(def)

the inadvertent administration of a

nonvesicant solution into surrounding tissues;
occurs from the dislodgement of the catheter
from the lumen of the vein

infiltration

What are 7 causes of infiltration?

1.
2.
3.
4.
5.
6.
7.

faulty catheter insertion

infusion device not secured properly
high delivery rate
high pressure from an electric pump
overmanipulation of an IV device
obstruction of blood flow through the catheter
phlebitis

What are 6 signs and symptoms of

infiltration?

1.
2.
3.
4.
5.
6.

infusion slows or stops

coolness of skin around IV site
taut skin
edema
absence of back flow or diluted blood return
pain (depending on degree of infiltration)

What are 3 advanced complications from

infiltration?

1. ulceration and possible tissue necrosis

2. compartment syndrome (change in pressure leads to
arterial compression, which leads to vascular spasm,
pain, and muscle necrosis)
3. Reflex sympathetic dystrophy syndrome- chronic and
exaggerated inflammatory process which leads to
limited function of the area

How quickly can muscular changes occur with

compartment syndrome? nerve damage?

muscular changes= 4-12 hours

nerve damage= 24 hours

How can you prevent infiltration?

check iv site every 2 hours (or more); check that iv isn't

caught underneath patient when turning

How can you check for infiltration?

place pressure 3 inches above catheter site in front of

tip and apply pressure either digitally or with a
tourniquet; if IV slows or stops, placement is proper. If
IV continues to run, suspect infiltration.

How do you treat infiltration?

- stop infusion; use warm or cold compress (depending

on hospital policy)
- possible to aspirate infused medication; stop infusion
but do not remove catheter and attempt to aspirate
surrounding fluid

inflammation of a vein

phlebitis

Phlebitis may lead to ________ if the patient

isn't treated early.

sepsis

True/False:
Phlebitis may lead to thrombophlebitis

true

Mechanical phlebitis can be caused by what?

the use of a large catheter in a small vein and improper

taping

Chemical phlebitis could occur with what 4

situations?

1.
2.
3.
4.

irritating or vesicant solutions are infused

improperly diluted medication
rapid infusion
presence of particulate matter in a solution

Bacterial phlebitis may occur in what 7

situations?

1.
2.
3.
4.
5.
6.
7.

poor aseptic technique

breaks in the integrity of the equipment
poor insertion technique
inadequately taped catheter
condition of the patient
vein condition
failure to do a site assessment

What two skills are essential to preventing

bacterial phlebitis?

1. handwashing
2. careful and proper site preparation

What are 5 measures to prevent phlebitis?

1. use large veins and central lines for hypertonic

solutions
2. rotate IV site ever 72-96 hours (or per hospital policy)
3. stabilize the catheter
4. use a 0.22 micron filter
5. choose the smallest catheter possible

True/False:
You should d/c infusion within 24 hours of the
first sign of phlebitis.

What are 4 steps/treatments for phlebitis?

False- you should d/c immediately

1.
2.
3.
4.

d/c infusion
apply warm/cold compress
notify MD
notify infection control (depends on hospital policy)

(def)
a blood clot that results from trauma to a vein

thrombosis

An IV site may appear healthy when a thrombosis is

present.

True

Should you ever force fluid into an IV site that

is resistant? Why or why not?

No, b/c a thrombosis could be present and become

dislodged with pressure

Can a thrombosis ever become infected?

yes, bacteria and other particles may become trapped

in the clot leading to thrombophlebitis

Thrombosis along with thrombophlebitis can
lead to what?

embolus

What are 3 methods to prevent thrombosis?

1. use an IV pump
2. when infusing by gravity @ rates lower than 50
ml/hr, select microdrip tubing
3. avoid IV placement in areas of flexion and the lower
extremities

What is the treatment method for a

thrombosis?

1. d/c and restart a new catheter

2. assess the site for circulatory impairment
(never flush a catheter to remove an occlusion)

What are the signs/symptoms of

thrombophlebitis?(6)

1.
2.
3.
4.
5.
6.

sluggish flow rate

edema
tender/cordlike vein
site warm to touch
red line above site
mottling/cyanosis of the involved extremity

What is the treatment for thrombophlebitis?

