IV Therapy Quiz: Complications and Solutions

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.