Podcast
Questions and Answers
Which organization is recognized as the global authority in infusion nursing and publishes standards of practice for infusion therapy?
Which organization is recognized as the global authority in infusion nursing and publishes standards of practice for infusion therapy?
- American Association of Colleges of Nursing (AACN)
- Infusion Nurses Society (INS) (correct)
- National League for Nursing (NLN)
- American Nurses Association (ANA)
Which of the following is a primary indication for intravenous (IV) therapy?
Which of the following is a primary indication for intravenous (IV) therapy?
- Long-term nutritional support for patients with intact digestive function.
- Routine hydration for patients who can tolerate oral fluids.
- Providing fast-acting medications during an emergency. (correct)
- Administering oral medications for chronic conditions.
A patient is receiving a continuous IV infusion. What is the MOST important action to ensure accurate medication delivery?
A patient is receiving a continuous IV infusion. What is the MOST important action to ensure accurate medication delivery?
- Verifying the order and using an electronic infusion device (EID). (correct)
- Maintaining the IV bag at least 4 feet above the infusion site.
- Documenting the infusion rate only at the beginning of the shift.
- Using a large-volume bag (1,000 mL) to minimize bag changes.
When administering an intermittent IV medication via piggyback, what is the primary consideration for the nurse?
When administering an intermittent IV medication via piggyback, what is the primary consideration for the nurse?
A nurse is preparing to administer a medication via IV push. What action is MOST critical to ensure patient safety?
A nurse is preparing to administer a medication via IV push. What action is MOST critical to ensure patient safety?
When calculating IV drip rates using a gravity drip set, what information is essential to determine the drops per minute?
When calculating IV drip rates using a gravity drip set, what information is essential to determine the drops per minute?
A patient's IV infusion rate is slower than prescribed. Which of the following actions should the LPN/LVN take FIRST?
A patient's IV infusion rate is slower than prescribed. Which of the following actions should the LPN/LVN take FIRST?
What is the primary purpose of using an in-line filter with an intravenous (IV) administration set?
What is the primary purpose of using an in-line filter with an intravenous (IV) administration set?
A patient is prescribed an isotonic intravenous (IV) solution. What effect does this type of solution have on the body's fluid balance?
A patient is prescribed an isotonic intravenous (IV) solution. What effect does this type of solution have on the body's fluid balance?
In which clinical scenario is a hypertonic intravenous (IV) solution MOST appropriate?
In which clinical scenario is a hypertonic intravenous (IV) solution MOST appropriate?
Which of the following assessments is MOST critical for an LPN/LVN to perform on a patient receiving intravenous (IV) therapy?
Which of the following assessments is MOST critical for an LPN/LVN to perform on a patient receiving intravenous (IV) therapy?
An older adult patient is receiving intravenous (IV) fluids. Which sign or symptom indicates potential fluid volume excess?
An older adult patient is receiving intravenous (IV) fluids. Which sign or symptom indicates potential fluid volume excess?
An LPN/LVN is caring for a patient with an IV. Which nursing intervention is MOST important to prevent infection at the IV site?
An LPN/LVN is caring for a patient with an IV. Which nursing intervention is MOST important to prevent infection at the IV site?
What is the MOST appropriate initial action for an LPN/LVN to take if a patient reports pain, redness, and swelling at the IV insertion site?
What is the MOST appropriate initial action for an LPN/LVN to take if a patient reports pain, redness, and swelling at the IV insertion site?
A patient receiving IV therapy suddenly develops shortness of breath, chest pain, and a rapid heart rate. Which systemic complication is MOST likely occurring?
A patient receiving IV therapy suddenly develops shortness of breath, chest pain, and a rapid heart rate. Which systemic complication is MOST likely occurring?
What is the primary purpose of a central venous access device (CVAD)?
What is the primary purpose of a central venous access device (CVAD)?
What is a key difference between a tunneled and a nontunneled central venous catheter?
What is a key difference between a tunneled and a nontunneled central venous catheter?
A patient has a peripherally inserted central catheter (PICC). What is the MOST important nursing intervention related to this device?
A patient has a peripherally inserted central catheter (PICC). What is the MOST important nursing intervention related to this device?
What is the MOST significant advantage of using an implanted port for long-term IV therapy?
What is the MOST significant advantage of using an implanted port for long-term IV therapy?
A patient is receiving parenteral nutrition (PN). What is the MOST important nursing action related to PN administration?
A patient is receiving parenteral nutrition (PN). What is the MOST important nursing action related to PN administration?
Under what circumstances might an LPN/LVN be allowed to initiate peripheral parenteral nutrition (PPN)?
Under what circumstances might an LPN/LVN be allowed to initiate peripheral parenteral nutrition (PPN)?
What is the primary benefit of home intravenous (IV) therapy for patients?
What is the primary benefit of home intravenous (IV) therapy for patients?
What should the nurse instruct the patient to do to prepare their IV solution before the home health nurse arrives
What should the nurse instruct the patient to do to prepare their IV solution before the home health nurse arrives
In which patient population is subcutaneous infusion (hypodermoclysis) becoming an increasingly common route for fluid and medication administration?
In which patient population is subcutaneous infusion (hypodermoclysis) becoming an increasingly common route for fluid and medication administration?
When administering fluids via hypodermoclysis, and edema is observed at the site what action should the nurse take?
When administering fluids via hypodermoclysis, and edema is observed at the site what action should the nurse take?
A patient receiving a continuous IV infusion of 0.9% sodium chloride develops a hematoma at the insertion site. Which of the following actions should the nurse take FIRST?
A patient receiving a continuous IV infusion of 0.9% sodium chloride develops a hematoma at the insertion site. Which of the following actions should the nurse take FIRST?
