IV therapy use advantage & disadvantage

Question 1

IV cannulation tips and tricks:

Answer 1

start low (distal veins) and work proximally, caution with fragile skin, avoid inner wrist, antecubital is the LAST option, take your time

Question 2

sites to avoid for IV cannulation:

Answer 2

-legs, ankles, & feet
-sclerosed or thrombosed veins
-veins that are knotted or tortuous
-veins below an infiltrated site or areas of phlebitis
-areas of inflammation, disease, bruising, or breakdown
-veins of surgically compromised or injured extremities
-dominant hands (if possible) and extremities with AV shunts

Question 3

considerations for selecting a vein:

Answer 3

condition, reason for the IV, what solution or meds will be used

Question 4

vein evaluation:

Answer 4

palpate (best palpated when engorged) & suitable veins should be round, firm, & elastic

Question 5

selection of catheter size: 14g or 16g

Answer 5

great for trauma or surgery when needing rapid infusions

Question 6

selection of catheter size: 18g

Answer 6

good for patients going into surgery, receiving blood or caustic meds

Question 7

selection of catheter size: 20g or 22g

Answer 7

most common size for adult patients

Question 8

selection of catheter size: 24 g

Answer 8

most common for pediatric patients, can use for adults with small or fragile veins

Question 9

methods of administration: intermittent

Answer 9

medications on scheduled dose daily or several times per day (ex: vancomycin 750 mg/250mL @ 250 mL/hr Q12 hours)

Question 10

methods of administration: continuous

Answer 10

IV solutions continuously (ex: NS @ 100 mL/hr)

Question 11

methods of administration: bolus

Answer 11

specified amount of solution to be administered in a specific time frame (through IV pump or syringe - often quickly administered)

(ex: 10 mL of drug A to be admixed with 100 mL of NS and infused over 30 min)

Question 12

methods of administration: push

Answer 12

specified amount of medication to be administered in a specific time frame (through IV syringe ONLY)

(ex: 20 mg pantoprazole IVP over 2 min)

Question 13

IVs that are being used intermittently are commonly referred to as an “____”

Answer 13

“I N T”

Question 14

continuous has fluids continuously infusing, can be used for _____, ______ ______, or both depending on the Pt’s needs

Answer 14

hydration, electrolyte replacement

Question 15

IV bolus can be administered via a(n) ___ ____ OR with a _____

Answer 15

IV bag; syringe

Question 16

an IV push is only administered via a _____ and pushed in via the _____

Answer 16

syringe; plunger

Question 17

nurse’s responsibilities for IV therapy:

Answer 17

assess IV site for any irritation/or infection, patency, adverse reactions, teach the patient, and restart any questionable peripheral sites

Question 18

where do you apply the tourniquet for IV therapy?

Answer 18

approx. 4-6 inches above insertion site

Question 19

IV medication advantages:

Answer 19

direct access to circulatory system -> instant drug action and drug termination, rapid treatment, better control of rate, great for those with GI tract limitations, good for meds that irritate gastric mucosa

Question 20

IV medication disadvantages and complications:

Answer 20

reconstitution errors, venous spasms, drug incompatibilities, impaired drug absorption, speed shock, chemical phlebitis, extravascular of vesicants, air embolism

Question 21

air embolism:

Answer 21

air enters the central veins

Question 22

air embolism: causes

Answer 22

solutions runs dry, air in tubing, loose connections, improper removal of CVAD, poor technique with dressing or tubing changes

Question 23

air embolism: S&S

Answer 23

dyspnea, tachypnea, lightheadedness, palpitations, drop in BP, weakness, cyanosis, and expiratory wheezes

Question 24

air embolism: intervention

Answer 24

call for help, position patient in trendelenburg on THEIR LEFT SIDE, administer oxygen, monitor VS, and have emergency equipment ready

Question 25

complications of IV therapy: fluid overload

Answer 25

too much fluid overloads the circulatory system

Question 26

complications of IV therapy: infection

Answer 26

localized or systemic

Question 27

complications of IV therapy: phlebitis

Answer 27

irritation to vein; mechanical or chemical

Question 28

complications of IV therapy: infiltration

Answer 28

fluid seeps into tissue

Question 29

complications of IV therapy: extravasation

Answer 29

infiltration of any caustic medication into tissue

Question 30

chemical phlebitis:

