IV Therapy Quiz: Complications and Solutions

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Questions and Answers

What is the primary concern with compartment syndrome related to IV therapy?

Increased tissue pressure causing reduced blood flow (correct)

Anaphylactic reaction to the IV solution

Formation of a blood clot within a vein

Localized inflammation at the insertion site

Why is a fracture considered a contraindication for IV therapy at the site of the fracture?

It creates an increased risk of infection at the insertion site

It can directly interfere with the structural integrity of bone (correct)

It reduces the absorption rate of the IV medications

It increases the risk of allergic reaction to the IV fluids

Which of the following is not a recommended antiseptic for preparing the skin prior to IV insertion?

Chlorhexidine

Povidone-Iodine

Hydrogen Peroxide (correct)

Alcohol

What is the significance of the 'no-touch technique' in preventing infection during IV insertion?

It prevents the introduction of contaminants after the skin has been prepped (B) Signup and view all the answers

How long should the hub of the IV catheter be scrubbed with an alcohol pad each time it is accessed?

30 seconds (A) Signup and view all the answers

What range defines normal blood osmolarity?

270 to 300 mOsm/L (C) Signup and view all the answers

A solution with an osmolarity of 450 mOsm/L would be classified as which type?

Hypertonic (D) Signup and view all the answers

Which of the following is a hypotonic solution?

0.45% saline (1/2 NS) (B) Signup and view all the answers

What is the primary risk when placing an IV in a patient with confusion?

Increased risk of the patient pulling out the IV (B) Signup and view all the answers

Which of the following solutions is an example of a hypertonic IV solution?

10% dextrose in water (D10W) (D) Signup and view all the answers

Why is it important to use flexible dressings to cover an IV site?

To ensure the dressing is not too tight, and to allow the insertion point to be viewed. (D) Signup and view all the answers

Besides IV solutions, what are other types of infusion therapy fluids?

Blood and blood components, Drug therapy (C) Signup and view all the answers

Which of the following represents an isotonic solution?

A solution with the same concentration as blood, 270 to 300 mOsm/L (B) Signup and view all the answers

Which of the following is NOT a component of the Nurse Practice Act (NPA)?

Outlines the procedures for developing new nursing innovations. (D) Signup and view all the answers

Which of the following professionals may be trained and credentialed to insert IV catheters and assist with infusions, depending on state and facility regulations?

Licensed Practical Nurses (LPNs) (A) Signup and view all the answers

What is the term used to describe medical treatments administered by injection?

Parenteral Therapy (C) Signup and view all the answers

When a nurse is unsure about the appropriate procedures for administering IV medication or initiating IV therapy, what should they consult?

The state's nurse practice act and facility policies. (C) Signup and view all the answers

What are the responsibilities of a registered nurse concerning IV therapy?

Documenting all IV therapy processes. (C), Supervising practical nurses in IV administration. (D) Signup and view all the answers

Which of the following is a key point regarding the nurse practice act as it relates to IV therapy?

Only registered nurses can perform IV therapy. (D) Signup and view all the answers

When preparing equipment for IV therapy, which of the following supplies is essential?

IV fluid bags and administration sets. (C) Signup and view all the answers

What must a nurse do before interpreting a doctor's orders for IV therapy?

Verify the patient's identity and condition. (D) Signup and view all the answers

What is the rationale for selecting specific IV solutions?

To treat the patient's medical condition effectively. (D) Signup and view all the answers

What is one expected outcome of effective IV therapy management?

Stabilization of the patient's condition. (A) Signup and view all the answers

Which of the following describes a step in the process of starting IV therapy?

Selecting the appropriate venipuncture site. (D) Signup and view all the answers

Which of the following is a common guideline for managing IV therapy with a piggyback setup?

Clear the primary line with a saline flush before administration. (B) Signup and view all the answers

What is the primary difference between peripheral circulation and central circulation?

Central circulation consists of larger veins found in the body's central portions. (B) Signup and view all the answers

When should central circulation be utilized for administering a solution?

When the osmolarity of the solution exceeds 600 mosm/l. (C) Signup and view all the answers

Which of the following is NOT a common type of Central Vascular Access Device?

Short Peripheral IV Device (A) Signup and view all the answers

What is one of the main advantages of using central circulation for infusing TPN?

Central circulation provides greater blood flow and hemodilution. (A) Signup and view all the answers

Which of the following devices is primarily used for short-term therapy?

Short Peripheral IV Device (C) Signup and view all the answers

What potential risk is associated with incorrect osmolarity administration?

Damage to blood vessels and the vein may occur. (B) Signup and view all the answers

Which vascular access device is often implanted for long-term use?

Tunneled Catheters (A) Signup and view all the answers

What is a primary characteristic of peripheral vascular access devices?

They are typically inserted in veins of the forearm and hand. (C) Signup and view all the answers

Which assessment finding is indicative of phlebitis?

Redness along the vein with warmth and pain (B) Signup and view all the answers

What is the primary intervention when a patient shows signs of infiltration?

Stop the infusion and remove the IV catheter (B) Signup and view all the answers

To prevent circulatory overload during IV therapy, what should be monitored closely?