When a patient receiving IV therapy develops phlebitis at the insertion site, what signs and symptoms would the nurse expect to observe?
When a patient receiving IV therapy develops phlebitis at the insertion site, what signs and symptoms would the nurse expect to observe?
Which statement best describes extravasation related to IV therapy?
Which statement best describes extravasation related to IV therapy?
Which intervention is MOST appropriate for a patient experiencing circulatory overload due to rapid IV infusion?
Which intervention is MOST appropriate for a patient experiencing circulatory overload due to rapid IV infusion?
A patient with a central venous catheter reports difficulty breathing and chest pain. What action should the nurse take FIRST?
A patient with a central venous catheter reports difficulty breathing and chest pain. What action should the nurse take FIRST?
Initiating an infusion of peripheral parenteral nutrition (PPN) for a patient would be contraindicated in which of the following situations?
Initiating an infusion of peripheral parenteral nutrition (PPN) for a patient would be contraindicated in which of the following situations?
Which of the following is the MOST appropriate action for the nurse to take when troubleshooting a clotted IV line?
Which of the following is the MOST appropriate action for the nurse to take when troubleshooting a clotted IV line?
The nurse is administering a medication via IV push. Immediately after the injection, the patient reports tightness in their chest and starts coughing. What is the nurse's priority action?
The nurse is administering a medication via IV push. Immediately after the injection, the patient reports tightness in their chest and starts coughing. What is the nurse's priority action?
A patient is prescribed 1,000 mL of normal saline to be infused over 8 hours. Using an administration set with a drop factor of 15 gtt/mL, what is the correct drip rate in drops per minute (gtt/min)?
A patient is prescribed 1,000 mL of normal saline to be infused over 8 hours. Using an administration set with a drop factor of 15 gtt/mL, what is the correct drip rate in drops per minute (gtt/min)?
Which statement is correct regarding the use of needleless connectors in intravenous (IV) therapy?
Which statement is correct regarding the use of needleless connectors in intravenous (IV) therapy?
Which of the following actions should the nurse take to maintain positive pressure in the lumen of the canula during a saline flush?
Which of the following actions should the nurse take to maintain positive pressure in the lumen of the canula during a saline flush?
An LPN/LVN is preparing to administer a medication via IV. Which of the following actions demonstrates adherence to the standards of practice published by the Infusion Nurses Society (INS)?
An LPN/LVN is preparing to administer a medication via IV. Which of the following actions demonstrates adherence to the standards of practice published by the Infusion Nurses Society (INS)?
A patient is ordered to receive IV fluids due to persistent vomiting and dehydration. Besides fluid replacement, what is another primary goal of intravenous therapy in this scenario?
A patient is ordered to receive IV fluids due to persistent vomiting and dehydration. Besides fluid replacement, what is another primary goal of intravenous therapy in this scenario?
When administering a continuous IV infusion, which factor has the greatest impact on maintaining a consistent and accurate flow rate?
When administering a continuous IV infusion, which factor has the greatest impact on maintaining a consistent and accurate flow rate?
Which action is MOST important for the nurse to perform immediately after injecting a medication via IV push?
Which action is MOST important for the nurse to perform immediately after injecting a medication via IV push?
Which factor is MOST likely to affect the accuracy of an IV infusion rate when using a gravity drip system?
Which factor is MOST likely to affect the accuracy of an IV infusion rate when using a gravity drip system?
Following assessment, the nurse identifies that a patient's IV infusion rate is running slower than prescribed. After checking the IV site and repositioning the patient's arm, what is the NEXT appropriate action?
Following assessment, the nurse identifies that a patient's IV infusion rate is running slower than prescribed. After checking the IV site and repositioning the patient's arm, what is the NEXT appropriate action?
A patient receiving IV fluids develops new onset crackles in the lungs. What is the MOST likely cause?
A patient receiving IV fluids develops new onset crackles in the lungs. What is the MOST likely cause?
What nursing intervention is MOST important for preventing systemic infection in a patient with an intravenous (IV) line?
What nursing intervention is MOST important for preventing systemic infection in a patient with an intravenous (IV) line?
A patient reports pain and redness at the IV insertion site. After observing for signs of phlebitis, what is the nurse's NEXT appropriate action?
A patient reports pain and redness at the IV insertion site. After observing for signs of phlebitis, what is the nurse's NEXT appropriate action?
A patient receiving IV therapy suddenly develops shortness of breath and chest pain. What is the priority nursing intervention?
A patient receiving IV therapy suddenly develops shortness of breath and chest pain. What is the priority nursing intervention?
What is the primary advantage of using a tunneled central venous catheter compared to a non-tunneled catheter?
What is the primary advantage of using a tunneled central venous catheter compared to a non-tunneled catheter?
When caring for a patient with a peripherally inserted central catheter (PICC), what assessment finding requires immediate intervention?
When caring for a patient with a peripherally inserted central catheter (PICC), what assessment finding requires immediate intervention?
What is the primary reason for using a non-coring needle when accessing an implanted port?
What is the primary reason for using a non-coring needle when accessing an implanted port?
What laboratory value is MOST critical to monitor in a patient receiving parenteral nutrition (PN)?
What laboratory value is MOST critical to monitor in a patient receiving parenteral nutrition (PN)?
Peripheral parenteral nutrition (PPN) is typically used for patients who:
Peripheral parenteral nutrition (PPN) is typically used for patients who:
Before initiating home intravenous (IV) therapy, what is the MOST important factor to assess regarding the patient's home environment?
Before initiating home intravenous (IV) therapy, what is the MOST important factor to assess regarding the patient's home environment?
What is a key advantage of subcutaneous infusion (hypodermoclysis) compared to intravenous infusion in select patient populations?
What is a key advantage of subcutaneous infusion (hypodermoclysis) compared to intravenous infusion in select patient populations?
