IV Therapy

Question 1

How many RNs are required for patient identification when administering blood products?

Answer 1

2

Question 2

At what anatomical location do all central lines end in?

Answer 2

Superior vena cava (SVC)

Question 3

Define tunneled CVC.

Answer 3

Tunneled central venous catheter; a portion of the catheter first travels subcutaneously before entering the vein; prevents organisms from reaching the bloodstream

Question 4

Define nontunneled percutaneous CVC.

Answer 4

Nontunneled percutaneous central venous catheter; catheter enters the vein directly and ends in SVC; commonly used for short-term emergent or trauma situations

Question 5

For how long should the hub of a central line be cleaned before use?

Answer 5

At least 30 seconds

Question 6

What should you do if you see a PICC that is not covered?

Answer 6

Assess the site for redness, swelling, drainage; clean and dress the site

Question 7

What is the purpose of a hypotonic IV solution?

Answer 7

Cellular replenishment

Question 8

What is the purpose of a hypertonic IV solution?

Answer 8

To correct fluid, electrolyte or acid-base imbalances

Question 9

What is the purpose of an isotonic IV solution?

Answer 9

Fluid replacement

Question 10

0.9% NaCl: Isotonic, hypotonic or hypertonic?

Answer 10

Isotonic

Question 11

0.45% NaCl: Isotonic, hypotonic or hypertonic?

Answer 11

Hypotonic

Question 12

D5W: Isotonic, hypotonic or hypertonic?

Answer 12

Isotonic

Question 13

D10W: Isotonic, hypotonic or hypertonic?

Answer 13

Hypertonic

Question 14

D5W in 0.9% NaCl: Isotonic, hypotonic or hypertonic?

Answer 14

Hypertonic

Question 15

D5W in 0.45% NaCl: Isotonic, hypotonic or hypertonic?

Answer 15

Hypertonic

Question 16

D5W in 0.225 NaCl: Isotonic, hypotonic or hypertonic?

Answer 16

Isotonic

Question 17

RL: Isotonic, hypotonic or hypertonic?

Answer 17

Isotonic

Question 18

D5W in RL: Isotonic, hypotonic or hypertonic?

Answer 18

Hypertonic

Question 19

What is the first sign of fluid overload?

Answer 19

Thready, rapid, bounding pulse

Question 20

Which complication will be seen if a patient it receiving IV fluid but has no urine output?

Answer 20

Cardiac overload

Question 21

Define CR-BSI.

Answer 21

Catheter-related blood stream infection

Question 22

Which solution is best practice for cleaning the site prior to IV placement?

Answer 22

Chlorhexidine

Question 23

Which assessment is essential before using betadine to clean the site?

Answer 23

Ask for iodine or shellfish allergies

Question 24

How long does betadine need to sit on the skin before it is effective?

Answer 24

2 minutes

Question 25

How can you protect an elderly patient from skin tearing?

Answer 25

Apply a skin barrier before placing adhesive

Question 26

If necessary, how should you remove a patient's hair prior to IV placement?

Answer 26

Clipping; Never shave hair - shaving makes abrasions on the skin and increases risk for infection

Question 27

Define infiltration.

Answer 27

Leakage of IV fluids into surrounding tissue

Question 28

Define extravasation.

Answer 28

Leakage of IV fluids into surrounding tissue with tissue damage

Question 29

Define phlebitis.

Answer 29

Inflammation of the vein

Question 30

Define thrombosis.

Answer 30

Blood clot inside the vein

Question 31

Which signs & symptoms indicate infiltration?

Answer 31

Slowed IV rate, increasing edema around site, blanching or coolness, burning or tenderness, leakage of fluids, absence of blood return

Question 32

Which signs & symptoms indicate extravasation?

Answer 32

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

Question 33

Which signs & symptoms indicate phlebitis?

Answer 33

Pain at IV site, redness, swelling; vein may be hard, cord-like

Question 34

Which signs & symptoms indicate thrombosis?

Answer 34

Slowed or stopped IV rate, pain, redness, swelling, engorged peripheral veins

Question 35

Which signs & symptoms indicate ecchymosis and hematoma?

Answer 35

Swelling, bruising, pain

Question 36

Which signs & symptoms indicate infection?

Answer 36

Swelling, redness, tenderness, warmth, purulent or malodorous drainage

Question 37

Which signs & symptoms indicate venous spasm?

Answer 37

Cramping or pain at or above insertion site, slowed IV rate, localized numbness, inability to withdraw IV catheter

Question 38

Which signs & symptom indicate nerve damage?

Answer 38

Tingling, numbness, decreased pulse, coolness

Question 39

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?

Answer 39

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

Question 40

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?

Answer 40

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

Question 41

What should you do if you notice pain, redness, swelling, and a hard, cord-like vein at a short peripheral IV site?

Answer 41

Remove catheter, apply a warm compress, document using the phlebitis scale, and insert a new IV catheter on opposite extremity

Question 42

What should you do if you notice pain, redness, swelling, and a hard, cord-like vein with a PICC line?

Answer 42

Apply continuous heat, rest & elevate extremity; remove catheter if phlebitis is not resolved within 72 hours

Question 43

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?

Answer 43

Stop infusion, remove IV catheter, apply cold compress, elevate extremity; surgical intervention may be necessary

Question 44

What should you do if you notice a slowed or stopped IV rate, pain, redness, swelling and engorged peripheral veins with a CVC?

Answer 44

Stop infusion, notify MD, request diagnostic study; thrombolytic agents may be used to lyse the clot

Question 45

What are urokinease and streptokinase? How are they used?

Answer 45

Thrombolytic agents; inject into line for 3-5 miutes, then aspirate residual

Question 46

What should you do if you notice swelling, bruising and pain when an IV is initially inserted?

Answer 46

Remove IV catheter, apply light pressure, elevate and apply cold compress for the first 24 hours, then apply warm compresses for comfort

Question 47

What should you do if you notice swelling, redness, tenderness, warmth and purulent or malodorous drainage at an IV site?

Answer 47

Remove catheter with sterile technique, clean site with alcohol, cover with sterile dressing, send catheter for culture if ordered

Question 48

What should you do if you notice cramping or pain at or above insertion site, slowed IV rate and localized numbness?

Answer 48

Temporarily slow IV rate and apply warm compress

Question 49

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?

Answer 49

Reapply dressing, apply heat, encourage patient to drink warm fluids, keep extremity covered and dry; 12-24 hours may be necessary before removing catheter

Question 50

What should you do if you notice tingling or numbness when inserting an IV catheter?

Answer 50

Immediately stop if patient reports extreme pain; remove catheter if sx are not resolved once IV is secured

Question 51

Define intraosseous therapy.

Answer 51

IV therapy with access placed into the red marrow of bones; used in emergency when IV access cannot be obtained