Initiating IV therapy

Question 1

what are the veins most often used for initiating intravenous (IV) therapy?

Answer 1

cephalic, basilic, and median cubital veins in the hand and forearm

Question 2

Why is an IV used?

Answer 2

To administer fluids, nutrition, medication, provide immediate access to the vascular system

Question 3

What size gauge catheter for adults?

Answer 3

For most adults, a 20- to 22-gauge catheter is adequate for infusing fluids and medication

Question 4

What size gauge catheter for children?

Answer 4

22- to 24-gauge catheter is best for children, older adults, and anyone who has small or fragile veins

Question 5

When do you use a larger gauge catheter (i.e. 18)

Answer 5

If the patient will receive large quantities of fluids at a rapid rate or blood or blood products,

Question 6

What supplies are needed to start an IV?

Answer 6

IV catheter, a tourniquet or a blood-pressure cuff, an antimicrobial wipe, several small gauze pads, tape, a transparent dressing, and gloves.

Question 7

What products are most often used to clean the site prior to initiating IV access

Answer 7

alcohol, chlorhexidine, and povidone-iodine

Question 8

What 2 methods are there for inserting a peripheral IV catheter

Answer 8

direct and indirect

Question 9

What is the direct method?

Answer 9

involves piercing the skin immediately over the vein and approximately ½ inch below the proposed IV site.

Question 10

What is the indirect method?

Answer 10

indirect method involves piercing the skin along the side of the vein and then angling the catheter toward the vein

Question 11

How long can I safely leave a tourniquet tied while starting an IV line?

Answer 11

4-6 min

Question 12

How long can an IV catheter stay in place?

Answer 12

ccording to guidelines from the Centers for Disease Control and Prevention (CDC), as long as there are no signs or symptoms of infiltration or phlebitis or concerns about possible contamination, a peripheral venous catheter can remain in place in an adult for 72 to 96 hours.

Question 13

How long can an IV solution be used?

Answer 13

Hang lipid-containing solutions for no longer than 24 hours.
Hang lipid-only emulsions for no longer than 12 hours.
Hang blood and blood products for no longer than 4 hours.

Question 14

How long can infusion sets be used?

Answer 14

Replace tubing used to infuse blood or blood products or lipid-containing solutions at least every 24 hours.
Replace tubing used to infuse propofol every 6 to 12 hours, following the manufacturer’s guidelines.
Replace tubing used to infuse solutions containing dextrose and amino acids without lipids every 72 hours.
Replace other tubing every 96 hours.

Question 15

Why is it so important to get all of the air out of an infusion set and any add-on devices?

Answer 15

ir embolism is a potential complication of any intravenous therapy. Air can enter the patient’s bloodstream through cut IV tubing, unprimed infusion sets, ports and injection caps, drip chambers with too little fluid, and vented infusion containers that are allowed to empty completely. It is not known how much air is harmful, but death can result with as little as 10 mL, depending on the patient’s condition and size. The nitrogen that comprises the majority of the air dissolves fairly quickly in the patient’s blood, but large amounts might not dissolve quickly enough to avoid embolism.

Question 16

Why do I have to let cleansing agent(s) air-dry?

Answer 16

Letting a cleansing agent air-dry completely (30 seconds for chlorhexidine, 60 seconds for alcohol, 2 to 3 minutes for povidone-iodine) allows time for the agent to reduce microbial counts adequately. Do not fan or blow on the skin to expedite the drying as this can reintroduce microbes to the area.

Question 17

If I use lidocaine as a local anesthetic, how long should I wait for it to take effect?

Answer 17

Lidocaine takes effect quickly, usually within 10 seconds.

Question 18

How high above the IV site should I hang the IV fluid bag?

Answer 18

For an optimal flow rate, position the IV bag about 36 inches above the IV site.

Question 19

Why should I use a time tape?

Answer 19

A time tape provides an easy reference for indicating the accuracy of the flow rate.

Question 20

Why should I backprime secondary tubing instead of just priming it?

Answer 20

Backpriming the secondary tubing fills the tubing backward, from the connecting end to the drip chamber. This ensures that none of the medication in the secondary bag is wasted or lost while you prime the tubing.

Question 21

Why can’t I use an alcohol pad at the site when I discontinue an IV infusion?

Answer 21

Not only will the alcohol sting when it enters the open wound, it will also cause vasodilation and increase post-removal bleeding.

Question 22

Why must I inspect an IV catheter after I remove it?

Answer 22

It is possible for an IV catheter to be damaged during insertion or removal. It can then break off and become an embolism. The catheter can also be damaged if the needle is reinserted into the catheter during IV insertion or if excessive pressure or an improper angle is used during removal of an IV catheter. Also, any signs or symptoms of infection at the catheter site at the time of removal could warrant culture of the catheter tip

Question 23

What documentation is needed when inserting an IV?

Answer 23

the date and time the IV catheter was inserted
the type, length, and gauge of the catheter inserted
the location where the IV catheter was inserted
the number and location of attempts to insert the catheter
the IV solution and any additives infused
the flow rate
the condition of the IV site
the name of the person starting the IV

Question 24

What documentation is needed when discontinuing an IV?

Answer 24

the date and time the IV infusion was discontinued
whether or not the IV catheter was intact
the condition of the IV site
the type of dressing applied (such as a pressure dressing)
the amount of fluid infused
the name of the person discontinuing the IV infusion