1
Q
What type of technique is used Every Time you start (initiate) or work with (maintain) an IV site or infusion?
A
Careful ASEPTIC technique
2
Q
What happens to the $$ your facility receives if a client in your care gets a CRBSI (catheter-related bloodstream infection)
A
Won’t be reimbursed
3
Q
Over the needle
A
“angiocaths” (ideal for brief therapy) a catheter is threaded over a metal needle which pierces the skin. Retract the metal needle, leaving the plastic catheter
4
Q
Inside the needle
A
catheter is inside the metal needle which is retracted after used to pierce the skin
5
Q
Butterfly
A
(scalp vein needle or wing tipped catheter) short metal needle with plastic flaps on the shaft.
6
Q
What is the disadvantage of a butterfly?
A
More likely to damage the vein and infiltrate (allow fluid into interstitial space)
7
Q
What is a butterfly commonly used for
A
Usually for intermittent or short term therapy for children and infants, single dose meds or drawing blood
8
Q
Midline
Usually inserted where?
A
Antecubital fossa then advanced into larger vessels in upper arm
9
Q
Midline Can be left inserted for how long?
A
1-4 weeks
10
Q
What is a midline easily confused with?
A
PICC
11
Q
Why is a peripheral IV lock placed?
A
Established a venous route for pts who’s conditions may change rapidly or require intermittent infusion therapy
12
Q
Peripheral IV lock - What are the names commonly used for this?
A
saline lock, prn adapter, heparin lock
13
Q
Peripheral IV lock - Since no fluid is running through it, what is the lock flushed with to keep it from clotting closed?
A
NS or a dilute heparin solution
14
Q
central venous access device (CVAD)
A
Intravenous line inserted into a major vein
15
Q
Which veins are CVADs commonly placed into?
A
Subclavian or internal jugular using SURGICAL ASEPSIS
16
Q
Where does the end or tip of the catheter go for Central lines
A
Superior vena cava
17
Q
advantages of Central lines
A
ADVANTAGES
- Can accommodate highly irritating and hyperosmolar solutions bc blood and solution mix rapidly
- central veins are accessible even w fluid depletion
- can be used to monitor central venous pressure
- can be left in longer than peripheral IVs
- nutrition given parenterally
- phlebitis and infiltration < likely
- can have extra ports to withdraw blood
18
Q
disadvantages of Central lines
A
- specialized training is needed
- consent required
- placing and dressing changed requires STRICT STERILE technique
- placement confirmed by radiography
- risks (sepsis, air embolus, ventricular dysrhythmias, or pneumothorax)
19
Q
preventing CLABSIs (Central Line-Associated Bloodstream Infections)
A
- education and training (encourage pts to report changes or irritation)
- hand hygiene (WASH HANDS)
- full barrier precautions for insertion (sterile drape, hat, mask, sterile gown and gloves)
- optimal cath site selection (subclavian has lowest infection rate and try to avoid femoral)
- chlorhexidine skin antisepsis ( use 2% chlorhexidine in 70% alcohol to prep
- type of cath (fewest ports lessen risk for infection
- daily line review (remove as soon as not needed
20
Q
PICC
A
- peripherally inserted central catheter // are long, soft and flexible catheters
- antecubital fossa through basilic or cephalic vein in arm
- a qualified provider inserts it
21
Q
Nontunneled
A
- sutured into place, aka single, double, triple or quadruple lumen catheters (shorter use than PICC <6 weeks and not routinely placed)
- jugular or subclavian and occasionally femoral
22
Q
Tunneled
A
- intended for long term use. One end comes out of the skin and sutured in place and tunneled through skin rather than veins and have lower risk of infection
- subq tunnel in the chest then into jugular or subclavian
23
Q
Implanted port
A
- made or radiopaque silicone and an injection port with self sealing septum
- enters internal jugular then tunneled or untunneled to a port in the upper chest
- inserted by surgeons and only specially trained nurses can access it
24
Q
Where is IOs (Intraosseous) access placed?
A
Matrix of the bone and most common site is proximal tibia for adults and children, sternum and head of humerus for adults.