Patient's intake and output (B) Signup and view all the answers

Which complication is characterized by the leakage of vesicant solutions into surrounding tissues?

Extravasation (D) Signup and view all the answers

What should be done if a blood clot in the vein is suspected?

Stop the infusion and elevate the extremity (D) Signup and view all the answers

What is a common assessment finding for circulatory overload?

Shortness of breath and edema (B) Signup and view all the answers

Which of the following is a primary prevention method for infection during IV therapy?

Using appropriate infection control measures (A) Signup and view all the answers

How often should IV dressing be changed according to infection control guidelines?

Whenever visibly soiled (A) Signup and view all the answers

Which patient demographic may be at higher risk for ecchymosis during IV therapy?

Older adults (B) Signup and view all the answers

What immediate action should be taken if an air embolism is suspected during IV therapy?

Stop the infusion and notify a physician (B) Signup and view all the answers

If extravasation occurs, what should be administered if available?

Antidote specific to the vesicant (B) Signup and view all the answers

What is the key characteristic of thrombophlebitis during assessment?

Cord-like hardness of the vein (B) Signup and view all the answers

Which guideline should be followed for changing IV tubing to reduce infection risk?

Every 96 hours per CDC recommendations (A) Signup and view all the answers

Which technique is recommended to ensure IV catheter stability?

Regularly checking the insertion site (C) Signup and view all the answers

Study Notes

Module B: IV Therapy - Learning Objectives

Define terms associated with IV therapy
Describe key points of the nurse practice act concerning IV therapy
Explain CDC guidelines and agency policies for IV therapy
Explain selected ethical concepts and patient rights related to IV therapy
Differentiate between registered and practical nurse responsibilities for IV therapy
Explain the registered and practical nurse's responsibilities in administering blood, blood products, and volume expanders
Interpret doctor's orders for IV therapy
Explain anatomical and physiological considerations associated with IV therapy
Explain rationale for the selection of IV solutions
Describe the purpose of equipment and supplies for IV therapy
Select appropriate equipment and supplies for specified IV therapy
Describe the process of preparing a patient for IV therapy
Describe the process of preparing equipment for performing IV therapy
Calculate IV flow rates
Describe the process of starting IV therapy
Describe the process of managing IV therapy including IV piggyback and saline flush
Identify expected outcomes of treatments for IV therapy
Use critical thinking to prioritize management of care for clients receiving selected IV therapy
Identify equipment and techniques for collecting blood specimens
Select the appropriate color collection tube for an ordered diagnostic test based on organizational protocol
Describe the process of preparing a patient for collecting blood specimens
Explain the process for obtaining blood specimens
Explain CDC guidelines and/or agency policies for handling blood specimens
Explain procedures for handling and disposing of specimen-gathering materials

What is Infusion Therapy?

Provides immediate vascular access for rapid delivery of specific solutions without gastrointestinal absorption.
Includes medications, fluids, blood products, and nutrition.
May also be referred to as parenteral therapy.
Is a common invasive therapy procedure in hospitalized patients.

Who Can Perform Infusion Therapy?

Nurse Practice Acts (NPAs) define scope of practice and licensure requirements.
Guidelines for educational programs and disciplinary actions are monitored by state boards of nursing.
Licensed practical nurses (LPNs) may be trained and credentialed to insert IV catheters and assist with infusions, depending on the state and facility.

Who Can Perform Infusion Therapy (additional considerations)

If ever in doubt about IV medications or initiation of IV therapy, always refer to the state nurse practice act and facility policies and procedure manuals.

Peripheral Circulation vs Central Circulation

Peripheral Circulation involves smaller veins in the upper and lower extremities.
Central Circulation involves larger veins in the central portions of the body (ex. subclavian, femoral).
Solution osmolarity influences the need for central circulation (for > 600 mosm/L).

Vascular Access Devices (VADs)

Plastic tubes placed in blood vessels for delivering fluids, medications, blood products, and nutrition
Common devices include short peripheral IV devices, midline catheters, peripherally inserted central catheters (PICCs), tunneled catheters, implanted ports, and hemodialysis catheters.

Intravenous (IV) Devices

Peripheral IV Devices (Plastic Cannulas)
Used for short-term therapy.
Most commonly placed in the veins of the forearm and hand
Lower extremity veins should be avoided due to risks for clot formation.

Intravenous (IV) Devices and Precautions

Allergies
Assessment (every 4 hours for infusions, once a shift for saline locks)
Infection control (hand hygiene; aseptic prepping skin with 70% alcohol or chlorhexidine; changing dressings; dwell time)
Sites to Avoid (areas of joint flexion; median nerve/dominant arm; sites of previous complications; sites of cellulitis)
Technology Advancements (vascular visualization technology, ultrasound-guided IV placement)

Midline Catheter

3 to 8 inches long
Double or single lumen
Used for 1–4 weeks
Inserted using sterile techniques
Dressing changes using sterile technique
Avoid vesicants and TPN
Do not draw blood

Peripherally Inserted Central Catheter (PICC)

18-29 inches long
Sterile technique for insertion and dressing changes
Available in single, double, and triple lumens
Solutions of any osmolarity can be used
Dwell time can be months or years

Implanted Ports

Used for patients needing IV therapy for more than a year.
Surgically implanted, typically in the upper chest, with a self-sealing silicone center.
All types of solutions can be used.

