IV Therapy

Question 1

Vascular access

Answer 1

Cannulation of a peripheral extremity vein.
Intraosseous access for infusion

Question 2

Assembling your equipment

Answer 2

Gather and prepare equipment, sterilize equipment, two ports (injection port, access port)

Question 3

Choosing a solution

Answer 3

Identify the needs of the patient (critical, stable, fluid replacement, medications), usually limited to 2 isotonic crystalloids (normal saline, LR solution)

Question 4

Choosing an administration set

Answer 4

Piercing spike, drip sets (60gtts=1mL, 10gtts=1mL)

Question 5

3 C’s and an E

Answer 5

Expiry date, solution clarity, solution colour, solution concentration

Question 6

Parts of IV solution containers

Answer 6

Fluid amount (mL), expiration date, fluid type, med admin port, admin set port

Question 7

Most appropriate vein

Answer 7

Avoid valves, avoid rolling veins

Question 8

Criteria for finding a vein

Answer 8

Straightest, firm, round, springy when palpated.
Avoid, joints, edematous extremities, extremities with a dialysis fistula, extremities on side of mastectomy, areas of overlying cellulitis

Question 9

Why can large protruding arm veins be deceiving?

Answer 9

Often roll from side to side

Question 10

Why would you start attempting distally and work proximally?

Answer 10

Distal site ruptures or infiltrates

Question 11

Criteria for choosing an IV cannula

Answer 11

Purpose of the IV, age of the patient, location for the IV, available vessels for venipuncture

Question 12

Needle types

Answer 12

Over-the needle cannulas, butterfly cannulas, through-the-needle cannulas

Question 13

Syringe and needles

Answer 13

Prepackaged in colour-coded packs with a needle, plunger, body or barrel, flange and tip, hypodermic needle lengths vary from 1-5cm, gauge refers to the diameter, smaller the number larger the diameter

Question 14

Needle gauges, what they’re for?

Answer 14

14-16g: aggressive fluid resuscitation (orange, grey)
18g: fluid resuscitation (green)
20g: medication administration (pink)
22g: medication administration (blue)

Question 15

Contaminated stick

Answer 15

When you puncture the skin with the same cannula used to cannulate the vein

Question 16

Preparing supplies

Answer 16

IV solution, IV drop set, IV needle, tourniquet, tape (2-3 pieces, 1-1.5in), OP site, antimicrobial swabs, sterile 4x4s, sharps containers, PPE (eye shields, gloves)

Question 17

Catheter shear

Answer 17

Keep the beveled side of the cannula up. Do not extend catheter over the end of the needle

Question 18

Prepping the IV site

Answer 18

Alcohol or iodine swab; apply gentle downward or lateral traction, clean the site in a circular motion; small to large circles

Question 19

Insertion angle of the IV cannula

Answer 19

20-30 degrees , once there is flash, drop angle down to 15 degrees

Question 20

How will you know if your cannula is in the vein?

Answer 20

Flash of blood in the flash chamber

Question 21

Securing the line

Answer 21

Secure Op site (tegaderm) over coloured IV catheter but not over the IV tubing or lock, tape the area

Question 22

Changing an IV bag

Answer 22

Do not allow an IV fluid bag to become completely depleted, always ensure some fluid is left in the drip chamber and tubing

Question 23

Steps of changing an IV bag

Answer 23

Stop the flow of fluid, prepare the new IV bag, insert the piercing spike, ensure that the drip chamber is appropriately filled

Question 24

Steps for discontinuing the IV line

Answer 24

Shut off the flow, peel back the tape toward the IV site, stabilize the cannula while you loosen the tape, do not remove the IV tubing, place a 10x10 cm piece of gauze over the site, gently pull the cannula and the IV line.

Question 25

Factors affecting IV flow rates; perform the following checks

Answer 25

Check the IV fluid, check the administration set, height of the IV bag (must be hung high), check the type of cannula used, check the tourniquet (do not leave it on after completing the IV)

Question 26

Potential complications of IV therapy

Answer 26

Infiltration, thrombophlebitis, occlusion, vein irritation, hematoma, nerve/tendon/ligament damage, arterial puncture

Question 27

Infiltration

Answer 27

The escape of fluid; IV passes through the vein, cannula enters the tissue surrounding the vein
Signs and symptoms; Edema at venipuncture site, pt complains of pain at venipuncture site