IV Checkoff

Question 1

1. Check the physician order. What information do you need?

Answer 1

a. 6 rights (medication, dose, client, route, time, documentation)
b. Patient allergies
c. Type of fluid
d. Any additives
e. Infusion rate (KVO is not an IV rate)
f. Time frame (if appropriate).
g. Can this medication be safely given by IV without cardiac monitoring (allowed to be given in this setting)?
h. Can this medication be given without dilution?
i. Is this medication compatible with the current primary fluid hanging?

Question 2

2. Ask yourself: what is the purpose of this IV?

Answer 2

a. Hydration/electrolyte replacement
b. Contrast for tests
c. Blood transfusion
d. Antibiotic therapy

Question 3

3a. IV fluid (What kind? What size bag?)

Answer 3

i. Isotonic-
1. Dextrose 5% in water (D5W)
2. 0.9% sodium chloride (NS; 0.9%NS)
3. Lactated Ringer’s (LR)
ii. Hypertonic-
1. Dextrose 10% in water (D10W)
2. 3%-5% sodium chloride (3%-5% NS)
3. Dextrose 5% in 0.9% sodium chloride (D5NS)
4. Dextrose 5% in 0.45% sodium chloride (D5 ½ NS)
5. Dextrose 5% in Lactated Ringer’s (D5LR)
iii. Hypotonic-
1. 0.45% sodium chloride ( ½ NS; 0.45%NS)
iv. What about bag sizes???

Question 4

3c. IV start kit (What is in it?)

Answer 4

i. Sterile gloves
ii. Tourniquet
iii. Tape
iv. Tegaderm
v. Chloraprep (or other antiseptic prep)
vi. 2 x 2 gauze

Question 5

3f. IV Catheters (what sizes, based on what, how many?)

Answer 5

i. Catheter sizes-
1. 14 gauge – largest
2. 18-22 gauge – most common for adults
3. 24 gauge – smallest; used for difficult to access, fragile or dehydrated veins.
4. Catheter should be as small as possible for the intended therapy
5. Based on size of person and size of vein

Question 6

What do do first when you enter the patient’s room?

Answer 6

Introduction and explanation

Question 7

What does the introduction and explanation consist of?

Answer 7

a. Make pt. comfortable
b. “Which arm do you prefer?”
c. Any medical restrictions on which arm to use? Such as…

Question 8

Any medical restrictions on which arm to use? Such as…

Answer 8

i. Avoid site with burns, scars, mastectomy
ii. Bruised, red, swollen, or near previous site
iii. NEVER use the side that has a shunt or graft

Question 9

2. Preparation to Initiate IV:

Answer 9

a. Choose arm, place tourniquet and identify site
b. When might you not use a tourniquet?
c. What do you do to improve finding site, if no site is evident?
d. Remove tourniquet
e. Layout supplies; tear tape

Question 10

When may you not use a tourniquet?

Answer 10

Impaired skin integrity, elderly,??

Question 11

What do you to do improve finding a site, if no site is evident?

Answer 11

????

Question 12

3. IV insertion and taping.

Answer 12

a. Replace tourniquet
b. Cleanse site - allow to dry
c. Loosen hub
d. Needle insertion
e. Blood return (flash) – decrease angle to parallel with skin.
f. Progress cath/needle until hub is against the skin (cath completely under skin)
g. Remove needle
h. Attach J-loop
i. Remove tourniquet
j. Flush to confirm placement
k. Secure hub (with small piece of tape or Tegaderm)
l. Taping
m. Clean up, discard used materials as appropriate…garbage, sharps, etc.

Question 13

How do you cleanse the IV site?

Answer 13

Rub chloroprep in gentle repeated back and forth strokes for 30 seconds

Question 14

At what angle should you insert the needle?

Answer 14

20 degrees

Question 15

What is the principle to remember about taping?

Answer 15

Do not cover the connector, ??

Question 16

How often do you assess the IV site? Before what nursing actions?

Answer 16

a. Hourly or per agency policy
b. Before administering medication?
c. ???

Question 17

What do you look for when assessing the IV site?

Answer 17

a. Type and rate of fluid infusing
b. Patency of the IV infusion
c. When was the IV tubing last changed
d. Status of the IV site:
i. Check for leakage/bleeding
ii. Check dressing-is it dry and intact?
iii. Observe skin for redness or swelling
iv. Palpate skin for swelling or pain

Question 18

What do you document of the IV procedure?

Answer 18

a. Number of attempts for insertion
b. Insertion site
c. Size and type of catheter
d. Type of fluid started
e. Flow rate of fluid
f. When infusion was begun
g. Any complications that occur

Question 19

What are the main steps/order of the IV procedure?

Answer 19

1. Check the physician order. What information do you need?
2. Ask yourself; what is the purpose of this IV?
3. Gather supplies
4. Enter patients room
   a. Introduction and explanation
   b. Preparation to initiate IV
   c. IV insertion and taping
5. Assessment of IV site
   a. How often? Before what nursing activities?
   b. What to look for?
   c. Document