukremovekthekneedlekfromkthekinjectionksidekatktheksamekanglekthatkyoukinserted?k- kCorrectkAnswer-YES!k(90kdegrees) DokyoukmassagekIMkinjections?k-kCorrectkAnswer-yesk(unlesskC/I) WhenkiskmassagekC/IkinkIMkinjections?k-kCorrectkAnswer-Z-TrackkMethod
WhatkarekthekpotenitalkcomplicationskofkankIMkinjection?k-kCorrectkAnswer- (1)kInjectionkintokvesselk(Toxickreaction,kvesselkinjury,khematoma) (2)kInjectionkintoknervek(pain,kparesthesia,knervekdamage) (3)kNeedlekbreathkoffk(intokmm) (4)kSterile/SeptickAbscessk(sterilitykissue/sitekoveruse) Whatkiskonekofkthekmostkversitilekroutekofkparentalkadministrationkb/ckitkcankbekusedkforkboth kshortkandklongktermktherapies?k-kCorrectkAnswer-SQ WherekiskSQkinjectionkgiven?k-kCorrectkAnswer-inkadiposektissuekbelowkskin WhatktypekofkdrugskarekgivenkSQ?k-kCorrectkAnswer- slowerkabsorptionkandklongerkdurationkofkaction WhatkarekthekC/IkforkSQkinjections?k-kCorrectkAnswer-Sitekw/kdermatitiskorkcellulitis DokNOTkgivekintokscarkorkintokbonykprominence WhatksiteskarekusedkforkSQkinjections?k-kCorrectkAnswer- upperkarm,kanteriorksurfacekofkthigh,korklowerkportionkofkabdomenk(upperkbackkalso) makeksurekyoukarekatkleastk 1 - 2 kincheskawaykformkumbilicus Sitekrotatedkw/kfrequentkinjections WhatkiskthekmaximumkamountkofkmedicationkthatkcankbekinjectedkSQ?k-kCorrectkAnswer- 1 kcc Whatksizekneedlek(lengthkandkgauge)kiskusedkforkSQkinjections?k-kCorrectkAnswer-3/8k- k 1 kinch 25 - k 27 Whatk 2 kdrugskarekMOSTkCOMMONLY*kgivenkSQ?k-kCorrectkAnswer-InsulinkandkHeparin InkSQkinjection,ksincekonlyksmallkvolumeskcankbekinjectedkwhatkmustkthekdrugskbe?k- kCorrectkAnswer-solublekandkpotentkinksmallkconcentrations Whatkcolorkhubskarekyouklookingkforkwhenkyoukwantkak 25 kork 27 kgaugekneedle?k- kCorrectkAnswer- 25 k-kBLUE 27 k-kGREY
WhatkarekthekcontraindicationkforkIDkinjections?k-kCorrectkAnswer- dermatitis,kcellultitis,korkpreviouskpositivekTBkskinktest WhatklengthkandkgaugekiskusedkforkankIDkinjection?k-kCorrectkAnswer-Length:k1/2kinch Gauge:k 27 WhatkiskthekMOSTkCOMMONksitekforkIDkinjection?k-kCorrectkAnswer- Ventralk(Volar)kforearm WhatkiskthekexceptionktokthekMCkrulekofkIDkinjectionskinkthekventralkforearm?k- kCorrectkAnswer-Rabiesk-kusekDELTOIDkareakforkdermal Whatklocationkiskusedkforkskinkallerginktesting?k-kCorrectkAnswer-Back (bewarekofksevereklocalkskinkreactionskinkhypersensitivekpts) AtkwhatkanglekdokyoukholdkthekneedlekrelativektokthekskinkforkankIDkinjection?k- kCorrectkAnswer- 10 - 15 kdegreesk(bevelkup),kalmostkparellelktokthekskin Injectionkofksubstancekproduceskak"wheal/bleb" HowkfarkshouldkyoukinsertkthekneedlekinkankIDkinjection?k-kCorrectkAnswer-2/3ktheklength