Intravenous Infusion

Question 1

Efficient and effective way of administering medications and supplying fluids

Answer 1

Intravenous Therapy

Question 2

Reasons for IV therapy (4)

Answer 2

1. Replaces and maintains balance of fluids and electrolytes
2. Administration of medications
3. Administration of blood and blood products
4. Delivers nutrients and nutritional supplements

Question 3

Guidelines for IV therapy (8)

Answer 3

1. Ordered by a physician or a nurse practitioner
2. It is an invasive procedure
3. Maintain aseptic technique
4. Understand indications and duration of IV therapy
5. TKVO
6. There are complications with IV therapy
7. Assess site of insertion for 2 hours prn
8. Assess saline lock site for 12 hours prn

Question 4

Types of Venous Access

Answer 4

Peripheral IV and Central Venous Catheter

Question 5

It is a short term method for IV therapy and done through a subcutaneous venipuncture through the peripheral vein

Answer 5

Peripheral IV

Question 6

Guidelines in removing PIV (6)

Answer 6

1. Every 72 to 96 hrs prn
2. If client is stable and no longer requires IV therapy
3. If client is stable and needs an insertion of a cannula in an area of flexion
4. If there is inflammation, redness or purulent drainage from insertion site
5. If new administrations set is needed
6. If there are several potential complications

Question 7

Potential complications: Inflammation of inner lining of nerve (tunica intima)

Answer 7

Phlebitis

Question 8

Mechanical & Chemical causes of Phlebitis

Answer 8

• Rubbing of cannula (irritation) on inner lining

- Use of medications that are high in alkaline, acidic or hypertonic

Question 9

Treatment for Phlebitis

Answer 9

• Remove cannula
• Elevate arm and apply warm compress to IV site
• Document and insert new IV set if necessary

Question 10

Potential complications: Inadvertently administering non-vesicant solution on surrounding tissues

Answer 10

Infiltration

Question 11

Treatment for Infiltration (4)

Answer 11

• Remove cannula
• Follow agency policy
• Secure with gauze or any IV stabilization device
• Avoid areas of flexion and assess IV site before administration

Question 12

Potential complications : Inadvertently administering vesicant solutions (medication) to surrounding tissues

Answer 12

Extravasation

Question 13

Treatments for Extravasation

Answer 13

Stop and remove infusion, follow agency policy

Question 14

Potential complications : Bleeding at IV insertion site

Answer 14

Hemorrhage

Question 15

Treatment for Hemorrhage

Answer 15

• Apply gauze at site to stop bleeding

- Apply transparent sterile dressing

Question 16

Systemic complications: Purulent drainage from IV site 2-3 days after insertion

Answer 16

Local Infection

Question 17

Treatment for Local infections

Answer 17

• Remove IV infusion while practicing sterile technique

- Monitor for signs and symptoms for systemic infections

Question 18

Systemic complication: Fluid overload or circulatory overload.
- Fluid accumulation in lungs due to accumulation of fluid in circulatory system.

Answer 18

Pulmonary edema

Question 19

Systemic complication: Presence of air in vascular system

Answer 19

Air embolism - caused by air introduced in the venous system which travels into the right ventricle and enters the pulmonary circulation

Question 20

Treatment for Air embolism (4)

Answer 20

• Occlude source of air entry
• Position client in Trendelenburg on their left side
• Apply oxygen at 100%
• Obtain Vital signs & Notify physician

Question 21

Systemic complication: Tip of cannula has broken off and is in the vascular system

Answer 21

Catheter Embolism - check tip of cannula when removing it

Question 22

Systemic complication : Microorganisms introduced in bloodstream through IV site, hub or IV tubing and solution

Answer 22

Catheter-related bloodstream Infection ( CR-BSI ) - Leads to bacteremia or sepsis

Question 23

Treatment for CR - BSI

Answer 23

Antibiotic therapy and for prevention, proper hand hygiene…

Question 24

It is known as a central venous line or access and its administered by inserting the IV catheter into a large vein in the central nervous system to the superior vena cava and an area right above the right atrium