- Remove entire IV set up and restart in opposite upper

extremity using ALL new equipment
- follow treatment measures for thrombosis and
phlebitis

Clotting at the tip of the cannula that results

in sluggish or absent flow is caused by what 4
things?

1.
2.
3.
4.

How can you prevent clotting at the tip of the

cannula?

1. monitor flow rate regularly

2. use microdrip if flow rate is less than 50ml/hr
3. flush saline/heparin lock every shift and before/after
medications

What steps do you take if you suspect a clot

at the tip of a cannula?

- aspirate blood with a 5cc syringe and discard blood

(do not irrigate)
- restart IV infusion and observe if flow resumes and
observe site
- if flow does not infuse, remove IV and restart in
another suitable site

What is the result when the patient's own

blood infiltrates the tissues at the
venipuncture site?

ecchymosis/hematoma

What causes an ecchymosis/hematoma at the

IV site? (3)

1. nicking the vein during an unsuccessful venipuncture

attempt

IV rate too slow

saline/heparin lock not flushed regularly
IV bag allowed to run dry
precipitates from incompatible medications

2. d/c of an IV cannula without sufficient pressure held

over the site
3. applying a tourniquet too tightly, too long, or too
soon above a previously attempted venipuncture site

What are 5 recommendations to reducing the

likelihood of hematoma development at the
IV site?

1. apply tourniquet just before venipuncture (no longer

than 2 minutes)
2. use a 20-22 gauge for patients with paper-thin skin
3. be gentle
4. use a dry, sterile gauze when removing cannula
5. be alert to coagulation problems

What are 3 treatment measures for

hematomas?

1. after removal apply direct, firm pressure for 2-3

minutes using dry, sterile gauze (5-10 if patient is on
anticoagulants)
2. elevate on a pillow
3. use ice to prevent the hematoma from enlarging

(def)
the inadvertent administration of a vesicant
solution into the surrounding tissues which
results in the formation of blisters and
subsequent sloughing of tissues due to
necrosis

extravasation

What are examples of vesicant solutions?

antineoplastic drugs
electrolyte solutions
certain antibiotics
vasopressors
radiocontrast media
hypertonic dextrose solutions
misc. IV drugs (phenergan, ativan, dilantin)

What are 6 causes of extravasation?

1. puncture of the vein wall during venipuncture or by

mechanical friction from the catheter
2. dislodgement of the catheter
3. poorly secured infusion device
4. high delivery rate/high pressure
5. overmanipulation of the infusion device
6. thrombus at catheter tip

What are the signs/symptoms of

extravasation? (7)

What determines the severity of damage due

to extravasation?

- type, concentration and volume of fluid

slow or stopped infusion

complaint of pain or burning
swelling proximal or distal to IV site
puffiness in the dependent part of the extremity
skin tightness at the IV site
blanching or coolness of the skin
damp or wet dressing

What are 4 ways to prevent extravasation?

1. use a skilled practitioner for infusion

2. verify good blood return
3. use free-flowing IV solution for push medications
4. remove gauze dressing fully to visualize site during
administration

If extravasation is suspected, what should you

do? (list steps in order) (9)

1. stop infusion
2. leave catheter in place
3. aspirate medication and blood
4. instill antidote immediately through catheter
5. remove catheter
6. apply cold compress for 24-72 hours for all
extravasation except those of the vinka alkaloids
(antineoplastics)
7. notify MD
8. photograph area
9. document an incident report

(def)
a spasm of a vein resulting in temporary
cessation of blood flow

vasospasm

Vasospasms can be caused by what? (4)

1.
2.
3.
4.

administering cold solution

administering an irritating solution
too rapid infusion
administering a viscous solution

What are 2 signs/symptoms of vasospasm?

1. sharp pain at the IV site that travels up the arm

2. slowing of the flow

What techniques are used to prevent

vasospasm?

1. dilute meds as recommended in IV book

2. keep solution at room temperature
3. consider using a fluid warmer for rapid infusions of
cold agglutins
4. wrap extremity with warm compress during infusion

What is the treatment method for

vasospasms?

