Intravenous Therapy 3

Question 1

IV Discontinuation

Answer 1

have to have an order, there can be complications

Question 2

IV Discontinuation Guidelines:

Answer 2

CDC; Facility policy; 72-96 hours/site & tubing; Tubing Exceptions-TPN, Blood, Lipids/24 hrs

Question 3

IV Discontinuation Steps

Answer 3

1. Explain to patient 2. Clamp tubing 3. Remove dressing & tape/stabilizing catheter 4. Inspect site 5. Using sterile gauze & light pressure 6. Pull catheter straight in line with insertion 7. Apply pressure 2-3 min (5-10 as indicated) 8. Inspect cannula 9. Document 10. Reassess site

Question 4

Removing CVCs

Answer 4

Position patient with head as low as possible; Remove sutures and pull line with steady motion as patient holds breath or during expiration (have pt take deep breath and remove with exhale); Assure tip is present. For PICCs, see measurement obtained at time of insertion; Hold pressure until bleeding stops, apply dressing.

Question 5

IV Complications -

Answer 5

1. Occlusion 2. Bleeding 3. Infiltration 4. Phlebitis 5. Infection 6. Fluid Overload

Question 6

Occlusion Causes -

Answer 6

Tubing clamped or kinked, Positional, Tape or dressing, Damaged cannula, Clot

Question 7

Occlusion Assessment:

Answer 7

Tubing & site, Lower IV bag

Question 8

Occlusion Intervention:

Answer 8

Correct any problem or discontinue site

Question 9

downstream occlusion:

Answer 9

from pump to pt; tube clamped, pt postion

Question 10

upstream occlusion:

Answer 10

from pump to bag

Question 11

bleeding causes:

Answer 11

Anticoagulation therapy

• Low PLTs • Dislodged or disconnected

Question 12

bleeding assessment:

Answer 12

Site- blood, hematoma or disconnection

Question 13

bleeding intervention:

Answer 13

Small amount- change dressing & clean site; Discontinue site, apply pressure as needed

Question 14

Infiltration causes:

Answer 14

Ruptured vessel • Dislodge cannula • Occlusion

Question 15

Infiltration assessment:

Answer 15

Swelling, Blanched, Cool, Pain, Occlusion

Question 16

Infiltration intervention:

Answer 16

Discontinue site; Elevate & Warm compress

Question 17

with infiltration will not have what?

Answer 17

blood return

Question 18

Infiltration Scale

Answer 18

Blanching & Cool plus-
1 Edema < 1”; With or without pain
2 Edema 1-6”; With or without pain
3 Gross Edema > 6”; Mild-Mod Pain; Possible numb
4 Gross Pitting Edema >6”; Skin tight; Leaking; Discolored; Circulation impaired; Mod-Severe Pain
OR any amount of blood, irritant or vesicant

Question 19

Phlebitis causes:

Answer 19

Irritant solution • Dehydration • Infection

Question 20

Phlebitis assessment:

Answer 20

Erythema, Warmth, Pain

Question 21

Phlebitis intervention:

Answer 21

Discontinue site; Warm compress

Question 22

Phlebitis site

Answer 22

warm to touch, “burned the vein”, can get blood return

Question 23

Phlebitis Scale

Answer 23

1 Erythema; With or without pain
2 Erythema and/or edema; Pain
3 Erythema and/or edema: Pain; Streak, Palpable venous cord
4 Erythema and/or edema: Pain; Streak, Palpable venous cord >1” Drainage

Question 24

infection causes:

Answer 24

Contamination at insertion • Migration of skin organism • Catheter hub or port contamination

Question 25

infection assessment

Answer 25

Warmth, tenderness, redness, fever of unknown origin

Question 26

infection intervention:

Answer 26

Discontinue site • Notify provider (because of if pt gets discharged)

Question 27

Fluid Overload causes:

Answer 27

Rapid or large volume fluid administration, Compromised cardiac function

Question 28

Fluid Overload assessment:

Answer 28

SOB & Crackles, Tachycardia, Agitation or anxiety

Question 29

Fluid Overload interventions:

Answer 29

Slow infusion; Raise HOB (set up pt); Monitor VS ; Notify Provider

Question 30

ways to get hemotomia

Answer 30

leave turnicate on, puncturing the back wall of a vessel

Question 31

parental nutrition

Answer 31

pt failing to mature oral intake

Question 32

Common Indications for PN

Answer 32

Patient has failed EN with appropriate tube placement  Severe acute pancreatitis  Severe short bowel syndrome  Mesenteric ischemia  Paralytic ileus  Small bowel obstruction  GI fistula unless enteral access can be placed distal to the fistula or where volume of output warrants trial of EN

Question 33

Contraindications for PN

Answer 33

Functional and accessible GI tract  Patient is taking oral diet  Prognosis does not warrant aggressive nutrition support (terminally ill)  Risk exceeds benefit  Patient expected to meet needs within 14 days

Question 34

PN Central Access

Answer 34

May be delivered via femoral lines, internal jugular lines, and subclavian vein catheters in the hospital setting  Peripherally inserted central catheters (PICC) are inserted via the cephalic and basilic veins  Central access required for infusions that are toxic to small veins due to medication pH, osmolarity, and volume

Question 35

last resort PN -

Answer 35

femoral lines

Question 36

most common PN -

Answer 36

subq

Question 37

peripheral can cause

Answer 37

plebitis

Question 38

TPN -

Answer 38

Total Parenteral Nutrition, glucose, amino acids, vitamins & minerals; used for 7 days

Question 39

PPN -

Answer 39

Peripheral Parenteral Nutrition; ph, amino acids

Question 40

TNP -

Answer 40

Total Nutrient Admixture, glucose, amino acids, vitamins & minerals, & lipids

Question 41

Monitoring Needs

Answer 41

(monitor every 4-6 hours) Glucose Monitoring  Intake and Output  Daily weight  Labs...CBC, BUN/CRE, Electrolytes (Mag, K+, Phosphate levels, Ca+), ABGs, Liver function test, PT/PTT, Urine osmolality, 24-hour urine collection.

Question 42

Complications of TPN

Answer 42

Sepsis (because of glucose because mediator for bacteria )  Electrolyte Imbalance  Hyperglycemia  Hypoglycemia  Hypervolemia  Hepatic Dysfunction (lipids) Hypercapnea (CO2 in the blood)  Lipid Intolerance

Question 43

Prior to administration:

Answer 43

Obtain a complete health history including allergies, drug history, and possible drug interactions. ■ Obtain a complete physical examination. ■ Assess for the presence or history of nutritional deficits such as inadequate oral intake, GI disease, and increased metabolic need. ■ Obtain the following laboratory studies: total protein/albumin levels, creatinine/ blood urea nitrogen (BUN), CBC electrolytes, lipid profile, and serum iron levels.

Question 44

Ongoing Nursing Interventions

Answer 44

Use a pump to administer infusion of parenteral nutrition. Infusions should be started slowly to observe for untoward reactions. Check infusion rate at least every 2 hours.  If administration is interrupted, administer a 5% to 10% dextrose solution to prevent hypoglycemia, based on facility policy.  Check vital signs every 4 hours to monitor for the development of infection or sepsis. ; Monitor blood glucose levels every 6 hours.  Use aseptic technique when changing solution, tubing, filter or dressings according to agency policy.  Compare the client’s daily weights to fluid intake and output. Total weight gain should not be greater than 3 lb. per week. Weight gain greater than 1 lb. per day indicates fluid retention.