Hemodialysis Catheter

Large lumen catheters for hemodialysis or apheresis procedures
Surgically placed for long-term use.
Catheter-related bloodstream infections and vein thrombosis are common complications
Not used for routine infusions, only in emergencies

Alternative Sites for Infusion (Intraosseous (IO))

Access to vascular network in bone marrow.
Used in emergencies and pediatrics.
Avoid fractures.

Complications of IV Therapy - Infection

Catheter-Related Bloodstream Infections
Prevention:
- Hygiene (wash hands);
- Antisepsis; clean and dry skin before catheter insertion.
- No-touch technique
- Proper documentation, dressings, and tubing changes

Complications of IV Therapy - Phlebitis

Inflammation of the vein
Assessment tools include pain, erythema, warmth, and red streaks.
Grading scales exist to assess the severity.

Complications of IV Therapy - Infiltration

Leakage of non-vesicant solution into surrounding tissues
Assessment features include increased edema, pallor, and coolness.
Grading scales exist to assess severity.

Complications of IV Therapy - Extravasation

Leakage of vesicant solution into surrounding tissues
Assessment includes edema, blistering, and tissue sloughing.
Treatment includes stopping the infusion, disconnecting tubing, aspirating remaining medications if available, applying cold compresses, and possibly surgical interventions.

Complications of IV Therapy - Thrombophlebitis

Blood clot in the vein.
Assessment involves slowed or occluded infusions, hard cord-like veins, swollen, tender, red extremities
Treatment necessitates stopping the infusion immediately, applying cold compresses, elevating extremity, possible use of thrombolytics, and monitor site frequently.

Complications of IV Therapy - Ecchymosis and Hematoma

Blood leaks into surrounding tissues of insertion site.
Assessment features involve swelling (edema), bruising (ecchymosis), and possible pain or tenderness.
Prevention strategies include avoiding veins that cannot be palpated, proper catheter insertion technique and site selection.

Complications of IV Therapy - Circulatory Overload

Excessive fluid volume in the circulatory system
Monitor intake and output and fluid balance closely.
Use caution with speed shocks, infusion control devices, and double-checking infusion rates.

Types of Infusion Therapy Fluids

IV Solutions (including blood and blood components and drug therapy)
Solutions are classified by osmolarity (isotonic, hypotonic, and hypertonic)
Isotonic solutions have the same osmolarity as blood, hypotonic solutions are lower, and hypertonic solutions are higher.

Blood Transfusions

Blood components available for transfusion (packed red blood cells (PRBCs), platelets, fresh frozen plasma).
Client data collection (including cultural and religious beliefs).
Compatibility testing (including blood type, Rh factor, and antibody status—crossmatching).
Role of the LPN in collecting data, identifying the patient, monitoring vital signs.

Types of Infusion Therapy Fluids (additional detail)

Isotonic solutions (0.9% Sodium Chloride (NS), Lactated Ringer's solution, 5% dextrose in water)
Hypertonic solutions (> 300 mOsm/L)
Hypotonic solutions (< 270 mOsm/L)

Blood Transfusions (additional considerations)

General Precautions (infusions should be given within 20-30 minutes of receiving them from the bank).
Monitoring vital signs (and lung sounds) frequently.
Administration protocols and documentation.
Potential transfusion reactions: mild (facial flushing, hives), severe (anxiety, wheezing, hemolytic reactions).
Prevention with appropriate measures and physician notification of any life-threatening symptoms.

Medication Infusions

Allergies and reactions are immediate concerns.
Medication safety protocols, including dosages, routes, and concentrations must be followed.
All IV therapy must be prescribed by an authorized provider.
Documentation of the type of fluid, rate of administration, drug preparation, and length of time for infusion.
IV solutions cannot hang for more than 24 hours if volume remains.

Infusion Systems (Containers)

Glass containers require vented tubing.
Plastic does not require vented tubing.

Infusion Systems (Administration Sets)

Primary sets use gravity or electronic pumps
Piggyback sets—secondary infusion for intermittent medications.

Infusion Systems (Add-On Devices)

Filters—remove particles and microorganisms.
Needles—special engineering for safety
Syringe pumps—used to administer small-volume medications.

Infusion Systems (Rate Control)

IV pumps regulate infusion rate and volume.
Accurate rate control is crucial for patient safety.
SMART PUMPS offer dosage calculations to reduce errors.

How to Calculate IV Flow Rates

Standard formulas are used to determine IV flow rates
Formulas/calculations are used to determine flow rates for various infusions and conditions.

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Description

Test your knowledge on intravenous (IV) therapy, focusing on complications such as compartment syndrome and contraindications like fractures. This quiz also covers antiseptics, osmolarity, and the significance of using flexible dressings. Dive into important principles to enhance your understanding of IV practices.