Techniques for Peripheral IV therapy

Question 1

Veins of the hand

Answer 1

Metacarpal: dorsum of the hand. usually easily visualized. Small veins that should be avoided if infusing irritation ABX, KCl, or chemotherapy agents or using high infusion rate.

Question 2

Radial portion of the lower arm along the radial bone of the forearm. Large vein, easy to access. Avoid area about 4-5 inches above the tub d/t risk for nerve damage. First use most distal section and work upward for long-term therapy. useful for infusing blood and chemically irritating meds.

Answer 2

Cephalic

Question 3

Ulnar aspect of the lower arm and runs up the ulnar bone. Difficult to access because of location. Large vein, easily palpated, but moves easily; stabilize with traction during venipuncture. Often available after other sites have been exhausted.

Answer 3

Basilic

Question 4

Advantages of PIVs

Answer 4

Provides a route for immediate availability to the systemic circulation. Drug absorption more predictable. Blood levels of the drug can be maintained for even distribution and titrated according to the pt’s needs. It provides a reliable route for emergency situations. It is ideal for drugs that cannot be given orally or by other routes. It is often the only available route for the unconscious or uncooperative pt. It is ideal for pts who are nauseated, vomiting, or have GI disruptions. There is less discomfort b/c, once initiated, the site may be accessed for 72 hours or more.

Question 5

Disadvantages of PIVs

Answer 5

There is a greater possibility of a serious allergic rxn occurring because of rapid delivery to the systemic circ. Once administered, IV drug cannot be retrieved. There is a possibility of fluid overload. Should an error occur in dosage or administration, the potential for dangerous outcomes is amplified. There is possibility of infection and sepsis whenever the skin barrier is breached through percutaneous tissue. There is pain assoc. with cannula insertion as well as psychological discomfort assoc. with the knowledge of an indwelling device. There may be impaired mobility, depending on placement. The potential for nerve or vessel damage exists with improper venipuncture technique and incorrect cannula placement. There may be pain assoc with the admin of irritating drugs. Tissue damage can occur with extravasation of vesicants. There is always the potential for phlebitis, thrombophlebitis, or embolization.

Question 6

Veins to avoid

Answer 6

Sites located below previous insertion sites. Phlebotic, infiltrated or bruised areas. Areas of flexion. Anticubital veins as long a possible. Veins of the limb where a radical mastectomy with lymph node striping. Edematous extremity or one that has suffered a 3rd degree burn. Extremity with an AV fistula. Feet and legs of adults or anyone walking.

Question 7

Steps 1-5 of 15 step venipuncture method

Answer 7

Before initiating cannulation:

1) Check the physicians orders
2) Hand hygiene
3) Equipment preparation
4) Patient assessment and psychological preparation
5) Site selection and vein dilatation

Question 8

Vein dilatation

Answer 8

Type of soln. Condition of vein. Duration of therapy. Cannula size (use smallest catheter to do the job you need to do). Patient age. Patient preference. Patient activity. Presence of disease or previous surgery. Presence of shunt or graft. Patient receiving anticoagulation therapy. Patient with allergies.

Question 9

Ways to increase blood flow in the upper extremities

Answer 9

Factors affecting the capacity for dilatation: blood pressure, presence of valves, sclerotic veins, multiple previous IV sites.

Question 10

Ways to dilate vein

Answer 10

Gravity. Fist clenching. Tapping. Warm compresses. Blood pressure cuff. Tourniquet. Multiple tourniquets. Transillumination. Ultrasonography

Question 11

Cannulation

Answer 11

The site must tolerate the rate of flow. The site must be capable of delivering the meds ordered. The site must tolerate the gauge of cannula needed. When possible the pt should be comfortable with the site chosen. The site must not impede the pt’s activities of daily living.

Question 12

Tips for selecting veins

Answer 12

A suitable vein should feel relatively smooth, pliable with valves well spaced. Veins will be difficult to stabilize in a pt who has recently lost weight. Debilitated pts and those taking corticosteroids have fragile veins that bruise easily. Sclerotic veins are common among narcotic addicts and the elderly population. Dialysis pts usually know which veins are good for venipuncture. Start with distal veins and work proximally. Veins that feel bumpy, like running your finger over a cat’s tail, are usually thrombosed or extremely valvular.

Question 13

Steps 6-11 for venipuncture

Answer 13

6) Needle selection
7) Gloving
8) Site preparation
9) Vein entry
10) Catheter stabilization and dressing management
11) Labeling (initial, date, gauge)

Question 14

Steps 12-15

Answer 14

12) Equipment disposal
13) Patient education
14) Rate calculations
15) Monitoring and documenting

Question 15

9 Rights of IV medication administration

Answer 15

1) Patient- confirm right pt and check against ID
2) Drug- confirm correctly prescribed and appropriate for pt
3) Route- IV route suitable
4) Dose- is the dose correct
5) Time- is the time correct
6) Dilution/compatibility
7) Flow-rate
8) Monitoring-crucial to ensure pt response and safety
9) Documentation- record promptly and directly

Question 16

Documentation

Answer 16

Date and time of insertion. Manufacturer’s brand name and style of device. The gauge and length of the device. Specific name and location of the accessed vein. The infused solution and rate of flow. Infusing by gravity or pump. The number of attempts for a successful IV start. Condition of extremity prior to access. The pt’s specific comments r/t the procedure. Pt response, excessive anxiety, pt movement, or an untoward response. Signature

Question 17

Documentation of observation

Answer 17

Tenderness, temperatures at and around the site. Discoloration. Swelling. Draining. Actions taken by the nurse.

