Chapter 4 (IV Therapy)

Question 1

What are the advantages and disadvantages of IV usage?

Answer 1

Advantages: rapid effects, precise amounts, less discomfort after initial insertion, constant therapeutic blood levels, less irritation to the subcutaneous and muscle tissue, permits the use of large volumes of fluids for medications that are poorly soluble and need larger amounts of fluids to dissolve, and permits the use of medications that contain irritant properties, such as chemotherapy.

Disadvantages: circulatory fluid overload is possible if the infusion is too large or too rapid, immediate absorption leaves little time to correct errors, if fluid admin can irritate the lining of the vein, and failure to maintain surgical asepsis can lead to local and systemic infection.

Question 2

What are the types of IV access?

Answer 2

Peripheral (in the veins of the arms, hands, feet, legs, etc), or central venous access.

Question 3

Infiltration; and what is the treatment/prevention?

Answer 3

infiltration of a nonvesicant (does not cause irritation/damage) solution into surrounding tissues.

Tx: stop the infusion and remove catheter, elevate the extremity, encourage active range of motion of the extremity, apply cold or warm compress depending on the solution type, and check with provider to see if client still needs IV (if so start a new IV proximal to the site or in another extremity.)

Prevention: carefully select the site and catheter, secure the catheter, and inspect IV infusion site frequently for any findings of infiltration.

Question 4

Extravasation; what is the treatment and prevention?

Answer 4

This is the infiltration of a vesicant or tissue damaging medication into surrounding tissues.

Tx: stop infusion and notify provider, elevate the extremity, encourage active range of motion of the extremity, apply cold or warm compress depending on the solution type, and check with provider to see if client still needs IV (if so start a new IV proximal to the site or in another extremity.

Prevention: closely monitor the IV site and dressing, and always use an infusion pump.

Question 5

What are signs of fluid overload?

Answer 5

• distended neck veins
• increase blood pressure
• tachycardia (fast heart rate)
• shortness of breath
• crackles in the lungs
• edema

Tx: slow IV rate or stop infusion, raise the head of the bed, monitor vital signs and oxygen saturation, adjust rate after correcting fluid, anticipate administering diuretic.

Prevention: use an infusion pump, and monitor I & O (input should never be higher than output)

Question 6

What are the symptoms of phlebitis/thrombophlebitis?

Answer 6

• edema, erythema (swelling and redness)
• throbbing, burning, or pain at the site
• increased skin temperature
• red line up the arm with a palpable band at the vein site (thrombophlebitis)
• slowed infusion

Tx: promptly discontinue the infusion and remove the catheter, elevate the extremity, apply cold compress to minimize flow of blood then apply warm compress to increase circulation, check with provider to determine if need for IV still, and obtain a specimen for culture at the site and prepare the catheter for culture if drainage is present.

Prevention: rotate sites at least every 72 hrs, monitor IV using phlebitis scale, avoid lower extremities, use hand hygiene, and use surgical aseptic techniques.