Nsg: IV's

Question 1

Assessment of IV’s

Answer 1

• Bag: Solution, amount left.
• Site: Infection-redness,pain,swelling,discharge, infiltration, phlebitis (inflammation of the vein)
• Change bag q24hrs
• Change tubing q72hrs
• Change site q72hrs (use clinical judgment)

Question 2

What are some IV trouleshooting problems?

Answer 2

1) Incorrect solution
2) Positional IV altering flow rate.
3) Incorrect Flow Rate
4) Iv is behind schedule (Inadequate amount of fluid in 24 hrs)
5) Ive is ahead of schedule (Too much fluid in 24 hrs)
6) Blood in IV tubing
7) Air in IV line
8) Leakage at IV site.
9) Drip chamber is full.

Question 3

What are IV complications?

Answer 3

1) Infiltration
2) Extravasation
3) Phlebitis/Thrombophlebitis
4) Local infection

Question 4

Purpose of a NS lock?

Answer 4

• To maintain venous access without continuous infusion of fluids.
• To reduce risk of fluid overload and electrolyte imbalance.
• To increase pt comfort.

Question 5

How to Flush a NS lock.

Answer 5

Flush every shift to maintain patency, and before+after every med administration (to ensure all med is administered)

• Prepare flush solution
• clean end of injection cap
• Attach syringe to cap
• Flush
• Clamp tubing right before all NS has gone in (prevent reflux and occlusion) and maintains IV access.

Question 6

Interventions for Incorrect Solutions

Answer 6

• Slow rate to KVO until right sloution is hung.
• Assess pt
• Notify MD (SBAR)
• Lab Tests may be ordered (especially if it was a sloution with electrolytes not ordered)
• Incident report

Question 7

Interventions for Positional IV problems

Answer 7

• Repostion limb
• Pt teaching to maintain proper positioning so IV can flow right.
• possible need for an arm board so arm doesn’t bend
• Re-taping the device
• Avoid flexion area.

Question 8

Factors for Incorrect flow rate

Answer 8

-IV bag: Fluid viscosity, height.
-Tubing: kinked, hanging below pt bed lvl, roller clamp not properly adjusted/pt moves roller clamp
-IV site: Position of cannula (against vein wall), contrictive devices (Laying on arm, clothing, clot formation, infiltration, bent arm)
Temp: Hot= vasodilation. Cold=vasoconstriction.
-Pump: Malfunction, battery low, wrong programming

Question 9

Interventions for an IV that’s behind schedule

Answer 9

• Assess for hypovolemia
• Determine factors of slow rate/ fix them.
• recalculate new faster rate for time remainging in shift/day.
• If new rate is >180ml/hr, consider pts condition and contact MD.

Question 10

Interventions for an Iv that’s ahead of schedule.

Answer 10

• Assess for hypervolmemia
• Determine factors for fast rate/fix them.
• Recalculate new slower rate for time remaining in shift/day.

Question 11

Interventions for when there’s blood in the IV tubing.

Answer 11

• Correct arm position.
• Change IV bags early
• Maintain IV bag 1 meter above insetion site
• Flush blood from tubing by temporarily increasing IV rate, if safe for pt.
• Change IV site or Tubing PRN

Question 12

Interventions for Air in IV tubing

Answer 12

Small Bubbles high in tubing:
-Clamp, stretch, flick tubing

Large Bubbles high in tubing:
-Clamp, insert needle +syringe into port below bubble, kink tubing b/w pt and needle, open clamp, aspirate syringe –> IV solution and air will enter syringe, continue till all air is removed.
(The kinked tubing will prevent backflow of blood)

Air in tubing beyong last port:
-Clamp, removing IV drsg, attach 10cc NS syringe to hub of cannula (or as per policy), flush catheter gently, remove syringe, reattach IV tubing, unclamp, document.

Question 13

Interventions for Leaking at IV site

Answer 13

• Replace contaminated tubing
• Remove catheter (high risk of infection) if catheter is compromised
• Insert IV’s in non-flexion areas and connect well.

Question 14

Interventions when IV drip chamber is full.

Answer 14

-Pinch tubing and invert IV bag, squeeze drip chamber into IV bag, hang bag up and release tubing, check for air in tubing.

Question 15

What is infiltration?

Answer 15

Administration of NON-VESICANT fluid or medication into the tissues.
It’s the puncture of the catheter though the vein walls.

Question 16

S/s of infiltration

Answer 16

Swelling
Pallor
IV cool to touch
Pain/Discomfort
Poor/no blood return
Inability to reestablish flow rate

Question 17

What is Extravasation?

Answer 17

Administration of VESICANT fluids/meds into tissues (Solutions that can cause necrosis)

Question 18

S/s of Extravasation and prevention.

Answer 18

Pain
Swelliing
Blisters
Black scabs
TIssues Sloughing

Question 19

What is phlebitis?

Answer 19

Inflammation of a vein with or without a clot.

Question 20

S/s of phlebitis and prevention.

Answer 20

S/s:

• Pain
• Redness
• Swelling
• Change in IV flow rate
• Possible Fever
• Palpable vein.

Prevention:

• Assess IV site q/hr
• Rotation of site q72hrs.
• Avoid felxion area.
• “when in doubt, take it out” to decr. risk of infection.

Question 21

What can cause an infection at the IV insertion site?

Answer 21

• Bacteria on the catheter tip or in the tissue at the insertion tip
• IV >72 hrs
• Poor insertion technique (spectic)
• To and Fro motions of cannula
• Progression of phlebitis

Question 22

S/s of Infection of IV site and prevention.

Answer 22

Signs:
Inflammation
induration
purulent discharge (Pus)
fever
chills
malaise (weak)
confusion
N/V
Decrease in BP (/vasodilation/septic shock)

Prevention:
Strict asepctic technique
Rotate site q72hrs (clinical judgement)
Observe s/s infection

Question 23

Interventions for Infections at IV site

Answer 23

• Remove IV + reinsert a new one @ different site (if suspicious of sepsis)
• Culture IV site, blood cultures
• Monitor pt, check VS (Septic shock)
• Antibiotics prn

Question 24

How to Discontinue an IV

Answer 24

Clamp.
Stabilize limb + IV cannula and remove drsg.
Remove catheter @ lvl of vein (horizontal)
Apply firm pressure to site w/ sterile gauze.
Apply new drsg when bleeding has stopped.
Inspect catheter for completeness.
Document reason for removal, amount of solution infused, and other important data.

Question 25

S/s of Positional IV that changes flow rate.

Answer 25

• Volume of IV infused is not the expected amount
• Drip rate changes visible with pt’s arm position
• Blood in IV tubing.

Question 26

Factors for blood in tubing.

Answer 26

• Position of extremity
• Pressure on arm
• If IV bag is empty.
• Inadequate/missed flushing = vein occlusion.

Question 27

Interventions for Extravasation of IV

Answer 27

• Remove IV
• Notify MD
• Extravasation protocols (Antidotes)
• Close observation of site
• Incident report.