An order is written for 1000 mL of Lactated Ringers to infuse at 50 mL per hour. Using a 15 drop set, how many drops per minute should the IV infuse?
An order is written for 1000 mL of Lactated Ringers to infuse at 50 mL per hour. Using a 15 drop set, how many drops per minute should the IV infuse?
A nurse is administering Normal Saline at 75 mL per hour, but the infusion is only running at 60 mL per hour. What action should the nurse take first?
A nurse is administering Normal Saline at 75 mL per hour, but the infusion is only running at 60 mL per hour. What action should the nurse take first?
During sterile field preparation for IV insertion, what is the recommended length of time for vigorously scrubbing the site with chlorhexidine?
During sterile field preparation for IV insertion, what is the recommended length of time for vigorously scrubbing the site with chlorhexidine?
What actions by the nurse could cause a venous air embolism during IV insertion? (Select all that apply)
What actions by the nurse could cause a venous air embolism during IV insertion? (Select all that apply)
A patient who is immunocompromised is ordered to have IV fluids initiated. What is the best practice to prevent infection in this patient?
A patient who is immunocompromised is ordered to have IV fluids initiated. What is the best practice to prevent infection in this patient?
What type of fluid is most appropriate for a patient requiring fluids to enter the cell?
What type of fluid is most appropriate for a patient requiring fluids to enter the cell?
What type of fluid is 3% saline?
What type of fluid is 3% saline?
A patient is receiving platelets and is experiencing facial flushing, fever, and chills. What is the priority action by the nurse?
A patient is receiving platelets and is experiencing facial flushing, fever, and chills. What is the priority action by the nurse?
A patient who is NPO is prescribed IV dextrose and sodium chloride. What is the primary advantage of this order?
A patient who is NPO is prescribed IV dextrose and sodium chloride. What is the primary advantage of this order?
A nurse is preparing to administer potassium through the IV. What action must be taken by the nurse prior to administration?
A nurse is preparing to administer potassium through the IV. What action must be taken by the nurse prior to administration?
The nurse has several IV antibiotics to administer. Which IV fluid is appropriate to use when priming administration sets for blood?
The nurse has several IV antibiotics to administer. Which IV fluid is appropriate to use when priming administration sets for blood?
The provider writes an order to 'catch up' an infusion if it is more than 200 mL behind. What action should the nurse take?
The provider writes an order to 'catch up' an infusion if it is more than 200 mL behind. What action should the nurse take?
A patient who has a history of cardiac and renal dysfunction is receiving IV fluids. For what signs and symptoms should the nurse closely monitor?
A patient who has a history of cardiac and renal dysfunction is receiving IV fluids. For what signs and symptoms should the nurse closely monitor?
A patient is receiving multiple IV infusions. The nurse assesses the patient's laboratory results. What laboratory result should be immediately reported to the healthcare provider?
A patient is receiving multiple IV infusions. The nurse assesses the patient's laboratory results. What laboratory result should be immediately reported to the healthcare provider?
The provider orders a peripherally inserted central catheter (PICC) to be discontinued. What action must be taken by the nurse before the PICC is discontinued?
The provider orders a peripherally inserted central catheter (PICC) to be discontinued. What action must be taken by the nurse before the PICC is discontinued?
What is a common use of subcutaneous infusions (hypodermoclysis)?
What is a common use of subcutaneous infusions (hypodermoclysis)?
The nurse is administering a subcutaneous infusion, but the infusion site is beginning to swell. What is the priority action of the nurse?
The nurse is administering a subcutaneous infusion, but the infusion site is beginning to swell. What is the priority action of the nurse?
Which of the following are complications associated with IV therapy?
Which of the following are complications associated with IV therapy?
The nurse finds the IV tubing disconnected form the IV bag laying on the floor. What is the most appropriate action?
The nurse finds the IV tubing disconnected form the IV bag laying on the floor. What is the most appropriate action?
A patient receiving Total Parenteral Nutrition (TPN) begins to exhibit an elevated temperature, and glucose levels above 200 mg/dL. What is the most likely cause and intervention?
A patient receiving Total Parenteral Nutrition (TPN) begins to exhibit an elevated temperature, and glucose levels above 200 mg/dL. What is the most likely cause and intervention?
A patient receiving a continuous IV infusion starts to exhibit signs of fluid volume overload. After notifying the RN, what is the MOST appropriate nursing intervention while waiting for further orders?
A patient receiving a continuous IV infusion starts to exhibit signs of fluid volume overload. After notifying the RN, what is the MOST appropriate nursing intervention while waiting for further orders?
An LPN/LVN is preparing to administer an IV medication via a needleless connector. What is the MOST crucial step in preventing infection?
An LPN/LVN is preparing to administer an IV medication via a needleless connector. What is the MOST crucial step in preventing infection?
A patient receiving IV fluids complains of pain and burning at the insertion site. Upon assessment, the nurse notes redness and swelling along the vein. What complication is MOST likely occurring?
A patient receiving IV fluids complains of pain and burning at the insertion site. Upon assessment, the nurse notes redness and swelling along the vein. What complication is MOST likely occurring?
The provider orders 1000 mL of 0.9% sodium chloride to be infused over 6 hours. The IV administration set has a drop factor of 20 gtt/mL. What is the correct drip rate in drops per minute (gtt/min)?
The provider orders 1000 mL of 0.9% sodium chloride to be infused over 6 hours. The IV administration set has a drop factor of 20 gtt/mL. What is the correct drip rate in drops per minute (gtt/min)?
A hypertonic IV solution is prescribed for a patient. What is the MOST important nursing consideration when administering this solution?
A hypertonic IV solution is prescribed for a patient. What is the MOST important nursing consideration when administering this solution?