How long is it left in place? Immediate access (seconds) or short term (< 24 hours)
25
What are complications of IOs
Osteomyelitis and don’t use for obesity, fracture, recent surgery, infection or poor circulation at site)
26
16g to 18g
for rapid infusion, thick fluids, surgical or trauma pts
27
20g
adult blood transfusions
28
20g to 22g
adult peripheral transfusion
29
macrodrip
delivers 10-20 drops per mL of solution (for most adult infusions)
30
microdrip
deliver 60 drops per mL or solution (slow infusion rates and for infants and children
31
How many times should you attempt to initiate an IV?
No more than two tries, if you miss the first, go above the initial site or opposite extremity
32
Primary and secondary IV administration sets should be changed how often?
No more frequently than 96 hours, at least every 7 days
33
Intermittent administration sets should be changed how often?
Every 24 hours
34
What is the preferred type of dressing for an IV site? AND WHY?
Transparent semipermeable so you can see the site and permits evaporation or moisture and provide a secure anchor
35
What should you always do AND document when discontinuing an IV?
Inspect to insure its still intact, ensure patient is ready (can take oral and had an adequate urine output and check to order
-document discontinuation, how the site looks, bleeding, discomforts, etc
36
The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. After stopping the infusion, which priority action will the nurse take?
Notify the primary health care provider immediately about the client’s condition.
Take the client’s blood pressure.
Obtain the client’s pulse oximetry.
Assess the client’s respiratory status.
Assess the client’s respiratory status.
The client is experiencing an allergic reaction. Severe allergic reactions commonly cause respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client’s airway is the priority. The nurse must determine the client’s status before notifying the primary health care provider. Vital signs, including blood pressure and pulse oximetry, are obtained after airway patency is ensured and maintained.
79%
37
The nurse assesses a client’s intravenous (IV) site. Which clinical finding leads the nurse to conclude that the IV has infiltrated, rather than caused inflammation?
Pain
Coolness
Localized swelling
Cessation in flow of solution
Coolness
When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (approximately 75°F [23.9°C]), whereas body temperature is approximately 98.6°F (37°C); therefore the client’s skin will feel cool to the touch at the site of an IV infiltration.
38
When administering albumin intravenously, which fluid shift would the nurse anticipate?
Interstitial compartment to the intracellular compartment
Intravascular compartment to the interstitial compartment
Interstitial compartment to the intravascular compartment
Extracellular compartment to the intracellular compartment
Interstitial compartment to the intravascular compartment
39
Which is the primary reason an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium is prescribed for a client with a nasogastric (NG) tube set to low intermittent suction?
Prevent constipation
Prevent dehydration
Prevent vomiting
Prevent electrolyte imbalance
Prevent electrolyte imbalance
When clients do not receive nutrients or fluids by mouth and have a loss of electrolytes through the removal of gastric secretions via an NG tube, electrolyte imbalance is a primary concern. Constipation is usually not a concern in this situation. Although dehydration is a possible effect of an NG tube that removes gastric secretions and fluid, electrolyte balance is still the priority. An NG tube set to low intermittent suction usually relieves nausea and vomiting.
40
A client has a peripherally inserted central catheter (PICC) in place. The client notifies the nurse that the catheter got tangled up in bedclothes and came out. Which action would the nurse take to determine the likelihood of a catheter embolus?
Inspect the catheter.
Obtain an oxygen saturation level.
Observe the catheter insertion site.
Inspect the catheter.
The nurse should first assess the catheter to see if anything may have broken off. Anything that damages the catheter during insertion, dressing change, or excessive force may cause a catheter embolism, which could be a life-threatening situation. If the catheter is broken, the nurse should perform a quick respiratory assessment and take vital signs.
41
A primary health care provider prescribes the application of a warm soak to an intravenous (IV) site that has infiltrated. The application of local heat transferring temperature to the body is which principle?
Radiation
Insulation
Convection
Conduction
Conduction
42
A client’s intravenous (IV) infusion infiltrates. Which factor would the nurse recognize as the cause of the infiltration?
