IV Therapy Flashcards
How many RNs are required for patient identification when administering blood products?
2
At what anatomical location do all central lines end in?
Superior vena cava (SVC)
Define tunneled CVC.
Tunneled central venous catheter; a portion of the catheter first travels subcutaneously before entering the vein; prevents organisms from reaching the bloodstream
Define nontunneled percutaneous CVC.
Nontunneled percutaneous central venous catheter; catheter enters the vein directly and ends in SVC; commonly used for short-term emergent or trauma situations
For how long should the hub of a central line be cleaned before use?
At least 30 seconds
What should you do if you see a PICC that is not covered?
Assess the site for redness, swelling, drainage; clean and dress the site
What is the purpose of a hypotonic IV solution?
Cellular replenishment
What is the purpose of a hypertonic IV solution?
To correct fluid, electrolyte or acid-base imbalances
What is the purpose of an isotonic IV solution?
Fluid replacement
0.9% NaCl: Isotonic, hypotonic or hypertonic?
Isotonic
0.45% NaCl: Isotonic, hypotonic or hypertonic?
Hypotonic
D5W: Isotonic, hypotonic or hypertonic?
Isotonic
D10W: Isotonic, hypotonic or hypertonic?
Hypertonic
D5W in 0.9% NaCl: Isotonic, hypotonic or hypertonic?
Hypertonic
D5W in 0.45% NaCl: Isotonic, hypotonic or hypertonic?
Hypertonic
D5W in 0.225 NaCl: Isotonic, hypotonic or hypertonic?
Isotonic
RL: Isotonic, hypotonic or hypertonic?
Isotonic
D5W in RL: Isotonic, hypotonic or hypertonic?
Hypertonic
What is the first sign of fluid overload?
Thready, rapid, bounding pulse
Which complication will be seen if a patient it receiving IV fluid but has no urine output?
Cardiac overload
Define CR-BSI.
Catheter-related blood stream infection
Which solution is best practice for cleaning the site prior to IV placement?
Chlorhexidine
Which assessment is essential before using betadine to clean the site?
Ask for iodine or shellfish allergies
How long does betadine need to sit on the skin before it is effective?
2 minutes
How can you protect an elderly patient from skin tearing?
Apply a skin barrier before placing adhesive
If necessary, how should you remove a patient’s hair prior to IV placement?
Clipping; Never shave hair - shaving makes abrasions on the skin and increases risk for infection
Define infiltration.
Leakage of IV fluids into surrounding tissue
Define extravasation.
Leakage of IV fluids into surrounding tissue with tissue damage
Define phlebitis.
Inflammation of the vein
Define thrombosis.
Blood clot inside the vein
Which signs & symptoms indicate infiltration?
Slowed IV rate, increasing edema around site, blanching or coolness, burning or tenderness, leakage of fluids, absence of blood return
Which signs & symptoms indicate extravasation?
Same as infilitraton (Slowed IV rate, increasing edema around site, blanching or coolness, burning or tenderness, leakage of fluids, absence of blood return) but with a vesicant IV fluid; tissue sloughing and blistering may not appear for a few days
Which signs & symptoms indicate phlebitis?
Pain at IV site, redness, swelling; vein may be hard, cord-like
Which signs & symptoms indicate thrombosis?
Slowed or stopped IV rate, pain, redness, swelling, engorged peripheral veins
Which signs & symptoms indicate ecchymosis and hematoma?
Swelling, bruising, pain
Which signs & symptoms indicate infection?
Swelling, redness, tenderness, warmth, purulent or malodorous drainage
Which signs & symptoms indicate venous spasm?
Cramping or pain at or above insertion site, slowed IV rate, localized numbness, inability to withdraw IV catheter
Which signs & symptom indicate nerve damage?
Tingling, numbness, decreased pulse, coolness
What should you do if you notice a slowed IV rate, increasing edema around site, blanching or coolness, burning or tenderness, leakage of fluids, and absence of blood return?
Stop the infusion, remove catheter, elevate the extremity, apply warm (to absorb fluid) or cold (to reduce swelling) compresses, insert a new IV catheter on opposite extremity, rate and document using the infiltration scale
What should you do if you notice a slowed IV rate, increasing edema around site, blanching or coolness, burning or tenderness, leakage of fluids, and absence of blood return when infusing a vesicant IV fluid?
Stop the infusion, remove administration set, aspirate residual drug, leave IV catheter in place and deliver antidote if indicated, apply cold compress except for vinca alkaloids and epipodophyllotoxins, photograph & monitor site
What should you do if you notice pain, redness, swelling, and a hard, cord-like vein at a short peripheral IV site?
Remove catheter, apply a warm compress, document using the phlebitis scale, and insert a new IV catheter on opposite extremity
What should you do if you notice pain, redness, swelling, and a hard, cord-like vein with a PICC line?
Apply continuous heat, rest & elevate extremity; remove catheter if phlebitis is not resolved within 72 hours
What should you do if you notice a slowed or stopped IV rate, pain, redness, swelling and engorged peripheral veins at a short peripheral IV site?
Stop infusion, remove IV catheter, apply cold compress, elevate extremity; surgical intervention may be necessary
What should you do if you notice a slowed or stopped IV rate, pain, redness, swelling and engorged peripheral veins with a CVC?
Stop infusion, notify MD, request diagnostic study; thrombolytic agents may be used to lyse the clot
What are urokinease and streptokinase? How are they used?
Thrombolytic agents; inject into line for 3-5 miutes, then aspirate residual
What should you do if you notice swelling, bruising and pain when an IV is initially inserted?
Remove IV catheter, apply light pressure, elevate and apply cold compress for the first 24 hours, then apply warm compresses for comfort
What should you do if you notice swelling, redness, tenderness, warmth and purulent or malodorous drainage at an IV site?
Remove catheter with sterile technique, clean site with alcohol, cover with sterile dressing, send catheter for culture if ordered
What should you do if you notice cramping or pain at or above insertion site, slowed IV rate and localized numbness?
Temporarily slow IV rate and apply warm compress
What should you do if you notice cramping or pain at or above insertion site, localized numbness and an inability to withdraw IV catheter when attempting to remove an IV catheter?
Reapply dressing, apply heat, encourage patient to drink warm fluids, keep extremity covered and dry; 12-24 hours may be necessary before removing catheter
What should you do if you notice tingling or numbness when inserting an IV catheter?
Immediately stop if patient reports extreme pain; remove catheter if sx are not resolved once IV is secured
Define intraosseous therapy.
IV therapy with access placed into the red marrow of bones; used in emergency when IV access cannot be obtained
