IV Theory: Trouble Shooting

Question 1

What are the complications of IV therapy?

Answer 1

• Fluid volume deficit
• Fluid volume excess (overload)
• Trauma from IV therapy (chemical, biological, mechanical)

Question 2

Which patients are more at risk for develop fluid volume overload?

Answer 2

• Renal failure
• Congestive Heart Failure
• Liver damage

Question 3

What is chemical IV trauma?

Answer 3

When the chemicals in the solution damage tissue

Question 4

What is biological IV trauma?

Answer 4

Infections, incompatibility and allergic reactions

Question 5

What is mechanical IV trauma?

Answer 5

When a portion of the IV has broken off inside the body

Question 6

What are the manifestations of circulatory overload?

Answer 6

• Crackles
• Dsypnea
• SOB
• Edema
• HTN
• Tachycardia

Question 7

What do we do if we suscept circulatory overload?

Answer 7

• Notify physician

- Slow rate to TKVO (do not discontinue IV)

Question 8

What is infiltration?

Answer 8

When fluid enters the interstitial spaces (it is outside of the vein), causing swelling (fluid has to go somewhere)

Question 9

What can cause infiltration?

Answer 9

• Mechanical and chemical
• Displaced cannula
• Enlarged puncture wound
• Pain, swelling, cool, slow or stopped infusion

Question 10

What nursing interventions do we do for an individual with infiltration?

Answer 10

• D/C IV (remove cannula)
• Warm compress (vaso dilate)
• Elevate arm
• Re-start elsewhere (go for a different limb)
• Document

Question 11

What is extravasation?

Answer 11

• One step worse than infiltration

- When the drug leaks into SC tissues and causes necrosis/damage (chemical damage)

Question 12

What are the S&S of extravasation?

Answer 12

• Swelling
• Tenderness
• Slow or stopped flow
• Eventual tissue necrosis

Question 13

What are nursing interventions for extravasation?

Answer 13

• D/C IV unless you need to give antidote (remove cannula)
• Ice packs or warm compresses
• Elevate arm
• Notify physician/document

Question 14

What happens in infection?

Answer 14

• Biological trauma
• Faulty aseptic technique (frequently the result of RN’s)
• Redness, warmth, tenderness **, swelling and exudate

Question 15

What are nursing interventions for infection?

Answer 15

• D/C IV (remove cannula)
• Culture insertion site and tip of cannula
• Cleanse with normal saline
• Notify physician and document

Question 16

What is Phlebitis?

Answer 16

• An infection contained to the vein
• Mechanical and chemical trauma
• Movement of cannula in vein and irritating meds

Question 17

What are the S&S of phlebitis?

Answer 17

• Red, tender and warm cord
• Slow or stopped flow
• Irritation with infusion
• Increased risk of sepsis (look for manifestations)

Question 18

What are nursing interventions for phlebitis?

Answer 18

• D/C IV (remove cannula)
• Warm compresses
• Observe for S&S of sepsis
• Take a culture swab (optional)
• Notify physician/document

Question 19

What happens in a drug or fluid reaction?

Answer 19

• Biological trauma
• Systemic/allergic reaction
• Side effect, allergy or interaction with other drugs

Question 20

What are the S&S of drug or fluid reactions?

Answer 20

• Tachycardia
• Tachypnea
• Subtle changes in pt (appearance/behaviour)

Question 21

What are nursing interventions for drug or fluid reactions?

Answer 21

• Stop infusion immediately
• Do not d/c
• Notify physician and document

Question 22

What is septicemia? What are the S&S of it?

Answer 22

• Biological trauma
• Contaminants or exceeded expiry
• Tachycardia, tachypnea, hypotension, N/V, temp

Question 23

What are nursing interventions for septicemia?

Answer 23

• D/C IV
• Notify physician
• Obtain blood cultures

Question 24

What happens with an embolism?

Answer 24

• Mechanical trauama
• IV catheter piece
• Air or clot
• Speciic to location
• Respiratory distress and CVS distress
• Rarely caused by nurses **

Question 25

What are nursing interventions for an embolism?

Answer 25

• D/C IV
• Turn patient to their left side, head down (keep air bubble at top right atrium of heart)
• Oxygen, anti-coagulants
• Notify physician/document

Question 26

How do we trouble shoot for an increased flow rate?

Answer 26

• Assess pt for S&S of overload and pulmonary edema
• Look for cause
• Check entire system
• Lower solution
• Reconnect tubing/tape
• Use a pump
• Document

Question 27

How do we trouble shoot for decreased flow rate?

Answer 27

• Assess pt. (deprivation of fluids /medications)
• Check entire system (fluid in bag, clamp open, lying on tubing, kinked, cannula position)
• Raise bag
• Readjust flow rate
• Recalculate rate
• Document

Question 28

How do we discontinue an IV?

Answer 28

• Use your hands to first loosen tape
• Then apply clean gloves to remove the transparent dressing (tagaderm/opsite)
• Be careful not to pull out the IV cannula
• Cover insertion site with a sterile 2x2 and pull cannula out (being careful not to splatter) (turn head away while pulling).
• Apply pressure for at least 1 minute (even more for pt on anticoagulants)
• Apply a new sterile dressing, reassess in 10-15 minutes
• Document on fluid balance sheet or in nurses notes. Be sure to update Kardex.