Excessive height of the IV bag
Failure to secure the catheter adequately
Contamination during the catheter insertion
Infusion of a chemically irritating medication
Failure to secure the catheter adequately
Infiltration is caused by catheter displacement, which allows fluid to leak into the tissues. Excessive height of the IV bag will affect the flow rate, not cause infiltration. Contamination during the catheter insertion can lead to infection and phlebitis, not infiltration. Infusion of a chemically irritating medication can lead to phlebitis, not infiltration.
43
How would the nurse position a dehydrated client who is hypotensive while waiting for an intravenous line to be started?
Prone
High-Fowler
Supine with feet elevated 6 inches above the bed
Whatever position is most comfortable for the client
Supine with feet elevated 6 inches above the bed
Feet elevated while keeping head flat or elevated to no more than a 30-degree angle is the best position for dehydration.
44
A 7-year-old child has a peripherally inserted central venous catheter placed into the left arm. A peripheral intravenous (IV) line is still in place, and an antibiotic is to be administered immediately. Which action would the nurse take next?
Connect the IV antibiotic to the peripheral line.
Administer the antibiotic through the central venous catheter.
Order an x-ray confirmation report on central line placement.
Document a verbal prescription on the chart stating the central line can be used.
Connect the IV antibiotic to the peripheral line.
45
Which is the priority nursing intervention for a client with leakage of a vesicant intravenous solution into extravascular tissue via a short peripheral catheter after the nurse has stopped the infusion and disconnected administration set?
Photograph the site.
Administer the antidote.
Aspirate the medication from a short peripheral catheter.
Apply cold compresses for all medications except vinca alkaloids and epipodophyllotoxins.
Aspirate the medication from a short peripheral catheter.
46
A client will be discharged with a peripherally inserted central venous catheter (PICC) for administration of peripheral parenteral nutrition (PPN). Which instruction would be appropriate for the nurse to include in the client’s discharge teaching?
Learning how to change the percutaneous catheter
Determining which days to self-administer the PPN solution
Arranging for professional help monitor the alternative nutrition
Scheduling administration of the PPN solution around mealtimes
Arranging for professional help monitor the alternative nutrition
47
A client’s intravenous cannula insertion site has become red, swollen, and warm to the touch. Purulent drainage is also noted. Which intervention would the nurse implement?
Temporarily slow the infusion rate to a "keep vein open" rate.
Elevate the extremity slightly above the level of the client’s heart.
Frequently apply cold and warm compresses to the site.
Clean the site with alcohol, remove the cannula, and save for culture.
Clean the site with alcohol, remove the cannula, and save for culture.
A client with redness, swelling, and warmth with purulent drainage at the insertion site may have an infection. The nurse should clean the site immediately with alcohol and remove the catheter (if vesicant medications were not infusing) because of the obvious development of an infection.
48
Which nursing intervention is the priority for the nurse preparing to administer an intravenous (IV) piggyback medication to a client who is receiving a continuous infusion of IV fluids?
Get an additional IV infusion pump for the medication.
Check the compatibility of the medication and the continuous IV solution.
Disconnect the continuous IV solution while administering the piggyback medication.
I
Flush the client’s venous access device to ensure patency.
Check the compatibility of the medication and the continuous IV solution.
49
Which clinical indicators would the nurse expect when an intravenous (IV) line has infiltrated? Select all that apply. One, some, or all responses may be correct
Heat
Pallor
Edema
Decreased flow rate
Increased blood pressure
Pallor
Edema
Decreased flow rate
50
The nurse is to initiate an intravenous line and applies the tourniquet to the selected site. The nurse would release the tourniquet at which time?
After cleaning the insertion site
When the needle enters the vein
As soon as the needle pierces the skin
After the device is secured with tape
When the needle enters the vein
The tourniquet causes the vein to become distended and makes entry into the vein easier. The tourniquet should be removed when the needle enters the vein. Removing the tourniquet after cleaning the insertion site and removing the tourniquet as soon as the needle pierces the skin do not assist the nurse in keeping the vein distended and visible for complete insertion. Keeping the tourniquet on until after the device is secured could cause damage by impairing circulation.
FPCC
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