what is the RN accountable for in IV - moves water into cells

therapy? - can be given to pt with high sodium levels

- what IV therapy is ordered and its - causes fluids to move out of vascular
indication system into cells
- desired outcome of the IV therapy - causes cells to swell
- possible adverse or SE that may occur
- prepare the pt mentally and physically what are some hypotonic solutions ?
- administer, maintain, and monitor the - D2.5W
therapy - 1/2 NS (0.45 NS) (<0.9 = hypotonic)
- discontinue therapy when ordered
- document and report don't give hypotonic solutions to
patients with:
what are some advantages of IV therapy? - increased intracranial pressure
IV therapy provides: - hypotension
- access route for meds, fluids, anesthetics
in an emergency situation hypotonic solutions are used to treat:
- access route for unconscious or NPO pt - cellular dehydration
- alternative choice for irritating or poorly
absorbed meds by other routes hypertonic solutions
- faster absorption (have to be very careful) - more particles than intracellular/rest of
body
what are some disadvantages of IV - causes more fluid to be pulled in vascular
therapy? space
- patient discomfort - moves water out of cells into circulating
- fluid overload volume
- speed shock - used for really low sodium level
- local or systemic infection (could be - irritating to the veins -> often given through
caused by poor technique) larger central lines
- venous thrombosis or emboli
- transmission of Hep B, Hep C, HIV (needle what are some hypertonic solutions?
safety is important) - D10W (anything > D5W)
- 3% normal saline (> 0.9% = hypertonic)
IV fluids are prepared in bags or bottles - mannitol
ranging in size from 500-1000ML - parenteral nutrition

isotonic solutions hypertonic solutions can cause

- same amount of particles as body fluids - cellular dehydration
- expand circulating volume but no shifts - fluid overload (use cautiously in pt with HF,
into or out of vessels/cells dehydration)
- stay in intravascular compartment
- given to build up and replace intravascular if the IV solution is in a glass bottle, what
volume special equipment do you need?
- vented tubing
what solutions are isotonic?
- 0.9% NaCl (normal saline) what can be used to make sure pt does
- D5W (5% dextrose in water) not get too much med or fluid?
- LR (lactated ringer) Buretrol

risk of isotonic solutions what size needle gauge is best to use for
- fluid overload especially in older adults an elderly pt going to surgery?
(sx: crackles, edema, weight gain, increased 20 gauge
RR, increased HR, increased BP, JVD)
what needle gauge sizes are used to
isotonic solutions are used to: draw blood?
- replace fluid lost by hemorrhage, low BP, 18-20
bleeding
what needle gauge sizes are used to for
hypotonic solutions adults?
- less particles than intracellular/rest of 18, 20, 22 most commonly
blood and body
what are winged needles used for?
- used primarily for peds what is infiltration?
- used for phlebotomy to draw blood - the IV catheter dislodges and solution
- not left in place infuses into surrounding tissue
- used for one time use
signs and sx of infiltration
do not use wrist for an IV site because of cool, pale, swollen extremity
risk for ____ - coolness
- Nerve damage - tautness of skin
- dependent edema
an IV start kit contains what? - slowed infusion rate
- tourniquet - no back flow
- antiseptic skin preparation
- gauze ways to prevent infiltration
- tape - use smallest size angiocath
- dressing - stabilize angiocath (by taping it)
- avoid area of flexion (elbow, wrist)
what IV equipment must have a label on
them? treatment for infiltration
- IV solution - stop infusion
- Tubing - remove IV catheter
- insertion site - apply pressure to stop bleeding
- elevate extremity
IV tubing should be changed _____ - apply cold or your agency policy or HCP
every 72-96 hours orders
- apply warm to help body absorb fluid
saline lock should be changed every
24 hours what is extravasation?
- type of infiltration
any time you add a med to a bag, you - leakage of vesicant (med, irritating
must solution) into the tissue surrounding the vein
put a label on it
signs and sx of extravasation
what is a hematoma? - severe burning pain
- complication of IV therapy - blistering of skin
- infiltration of blood into tissue - tissue sloughing
- damage to vessel wall - tissue necrosis

what patients are at risk for a treatment of extravasation

hematoma? - stop infusion
- bruise easily (elderly patients) - tx depends on the medication - sometimes
- anticoagulant therapy the cath is left in place and an antidote is
- long term steroid use given

signs and sx of hematoma what is a thrombosis?