When administering IV fluids via gravity, the nurse observes that the flow rate has slowed significantly. What is the MOST appropriate initial action?
When administering IV fluids via gravity, the nurse observes that the flow rate has slowed significantly. What is the MOST appropriate initial action?
A patient with a history of heart failure is receiving an IV infusion of normal saline. What assessment finding would be of MOST concern?
A patient with a history of heart failure is receiving an IV infusion of normal saline. What assessment finding would be of MOST concern?
What is the primary reason for using an electronic infusion device (EID) when administering intravenous fluids or medications?
What is the primary reason for using an electronic infusion device (EID) when administering intravenous fluids or medications?
A patient is to receive medication via IV push. What information is MOST important for the LPN/LVN to verify BEFORE administering the medication?
A patient is to receive medication via IV push. What information is MOST important for the LPN/LVN to verify BEFORE administering the medication?
A patient is receiving parenteral nutrition (PN) via a central line. What is the MOST important nursing intervention to prevent infection?
A patient is receiving parenteral nutrition (PN) via a central line. What is the MOST important nursing intervention to prevent infection?
When discontinuing a peripheral IV, what is the MOST important step to prevent complications?
When discontinuing a peripheral IV, what is the MOST important step to prevent complications?
The nurse notes that a patient's IV insertion site is cool to the touch, pale, and swollen, and the patient reports discomfort. What complication is MOST likely?
The nurse notes that a patient's IV insertion site is cool to the touch, pale, and swollen, and the patient reports discomfort. What complication is MOST likely?
Which of the following is a key difference between crystalloid and colloid solutions?
Which of the following is a key difference between crystalloid and colloid solutions?
An elderly patient is receiving a subcutaneous infusion (hypodermoclysis) for hydration. The nurse observes edema at the infusion site. What is the FIRST action the nurse should take?
An elderly patient is receiving a subcutaneous infusion (hypodermoclysis) for hydration. The nurse observes edema at the infusion site. What is the FIRST action the nurse should take?
A patient is receiving IV fluids via gravity infusion. The nurse notes the fluid is infusing much faster than prescribed. What is the MOST appropriate initial action?
A patient is receiving IV fluids via gravity infusion. The nurse notes the fluid is infusing much faster than prescribed. What is the MOST appropriate initial action?
A patient is receiving a blood transfusion, and the nurse observes the patient develop facial flushing, fever, and chills. What is the FIRST action the nurse should take?
A patient is receiving a blood transfusion, and the nurse observes the patient develop facial flushing, fever, and chills. What is the FIRST action the nurse should take?
What is the primary purpose of flushing an intermittent IV catheter with normal saline?
What is the primary purpose of flushing an intermittent IV catheter with normal saline?
A patient with a peripherally inserted central catheter (PICC) line reports pain in the shoulder and neck on the insertion side. What action should the nurse take FIRST?
A patient with a peripherally inserted central catheter (PICC) line reports pain in the shoulder and neck on the insertion side. What action should the nurse take FIRST?
An LPN/LVN notes blood backing up into the IV tubing of a gravity infusion. What could be a potential cause?
An LPN/LVN notes blood backing up into the IV tubing of a gravity infusion. What could be a potential cause?
A patient is receiving Total Parenteral Nutrition (TPN) and the infusion is running behind schedule. What is the BEST action to take?
A patient is receiving Total Parenteral Nutrition (TPN) and the infusion is running behind schedule. What is the BEST action to take?
Flashcards
Intravenous (IV) Therapy
Intravenous (IV) Therapy
Administration of fluids/meds directly into the bloodstream via needle or cannula.
Parenteral
Parenteral
Medication route other than the digestive tract.
Continuous Infusion
Continuous Infusion
Large-volume infusion over 2-24 hours.
Intermittent Infusion
Intermittent Infusion
Signup and view all the flashcards
IV Push/Direct Injection
IV Push/Direct Injection
Signup and view all the flashcards
Patient-Controlled Analgesia (PCA)
Patient-Controlled Analgesia (PCA)
Signup and view all the flashcards
Macrodrop Sets
Macrodrop Sets
Signup and view all the flashcards
Microdrop Sets
Microdrop Sets
Signup and view all the flashcards
Bevel
Bevel
Signup and view all the flashcards
Patency
Patency
Signup and view all the flashcards
Electronic Infusion Device (EID)
Electronic Infusion Device (EID)
Signup and view all the flashcards
Isotonic Solutions
Isotonic Solutions
Signup and view all the flashcards
Hypotonic Solutions
Hypotonic Solutions
Signup and view all the flashcards
Hypertonic Solutions
Hypertonic Solutions
Signup and view all the flashcards
Peripheral Veins
Peripheral Veins
Signup and view all the flashcards
Central Veins
Central Veins
Signup and view all the flashcards
Hematoma
Hematoma
Signup and view all the flashcards
Phlebitis
Phlebitis
Signup and view all the flashcards
Infiltration
Infiltration
Signup and view all the flashcards
Extravasation
Extravasation
Signup and view all the flashcards
Septicemia
Septicemia
Signup and view all the flashcards
Circulatory Overload
Circulatory Overload
Signup and view all the flashcards
Venous Air Embolism
Venous Air Embolism
Signup and view all the flashcards
Speed Shock
Speed Shock
Signup and view all the flashcards
Central Venous Access Device (CVAD)
Central Venous Access Device (CVAD)
Signup and view all the flashcards
Nontunneled Central Catheter
Nontunneled Central Catheter
Signup and view all the flashcards
Tunneled Catheters
Tunneled Catheters
Signup and view all the flashcards
Peripherally Inserted Central Catheter (PICC)
Peripherally Inserted Central Catheter (PICC)
Signup and view all the flashcards
Ports
Ports
Signup and view all the flashcards
Parenteral Nutrition (PN)
Parenteral Nutrition (PN)
Signup and view all the flashcards
Peripheral Parenteral Nutrition (PPN)
Peripheral Parenteral Nutrition (PPN)
Signup and view all the flashcards
Subcutaneous Infusion (Hypodermoclysis)
Subcutaneous Infusion (Hypodermoclysis)
Signup and view all the flashcards
Study Notes
- IV therapy involves administering fluids or medications directly into the bloodstream through a needle or cannula.