- decrease the flow rate until the spasm subsides and

restart
- apply warm compress to the affected extremity

Local infections of the vein (such as

intravascular thrombus) are one of the most
serious catheter related infections. What are
4 causes attributed to this type of infection?

1. catheters left in place longer than 5 days

2. field sticks not changed within 24 hours
3. poor technique in placing catheter
4. poor technique in maintaining and monitoring the
peripheral site

What are 4 signs/symptoms of a local

infection (such as thrombophlebitis)?

1.
2.
3.
4.

redness and swelling at the site

exudates of purulent material
elevated WBC
fever

How do we prevent local infections (such as

thrombophlebitis)? (5)

inspect all solution containers

change solution every 24 hours
adequate skin prep
thorough hand washing
maintaining asepsis at all times

What are the steps (in order) for treating a

local infection? (6)

- notify MD
- remove catheter and send for culture without
contaminating it
- obtain a swab from the insertion site for culture
- prepare for 2 blood cultures before antibiotic therapy
is started
- apply sterile dressing
- monitor IV site

What are 6 systemic complications related to

IV therapy?

1.
2.
3.
4.
5.
6.

septicemia
circulatory overload
pulmonary edema
air embolus
speed shock
catheter embolus

(def)
the presence of microorganisms or their toxic
products in the bloodstream

septicemia

What are the 2 most common

microorganisms involved in catheter-related
HAIs?

1. coagulase-negative staphylococcus
2. enterococci

What are examples of practitioner-related

factors for the development of septicemia (in
regards to IVs)? (6)

What are 4 infusion related factors linked to

the development of septicemia?

1.
2.
3.
4.

Often times, the development of septicemia if

related to patient risk factors. What are
examples of this? (4)

age
underlying disease
immune status
presence of other infectious processes

fever
cold sweat
tachycardia
hyperventilation
hypotension

What are 10 signs/symptoms of septicemia?

lack of handwashing
break in sterile technique
lack of experience inserting IVs
inadequately prepared skin over insertion site
inadequately stabilized and maintained IV access
repeated manipulation of IV system
problems with the solution container
problems with the catheter material
error at the insertion site
duration of the infusion

altered mental status

nausea
vomiting
diarrhea
abdominal pain

True/False:
To prevent septicemia, you should follow the
same techniques of prevention as used to
prevent local infections, phlebitis, and
infiltration.
True/False:
Solutions of albumin should be used within 1
hour of opening.

True

False- albumin should be used as soon as the seal is

broken.

When treating septicemia, the regimen is

similar to that of local infections, phlebitis,
and infiltration. Supportive treatment may
also be indicated for what 2 additional
systemic problems?

1. cardiovascular collapse
2. respiratory compromise

What are 3 causes of fluid overload?

1. excessive amounts of isotonic or hypertonic solutions

rapidly
2. failure to monitor IV infusion
3. too rapid infusion in a compromised patient
(renal/cardiopulmonary/elderly)

Fluid overload can lead to what?

pulmonary edema

What are the signs/symptoms associated with

fluid volume overload? (12)

irritated cough, SOB, or crackles, wheezing

drop in O2 sat.
pulmonary edema
distended neck vein
tachycardia
increased BP/ bounding pulse
polyuria
urine SG less than 1.01
moist, taut skin
headache, confusion, lethargy
weight gain in a short time
decreased sodium, BUN, hct.

If fluid volume overload is not corrected, what

can result? (4)

pulmonary edema
shock
congestive heart failure
cardiac arrest

How can fluid volume excess be prevented?

(4)

1. monitor the infusion and know the solution's

physiologic effect on the circulatory system
2. maintain prescribed rate (never try to "catch" up)

3. monitor intake/output
4. know the patients renal/cardio history

What are the treatment measure you should

implement for fluid volume overload? (7)

1.
2.
3.
4.
5.
6.
7.

decrease flow rate

position patient in high fowlers
monitor vital signs
place on continuous O2 saturation
administer O2 if less than 95%
Call MD
Keep patient warm

(def)
an air pocket that causes obstruction to the
forward flow of blood

air embolism

What are the chain of events following the

obstruction of blood flow due to an air
pocket?

air pocket causes pulmonary hypoxia ----> results in

vasoconstriction of lung tissue ----> reduces blood flow
out of the heart ----> leads to decreased cardiac output,
shock, and finally death

What are 5 causes of an air embolism?