Dokyoukaspiratekw/kIDkinjections?k-kCorrectkAnswer-NO! HowklongkafterkakIDkinjectionkforkakPPDkiskthekskinktestkread?k-kCorrectkAnswer- 48 - 72 khours WhenkmeasuringkakPPDktest,kdokyoukmeasurekthekerythemak+kindurationkorkjustkthekindurat ion?k-kCorrectkAnswer-indurationkonly (+)kifk>k 10 kmm WhatkmustkyoukALWAYSkremeberktokdokandkdocumentkbeforekperformingkakprocedure?k- kCorrectkAnswer- Thatkyoukprovidedkthekptkwithkfullkdisclosurekofkinformationk(risks,kbenefits,kalt)kandkthatkthe ykgavekinformedkconsentk(verbalkiskacceptedkinkmostkinjections) Failurektokdoksokcankresultkinkaklawksuit...EEK Summarykforklength,kgaugekandkmaxkamountkforkSQ,kID,kandkIMkinjections...k- kCorrectkAnswer-SQ:k Length:k5/8" Gauge:k 25 - 27 Max:k 1 kcc ID:
Length:k1/2kinch Gauge:k 27 Max:ktenthkofkakcc IM Length:k1.25-1. Gauge:k 22 Max:k 3 kcck(ifk 3 kcckgivenksplitkintok 2 kshotskatk 2 kdiffksites) Whatksiteskarekusedkforkirritatingkmeds?k-kCorrectkAnswer-largeksites Youkholdklargekmusclesk_____kandk_____ksmallkmusclesk-kCorrectkAnswer- LargekmuscleskTautkandkPinchksmallkmuscles Questionskatkthekendkofklecturek 1 k-kCorrectkAnswer-.... "Gauge"kreferskto: A.kLength B.kHub C.kDiameter D.kBevelk-kCorrectkAnswer-C.kDiameter WhatktypekofkinjectionkiskusedkforkskinktestingkandkTBktesting? A.kIM B.kSC C.kIntradermal D.kZ-trackk-kCorrectkAnswer-C.kIntradermal WhenkperformingkankIMkinjection,kak0.2kcckairkbubblekiskdrawnkintoktheksyringekinkorderktokpr eventkseepagekofkmedicationkafterkinjection. A.True B.kFalsek-kCorrectkAnswer-True.k(youkDOkNOTkalwayskhavektokusekairlocks) Ankampulekcontainskhowkmanykdosageskofkmedications A.k 1 B.k 2 C.k 3 D.kItkdependskonktheksizekofkthekampulek-kCorrectkAnswer-A.k 1 WhichkIMksitekiskNOTkusedkforkinfants?k-kCorrectkAnswer- GluteuskMaximuskb/ckthekmmkdevelopkforkwalkingkandkyoukdontkwantktokriskkinjuryktokthek sciaticknerve WhatkiskthekperferredksitekforkIMkinjectionskinkinfants?k-kCorrectkAnswer- VastuskLateralisk(Anteriolateralkthigh)
(4)kNervekDamagek-->kdirectktrauma/compression (5)kInfxn WhatkiskthekMCksitekusedkforkABGskandkwhatkiskitsklocation?k-kCorrectkAnswer- MCk=kradialkartery Location:krunkonktheklateralkaspectkofkthekantkforearmkandkcankbekpalpatedkbetweenkthekrad ialkstyloidkprocesskandkthekflexorkcarpikradialisktendon Wherekiskthekpointkofkmaximalkimpulsekofkthekradialkarteryklocated?k-kCorrectkAnswer- Proximalk(1- 2 kcm)ktokthektransversekwristkcrease Whatktestkiskusedktoktestkcollateralkcirculationkinkthekradialkartery?k-kCorrectkAnswer- AllenskTest kAskkthekptktokopenkandkclosekthekhandk 3 ktimes,kthenkmakekaktightkfistktokexsanguinatekthekh and.kCompresskthekradialkandkulnarkarterieskatkthekwristkwithkthekfingerskclenched.kRelease kthekulnarkartery.kIfkthekulnarkarterykiskpatentkthekpalmkwillkregainkitskcolorkink 