- State nurse practice acts regulate IV therapy, potentially including LPN/LVN roles.
- The Infusion Nurses Society (INS) sets global standards for infusion nursing practice.
- The Institute for Healthcare Improvement (IHI) provides information on central line care.
- The National Institute for Occupational Safety and Health (NIOSH) oversees workplace safety related to IV therapy.
- The American Society for Parenteral and Enteral Nutrition (ASPEN) offers resources on IV nutrition.
Indications for IV Therapy
- Fluids, electrolytes, nutrients, blood products, and medications can be administered via IV therapy.
- IV medications can be faster-acting, which is important in emergencies.
- Continuous IV administration maintains therapeutic blood levels of medications.
- Blood transfusions treat anemia or blood loss.
- IV fluids, electrolytes, and nutrition support patients unable to eat or drink adequately.
- Parenteral nutrition fulfills nutritional needs when patients cannot eat long-term.
- Parenteral refers to any medication route other than the digestive tract.
Types of IV Infusions
- Four primary administration modes exist for IV medications: continuous, intermittent, direct injection/IV push, and patient-controlled analgesia.
Continuous Infusion
- Continuous infusion involves large volumes (250–1,000 mL) over 2 to 24 hours.
- Healthcare provider (HCP) orders specify milliliters to be delivered over a set time, such as 100 mL per hour.
- It is used when a medication must be highly diluted, to maintain constant drug concentration, or to administer large fluid/electrolyte volumes.
- Electronic infusion devices (EID), mechanical controllers, or roller clamps control continuous infusion rates.
- Verify that orders are complete and understandable, and contact the registered nurse, health-care provider, or pharmacist if you have any questions.
Intermittent Infusion
- Intermittent infusion involves some IV medications, like antibiotics, infused over a short time (e.g., 30–60 minutes).
- HCP orders must specify route, drug, dose, and amount to be infused over a specified time.
Primary Intermittent Infusion
- Primary intermittent administration tubing is connected and disconnected with each use for intermittent medications and solutions.
- A short peripheral vascular access device, a saline lock, provides bloodstream access.
- This device has an IV cannula with a sterile needleless cap or valve that seals after each use.
- The tip of the tubing must be kept sterile using a sterile end cap, each time a primary intermittent set is disconnected.
- Flush peripheral intravenous (PIV) cannulas with saline, and flush central venous access devices (CVADs) with heparin (10 units/mL or 100 units/mL, based on agency policy) to keep intermittent cannulas patent while not in use.
Piggyback (Secondary) Intermittent Infusion
- Antibiotic (secondary) infusion can be piggybacked into a primary continuous IV line, where a patient already has a primary continuous IV infusing.
- Tubing remains attached to the primary administration set, for an intermittent infusion.
- The intermittent infusion must hang higher than the primary infusion to work.
- These can be infused using an EID, mechanical controller, or roller clamp.
- The LPN/LVN will administer intravenous piggyback (secondary) medications.
- The medication in the intermittent infusion tubing must be compatible with the solution that is in the primary intravenous tubing.
Needleless Connectors
- Needleless connectors connect to IV catheters (piggybacking into a primary IV line), administration sets, and syringes without a needle.
- Other terms used to describe such connectors are injection cap, port, or injection valve.
- An extension set of a peripheral cannula that is “capped off” with a needleless connector (saline lock) is available for intermittent or emergency access.
- A sterile closed infusion system is maintained because the needleless connector does not have to be removed to allow access.
- The patency (unobstructed flow) of an intermittent cannula must be maintained by flushing at periodic intervals based on institution flushing policy and procedure.
- Always check the patency of an intermittent device before administering a medication, by first scrubbing the hub, then attaching the syringe and drawing back to check for backflow of blood.
- The catheter is patent if blood is seen in the syringe.
- Once patency is confirmed, flush with normal saline (0.9% sodium chloride).
- The cannula should be flushed after each use or at least every 12 hours if not in use or according to institution policy, to maintain patency.
- Flushing with saline prevents mixing of incompatible medications and solutions, while also ensuring patency.
- The INS recommends using sodium chloride for maintaining peripheral intermittent devices.
- Heparin, an anticoagulant, is recommended for flushing CVADs.
- Positive pressure must be maintained in the lumen of the cannula during the administration of the flush solution, which prevents a backflow of blood or solution into the cannula lumen, and maintains a closed infusion system within the needleless connector.
- “SCRUB THE HUB” with 70% alcohol or chlorhexadine and alcohol for 10 to 15 seconds using friction before each access to prevent infection!
- Do not exert pressure on the syringe plunger to restore patency if resistance is met while a cannula is being flushed, because a clot may be occluding the cannula which could dislodge the clot into the vascular system or rupture the cannula.
Direct Injection/Intravenous Push
- An IV push, or direct injection medication, is injected slowly, between 1 and 10 minutes, via a syringe into an IV site or port.
- It provides a rapid effect because it is delivered directly into the patient’s bloodstream.
- Always check a drug reference to determine the safe amount of time over which the drug can be injected, because IV push drugs can be dangerous if given incorrectly.
- IV push drugs are usually administered by registered nurses (RNs), and may not be within the scope of practice of the LPN/LVN in some states.
Patient-Controlled Analgesia
- Patient-controlled analgesia (PCA) delivers analgesic or pain medications.
