Module 6: IV Therapy

Question 1

What is IV Therapy Used for?

Answer 1

Provide parenteral nutrition
 Transfuse blood products
 Provide a route for hemodynamic monitoring
 Provide a route for diagnostic testing
 Administer fluids and medications

The goal of IV therapy is to
 Maintain and prevent fluid and electrolyte imbalances
 Administer continuous or intermittent medications
 Replenish blood volume

Question 2

Vascular Access Device (VAD)

Answer 2

A short-peripheral IV line can stay in place when not in use and be locked with preservative-free 0.9% sodium chloride (normal saline [NS]) in adults. Then the device can be reaccessed without needing to start a new IV.

 In the case of CVADs, fill a lock with either heparin 10 units per mL or preservative-free 0.9% NS according to the directions for use of the VAD and agency policy

Question 3

IV Solutions - 3 Types, Isotonic

Answer 3

IV solutions fall into several categories based on fluid osmolality: isotonic, hypotonic, and hypertonic. Isotonic solutions have the same osmolality as body fluids.

Isotonic Solutions
Purpose: They are primarily used to replace fluid losses, expand intravascular volume, and treat dehydration without causing significant shifts in fluid between intravascular, interstitial, and intracellular spaces.
Example: Normal Saline
(Used for fluid resuscitation, hyponatremia, and as a vehicle for IV medication administration)
Lactated Ringer’s
(Contains sodium, potassium, calcium, chloride, and lactate (which is metabolized to bicarbonate) and is often used for fluid resuscitation, especially in surgical patients or those with mild metabolic acidosis)
5% Dextrose in Water
(Technically isotonic, but once dextrose is metabolized, it essentially becomes hypotonic, providing free water to the body and primarily serving to replace water losses and treat hypernatremia)

Question 4

Hypotonic IV Solutions

Answer 4

Osmolality: Hypotonic solutions have an osmolality lower than that of body fluids, promoting the movement of water into cells.

Purpose: Used to provide free water for excretion of bodily wastes and to treat cells that are dehydrated due to high osmolar conditions, such as hyperglycemia. They must be used cautiously to avoid causing cellular swelling, which can lead to complications such as cerebral edema.

Examples:
0.45% Sodium Chloride (Half Normal Saline): Often used to treat hypernatremia and provide free water to the body.

2.5% Dextrose in Water: Mainly used for nutritional purposes and as a diluent for IV medication administration.

Question 5

Hypertonic IV Solutions

Answer 5

Osmolality: Hypertonic solutions have an osmolality higher than that of body fluids and draw water out of cells into the extracellular space.

Purpose: Used to rapidly expand intravascular volume by pulling fluid from the interstitial and intracellular spaces, making them useful in treating hypovolemia and edema. Care must be taken to monitor for the risk of fluid overload and cellular dehydration.

Examples:
3% or 5% Sodium Chloride: Used in critical situations to treat severe hyponatremia and cerebral edema by pulling water out of swollen brain cells.

10% Dextrose in Water (D10W): Provides calories and free water but is mainly used for significant caloric intake in parenteral nutrition.

Colloids (like albumin solutions): These are also considered hypertonic and are used to expand plasma volume in cases of shock or severe hypovolemia.

Question 6

CVAD Usage

Answer 6

To prevent infusion-related complications, solutions and
medications with an osmolarity greater than 900 mOsm/L are infused through a CVAD.

Question 7

Reducing complications in infusion therapy

Answer 7

Compared with all other dressing types, the use of
chlorhexidine gluconate (CHG) impregnated dressings, in a patch or in a transparent dressing, is more effective in reducing the incidence of bloodstream infections in CVADs.

 Randomized controlled trials have shown similar outcomes with heparin and sodium chloride lock solutions for keeping multiple-lumen nontunneled CVADs, peripherally inserted central catheters, and implanted ports patent while accessed and when the access needle is removed. There is insufficient evidence to recommend one solution over the other.

Question 8

IV Complication: Infiltration

Answer 8

Stop infusion and remove IV catheter at first sign of
infiltration
 Elevate affected extremity.
 Avoid applying pressure, which can force solution into
contact with more tissue, causing tissue damage

Question 9

IV Complication: Catheter Occlusion

Answer 9

Determine cause and consider catheter removal.
 Positional catheters can be repositioned to improve IV
flow.
 Remove occluded IV catheter. Occluded catheters
should not be flushed

Question 10

IV Complication: Catheter Related Infection

Answer 10

Notify health care provider. Obtain order to culture
drainage.
 Remove IV catheter and culture purulent drainage from around IV site

Question 11

IV Complication: Phlebitis

Answer 11

Notify health care provider.
 Determine cause; consider VAD removal or replacement.
 Chemical phlebitis: Apply heat, elevate limb, and
consider slowing infusion rate.
 Mechanical phlebitis: Apply heat, elevate limb, monitor for 24 to 48 hours, consider catheter removal.
 Bacterial phlebitis: Remove IV catheter
 Evidence does not allow for recommendation of use of topical agents/ interventions
 Document phlebitis using a standardized scale

Question 12

IV Complication: Hematoma

Answer 12

Remove IV catheter, apply pressure and sterile dressing.
 Apply ice and monitor for additional bleeding.
 Elevate extremity and monitor for circulatory,
neurological, or motor dysfunction.