Question 18

Discontinuation of IV cannula

Answer 18

Discontinue if the integrity of the cannula is compromised or the physician orders the discontinuation.
1) Put on gloves. 2) Obtain a dry 2x2 gauze pad. Avoid alcohol. 3) Loosen the tape and apply the gauze pad loosely over the site. 4) Remove the cannula and transparent dressing as one unit, without pressure over the site. 5) after the catheter is removed, apply direct pressure with the sterile gauze pad over the site. 6) An adhesive bandage may be applied to the venipuncture site after bleeding is controlled. 7) Document site appearance, how tolerated, appearance of catheter.

Question 19

Catheters are ___ after each intermittent infusion to clear any medication from the catheter and to prevent contact between incompatible medications of IV solutions. When not done properly, a precipitate can form and block the catheter

Answer 19

flushed

Question 20

The layer of the vein that contains smooth muscle, fibrous tissue, and nerve fibers for vasoconstriction and vasodilation is the:

a) tunica media
b) tunica adventitia
c) tunica intima
d) Hypodermis

Answer 20

a) tunica media

Question 21

The vein that follows the radius side of the forearm is the:

a) metacarpal
b) cephalic
c) basilic
d) median cubital

Answer 21

b) cephalic

Question 22

PIV therapy labels should be applied to:

a) catheter site, tubing, and solution container
b) tubing, solution container, and chart
c) solution container, catheter site, and patients armband

Answer 22

a) catheter site, tubing, and solution container

Question 23

Which of the following infusate characteristics is appropriate for infusion through a PIV catheter?

a) osmolarity >60 mOsm/L
b) pH=6
c) pH=4
d) pH=10

Answer 23

b) pH=6

Question 24

Which of the following areas should be avoided for peripheral venous access in an adult pt?

a) mid-forearm
b) inner aspect of wrist
c) dorm of the hand
d) upper forearm

Answer 24

b) inner aspect of the wrist

Question 25

In a dark-skinned person, a good method for locating an accessible vein is:

a) multiple tourniquets
b) tangential lighting
c) direct overhead lighting
d) light application of a tourniquet

Answer 25

b) tangential lighting

Question 26

Which of the following are techniques to dilate a vein for venipuncture in the older adult with fragile veins? (SATA)

a) apply the tourniquet loosely over the pt’s sleeve
b) apply multiple tourniquets
c) Use digital pressure to enhance vein filling
d) use warm compresses before venipuncture

Answer 26

a) apply the tourniquet loosely over the pt’s sleeve

d) use warm compresses before venipuncture

Question 27

The preferred antiseptic solution for skin antisepsis is:

a) povidone iodine
b) tincture of iodine
c) 70% alcohol
d) Chlorhexidine/alcohol

Answer 27

d) Chlorhexidine/alcohol

Question 28

A nurse attempts peripheral venipuncture and fails to access the client’s vein. How many times may a nurse attempt venipuncture before obtaining help from another nurse?

a. Only once
b. No more than twice
c. A maximum of three times
d. A maximum of four times

Answer 28

b. No more than twice

Question 29

A nurse is preparing an IV administration set for a client’s IV infusion. Which administration set must be used with a closed-glass system?

a. A Y-set
b. A vented set
c. A nonvented set
d. A volume control set

Answer 29

b. A vented set

Question 30

A nurse prepares to insert a PIV over-the-needle cannula into a client’s forearm. Before cannulating the vein, which technique should the nurse use to cleanse the entry site with chlorhexidine gluconate/alcohol?

a. Scrubbing from the wrist toward the elbow
b. Scrubbing from the elbow toward the wrist
c. Using a back-and-forth method for at least 30 seconds
d. Using a circular motion outward, working toward the center for 30 seconds

Answer 30

c. Using a back-and-forth method for at least 30 seconds

Question 31

Current Infusion Nursing Standards of Practice (2011) recommend which of the following for routine site care and dressing changed on short-peripheral catheters.

a. Change dressings every 72 hours.
b. Change gauze and tape dressings every 7 days.
c. Routine dressing changes are not performed on PIV unless the dressing is soiled or no longer intact.
d. Change dressings daily.

