Chapter 2 Iv Therapy - Peripheral Iv Therapy

Front 1

1. Describe how you will psychologically prepare a patient for a venipuncture and peripheral infusion: (text, pp. 38-39)

Back 1

• Describe the procedure
IV means in side the vein, how long catheter will remain in place, pain during insertion should subside, IV fluid will feel cold at first
• Do's and don'ts
report any discomfort after the cathetar has been inserted, explain any restrictions, teach patient how to assist in care of IV system
• the worst is over
removing will be less painful!

Front 2

2. Name the equipment you will need to prepare for a venipuncture and IV infusion: (text, pp. 40-43)

Back 2

• solution container: usually plastic, sometimes glass (need vented tubing)
• administration set: basic, add-a-line (secondary), volume control (for small very exact amounts), the more viscous the solution the larger the drops and the fewer drops per mL; usually 70" to 110" long
• in-line filters: located in IV tubing, remove pathogens and particles, help to prevent air from entering the patient's vein (0.2 micron to 170 microns); make sure it can withstand the pumps infusion pressure; primer before use, change according the manufacturer instructions, increase cost so used with immunosuppressed patient, TPN, additives composed of separate particles, high risk of phlebitis

Front 3

3. Name 8 things that should occur in the process of preparing the solution for IV infusion: (text, pp. 44-45)

Back 3

1. check that container size if appropriate for the volume to be infused
2. check to see that the type of IV solution is correct
3. check expiration date
4. make sure solution container is intact
5. ensure solution is not cloudy, turbid, or separated
6. label solution container

Front 4

label the solution container:

Back 4

1. your name
2. patient's name, id number, room number, date/time container was hung, additives, container number

Front 5

4. List the 5 steps for priming a basic administration set: (text, p. 46)

Back 5

1. Close the roller clamp below the drip chamber
2. squeeze the drip chamber until it is half full
3. aim the distal end of the tubing at a receptacle
4. open the roller clam and allow the solution to flow through tubing to remove air
5. close the clamp after all of the air has been purged from the system

Front 6

5. What two additional steps must be taken to prepare a basic set plus an add-a-line set? (text, p. 46)

Back 6

1. Same as priming a basic set, plus
2. invert the backcheck tubes as the solution flows through the tubing
3. straighten the tubing and continue to purge air in the usual manner

Front 7

)8. Describe the proper procedure for dilating a patient’s vein prior t IV catheter insertion: (text, pp. 57-58)

Back 7

1. Use a tourniquet
place in a dependent position or warm by stroking/warm moist towels first
2. after applying tourniquet have patient open and close fist 4-6 times to dislodge the vein; flick the skin over the vein a couple of times
3. If vein does not appear round and firm, and fully filled with blood release the tourniquet
4. should be able to feel radial pulse

Front 8

10.What is the most important assessment parameter when using local anesthetic for a venipuncture? (text, p. 59)

Back 8

check for an allergy!
options: lidocaine, transdermal analgesic cream (takes 30 minutes), iontophoresis

Front 9

11.Describe the procedure for insertion of a venipuncture device: (text, pp. 61-68)

Back 9

1. Stabilize the vein by holding the skin taut and lightly pressing; apply traction with nondominant hand to hold skin and vein in place
2. let patient know you are about to insert the device; ask them to remain still and refrain from pulling away
3. bevel up, enter skin directly over the vein at a 5-15 degree angle; lower the distal portion of the adapter until almost parallel with the skin when needle enters vein
4. Advance device about half its length, should see blood in the flashback
5. if using winged device, squeeze the wings together
6. release the tourniquet within 2 minutes, and before advancing the device

Front 10

Intermittent infusion device:

Back 10

saline lock; used when venous access needs to be maintained; injection cap is self-sealing after the needle or needless injector is removed; can flush with diluted saline to expel air from the equipment.
Plusses: reduces risk of contamination/cost, minimizes risk of fluid overload/electrolyte balance; flush before and after

Front 11

documenting the venipuncture:

