IV Fluids

Question 1

Identify factors in selecting peripheral IV size or central line selection.

Answer 1

1. Vein condition
2. Type of solution
3. Duration (how long?)
4. Multiple (more than 1?)

Question 2

Peripheral IV Criteria

Answer 2

• pH: 5-9
• Less than 500 mOsm/L
• Infusion is not a vesicant
  If criteria not met = Central Line

Question 3

Assessments to help determine which IV site/size to select? (5)

Answer 3

1. Solution (pH, mOsm/L)
2. Vein condition
3. Therapy duration
4. POC (Plan of Care)
5. Infusion Nurses Society (INS Standards)

Question 4

What is each cannula size used for? (5)

Answer 4

1. 14g & 16g
   - Emergency, surgery, bolus
   - Need large vein
2. 18g
   - Trauma, surgery, blood transfusion, CT
   - Need large vein
3. 20g
   - Common size
   - Contrast & blood
4. 22g
   - Adult IV fluids, antibiotics
5. 24g
   - Small, shorter
   - Geriatrics & pediatrics

Question 5

Infiltration: What is it? S/Sx? Treatment?

Answer 5

IV fluid leaks into surrounding tissue

S/Sx:
- Pain
- Edema
- Coolness at site
- Redness
- No blood return

Treatment:
- Stop infusion & remove IV
- Sterile dressing applied
- Warm or cool compress
- Elevate extremity

Question 6

Extravasation: What is it? S/Sx? Treatment?

Answer 6

Vesicant or irritant solution/medication leaks into surrounding tissue

S/Sx:
- Pain
- Burning
- Redness
- Blistering, inflammation, necrosis can occur

Treatment:
- Stop infusion, notify MD (protocol: cannula may stay or be removed)
- Hospital protocol
- Warm or cold compress
- Neurovascular assessments (frequent)
- Antidote
- Do not use same extremity for new IV

Question 7

Central Line Care & Maintenance (6)

Answer 7

• Sterile occlusive dressing (change q7 days or when non-occlusive)
• Biopatch has CHG
• Flush daily or with each intermittent infusion (SASH)
• Check for blood return before infusion
• Some resistance normal
• Use an IV pump
• Use a syringe > 10 ml (PSI)

Question 8

How do you remove a central line?

Answer 8

Goal: Prevent air embolism
- Patient in flat or Trendelenburg (CVC exit site below heart)
- Clamp lumens, remove dressing & sutures
- May tape above dressing (avoid sliding out)
- Cover exit site with gauze & apply gentle pressure (remove slow, constant motion)
- Valsalva maneuver (hold breath) until CVC is removed
- Pressure on site at least 5 min
- Apply sterile occlusive dressing per policy
- May continue lying flat for 30 min

Question 9

Identify nursing care of a patient receiving total parenteral nutrition (TPN).

Answer 9

• Initial CXR
• PN prepared by pharmacist
• Filter on tubing (prevent infection)
  - Lipids: Filter, tubing change q24h
  - Amino acids, dextrose: Filter,
  tubing change q24-72 hrs
• Fat/emulsion often running (nutritional support), can hold 20-50% glucose
• Maintain sterile dressing
• Monitor electrolytes daily, glucose q4-6h
• MD order everyday or pharmacy protocol
• Nothing added to solution after preparation
• Verify placement (blood return)
• Taper off

Question 10

Identify the steps of infusing & monitoring a PRBC transfusion.

Answer 10

• Review patient history (Hx transfusions, any reactions), concurrent health problems
• Baseline assessment, VS, labs
• Patient teaching & obtain consent
• Need IV (20g or greater for PRBCs) & blood tubing, NS
• Identify patient & blood product; blood band
• Assess for additional Pall filter
• Monitor patient & VS
• Stay for first 15 min

Question 11

Blood Transfusion Considerations

Answer 11

• Unit cannot be out of the fridge for longer than 30 min
• Administer in 2-4 hrs
• May pre-medicate with Tylenol or Benadryl
• Monitor for fluid overload (Furosemide)
• Complete paperwork
• Dispose in red bag

Question 12

Reaction to Blood Transfusion

Answer 12

• Stop transfusion immediately
• Stay with patient & assess frequently
• Initiate NS with new IV tubing on secondary
• Save bag & tubing for testing
• Contact blood bank
• Blood & urine specimen
• Follow policy paperwork