1. improper priming of tubing with air still in the tubing

2. superimposing a new IV bag to a line that has run dry
without clearing the line
3. loose connections that allow air to enter the system
4. poor technique in tube changing for central lines
5. allowing the solution container to run dry

What are the "initial" signs/symptoms of an

air embolism? (12)

If an air embolism is left untreated, the

condition leads to what 4 signs/symptoms?

1.
2.
3.
4.

As a nurse, you should implement what 6

measures to prevent an air embolism?

palpitations
lightheadedness
weakness
cough
dyspnea
cyanosis
pulmonary edema
tachycardia
chest pain
hypotension
jugular vein distention
anxiety, confusion, seizure
hemiplegia
aphasia
coma
cardiac arrest

1. instruct patient to do the valsalva maneuver when

changing the tubing
2. remove air from the administration set
3. follow protocol for tubing changes of central lines
4. superimpose IV solution before the previous bag runs
dry
5. attach piggyback to the injection port closest to the
drip chamber

6. do not bypass the IV pump

If an air embolism is suspected, you should

immediately begin treatment. What 4 things
should you do (in order)?

1. have someone call MD

2. position patient on left lateral decubitus with the
head down
3. monitor vitals and O2 sat.
4. administer 100% O2

When treating an air embolism, what is the

rationale for placing the patient on his left
lateral side with the head down?

this will cause the air to rise in the right atrium away
from the pulmonic valve, preventing it from entering
the pulmonary artery

When treating an air embolism, what is the

rationale for administering 100% O2?

this causes nitrogen in the air embolus to dissolve in

the blood and the bubble to decrease in size

What type of therapy is indicated for a large

air emboli?

hyperbaric therapy

Describe the surgical procedure that may be

indicated for an air embolus.

percutaneous aspiration of the air through the right

ventricle

(def)
medication is rapidly introduced into
circulation which allows it to reach toxic
proportions

speed shock

What are the signs/symptoms of speed

shock? (7)

dizziness
facial flushing
headache
tightness in the chest
hypotension
irregular pulse
shock

What are 2 preventative measures of speed

shock?

1. follow manufacturer's recommendation re: rate of

administration
2. use an IV pump

What is the treatment for speed shock?

Call MD and give the antidote or resuscitation

medication as needed

(def)
a piece of catheter breaks off and travels
through the vascular system
What are the causes of catheter embolism?
(4)

catheter embolism

- reinsertion of the same catheter that was used in an

unsuccessful venipuncture attempt
- pressure directly over the catheter during d/c of
therapy

- placement of catheter in joint flexion

- removing a stylet and reinserting it thus shearing off
the catheter tip

What are the signs/symptoms of a catheter

emboli? (4)

How can a catheter embolism be prevented?

- never reinsert a needle in a catheter

- do NOT apply pressure over the site when removing
catheter
- avoid inserting over a joint flexion
- splint arm if flexion must be used

What is the treatment for a catheter

embolism?

1. have patient apply digital pressure on vein above

catheter site
2. apply a tourniquet above the elbow
3. call MD
4. start a new IV line
5. prep patient for xray
6. keep catheter in a clear specimen container to
facilitate measuring the remaining tip

systemic and immediate hypersensitivity

reaction caused by an immunoglobulin Ig-E
mediate release fro mast cells and basofils

anaphylaxis

True/False:

sharp, sudden pain at the IV site

minimal blood return
rough/uneven catheter noted on removal
additional s&s same as an air emboli

True

Anaphylaxis is often unpredictable.

What causes anaphylaxis? (5)

- meds such as antibiotics, muscle relaxants, radiocontrast media, anesthetics, non-steroidal antiinflammatory drugs
- latex
- food
- stings
- idiopathic causes

What are the signs/symptoms of anaphylaxis?