Question 13

IV Complication: Nerve Injuries

Answer 13

Notify health care provider of any signs and symptoms of nerve injury.
 Immediately stop VAD insertion and remove device if
patient complains of symptoms of paresthesia.
 Continue to monitor neurovascular status

Question 14

IV Complication: MARSI develops under adhesive covering IV site dressing (medical adhesive related skin injury)

Answer 14

If site IV site is to remain or if decision is made to remove IV ONC and insert a new one, protect skin with a skin barrier product. An alcohol-free product will not irritate skin if skin is broken.
* Treat affected skin with appropriate emollient.

Question 15

Smart Pump Issue: Solution does not infuse at prescribed rate - sudden large volume of infusion

Answer 15

Sudden infusion of large volume of solution occurs

 Slow infusion rate: KVO rates must have specific rate ordered by health care provider.
 Notify health care provider immediately.
 Place patient in high-Fowler position.
 Anticipate new IV orders.
 Anticipate administration of oxygen per order.
 Administer diuretics if ordered.

Question 16

Solution Runs Slower than Ordered

Answer 16

Check for positional change that affects rate, height of IV container, kinking of tubing, or obstruction.
 Check VAD site for complications.
 Consult health care provider for new order to provide necessary fluid volume

Question 17

Complication: IV patency is lost subsequent to IV solution container running empty

Answer 17

Discontinue present IV infusion and restart new short-
peripheral catheter in new site.

Question 18

Complication: Flow rate is incorrect; patient receives too little or too much solution

Answer 18

Notify health care provider if patient’s anticipated infusion is 100 to 200 mL less than or greater than anticipated (per agency policy and procedure).
* Evaluate patient for signs and symptoms of adverse effects of infusion (e.g., FVD or FVE).
* Determine and correct cause of incorrect flow rate (e.g., change in position, tubing kink, loss of IV patency or intactness).
* Use EID when accurate flow rate is critical.

Question 19

Complication: Fluid and/or electrolyte imbalances

Answer 19

Notify health care provider.
* Anticipate orders for changes in IV solution or additives

Question 20

Complication: IV solution infuses more slowly than ordered.

Answer 20

Check for positional change that affects rate, height of IV container, kinking of tubing, or obstruction.
* Check for patency by opening roller clamp.
* Check VAD site for complications.
* Prepare for insertion of new VAD if existing one is occluded

Question 21

Short-peripheral IV catheters

Answer 21

 Require strict adherence to infection-prevention measures to avoid systemic and local complications

 Stabilization of short-peripheral catheters decreases risk of catheter-related complications

Question 22

IV Dressings - Changing Dressings

Answer 22

Short peripheral catheter transparent semipermeable membrane (TSM) dressing changes should be performed every 5 to 7 days, and gauze dressings every 2 days
 If a gauze dressing is underneath a TSM, it should be changed every 2 days
 Change any dressing immediately when it becomes wet, soiled, or loosened or if the integrity is compromised

Question 23

Complication: IV catheter is removed or dislodged accidentally.

Answer 23

Restart new short-peripheral IV line in other extremity or above previous insertion site if continued therapy is
necessary

Question 24

Complication: IV solution is not infusing or runs more slowly than ordered

Answer 24

Check IV catheter for bending, kinking, or dislodgement
because catheter may require replacement.
* Check for positional IV site and reposition catheter, applying new dressing if necessary.
* Check and adjust height of IV container and for kinking or obstruction of IV tubing.

Question 25

Managing Central vascular access device (CVAD)

Answer 25

The tip of a CVAD should be placed in the upper body in the lower segment of the superior or inferior vena cava at or near the cavoatrial junction.
 Catheter tip configuration can be either open ended or valve ended.
 CVADs can have single or multiple lumens.
 An implanted venous port is a CVAD that has a reservoir placed in a pocket under the skin with the catheter inserted into a major vessel.
 Complications associated with CVADs can include local or systemic infection.
 Care of CVADs requires knowledge of the purpose and function of the devices and prevention of complications.

Question 26

Dimensional Analysis Questions

Answer 26

2.2lbs = 1 kg
30ml = 1 oz
1mg = 1000mcg