15 ksecondsk(ma x).kIfk>k 6 ksecondskitkiskconsideredkdelayed,kifk>k 15 kseckitkiskdefinatlykabnormal Failurekforkcolorktokreturnktoknormalkindicateskocclusionkofkcollateralkcirculationk(negativekte st);kradialkarterykpuncturekmaykresultkinkischemiakorkgangrenekdistalktoktheksitekandkSHOUL DkNOTkbekattempted IskwrittenkinformedkconsentkusuallykrequiredkforkankABG?k-kCorrectkAnswer- NO!kWrittenkinformedkconsentkiskNOTkusuallykrequired,kbutkverbalkconsentkiskappropriateka ndkadvisablekifkptkiskawakekandklucid Onkthekpatientkpart,kwhatkiskthekextremelykimportantkthatktheykdokduringkankABG?k- kCorrectkAnswer-bekextremelykstill TheksyringekforkABGkiskak 3 - 5 kmlksyringekthatkcontainsk______kinkliquidizedkorklyophilizedkform?k-kCorrectkAnswer- Heparin WhatksizekneedkandklengthkiskusedkforkABGs?k-kCorrectkAnswer- 21 - 25 k(Avg:k23) 1/2k-k5/8kinch WhatkextrakpeicekofkequipmentkinkneedkinkthekABGskthatkwasknotkneededkinkinjections?k- kCorrectkAnswer-ICE Whatkiskthekprocedurekforkheparinizingktheksyringe?k-kCorrectkAnswer- Forksyringekwithkliquidkheparin,kholdktheksyringekwithkthekneedlekup,kpullkthekplungerktokthek endkofktheksyringekandkthenkdepresskthekplungerkevacuatingkallkthekheparin
Whatkcanktookmuchkheparinkleftkinktheksyringekcause?k-kCorrectkAnswer- lowerkthekPCO2,kbicarbonate,kandkpHkduektokdilutionkofkthekspecimen OncekthekPMIkofkthekarterykiskfoundkandkthekinjectionkareakiskclean,kwhatktwokfingerkdokyouk placekproximalktokthekpointkofkentrykalongkthekcoursekofkthekartery?k-kCorrectkAnswer- 2ndkandk3rdk(NOTkthumbkb/ckitkhaskakpulsekitself) Remember...k-kCorrectkAnswer-AlwayskkeepkBEVELkUP AtkwhatkanglektokdokyoukinsertkthekneedlekforkABGs?k-kCorrectkAnswer-insertkneedlekatk45- 60 kdegrees,kholdingksyringeklikekakpencilk-kwatchkforkarterialkbloodkflowkintokthekneedle Ifknokbloodkreturnsktokthekneedlekuponkinsertionkiskisklikeleykthatkyoukhavekgonekthroughkthek artery,kwhatkshouldkyoukdokatkthiskpoint?k-kCorrectkAnswer- Slowlykwithdrawktheksyringekandkneedlekandkuntilkyoukseekthekflowkofkbloodkintokthekhubkofkt hekneedle Ifkstillknone,kwithdrawkandkredirectkthekneedle HowkmanykmlkofkarterialkbloodkdokyoukwantktokobtainkforkankABG?k-kCorrectkAnswer- Atkleastk2kmlkofkblood Inkaknormalkpt,khowklongkdokyoukholdkthekguazekoncekthekneedlekiskremoved?k- kCorrectkAnswer- 5 kmin Ifkakptkhaskankcoagulationkdisorderkorkiskonkanticoagkrx,khowklongkdokyoukholdkthekgauzekpo stkremovalkofkneedle?k-kCorrectkAnswer- 10 kmin True/False.kItkiskokktokletkthekptkapplykthekpressurektokthekpunctureksite.k-kCorrectkAnswer- Falsek-kDOkNOTkHAVEkTHEkPTkAPPLYkTHEkPRESSURE Withinkhowkmanyksecondskdokyoukneedktokevacuatekallkairkbubbleskfromktheksyringe?k- kCorrectkAnswer-withink 