(3)

- mild skin reactions

- respiratory problems
- cardiovascular collapse

What measures should be taken to prevent

anaphylaxis? (5)

- identify known allergies

- take patient history
- perform physical exam
- inquire about and adverse drug reactions among
family
- have thorough knowledge of the medications

What is the treatment for anaphylaxis? (7)

- d/c suspect med.

- monitor vitals and O2 saturation

- EKG
- administer O2, IV fluids and adrenaline as ordered or
per hospital policy
- activate ERT
- maintaing ABCs
- start CPR if pulse is absent

(def)
nursing intervention relative to the initiation,
maintenance, and discontinuance of
intravenous fluids and medications
administered through a peripheral or central
line

Intravenous Therapy (as defined by the LSBN)

___% of hospitalized patients receive some form

of IV therapy.

80%

The number of IV therapies administered by

home health nurses is _______ (increasing or
decreasing).

increasing

What is the yearly estimated number of

catheter-related blood stream infections? Of
this number, what percent results in death?

80,000 estimated cases with a 14-18% mortality rate

What is the reasoning for using a vein for IV

therapy rather than an artery? (2)

- thin and less muscular

- distend easily (allowing for storage of a large volume
of blood under low pressure)

What are the 3 layers of a vein, from outer to

innermost?

1. Tunica Adventitia
2. Tunica Media
3. Tunica Intima

Which layer of a vein consists of connective

tissue that supports and surrounds the vessel?

Tunica Adventitia

Which layer of a vein consists of muscular and

elastic tissue along with nerve fibers used for
vasoconstriction and dilation?

Tunica Media

Which layer of of a vein is innermost, consists

of a single cell layer of fragile cells, an allows
for easy blood flow?

Tunica Intima

On average, a person requires ____ mL of water

per Kg of body weight for maintenance therapy.

30

List the requirements for maintenance IV

therapy for the following:
carbohydrates
potassium
sodium
Approximately how many mL of fluid is lost per
a day via normal evaporation?

carbohydrates - 100-150 gm
potassium - 40-60 mEq
sodium - 1-2 mEq per kg of body weight

400 mL

Approximately how many mL of fluid is lost per

day via breathing?

400 mL

Approximately how many mL of fluid is lost per

day via feces?

100-200 mL

Approximately how many mL of fluid is lost per

day via urinary output?

1000-1200 mL

List (7) factors that determine the type and

amount of IV solution needed.

1.
2.
3.
4.
5.
6.
7.

Describe the rate of absorption with IV

administration.

total, rapid absorption (therefore therapeutic effect

begins almost immediately)

True/False:
An exact dosage can be achieved with IV
administration of medications.

Imbalances identified by laboratory tests

weight
kidney function and urinary output
cardiac function
hepatic function
disease process and duration
hormonal imbalance

True- IV medications do not enter the hepatic portal

system, therefore there is no drug loss due to first
pass effect.

When medications must be repeated often, why

is the IV route preferred over the SQ/IM route?

There is less tissue damage with the IV route of

administration

Which would be preferred when administering a

drug with a high concentration, SQ, IM or IV?

IV

When administering medication with an IV, the

dose can be _________ to achieve a therapeutic
goal and to sustain continuous control.

titrated

List 4 disadvantages of IV administration.

1. administered dose cannot be withdrawn and the

action cannot be terminated
2. drug interaction due to incompatibility
3. leaching from plastic container and tubing
4. adsorption into plastic container and tubing

What are (6) factors that affect drug solubility

and compatibility?

1.
2.
3.
4.
5.
6.

DEHP, an additive in PVC to make plastic

flexible, may leach (be extracted) from the
plastic tubing into the medication or substance

drug concentration
pH
Temperature
Light
Preparation technique
duration of drug-solution contact

DEHP-induced toxicity

being administered. What could this

phenomenon result in?
What should you do to avoid DEHP-induced
toxicity in a patient receiving lipid (and certain
medication) infusions?

always use the nonreactive tubing that comes with

the medication from the pharmacy

In regards to IV tubing, glass, and/or plastic,

what is adsorption and how does it affect drug
administration?

Many drugs attach to glass and/or plastic (especially

PVC in plastic IV bags); this results in a lower dose
being administered

What should you do to deter adsorption of

drugs into IV equipment?

inject the drug as close to the IV insertion site as

possible

Are there any risks (to the patient or nurse)

associated with IV therapy? Give examples.