Back 11

1. date and time of procedure
2. number of solution container
3. type and amount of solution
4. name and dosage of additives
5. type of venipuncture device used
6. venipuncture site
7. number of insertion attempts
8. flow rate
9. adverse reactions and actions taken to correct them
10. patient teaching and evidence of patient understanding
11. name of person initiating infusion

Front 12

13.How frequently should IV site dressings be changed? (text, p. 71)

Back 12

Gauze dressings every 48 hours; transparent semipermeable if soiled/wet/loose, or every 7 days

Front 13

14.How long should one container of IV solution be allowed to hang? (text, p. 71)

Back 13

24 hours max

Front 14

15.How frequently should the IV administration set be changed? (text, p. 72)

Back 14

every 72 hours or according to agency policy

Front 15

17.What are the signs and symptoms of infiltration? (text, p. 78)

Back 15

infused fluid leaking into surrounding tissues; increased risk near a joint
• swelling around the IV site
• discomfort, burning, or pain at the site
• feeling of tightness at the site
• decreased skin temperature around the site
• blanching at the site
• continuing fluid infusion even when vein is occluded
• absent backflow of blood
• slower flow rate

Front 16

18.What is the cause of IV infiltration? (text, p.78)

Back 16

Venous device punctures the vein wall or migrates out of the vein

Front 17

19.List six appropriate nursing interventions when an IV becomes infiltrated: (text, p.78)

Back 17

1. remove the device
2. apply warm soaks to aid absorption
3. elevate the limb
4. notify the practitioner if severe
5. periodically assess circulation by checking for pulse, capillary refill, and numbness or tingling
6. restart the infusion, preferably in another limb or above the infiltration site
7. document the patient's condition and you interventions

Front 18

20.Identify three nursing actions to help prevent infiltration: (text, p. 78)

Back 18

1. Check the IV site frequently
2. Don't obscure the area above the site with tape
3. teach the patient to report discomfort, pain, swelling

Front 19

21.What are five possible causes of an occluded catheter? (text, p. 79)

Back 19

1. IV flow interrupted
2. intermittent device not flushed
3. blood back-up in line when patient walks
4. hypercoagulable patient
5. line clamped too long

Front 20

22.What would appropriate nursing intervention be for an occluded catheter? (text, p. 79)

Back 20

1. Use a low pressure syringe during injection. Do not use force
2. Reinsert IV device if cannot clear

Front 21

23.What nursing interventions might prevent occlusion of the catheter? (text, p. 79

Back 21

1. Maintain IV flow rate
2. Flush promptly after intermittent piggyback administration
3. Have patient walk with their arm below heart level to reduce the risk of blood back-up

Front 22

25.Describe the appropriate technique for discontinuing a peripheral IV: (text, p. 83)

Back 22

1. Gloves on, lift tape from skin to expose the insertion site
2. avoid manipulating device in skin to prevent skin organisms from entering the bloodstream
3. apply sterile 2x2 dressing over site and remove device
4. maintain direct pressure on IV site for several minutes, then tape a dressing over it, do not encircle limb
5. tell patient to restrict activity for 10 minutes and leave dressing in place for about 8 hours
6. properly dispose of used equipment
7. document time of removal, catheter length and integrity, condition of the site, how patient tolerated and any nursing interventions

Front 23

26.Define mechanical phlebitis: (text, p. 322)

Back 23

Painful inflammation of the vein, possibly the most common peripherally inserted catheter complication, may occur during the first 24-72 hours after insertion; more common in left-sided insertions and when a large gauge catheter is used

Front 24

27.Define over-the-needle catheter: (text, p. 323)

Back 24

the most commonly used peripheral IV device, consists of a plastic outer tube and an inner needle that is removed after insertion, leaving the catheter in place

Front 25

28.Define piggyback line: (text, p. 324)

Back 25

Adjunct of secondary IV line attached to a primary line to deliver medications of solutions IV

Front 26

29.Define butterfly needle: (text, p. 318)

Back 26

common name for a winged infusion set, which has flexible wings that lie flat after insertion and can be taped to the surrounding skin