30 ksecondskofkbloodkdraw Dokyoukcapktheksyringe?k-kCorrectkAnswer-YES! Whykmustkthekairkbekquicklykevacuated?kHowkmuchkairkcankcausektrouble?k- kCorrectkAnswer- Airkmustkbekquicklykevacuatedkb/ckPaO2kwillkbekINCREASEDkandkPCO2kwillkbekDECEASE D Akgaskbubblekw/kakvolumekgreaterkthank0.5- 1%kofkvolumekofkbloodkdrawnkresultskinkequilbriationkbtwnkairkandkbloodk- kacceleratedkbykAGITATION
TheklocationkofkthekfemoralkarterykiskmidwaykbetweenkthekASISkandk*PUBICkTUBERCLE
WhatkanglekdokyoukusekforkakfemoralkABG?k-kCorrectkAnswer-aksteeperkanglekofk60- 90 kdegrees DokyoukneedktokmonitorkfemoralkarterykABGsklongerkthankradial?k-kCorrectkAnswer- YES!kMonitorkpunctureksiteklonger,kapplykpressureklongerksincekhematomakriskkiskhigherka ndkDOkNOTkperformkthiskprocedurekoutkofkthekhospital WhenkiskakbrachialkarterykABGkindicated?k-kCorrectkAnswer- whenkradialkarteryksamplingknotkpossible Whichkhaskmorekcomplication,kbrachialkorkradialkABG?k-kCorrectkAnswer-Brachialk- kpotentiallykmorekseverekifkproperktechniquekisknotkfollowed,kgreaterkamountkofktissuekjeapa ridized,knervekinjurykmoreklikley SincektherekiskankincreasekinkcomplicationskandkriskkforkbrachialkarterykABGksamplingkwhat kdokyoukwantktokuse?k-kCorrectkAnswer-ankARMkBOARDk- kkeepskarmkimmbolizedkandkfullykextendedkalsokuseksmallerkneedle Wherekiskthekbrachialkarteryklocated?k-kCorrectkAnswer- lieskinkthekmedialkthirdkofkthekantecubitalkfossa Whatk 2 kstructureskarekatkriskkduringkbrachialkarteryksampling?k-kCorrectkAnswer- basilickveinkandkmedianknervek Becausekthesekstructureskarekinkclosekproximitykthatkarekatkriskktokpuncturekinadvertantly Whatkprocedurekiskusedkonkcriticallykillkptskforkcontinuouskmonitoringkofkarterialkbloodkpress sure,kaskwellkaskfrequentkbloodkgasksampling?k-kCorrectkAnswer-RadialkArterykCath Whatkpercautionskarektakenkforkradialkarterykcath?k-kCorrectkAnswer- Mask,kGoggles,kSTERILEkgloves Whatksizekguagekandklengthkdokyoukusekforkankangiocath?k-kCorrectkAnswer- 18 - 20gkneedlekandk1.5- 2 kinchesklong (Usekak 5 kmlksyringe) Whatksizekneedlekandksyringekiskusedkforkadministeringkanesthetics?kWhatkanesthetickisku sed?k-kCorrectkAnswer-Lidocainek1%kiskused. 25gkneedlekandk 3 kmlksyringe
Whatkadditionalkmaterialskarekusedkforkradialkarterykcath?k-kCorrectkAnswer- sterilekpressurektubing,ksterilek 3 - waykstopcockkflushkbagkorksterilekD5Wkmxiedkw/kheparinktokmakek 1 kU/mlksolution Suturekmaterial:k 3 - 0 ksilkkandkcurvedkneedle Whenkapplyingktheklidocainekinkakradialkarterykcathkitkiskimportantktokdokwhat?k- kCorrectkAnswer-Aspiratekbeforekeachkinjectionkandkdoknotkaimkforkthekarterykatkthiskpoint