- The EID is programmed to administer the prescribed amount to the patient when he or she presses a button.
- PCA administrations are usually done by RNs, and may not be within the scope of practice of the LPN/LVN.
- When administering medications through an IV line on a patient receiving PCA, remember to consider the PCA medication in the tubing when researching for incompatibilities.
Methods of Infusion
- Gravity Drip: Gravity can administer a solution into a vein.
- The solution is positioned about 3 feet above the infusion site.
- Flow is controlled with a roller or screw clamp.
- A mechanical flow device can be added to achieve more accurate fluid delivery.
Calculating Administration Rates
- With gravity sets, calculate the infusion rate and/or drops per minute to deliver fluid at the ordered rate.
- Commercial parenteral administration sets vary in the number of drops delivering 1 mL of fluid (drop factor).
- Sets typically deliver 10, 15, 20, or 60 drops per milliliter of fluid.
- Sets delivering 10, 15, or 20 drops per milliliter are called macrodrop sets, and are used for fluids that need to be infused more quickly.
- Sets delivering 60 drops per milliliter are called microdrop or minidrop sets, and are used for solutions that need to be infused more slowly.
- Factors Affecting Flow Rates of Gravity Infusions: Change in Cannula Position.
- A change in the position of the cannula’s tip can affect the infusion flow rate,
- Decreasing flow rate when the bevel is against the wall of the vein, and increasing when away from the wall.
- Placement of a PIV in a joint area (wrist or elbow) can cause a kink in the cannula or change the tip position.
- Kinks in the tubing can cause a change in the flow rate. Minimize this problem through careful securing the cannula and avoiding areas of joint flexion.
Height of Solution
- In gravity infusions, changes in the height of the bag/bottle or bed level alter the flow rate.
- The flow rate increases as the distance between the solution and the patient increases.
- The ideal height for a solution is 3 feet above the level of the patient’s heart.
Patency of the Cannula
- A small clot or fibrin sheath can occlude the cannula lumen and decrease the flow rate or stop the flow completely, with fibrin sheath beginning to develop within the first 24 hours of the cannula insertion.
- Clot formation can result from irritation, vein wall injury, increased venous pressure, or backup of blood into the cannula.
- Avoid using a blood pressure cuff on the affected limb to prevent transient increase in venous pressure.
- A regular flush schedule helps maintain patency.
- Never exert pressure with a saline or heparin flush in an attempt to restore patency because doing so could dislodge a clot into the vascular system or rupture the cannula.
- Mechanical and Electronic Infusion Devices: Flow control devices, such as EIDs and mechanical controllers, regulate the rate of infusion and are used in all health care settings.
- Mechanical controllers measure the amount of solution delivered and depend on gravity to deliver the infusion.
- EIDs, sometimes called pumps, use positive pressure to deliver the solution.
- Pumps and controllers are used for infusing precise volumes and rates of solution.
- Institution policy often dictates use of controllers for very fast or slow rates and infusion of potent medications, such as heparin, concentrated morphine, and chemotherapy solutions.
- Some EIDs are portable and worn on the body, these are called ambulatory infusion devices.
Filters
- Filters can either be added to administration sets or built into the set during manufacturing.
- The INS (2021) standards address the use of in-line filters to remove bacteria, fungi, particulate matter, air, and some endotoxins from IV fluids, while also significantly reducing phlebitis in hospitalized patients.
Types of Fluids
- Three basic types of IV solutions: isotonic, hypotonic, and hypertonic.
- Fluids and electrolytes administered via the IV route pass directly into the plasma space of the extracellular fluid compartment, and are then absorbed based on the characteristics of the fluid and the hydration status of the patient.
- The most commonly infused fluids are dextrose and sodium solutions.
- These are called crystalloid solutions.
Crystalloid Solutions
- Dextrose Solutions are available in many concentrations (2.5%, 5%, and 10%), and are typically used for continuous peripheral infusions.
- Concentrations above 10% must be infused via a central line into a large vein such as the subclavian vein.
- Advantages of dextrose solutions include providing carbohydrates in a readily usable form for energy, reducing breakdown of glycogen and catabolism of protein to help prevent negative nitrogen balance, treating dehydration, acting as a means for medication administration, treating hyperkalemia or hypoglycemia, or in combination with parenteral nutrition, because they supply a large number of calories.
- Disadvantages of dextrose solutions include vein irritation, damage, and thrombosis, which can result when hypertonic dextrose solutions are administered in a peripheral vein.
- Sodium Chloride Solutions are available in concentrations of 0.25%, 0.33%, 0.45%, 0.9% (normal saline), 3%, and 5%.
- Sodium chloride 0.45% and 0.9% solutions are most common.
- Advantages of sodium chloride solutions are that they are useful for fluid replacement, treatment of shock, hyponatremia, and metabolic alkalosis, as a primer for blood transfusions, and during resuscitation after trauma.
- Blood component administration sets can be primed only with 0.9% sodium chloride solution.
- They are useful to replace sodium and chloride in patients receiving nasogastric suctioning.
- Combination dextrose and sodium chloride solutions, such as 5% dextrose with 0.45% sodium chloride (often referred to as “D1 and a half”), are commonly used for hydration and to check for kidney function before administration of potassium replacement therapy.
- Disadvantages of sodium chloride solutions are that they can cause circulatory overload if the prescribed rate is not monitored, hypernatremia can result if the patient is unable to excrete excess sodium, and acidosis can occur with continuous infusions.
- Balanced Electrolyte Solutions replace lost fluids and electrolytes by containing lactate or acetate (yielding bicarbonate), which helps combat acidosis and provides a truly balanced solution.
- Potassium is an electrolyte commonly added to balanced solutions to replace potassium deficits.
