Exam 2: IV Therapy

Question 1

What is the indication for a peripheral IV catheter?

Answer 1

Short term use to allow administration of IV meds, fluids, or blood

resuscitation (rapid absorption), routine maintenance, replacement, redistribution

Question 2

What do the various gauge sizes indicate?

Answer 2

Determines infusion flow rate

Question 3

Why is it important to maintain asepsis when placing and accessing an IV site?

Answer 3

Prevent spread of infection

Question 4

What is the process for assessing an IV site?

Answer 4

Location, gauge, visual inspection (bruising, redness, swelling), Infiltration/extravasation/phlebitis

Question 5

What are the signs and symptoms of infiltration, extravasation, phlebitis, and a localized IV infection?

Answer 5

Infiltration and extravasation (Similar in that both fluid entering interstitial area)

Infiltration - skin feel cool, edema
Extravasation - meds cause tissue damage (vesicant: K+, IV contrast, etc.)

Phlebitis: redness and heat at IV site, swelling, purulent drainage, streaking

Question 6

How is infiltration, extravasation, and phlebitis treated?

Answer 6

D/C IV - stop infusion, remove catheter
Warm compress for phlebitis, infiltration
Cold compress and admin antidote for extravasation

Question 7

What is the purpose and the procedure for scrubbing the hub?

Answer 7

Asepsis, alcohol or chlorhexidine for 15-30 seconds and allow to dry

Question 8

Why do we flush an IV catheter? When do we flush an IV catheter?

Answer 8

Ensure patency of catheter
Prevent mixing of medications within the catheter

Accomplish:
Prior to blood sampling
Prior to and after IV med administration
At least every 12 hours when IV not in use

Question 9

When do we discontinue a peripheral IV?

Answer 9

PT D/C
IV has complication
IV therapy is no longer needed as verified with provider

Question 10

What is the definition of a Central Venous Access Device (CVAD)?

Answer 10

Devices with catheters that terminate in a central vein
Ends in superior vena cava?
Have direct access to RA of heart

Question 11

What are the indications for a CVAD?

Answer 11

Long term access to the central venous circulation for administering large volumes of fluid, parenteral nutrition, or for medications that may irritate peripheral vessels
Can draw blood as well

Question 12

How do we confirm a CVAD is available for use?

Answer 12

X-ray to confirm placement
Provider must place order that line is ok to use

Question 13

What is a PICC line and what is it used for?

Answer 13

Peripherally inserted central catheter - catheter tip sits in the superior vena cava
Commonly inserted for long term antibiotic use
Clients may be be discharged with one in place

Question 14

What types of meds are preferred to be given through a CVAD?

Answer 14

Anything is better through a CVAD -> Blood, fluid
Meds that may irritate peripheral vessels (Vesicants)

Question 15

What are the components of a CVAD assessment?

Answer 15

Visualize external elements and insertion area
Ensure line is secure and catheter is not pulled out of body
Assess integrity of dressing and last dressing change
Assess surrounding skin
Line should be flushed to ensure patency

Question 16

When should a CVAD dressing be changed?

Answer 16

If wet, soiled, or dislodged
Every 7 days

Question 17

What is CLABSI?

Answer 17

Central line associated bloodstream infection
Considered a hospital acquired infection

Question 18

How do we prevent CLABSI?

Answer 18

Hand hygiene
Maintaining aseptic technique when accessing device
Avoid insertion in the femoral site
Routine cleaning with chlorhexidine wipes
Scrub access hub with alcohol prior to each use
Remove central lines that are no longer needed
Change dressing as needed/per protocol

Question 19

Where do you find the rate for pushing an IV medication?

Answer 19

Medication order (but not in order?)
Drug reference guide

Question 20

What is the process for pushing a medication through an IV line?

Answer 20

Flush - med - flush
Med injected by syringe directly into an injection site of an existing IV
Administered over short period of time; usually <5 min

Question 21

What is the difference between a continuous infusion and an intermittent infusion?

Answer 21

Continuous: medicated or non medicated. Fluids go for a set rate: maintenance fluids. Meds at set rate for desired pharmacological effect
No end date or time until doc says

Intermittent: method of administering meds at a set interval
Via secondary (piggyback) line
Common with antibiotics

Question 22

Why do we use IV pumps?

Answer 22

Ensures consistent rate that can be changed if needed
Safety

Question 23

What are indications that your client requires blood products?

Answer 23

Hemoglobin, hematocrit
Client is losing blood

Question 24

What is the process for ordering, obtaining and checking blood products?

Answer 24

Order from provider
Patient consent
Assessment
- Baseline vitals with temp,
- Verify IV line is functioning
Patient education
2 nurse check
- Verify blood components delivered were the ones that were ordered
- Client’s blood type is compatible with the delivered product the right pt is receiving the blood

Question 25

When should vital signs be taken when administering blood products?

Answer 25

Prior to infusion
15 min after start of transfusion (RN must stay with pt for first 15 mins)
Conclusion of transfusion

Question 26

What are symptoms of a transfusion reaction?

Answer 26

Allergic rxn
Chills, fever, flushing, hives, SOB, tachy

Question 27

What is the process for treating a transfusion reaction?

Answer 27

Stop blood and remove tubing
Infuse normal saline
Notify provider
Treat s/s
Stay with pt
Send blood and tubing to blood bank