- discoloration - clot within or around the IV catheter
- swelling/discomfort
- inability to advance catheter signs and sx of thrombosis
- resistance when attempt to flush - slowed or stopped infusion
- inability to flush catheter
ways to prevent hematoma - swollen extremity
- be gentle when starting IV
- use smallest needle prevention of thrombosis
- apply tourniquet just before sticking - make only 2 attempts to perform
venipuncture
treatment of hematoma - choose smallest gauge catheter
- apply pressure when discontinuing the - ensure adequate hydration (encourage
catheter (until pt stops bleeding) fluids)
- elevate
- ice (based on facility policy)
treatment for thrombosis what to do if fluid overload does occur:
- NEVER flush and force clot to move - decrease or stop IVF infusion
- if it doesn't flush easily, stop, dont force it, - notify HCP for further orders
discontinue IV
- assess for circulatory impairment signs and sx of a catheter-related blood
- elevate extremity stream infection
- with central lines, might use low dose - redness and swelling
thrombolytic to lyse the clot - drainage (purulent)
- increased WBC's
what is phlebitis? - elevated temp
- inflammation of the vein
- could be caused by infection at insertion prevention of a catheter-related blood
site or an irritating med like potassium or a stream infection
mechanical issue when inserting cath - aseptic technique with insertion
- assess
signs and sx of phlebitis - change site
- redness - vigorously clean ports with alcohol for 30
- tenderness seconds
- warm to touch
- local swelling treatment for a catheter-related blood
- sluggish infusion rate stream infection
- hard, cordlike when palpating - d/c catheter
- notify MD
ways to prevent phlebitis - might culture drainage if ordered
- prevention is the best intervention
- aseptic insertion technique what is the tx for an air emboli
- good hand washing - place pt in trendelenburg on left side
- use smallest length and gauge cannula - apply oxygen
- rotate sites every 72-96 hours - notify MD

what to do if phlebitis occurs what causes speed shock and what are
- stop IV infusion and d/c catheter the signs and sx of it
- restart in opposite arm - caused by giving meds too quickly
- warm compresses per policy - dizziness
- culture drainage if present - chest tightness
- notify HCP who may order antibiotics - flushed face
- feeling faint
fluid overload could be caused by - irregular pulse
- fluids infusing too fast - can cause cardiac arrest
- isotonic or hypertonic solutions
- CV disease or renal disease what is a catheter embolism and the tx
for it
signs and sx of fluid overload - a piece of catheter breaks off and floats
- JVD through blood stream
- mental status changes/ confusion - place pt in trendelenburg on left side
- increased RR - apply tourniquet above insertion site
- SOB - notify MD
- crackles in lungs
- peripheral edema when selecting a vein, the site selected
should:
prevention of fluid overload - provide the most appropriate access to the
- best intervention vessel
- place IVF on electronic device and monitor - accommodate the prescribed therapy
flow rate closely (always put them on an IV - minimize associated risks of complications
pump) - always start distal and work proxima
- monitor I&O, breath sounds, RR, daily
weight, VS when selecting a vein, the nurse should
consider:
- pt age, history, and health status
- purpose and duration of IV therapy the bigger the catheter, the higher the
- condition of the site risk for
- patients preference when possible - Phlebitis

you should not insert an IV where in an use 18-20 gauge needle for
elderly patient? - hypertonic or isotonic solutions with
- the hands (last resort) additives
- blood administration
common IV insertion sites for peds - trauma
- scalp - surgery
- feet - labor

the order for IV therapy should include use 22 gauge for:

