VIHA Package on IV

Question 1

How often to flush IV?

Answer 1

q8-12hrs

Question 2

What to do when discontinuing intermittent infusion (it has finished)

Answer 2

flush line

Question 3

What is a continuous infusion?

Answer 3

Infusion of IV soln at constant rate

- May be primary infusion

Question 4

What is the most common way to admin IV meds?

Answer 4

Secondary infusion (Piggyback)

Question 5

What is an IV bolus vs an iV direct vs IV push?

Answer 5

Bolus = concentrated med or soln given over short period of time via infusion set of IV direct
* could be 1000mL!

IV direct = admin of med through syringe over specified period of time (GREATER than 1 MINUTE)

IV PUSH = rapid admin of bolus of med via syringe (in class said

Question 6

Indication for IV push?

Answer 6

Used when need rapid response

Question 7

KVO?``

Answer 7

Keep Vein Open

Refers to maintenance of vascular access device for fuure requirements of IV tx
- May include extension set with cap or continuous infusion with low rate

Question 8

How do you know the rate for KVO?

Answer 8

Continuous infusions for KVO MUST contain a specific rate of infusion as ordered by the physician

Question 9

What to do if you can’t flush or aspirate the peripheral line?

Answer 9

Remove it

Question 10

What to check if you’re able to flush the peripheral line with some resistance?

Answer 10

Assess IV tubing to see if kinked (either higher or at the insertion site)

Question 11

Minimum size syringe for flushing CVC?

Answer 11

10mL

Question 12

How often is CVC dressing changed initially after insertion?

How often then for transparent and gauze dressings and caps?

Answer 12

Initial dressing changed 24 hrs post insertion

• Transparent dressings and caps q 7days and PRN
• Gauze dressings and cap(s) q 2days and PRN

Question 13

WHen does an xray need to be completed if you see a shift in the external segment of a CVC?

Answer 13

Adults movement > or equal to 5cm

Children > or equal to 1cm

Question 14

Tubing change for CVC?
Continuous
Intermittent
TPN

Answer 14

q96hrs if continuous infusion

q24hrs if intermittent use or TPN infusion

Question 15

Flushing CVC

- What to do first?

Answer 15

• Aspirate to ensure patency
• Flush with 10mL NS pre and post meds
• Lock catheter with 3mls heparin lock solution q24hrs and after intermittent use

Question 16

If you get to a patient and see that their PICC external segment has moved more than 5cm…can you proceed with care?

Answer 16

NO! Not until have had xray

Question 17

When should measurement of the PICC line external segment occur?

Answer 17

on the first visit as well as prior to any episode of care (flushing, dressing change, etc.)

Question 18

What’s done at the PICC insertion site post insertion?

Answer 18

Moist warm compresses TID X20 min for 1st 3 days

Question 19

Can person use arm after PICC insertion?

Answer 19

Yes, encourage regular use of arm

Question 20

Is some bleeding normal after pICC insertion?

Answer 20

Yes, some expected for first 24-48hrs.

If dressing is leaking or site cannot be visualized, should do dressing change

Question 21

WHen is tubing change done for PICC line?

Answer 21

????
I don’t get this…see PICC care plan

When administering meds via intermittent infusion to gravity change needleless connector and extension tubing q 3-4days along with changes of the med admin set tubing

When administering meds via CADD pump, all tubings and needless connector should be changed Q 4 days

For maintenance line care such as weekly flushing and dressing changes, change the needleless connector and extension tubing Q 7 days during these visits or when:

• leaking
• blood contamination
• removed for any reason

Question 22

What to do before flushing PICC?

Answer 22

Measure it

Question 23

What to do if can’t visualize numbers on PICc external segment to measure?

Answer 23

Can use dental floss and measuring tape

Question 24

How often do you flush a PICC if it’s not in use?

Answer 24

q7 days

Question 25

What does U.S.A.S. stand for as acronym for flushing a PICC line?

Answer 25

Unclamp
Scrub
Access (blood return?)
Saline

Question 26

How long to scrub PICC before flushing?

Answer 26

15-30seconds

Question 27

When checking for blood return, what to do if syringe becomes contaminated with blood? If doesn’t?

Answer 27

If does - discard

If doesn’t - can use this one + one more 10mL syringe (2nd and 3rd = 20mL total flush)

Question 28

When do you check for blood return?

Answer 28

Prior to flushing and before admin of any med.

does this mean twice if you’re flushing before a med??

Question 29

Do you need to clamp the CVC following flushing?

Answer 29

If using extension tubing apply clamp when flush is finished. If not using extension tubing there is no need to camp (the Groshong valve prevents backflow)

Question 30

When cleansing during dressing change over CVC, how long does it need to dry?

Answer 30

Allow 1 full minute per swab for drying - 3 full minutes total when using chlorhexidine swabs with alcohol

Question 31

What to assess when doing dressing change over PICC?

Answer 31

• Change q7 days
• Check insertion site for redness, drainage, etc
• Measure external segment
• Palpate insertion site up to axilla to assess for induration, pain, or redness

Question 32

Should you use the PICC line for high-pressure injections such as IV push meds?

Answer 32

No (??

Question 33

Client teaching following PICC removal?

Answer 33

Teach to keep band-aid on for 24 hours

Do not soak in tub or go swimming for 24 hours