Whichkdirectionktokdokyoukorientatekthektipkofkyourkneedlekinkradialkarterialkcath?k- kCorrectkAnswer-Orietatekthekneedlekproximallykw/kthekbevelkup Whatkanglektokyoukinsertkthekneedlekinkakradialkarterykcath?k-kCorrectkAnswer- 45 kdegreekanglektokthekwrist Oncekyoukhavekenteredkthekradialkarterykinkakradialkarterykcath,kyoukdecreasekthekanglekbet weenkthekcatheterkandkthekarteryktokwhat?k-kCorrectkAnswer- 45 kdegreekanglektokthekwrist... ...thenkadvancekthekcatheterkandkneedlekakfewkmm Lecturek3...k-kCorrectkAnswer-IntravenouskTherapy Whatkarekthekindicationskforkintravenousktherapy?k-kCorrectkAnswer- (1)kEstablishkorkmaintainkakfluidkorkelectrolytekbalance (2)kAdministerkContinuouskorkintermittentkmedication (3)kAdministerkboluskmedication (4)kAdministerkfluidktokKVO (5)kAdministerkbloodkorkbloodkcomponents (6)kAdministerkIVkanesthetics (7)kMaintainkorkcorrectkakpatientsknutritionalkstate (8)kAdministerkdiagnostickreagents (9)kMonitorkhemodynamickfunctions WhatkarekthekC/IkforkankIV?k-kCorrectkAnswer-(1)kAvoidkatktheksitekofkankactivekskinkinfxn (2)kShouldknotkbekinsertedkdistalktokanykareakofkpreexistingkthrombophlebitis
IskglucosekinkanykofkthekcommonkIVksolutions?k-kCorrectkAnswer- NO!kGlucosekwillkincreasekbloodksugarkandkosmolarityktookquickly Inkmoderatekhemorrhage,kiskLRkorkNSkTOC?k-kCorrectkAnswer-Theykarekbothkequivalent Inkmassivekhemorrhagekandkresusitation,kiskLRkorkNSkTOC?k-kCorrectkAnswer-LRkiskTOC CankdextroseksolutionsksuchkaskD5Wkbekusedkinkemergentksituationsksuchkaskhemorrhage ?k-kCorrectkAnswer-NO!kthekbodykcannotkutilizeksugarkinkstress Whatksolutionkiskhelpfulkwhenkcellskarekdehydrated?k-kCorrectkAnswer-Hypotonic Ex.kDialysiskptkonkdiuretickandkhyperglycemickconditionsksuckkaskDKA Whatkiskthekcompositionskofkakhypotonicksolution?k-kCorrectkAnswer-.45%kNaCL 2.5kDextrose Whatkarektheksolutionskthatkarekhypertonic?kWhenkarektheykdangerous?k-kCorrectkAnswer- D5%,k.45%kNS,kD5%LR,kD5%NS,kbloodkproducts,kalbumin Dangerouskwhenkusedkinkaksettingkofkcellkdehydrations Note:kthiskisknotkfromkthesekslideskbykakmajorkSEkofkhypertonicksolutionskisk"centralkpontene kmyelosis" Whatkiskakcrystalloidksolution?kExamples?k-kCorrectkAnswer-Isotonic Waterkandkelectrolyteskleakkintokinterstitialkspacek(aboutk2/3koutkinkankhour),kbutknotkthroug hkthekcellkmembrane RiskkofkEdema Shouldkgenerallykfollowkwithkbloodk(2L) Examples:kNS,kLR Whatkiskakcolloidksolution?kExamples?k-kCorrectkAnswer-Hypertonic Moleculesk(proteins)ktooklargektokcrosskvascularkmembranes GoodkatkREDUCINGkEDEMAk-kparticularlykpulmonarykandkcerebral Buildkintravascularkvolume Dramatickfluidkshiftk-kUSEkCAUTIOUSLY Examples:kAlbumin WherekshouldkyoukstartkwhenkinsertingkankIVkcath,kproximalykorkdistally?k-kCorrectkAnswer- Distally WhenkinsertingkankIVkcath,kshouldkyoukusekthekdominentkorknon-dominentkarm?k- kCorrectkAnswer-non-dominent