- The patient needs to be monitored for signs and symptoms of potassium imbalance.
Osmolarity of Intravenous Solutions
- IV fluids may be classified as isotonic, hypotonic, or hypertonic.
- Isotonic fluids have the same ratio of solutes to water as body fluids.
- Hypertonic solutions have more solutes than body fluids.
- Hypotonic solutions have fewer solutes than body fluids.
- Water moves from areas of lesser concentration to areas of greater concentration.
- Hypotonic solutions send water into areas of greater concentration (cells).
- Hypertonic solutions pull water from cells.
- Isotonic Solutions such as Normal saline (0.9% sodium chloride) solution, expand the extracellular fluid volume.
- A solution of 5% dextrose in water (D5W) is also isotonic when infused, however, the dextrose is quickly metabolized, making the solution hypotonic.
- Since isotonic solutions expand the extracellular fluid volume, be vigilant for signs of fluid overload when infusing isotonic solutions, such as monitoring lung sounds for new onset or worsening of crackles, which is a good way to recognize early fluid overload.
- Lactated Ringer solution and 5% albumin are other examples of isotonic solutions, which commonly treat dehydration, fluid loss, and hyponatremia.
- Hypotonic Solutions are used when fluid is needed to enter the cells, as in the patient with cellular dehydration, and are also used as fluid maintenance therapy.
- Hypotonic solutions, because they leave the intravascular space and enter cells, can worsen hypotension, cause cardiovascular collapse, and increase intracranial pressure, thus requiring you to proceed with extra caution.
- Examples of hypotonic solutions are dextrose 2.5% water and 0.33% or 0.45% sodium chloride solution.
- Hypertonic Solutions expand the plasma volume and replace electrolytes.
- Examples of hypertonic solutions include 5% dextrose in 0.9% sodium chloride, 3% sodium chloride, calcium chloride 10%, 5% dextrose in lactated Ringer solution, 10% dextrose in water, and albumin 25%.
- Be sure to monitor the patient receiving a hypertonic solution for circulatory overload, checking for elevation in blood pressure and reporting findings.
Intravenous Access
- IV therapy can be administered into the systemic circulation via the peripheral or central veins.
- Peripheral veins lie beneath the epidermis, dermis, and subcutaneous tissue of the skin, and usually provide easy access to the venous system.
- Central veins are deeper and located closer to the heart.
- A CVAD is a special catheter with a tip that ends in a large vessel (i.e., superior vena cava) near the heart.
- Insertions should be avoided close to joints if at all possible; however, if you must use a mobile site, such as the antecubital fossa or wrist area, immobilize the joint with an arm board or other immobilizer to reduce cannula movement.
- The LPN/VN will maintain and remove peripheral intravenous (IV) catheter.
- IV therapy is a medical intervention; the nurse is responsible for appropriate assessment, monitoring, documentation, and reporting related to the therapeutic goals.
Nursing Process for IV Therapy
- Some institutions require assessment of patients receiving IV therapy as often as every hour.
- Assess at least every 4 hours for patients not getting an irritant or vesicant who are alert and oriented.
- Assess every 1 to 2 hours for critically ill patients and adult patients who have cognitive sensory deficits, are receiving sedative medications or unable to notify the nurse of any problems, or have an IV placed in a joint area or external jugular vein.
- Assess every hour for pediatric or neonatal patients.
- Assess more frequently for any patient receiving vesicant medication.
- Assessment should be systematic and thorough, including physiological and psychosocial data, critical laboratory values, allergies and environmental issues, and presence of adverse reactions or complications related to infusion therapy.
- Older adults are at increased risk for complications.
- The LPN/LVN collaborates with the RN to perform physical assessment.
- The LPN/LVN collects data that contribute to the evaluation.
- Daily weights and measurement of intake and output, help determine whether the patient is retaining too much fluid.
- New onset of fine crackles in the lungs can indicate fluid retention.
- Inspect the insertion site for redness or swelling, evaluate the integrity of the dressing, inspect the tubing ensuring tight connections and the absence of kinks or defects and document your findings.
- Inspect the solution container and compare it with the HCP’s order for type, amount, and rate.
Nursing Diagnoses
- Priority nursing diagnoses for IV-related issues may include the following: Risk for Fluid Volume Excess related to IV fluid administration, Impaired Physical Mobility related to placement and maintenance of IV cannula, and Risk for Infection related to broken skin or traumatized tissue.
- To prevent infection, the INS (2021) standards of practice state, “in addition to routine changes, the administration set (tubing) is changed whenever the peripheral catheter site is changed or when a new central vascular access device (CVAD) is placed.”
- The INS also instructs clinicians to replace or remove any peripheral intravenous cannula placed in an emergency situation within 24 to 48 hours of the insertion or as soon as possible.
Complications of IV Therapy
- Complications of infusion therapy fall into two categories: local and systemic, both of which should be reported to the RN or HCP, including a quality improvement report prepared according to institution policy.
- Systemic complications can be serious, and include circulatory overload, septicemia, venous air embolism, and speed shock (a sudden reaction due to medication that is delivered too quickly).
- Complications, prevention, and care: Hematoma, Thrombosis, Phlebitis, Infiltration or extravasation, Local infection, Venous spasm, Septicemia, Circulatory overload, Venous air embolism, and Speed shock.
- Avoid the dorsal hand, radial wrist, and inner wrist as sites to prevent permanent nerve injury, as listed by the INS (2021).
Central Venous Access Devices
- The role of the LPN/LVN in CVAD care in most states is limited to assisting the RN with assessments.
- According to the 2020 NCLEX-PN Test Plan, the LPN can assist in maintaining a central venous catheter, assist in preparing the patient for insertion of the central line, and educate the patient on the reason for and care of a central venous device.