Answer 31

c. Routine dressing changes are not performed on PIV unless the dressing is soiled or no longer intact.
Peripheral catheter care should be performed after an IV catheter with catheter-site rotation or when the dressing is soiled or no longer intact. Current practice dictates that if the dressing is removed on a functioning intact catheter, the integrity of the catheter could be compromised.

Question 32

A nurse on a medical-surgical unit is assessing a client’s peripheral IV site. According to the Centers for Disease Control and Prevention (CDC), how often should a client’s IV site be rotated?

a. Every 24 to 48 hours
b. Every 36 to 48 hours
c. Every 48 to 72 hours
d. Every 72 to 96 hours

Answer 32

d. Every 72 to 96 hours
Peripheral-short venous cannulas should be scheduled to be replaced every 72 to 96 hours as a method to prevent phlebitis and catheter-related infections. An organization may consider extending the interval for up to 96 hours for routine cannula removal if there is a consistent monthly phlebitis rate of 5% or less.

Question 33

Which principle should a nurse teach first to a client being discharged with home infusion therapy?

a. Use of the equipment
b. Where to obtain supplies
c. How to report signs of infection
d. Proper hand-washing techniques

Answer 33

d. Proper hand-washing techniques

Question 34

A nurse is attempting to obtain venous access on the arm of a male client with a large quantity of body hair. When it is necessary to remove body hair from the intended site of venipuncture and venous cannulation, the nurse’s best intervention would be to:

a. use a surgical-grade depilatory.
b. gently clip the hair with scissors.
c. shave the area using a sterile safety razor.
d. shave the area using either a safety or electric razor.

Answer 34

b. gently clip the hair with scissors.
Shaving the hair is not recommended; instead, clip hair with scissors. Shaving is not recommended because it produces microabrasions. Surgical-grade depilatories are not recommended because of potential allergic reactions to chemicals in the shaving cream.

Question 35

A nurse gathers supplies to remove a peripheral IV catheter. The nurse correctly withdraws the catheter and then applies pressure on the site with a(n):

a. bandage strip.
b. alcohol swab.
c. povidone-iodine swab.
d. dry and sterile 2 × 2 gauze pad.

Answer 35

d. dry and sterile 2 × 2 gauze pad.

Question 36

A nurse is obtaining IV access for the purpose of administering an IV antibiotic. Which peripheral vein would be most appropriate for administration of anti-infective therapy?

a. Hand vein
b. Digital vein
c. Cephalic vein 4 to 5 inches from wrist
d. Median antecubital vein

Answer 36

c. Cephalic vein 4 to 5 inches from wrist
The cephalic vein is most appropriate for the administration of anti-infectives and is located in the radial portion of the lower arm along the radial bone of the forearm; it is a large vein and easy to access. It is very important to choose a site 4 to 5 inches above the wrist because of the potential risk for nerve damage. Both the hand and digital veins are too small for irritating medications such as anti-infectives. The median antecubital vein can support infusions of irritating medications; however, this site is usually reserved for blood withdrawal or emergency access.

Question 37

During a nurse’s initial assessment of a client, the nurse observes that the client’s IV solution is not infusing. Which intervention should the nurse implement first?

a. Notify the physician.
b. Inspect the tubing for kinks.
c. Discontinue the IV infusion.
d. Lower the height of the IV solution container.

Answer 37

b. Inspect the tubing for kinks.

Question 38

A nurse is distending a client’s vein that is normotensive, in preparation for venipuncture. Which is the most appropriate technique for applying a latex/nonlatex tourniquet?

a. Apply the tourniquet 6 to 8 inches distal to the venipuncture site.
b. Loosely apply the tourniquet 2 inches from the venipuncture site.
c. Apply the tourniquet at the very top of the limb and under the arm.
d. Apply the tourniquet 6 to 8 inches proximal to the venipuncture site.

Answer 38

d. Apply the tourniquet 6 to 8 inches proximal to the venipuncture site.

Question 39

A nurse is inserting a peripheral infusion venous (PIV) catheter into a client’s vein and knows that the catheter is correctly placed when which sign is first noted?

a. The catheter advances easily.
b. The vein is distended under the needle.
c. The client does not complain of any further discomfort.
d. There is blood return in the flashback chamber of the catheter.

Answer 39

d. There is blood return in the flashback chamber of the catheter.

Question 40

A nurse educator reviews the anatomical layers of a vein while discussing IV therapy. The nurse educator should state that the three layers of a vein are the:

a. tunica intima, epidermis, and dermis.
b. tunica center, tunica media, and fascia.
c. epidermis, dermis, and subcutaneous fascia.
d. tunica adventitia, tunica media, and tunica intima.

Answer 40

d. tunica adventitia, tunica media, and tunica intima.

Question 41

A nurse is calculating the drip rate before initiating an IV infusion. Upon which factor(s) should the calculation of the drip rate depend?

a. Tubing length and filter size
b. Gauge and length of the cannula
c. Drop factor of the tubing and hourly infusion amount
d. Hourly infusion amount and number of administration ports

Answer 41

c. Drop factor of the tubing and hourly infusion amount