IV Therapy Ch.41

Question 1

What is the purpose of intravenous therapy?

Answer 1

• to address fluid and/or electrolyte imbalance
• Administering medication
• Blood and blood components
• Parenteral nutrition

Question 2

What does the provider order?

Answer 2

the specific type and volume of a solution to be administered is identified by the prescriber

Question 3

What is the nurse responsible for?

Answer 3

initiating, monitoring, and discontinuing therapy
- critically evaluating the prescribed intervention before administering
- if they have any concerns about the type or amount of IV therapy prescribed they should immediately and clearly communicate that to the prescribing practitioner
- must understand the rationale for the use of IV therapy, the type of solution being used, its desired effect, and potential adverse reactions

Question 4

What does VAD stand for and how does the healthcare team decide what kind of VAD is best for the client?

Answer 4

Vascular Access Devices (VADs)

• length of time the infusion therapy is needed
• type of medication or product that will be delivered intravenously
  -patient’s vascular condition
• patient’s health status
• individualized needs

Question 5

What does the Infusion Nurses Society recommend for VAD selection?

Answer 5

to select the least invasive VAD with the smallest outer diameter and fewest number of lumens needed for the prescribed therapy

Question 6

What are the 3 big categories of VADs?

Answer 6

1. Peripheral venous catheter
2. Midline catheter
3. Central venous access devices (CVADs)

Question 7

Peripheral Venous Catheter

Answer 7

Peripheral intravenous catheters (PIVCs) inserted into and reside in veins of the periphery that include all extremities, the external jugular vein and scalp veins in neonates

Question 8

Most common types of Peripheral vascular catheters

Answer 8

1. Short PIVCs - inserted into superficial veins
2. Long PIVCs - inserted in either superficial or deep peripheral veins

Question 9

When is a short PIVC preferable?

Answer 9

long PIVCs are an option when a short PIVC is not long enough to adequately cannulate the available vein or the vessel is difficult to palpate or visualize with the naked eye

Question 10

What therapies is a PIVC is not appropriate for?

Answer 10

• vesicant chemotherapy
• drugs classified as irritants or PN

Question 11

When the anticipated duration of infusion therapy will be brief
( <4 days) what type of catheter will be used?

Answer 11

PIVC

Question 12

When is a midline catheter more appropriate?

Answer 12

when the anticipated duration of infusion therapy will be 5 to 14 days and peripheral infusion is appropriate, insert a midline catheter

Question 13

Describe a midline catheter. How long is it? Where does the tip of it lie inside the patient?

Answer 13

• Inserted peripherally into the upper arm into the basilic, cephalic, or brachial veins
• Longer than PVCs (>3 inches)
• Distal tip terminates in the basilic, cephalic, or brachial vein, at or below the axillary level and distal to the shoulder

Question 14

A midline catheter must not be used like a ___________

Answer 14

central line and should NOT be used to continuously infuse vesicants, solutions with extremes of pH or osmolarity, or PN

should be avoided for patients with a history of:
- thrombosis
- hypercoagualability
- decreased venous flow to the extremities
- end-stage renal disease

Question 15

The nurse should use the _______ gauge device that will do the job.

Answer 15

smallest

Question 16

What gauge is recommended for most infusions?

Answer 16

20 to 24-gauge catheter

Question 17

When is a 22-26 g appropriate?

Answer 17

for neonates, pediatric patients, or older adults, and patients with limited venous options to minimize insertion-related trauma

Question 18

True or False:

IV sites should be moved routinely such as every 72 hours.

Answer 18

False:

current guidelines and research support maintaining peripheral IV access devices until no longer clinically indicated (discontinuation; not used for 24 hours; no longer included in plan of care) or a systemic infection

Question 19

When is a CVAD appropriate?

Answer 19

should be considered when the anticipates duration of infusion is >15 days

Question 20

Where does the tip of a CVAD lie in the patient’s body?

Answer 20

tip of the catheter terminates in the central venous circulation, usually in the lower 1/3 of the the superior vena cava near its junction with the right atrium

Question 21

What must be completed before a CVAD is used?

Answer 21

ALL CVADs requires radiographic confirmation of position after insertion and before use

Question 22

Note the four types listed on p. 1696. Be able to identify each of these.

Answer 22

1. Peripherally inserted central catheter (PICC)
2. Non-tunneled percutaneous central venous catheter
3. Tunneled percutaneous central venous catheter
4. Implanted port

Question 23

PICC

What does PICC stand for?
Who inserts it?
Where does it enter the body?
What are advantages of the PICC?

Answer 23

• peripherally inserted central catheter
• a specially trained RN or other advanced practice professionals
• into a peripheral vein (basilic, brachial [preferred]), or cephalic veins) above the atecubital fossa

Advantages:
- Can remain in place for an extended period of time (6 months to a year or 18 month if no complications arise)
- obtaining blood samples
- associated with less risk of complications than other CVADs (such as nerve damage, stenosis, and pneumothorax) because it’s inserted peripherally

Question 24

Nontunneled

Where does the nontunneled CVC enter the body?
Why are they typically used?

Question 25

Tunneled

Where does the tunneled CVC enter the patient’s body?
What does it tunnel through?
What is its advantage?

Question 26

Implanted port

What are the advantages of a port?

Question 27

What is a CLABSI?