Answer 24

Central Venous Catheter

Question 25

Guidelines or Contraindications for CVC insertion (10)

Answer 25

1. Require antineoplastic medications 2. For those who are chronically ill 3. Require vesicants or irritant medications 4. Require central venous pressure monitoring 5. Rqr. long term venous access or dialysis 6. Rqr. toral parenteral nutrition 7. Rqr. meds greater than ph 9 or less than 5; and osmolality greater than 600 mOsm/L 8. Rqr. toxic or multiple meds 9. Have poor vasculature 10. Had multiple PIV insertions/attempts

Question 26

Potential complications with CVC ( 9 )

Answer 26

1. Pulmonary edema 2. Mechanical complications 3. CR-BSI 4. Infection at insertion site 5. CR- thrombosis 6. Air embolism 7. Occlusion of CVC 8. Damage to CVC line 9. Catheter migration

Question 27

Inserted directly through the skin and internal or external jugular vein or subclavian or femoral vein is used.

Answer 27

Percutaneous CVC(PCVC)

Question 28

Can be inserted at home, bedside or radiology setting.

Answer 28

Peripherally inserted central catheter (PICC)

Question 29

- Hickman,Boviac,or groshong | - Long term CVC which passes through subcutaneously and exits out of the skin

Answer 29

Subcutaneous or tunnelled central venous catheter (SCVC)

Question 30

Inserted into the body and is attached to a reservoir or port located under the skin

Answer 30

Implanted Central venous catheter (ICVC)

Question 31

IV FLUIDS

Answer 31

Crystalloid | Colloid

Question 32

Contains large molecules that cannot pass through the semi-permeable membrane ; used to expand intravascular volume

Answer 32

Colloid solutions

Question 33

Contains solutes such as electrolytes which can be easily mixed and dissolved in solutions

Answer 33

Crystalloid solutions

Question 34

Type of crystalloid solutions

Answer 34

Isotonic Hypotonic Hypertonic

Question 35

- osmolality is between 250-275 mOsm/L - increases intravascular volume - used for nausea,vomiting, diarrhea,shock,metabolic acidosis and resuscitations

Answer 35

Isotonic solutions

Question 36

- less than or equal to 250 mOsm/L - low conc. of solutes - cells will swell and may deplete fluid from vascular spaces

Answer 36

Hypotonic solutions

Question 37

- greater than or equal to 375 mOsm/l - higher conc. of solutes - can cause intravascular fluid overload and pulmonary edema

Answer 37

Hypertonic solutions

Question 38

-can be macro drip (10,15,20 gtts/ml) or micro drip (60 gtts/ml)

Answer 38

Primary IV tubing

Question 39

- used for secondary IV meds

Answer 39

Secondary IV tubing

Question 40

IV solution bags should have the following:

Answer 40

- date, time and initials of healthcare provider | - Add-on devices should be changed every 96 hrs.

Question 41

IV should be changed if:

Answer 41

- it is disconnected or contaminated - if its less than 100 ml - if there is cloudiness or precipitates - if its outdated ( equipment, IV set and solutions )

Question 42

Primary tubing with crystalloid solutions

Answer 42

every 72-96 hours

Question 43

Secondary or intermittents solutions

Answer 43

every 24 hrs

Question 44

infusions containing fat emulsions

Answer 44

every 24 hrs

Question 45

Blood and blood products

Answer 45

every 4 hours

Question 46

Ways in regulating IV fluid rates

Answer 46

- Gravity | - Electronic Infusion device

Question 47

Factors influencing flow rate

Answer 47

1. Tube occlusion 2. Vein spasms 3. Height of fluid container 4. Location / position of iv cannula 5. Infiltration or extravasation 6. Accidental bumping or touching of control clamp 7. Raising arm above heart level 8. Needle or cannula gauge diameter