- name of IVF - fragile veins in elderly
- drug and specific dose to be added to the
solution use 22-24 gauge for
- volumer to be infused (VTBI) - pediatric patients
- rate of infusion (mL/hr for ex. 125 mL/hr)
(volume over time period - for ex. 1000 mL steps to venipuncture
over 12 hours) - hand hygiene
- duration of infusion - prime tubing
- signature of provider - apply gloves
- apply tourniquet
what veins are commonly used for IV - find vein
therapy - take off tourniquet
- cephalic vein - prepare/clean the site with alcohol then
- basilic veins with povidine-iodine, chloraprep, or tincture
- median antebranchial vein of iodine
- apply tourniquet again
when selecting a vein, don't use - enter the vein
- veins of lower extremities (in adults bc of - stabilize the catheter and apply dressing
higher risk for blood clots) - label the site
- veins that are irritated or sclerosed (red - disposal of equipment
streak following vein) - regulate flow rate
- areas of flexion unless joint is immobilized - document
- veins in the antecubital fossa (primarily
used for drawing blood) steps to entering the vein
- pull skin taunt
don't use veins on the side in an - enter the skin at 10-20 degree angle
extremity with - after bevel enters the vein and flashback is
- mastectomy seen, lower the angle of the catheter and
- lymph node dissection advance into the vein another 1/4 inch by
- paralysis or stroke pushing tab forward with index finger and
- arm with an arteriovenous shunt or fistula then pull safety back
for dialysis - release the tourniquet
- surgery in that arm - remove the stylet
- connect the catheter hub to the
dont do phlebotomy or BP on same side administration set and determine patency
as IV bc increased risk of: what all should the nurse include in
- phlebitis or infiltration documentation of venipuncture
- date and time of insertion
what to do if you have difficulty locating - location of IV catheter (vein used)
a vein - device used: brand name, style, gauge,
- stroke or gently tap extremity (don't tap on length
elderly pt or pt taking anticoagulants) - name and rate of IVF infusing
- open and closing the fist - method of infusion: gravity, electronic
- apply warm washcloth or other heat on infusion device (IV pump)
extremity (vaodilates) - pt response and teaching
- lower the extremity below level of the heart - signature
 - select smallest access device
what should you put on each label and - be careful with tape
where - increased risk for heart failure and fluid
- date, time, size of Jelco, nurse's initials on overload - isotonic and hypertonic solutions
dressing should be used cautiously
- date, time, nurse's initials on tubing
- date, time, nurse's initials, any additives on special considerations for IV therapy in
IV bag pediatrics selection of vein:
- age and size of child
how often should you change dressing - mobility and level of acuity
of an IV site? - cognitive ability
- with each devise change or more often if peripheral veins:
wet or soiled to prevent infection - scalp
- hand/forearm
you do not have to flush the tubing if the - dorsum of foot
infusion is
- Continuous IV piggyback (IVPB)
- medication prepared in a 5-250mL infusion
peripheral catheters, dressings, and bag or syringe
primary tubing should be changed - short secondary infusion tubing used to
- every 72-96 hours connect to primary set
- needle or needless devise connects two
how often should a nurse replace the IV - may control infusion rate with pump,
administration set ? controller, mini infusion/syringe pump
at least every 72-96 hours - intermittent infusion of small volume
solution
how often should you replace an IV bag?
- every 24 hours or sooner per order cannot IV push
hang for longer the insertion of a small amount of
medication directly into the vein over a short
how often should a nurse replace lipid period of time.
containing solutions and infusion sets? - may be given through a port on an IV line
- every 24 hours or a peripheral access device.
- given over seconds to few minutes
when giving a med intermittent - injecting from syringe
piggyback, how often should a nurse
change the tubing and why? indications for IV Push
- every day bc of constant connecting and - unstable client in need of rapid, predictable
discontinuing medication response
- client on restricted fluid intake
steps to discontinuing IV therapy - for pt NPO, can't swallow, unstable
- don gloves - works quickly
- obtain 2x2 inch gauze pad
- loosen tape and apply gauze over insertion what are some advantages of IV Push?
site - quick onset of action
- remove cannula and dressing as one unit - small amount of volume
- apply direct pressure to the site
- apply band aid if needed disadvantages of IV push?
- document cannula removed intact and - rapid onset
condition of site - increased risk of infiltration or phlebitis

what are some special considerations what is the IV Push procedure?

that nurses should take when performing 1. check physician's order
IV therapy on geriatric patients? 2. follow six rights of medication
- loss of subcutaneous fat and thinning administration
makes skin and veins fragile 3. assess 4 key questions on IVP algorithm
- pull skin tight to stabilize veins and insert 4. administer per algorithm
at 10-20 degree angle
- use tourniquet loosely and for short period
of time
what are the 4 questions a nurse must
answer every time before administering
IV Push?
- can it be pushed?
- is it compatible?
- does it need to be diluted? if so, what is
the diluent and amount?
- how fast can it be pushed?

if a med is not listed as compatible or

incompatible..…
treat it as incompatible

rate of IV bolus: if the ordered dose

matches the instruction in the reference
book, ___________________________
administer as instructed