Answer 30

inflammation of a vein associated with chemical irritation

Question 31

causes of chemical phlebitis:

Answer 31

too rapid of infusion, presence of particulate matter in solution, improper dilution or reconstitution when preparing meds, and administration of irritating meds

Question 32

prevention of chemical phlebitis:

Answer 32

use an in-line filter for meds that do not reconstitute completely, increase volume of dilution, CVAD or larger peripheral veins for IV site, slow the rate of infusion, and restart any questionable IVs

Question 33

infiltration:

Answer 33

fluid leak into tissue around the vein

Question 34

infiltration S&S:

Answer 34

does not irritate the tissue, pain or burning at IV site, skin tightness at site, blanching/coolness of skin, and dependent edema

Question 35

infiltration: interventions

Answer 35

stop infusion, remove IV line, place a new IV line, continue to monitor infiltrated site and call physician if needed

Question 36

extravasation:

Answer 36

infiltration of a vesicant drug

Question 37

S&S of extravasation

Answer 37

pain or burning at IV site, skin tightness at site, blanching/coolness of skin, and dependent edema

Question 38

____ are the safest for administration of vesicant drugs

Answer 38

CVADs

Question 39

extravasation: prevention

Answer 39

dilute meds as recommended, avoid use of high-pressure pumps, assess & monitor IV site, teach pt what to report

Question 40

venous spasm:

Answer 40

sudden, brief, tightening of muscle cells inside the vein

Question 41

causes of venous spasm:

Answer 41

viscous solutions, too rapid administration, cold or irritating solutions

Question 42

symptoms of venous spasm:

Answer 42

sharp pain at the IV site, pain radiating up the arm with the IV site

Question 43

prevention techniques of venous spasm:

Answer 43

dilute meds as recommended, admin solutions and meds at room temperature, admin at recommended rate, restart questionable IVs, and consider a warm compress during infusion

Question 44

IV push preparation example:

Answer 44

HCP ordered: ceftriaxone 1 gm IV daily Pharmacy dispenses: 1 gm vial of ceftriaxone to be reconstituted in 10 mL sterile water the nurse uses a sterile syringe with a blunt fill needle to access sterile vials

Question 45

IV push administration:

Answer 45

follow 7 rights, verify pt allergy/status, scan pt's arm band, scan med vial and verify with eMAR (3rd check), HH & don clean gloves, remove alcohol permeated cap from IV lumen --> clean needle-less connector access with alcohol pad for 15 seconds

Question 46

IV push administration continued once you get ready to administer with syringe to catheter:

Answer 46

-purge air from a sterile saline flush -> attach syringe -> flush lumen & catheter with 9 mL -> remove syringe -clean needle-less connector access -> attach medication syringe -> administer med at recommended rate -> remove syringe -clean needle-less connector access -> attach post saline flush syringe -> flush slowly for the first 2-3 mL then vigorously for total of 9 mL -remove flush syringe -> clamp lumen -> attach new alcohol permeated cap

Question 47

figuring drops per minute for gravity infusion:

Answer 47

total volume x drop factor/ time in minutes = gtts/minute mL x gtts / min = gtts/min

Question 48

use ____ ____ included with the tubing delivery system to control the rate of administration

Answer 48

roller clamp

Question 49

IV gravity preparation:

Answer 49

activate vial & reconstitute the medication first -> insert and prime primary tubing to administer via gravity flow (prep of med can be done in med room or the pt room) clamp tubing, remove protection cover from the "set" site on med bag -> remove protective cover from spike and aseptically insert the spike into the "set" site of the bag, squeeze and fill the chamber 1/3 to 1/2 full slowly open the roller clamp and prime tubing to end port (leaving the protective cover on the tubing end)

Question 50

your primary fluid will be your _____,_____, or _____ solution; primary fluid is also called "___ __ ___" on the IV pump

Answer 50

isotonic, hypertonic, or hypotonic solution; guardrail IV fluids

Question 51

"_____ ______" programming are for your medication (abx, pain meds, etc.)

Answer 51

guardrail drugs

Question 52

avoid using ____ ____ on the IV pump because the smart pump can't help with parameters of infusion.

Answer 52

"basic infusion"