- Be careful not to confuse a central catheter with a dialysis catheter, where dialysis catheters should be used only for dialysis and not for IV therapy, and accessed only by HCPs or specially trained dialysis nurses.
- Central venous catheter tips terminate in the superior vena cava near the heart.
- Central lines are used when peripheral sites are inadequate, to deliver all types of solutions, medications, or blood products when continuous infusion is required, and when irritant or vesicant medication must be given into a large vein.
- CVADs include tunneled and nontunneled catheters, peripherally inserted central catheters, and implanted ports, which can have one, two, or three lumens in the catheter or one or more port chambers, where each lumen of a multilumen device exits the site in a separate line, called a tail.
- Any central line will require special insertion site care according to agency policy.
- Nontunneled Central Catheter is inserted by an HCP into the jugular, subclavian, or femoral vein.
- After insertion, correct placement is determined by x-ray before the catheter is used.
- These short-term CVADs may remain in place up to several weeks, and can be inserted at the bedside or in an outpatient setting, being cost-effective for short-term use.
- Tunneled Catheters are used when venous access is needed for months to years, and are typically composed of polymeric silicone with a Dacron polyester cuff, which anchors the catheter in place subcutaneously and provides a barrier to prevent bacteria from migrating to the tip of the catheter.
- Peripherally Inserted Central Catheter (PICC) is a long catheter that is inserted in the arm and terminates in the central vasculature.
- The PICC can be tunneled or nontunneled, and is used when therapy will last more than 2 weeks or the medication is too irritating for peripheral administration.
- Trained RNs can insert PICC lines, which can be left in place for long periods, minimizing the trauma of frequent IV insertions.
- Consult with the HCP for a PICC order if long-term therapy is anticipated.
- It is important to follow the manufacturer’s recommended guidelines for flushing the catheter and to be aware of your institution’s PICC policy.
- An LPN/LVN may assist the RN with this procedure if the state nurse practice act permits.
- Ports are a reservoir that is surgically implanted into a pocket created under the skin, usually in the upper chest.
- Ports are suitable for long-term therapy, and can be used to administer all types of medications, including chemotherapeutic agents and antibiotics that are toxic to tissues.
- Ports come in a variety of sizes and styles.
- Ports are usually accessed only by specially trained RNs.
Parenteral Nutrition
- Parenteral nutrition (PN) is complete IV nutrition administered to patients who cannot take adequate nutrients via the enteral route (by mouth or tube feeding), used to promote nutrition for wound healing, help a patient achieve optimal weight before surgery, or avoid malnutrition from chronic disease or after surgery.
- Every effort should be made to return a patient on PN to enteral feedings as soon as possible.
- Due to the components in PN, compatibility issues must be considered, and should not be infused (piggybacked) directly into PN solutions, requiring filtration and an EID for administration.
- 22-micron filter is required for lipid-free PN, and PN solutions with lipids must have a 1.2-micron filter.
- Initial assessment includes the patient’s height, weight, nutritional status, and current laboratory values.
- Because of high glucose concentration of PN, the patient is at risk for infection and blood glucose disturbances, thus requiring insulin therapy, and ongoing assessments for blood glucose levels and monitoring signs and symptoms of infection, hyperglycemia, and hypoglycemia.
- The rate is increased gradually on starting PN therapy to the prescribed rate to prevent hyperglycemia.
- Nutritional solutions containing concentrations exceeding 10% dextrose or 5% protein must be administered via a CVAD.
- Solutions containing concentrations less than 10% dextrose or 5% protein may be administered through a peripheral vein, referred to as peripheral parenteral nutrition (PPN). -PN requires participation of the entire health-care team, in which the pharmacist, dietitian, HCP, and nurse communicate as a team to discuss the assessment, plan, and outcome criteria.
Home Intravenous Therapy
- Home IV therapy enables patients the benefit of early discharge and the ability to receive health care in the privacy and comfort of their own homes.
- Good hand washing is essential.
- Instruct the patient to keep the IV site dry, keep a safe place to store supplies, and remove IV solution from the refrigerator 30 minutes prior to the arrival of the home health nurse.
- Most patients requiring home infusion therapy have a CVAD rather than a PIV.
Subcutaneous Infusion (Hypodermoclysis)
- Subcutaneous infusion, or hypodermoclysis, is more common in pediatrics, palliative care, home care, and hospice settings as well as for the elderly, as an alternative option for administration of medications or fluids.
- Isotonic fluids, most commonly 0.9% sodium chloride or 5% dextrose in water, and limited medications can be administered via this route.
- Hypodermoclysis is recognized as a safe, low-risk, cost-effective route to treat dehydration and for use in patients with poor vein quality, where pharmacological companies are developing subcutaneous formulations of medications that will improve response, physiologic effect, and patient compliance.
- To access the subcutaneous route, a needle or catheter is placed below the dermis and epidermis in the fatty tissue.
- Locations for subcutaneous access include the abdomen, thighs, upper arms, chest, and scapular areas.
- Patient education should include reporting pain, redness, swelling, or leaking at the site, and can be taught to obtain access and infuse the medications.
- The needle and site should be changed every 24 hours, as a means to reduce the risk of infection.
- Advantages include slow absorption rate, decreased severity of infection, and minimal training requirements; where disadvantages include risk of edema, fluid overload, and infection and cellulitis, and a limitation in drug choices.
- Recommended infusion rate of fluids should not exceed 62 mL/hr (1,500 mL total limit over 24 hr). where two sites may be used for high volume solutions up to 1 liter per day per site.
- Recommended rate when administering medications should not exceed 5 mL/hr.
- Fluids and medications will pass through the extracellular matrix to be absorbed by the capillaries and the lymphatic system.
- Edema could indicate that the infusion is exceeding the rate of absorption, and the rate must be decreased.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