HowkmanyktrieskcankyoukgivekyouselfkonkinsertingkakIVkcathkbeforekswitchingklocations?k- kCorrectkAnswer-Akcouple WhatkiskthekIDEALkVEINkSITEkinkthekhand?k-kCorrectkAnswer- DORALkMETACARPALkVEINS;ksupportkneeded AVOIDkinkthekelderly!!! Whatkarekthek 3 kveinskthatkarekgoodkforkIVkinkthekforearm?k-kCorrectkAnswer- Cephalic,kAccessorykCephalic,kBasilic Whichkforearmkveinskcankaccompanyklargekgaugekneedles?k-kCorrectkAnswer- CephalickandkAccessorykCephalic Whichkforearmkveinkiskavailablekinkthekupperkarm?k-kCorrectkAnswer- Cephalick(lateral/thumbkside)kandkBasilick(medial/pinkykside) Whichkveinkinkthekforearmkiskmostkoftenkoverlooked?k-kCorrectkAnswer-Basilic whatkarekthek 4 kquestionskyoukneedktokaskkforkappropriatekIVktechnique?k-kCorrectkAnswer- (1)kDokIkhavekthekrightkpatient? (2)kDokIkhavekthekrightksolution? (3)kDokIkhavekthekrightkdrug? (4)kDokIkhavekthekrightkroute? WhatkshouldkyoukinspectkonkthekIVkbag?k-kCorrectkAnswer-(1)kClear (2)kExpirationkdate (3)kLeaks (4)kCorrectkFluids Whatkshouldkyoukdoktokrelievekanxietykinkthekptk(alsokforklegalitykreasons)?k- kCorrectkAnswer- Introducekyourself,kexplainkprocedurek(riskskandkbenefits)kandkstepskinvolved WhatkallergieskshouldkyoukinquirekaboutkinkankIVkprocedure?k-kCorrectkAnswer- iodine,klatex,kandktapekallergies WhatkshouldkyoukadvicekthekptkofkthekextremitykoncekthekIVklinekiskinkplace?k- kCorrectkAnswer-needktoklimitkmovementkofkthekextremity DokyoukneedktokapplykaktourniquetkforkIVkcath?k-kCorrectkAnswer-YES! Howkdokyouk"optimizekakvein"?k-kCorrectkAnswer-makekakfist,ktapkveins,kfeelkveins Ifkallkelsekfailskyoukcankusekakwarmkmoistktowel
whatkarektheksystemickcomplicationskofkankIVkcath?k-kCorrectkAnswer- (1)kCatheterkEmbolization:krarek- kshearingkofkthekdistalkportionkofkthekcatheterkendkbykthekbeveealedkneedlektipk- kavoidkw/kproperktechnique (2)kSepticemia:kavoidedkviaksterilektechniquekandkIVkprotocol (3)kPulmonarykEmbolism:ksmallkbloodkclotknearkIVksitekdislodgeskandktravelskthoughkcircul ationkuntilkitklodgeskinkaksmallkcapillarykbedkinktheklungk- kavoidancekofkLEkveinskhelpskpreventkthis (4)kAirkembolism:kwhenkairkinadvertentlykleftkinkorkalowedkintokthekIVktubingktravelskintokthek bloodkstream.kThiskcankbekavoidedkbykflushingkallklineskbeforekconnection WhatkarekthekspecialkconsiderationskforkthekpediatrickptkpopulationkandkIVs?k- kCorrectkAnswer-ButterflykIVklinekequipementkiskespkuseful ProperksecuringkofkIVklinekiskparamount WhatkarekthekspecialkconsiderationkforkthekelderlykpopulationkandkIVS?k-kCorrectkAnswer- useksmallestkcatheterkpossiblek(basedkonkinfusionkindication) SkinkCare!kCarefulksecuringkfragilekskin AVOIDkLEklines!!!! WhatkshouldkyouktellkyoukptktoknotifykthekcliniciankofkwhenktheykhavekankIVkline?k- kCorrectkAnswer-burning,kstinging,kredness,kbleeding,korkswellingkatkinsertionksite Lecturek4....k-kCorrectkAnswer-Venipuncture Whatkiskankincisionkintokakveinkforkbloodlettingkorkcollection?k-kCorrectkAnswer- Venipuncturek(createdkbykhippocrates) Whatkiskthekindicationkforkvenipuncture?k-kCorrectkAnswer- anyktimekaksamplekofkvenouskbloodkisknecessarykinkquantitiesklargerkthankreadilykavailablek bykfingerkstickkmethod Whatkiskthekmostkimportantkstepkinkvenipuncture?k-kCorrectkAnswer-sitekselection WhatkareaskshouldkbekAVOIDEDkinksitekselection?k-kCorrectkAnswer- (1)kExtensivekScarskfromkburns/surgery (2)kUEkonksidekofkpreviouskmastectomyk (3)kHematomak-kifkanotherksiteknotkavailablektakektheksamplekDISTALktokthekhematoma (4)kIV/Bloodktransfusions
(5)kcannula/fistua/heparinklockk- kbloodkshouldknotkbekdrawnkw/okconsultingkwithkakphysiciank(SG) (6)kedeamatouskextremity IfktakingkakvenipuncturekfromkankarmkthatkhaskankIV,kshouldkitkbekdrawnkbelowkorkabovekthek IV?k-kCorrectkAnswer-BELOW HowkmanykminuteskmustkthekIVkbekturnedkoffkbeforektakingkakvenipunctureksample?k- kCorrectkAnswer- 2 kminutes Shouldkthektourniquetkbekplacedkabove/belowkthekIVksite?k-kCorrectkAnswer-BELOW True/False.kItkiskproperktechniquektoktakekakvenipuncturekfromktheksamekveinkusedkforkthekI V.k-kCorrectkAnswer-FALSEk-kyoukmustkchoosekakdifferentkone,kdistal/belowkthekIVksite Howkmanykmlkofkbloodkshouldkyoukdrawkandkdiscardkbecforekdrawingkthekspecimenktubeskf orktestingkinkakptkw/kankIV?k-kCorrectkAnswer- 5 kmL WhatkarekthekMOSTkCOMMONLYkusedkveinskforkvenipuncture?k-kCorrectkAnswer- MediankCubitalkandkCephalickveins Whenkselectingkakveinkyoukpalpatekandktracekthekpathkwithkyoukindexkfinger,kifkuponktracingk youkfeelkakpulsating,kelastic,kthickkwallkwhatkarekyoukmostklikelykpalpating?k- kCorrectkAnswer-AnkArtery Whenkselectingkakveinkyoukpalpatekandktracekthekpathkwithkyourkindexkfinger,kifkuponktracin gkyoukfeelklikekthekvesselklackkresilience,kiskcord- liike,korkrollskeasily,kwhatkarekyoukmostklikelykpalpating?k-kCorrectkAnswer- ThrombosedkVein Ifkyoukarekperformingkakvenipuncturekandktheksuperficialkveinskareknotkreadilykapparent,kwh atkcankyoukperformktokincreasekthekvisibility?k-kCorrectkAnswer- (1)kMassagekarmkfromkwristk-->kelbow (2)kTapeksitekw/kindexkandksecondkfinger (3)kApplykwarm,kdampkwashclothkxk 5 kmin (4)kLowerkextremitykoverkthekbedsidektokallowkthekveinsktokfill WhatkarekthekESSENTIALkstepsktokaksuccessfulkcollection?k-kCorrectkAnswer-IDkpatient Assesskptkphysicalkdepositionk(i.e.kdiet,kexercise,kstress,kbasalkstate)