Yes, there are risks of needlesticks among nurses.

Additionally, the patient is at risk for complications
such as infection, speed shock, phlebitis, infiltration,
and discomfort that may lead to emotional distress

When in doubt about IV drug compatibility,

what should you do before and after giving
each medication?

flush the IV tubing with normal saline

What should you do if a drug is discolored or

has formed a precipitate?

Do NOT administer that drug. Notify pharmacy.

If you do not have a clear understanding of the

compatibility or stability of the solution or
medication you are to administer, what are
some options to obtaining that information?

- check your IV guide book

- refer to manufacturer's recommendation
- call the pharmacist

a set volume of an IV solution delivered over an

ordered time range (ex. infuse NS @ 100 mL/hr)

continuous infusion

a set amount of medication delivered at a

regular interval, often administered as a
piggyback (ex. Ceftazidime 1 Gm in 50 ml D5W
IVPB Q 8 hours)

intermittent infusion

administration of a prescribed concentration of

medication by injecting through a Y port of
primary administration tubing or through a
saline lock (ex. Digoxin 0.25 mg IVP Q AM)

intravenous push

How fast do you deliver an IV push?

Varies with the drug, refer to IV med book for rate of

administration

For an IV push, which method is preferred:

Sharp needle or Blunt cannula? Why?

Blunt cannula, as it reduces the risk of needlestick

injury to the nurse

the minimal volume of IV solution on

continuous infusion to lessen possibility of
occlusion and to maintain an IV access
available (ex. D5W or NS at 10-20 ml/hr)

KVO (keep vein open)

method of IV administration where the pump

delivers a fixed hourly dose, basal dose, or a
combination of both, and the patient is able to
self administer a preset amount in addition to
the fixed hourly dose

Intermittent/continuous dosing (ex. PCA)

a dose of a medication or a contrast material

injected all at once intravenously; rapid
delivery of an IV medication or solution

bolus

What tool should be used when administering

an IV fluid bolus to ensure accurate dosage?

IV pump

What should be evaluated when administering

a fluid IV bolus?

monitor for signs of fluid overload or the need for

additional fluids

True/False:
You should closely monitor a patient who
receives an IV medication bolus, however an IV
fluid bolus does not require close attention.

False- both should be monitored closely

What factors may influence IV flow rate? (10)

- position of the arm or forearm

- position and patency of the tubing (bent, taped, etc.)
- use of a pressure bag
- height of the infusion bag
- fluid viscosity
- patient's BP
- clamp position
- amount of fluid in the IV container
- size of vein in relation to the size of the catheter
- condition of the infusion site (infiltration,
extravasation, clotted cannula, location of cannula)

Water accounts for ___% of total body weight.

60%

____ % of total body weight is water residing in

the intracellular fluid compartment, and ___% if
water residing in the extracellular fluid
compartment.

40%=ICF
20%=ECF

What are the 2 divisions of ECF, and what

percent of total body weight does each account
for?

intravascular = 5%
interstitial/transcellular = 15%

What are 6 functions of body fluids?

1. maintains blood volume

2. transports oxygen, nutrients, electrolytes, and

hormones to cells
3. carries waste products away from the cells
4. keeps cell shape
5. temperature regulation
6. lubricates membranes and joints
movement of water through a semipermeable
membrane from an area of lower concentration
to an area of higher concentration

osmosis

The tunica intima, capillary walls, and cell

membranes of RBCs all have what in common?

they are all semi-permeable membranes

the pressure of intravascular fluid against the

wall of a blood vessel

hydrostatic pressure

osmotic pressure exerted by plasma colloids

(keeps plasma in the intravascular space)

colloid oncotic pressure

What is the osmolarity of normal serum?

275-295 mOsm/L

Isotonic solutions have an osmolarity range of

what?

240-340 mOsm/L

Hypertonic solutions have an osmolarilty range

of what?

Above 340 mOsm/L

Hypotonic solutions have an osmolarity range

of what?

below 240 mOsm/L

What effect does an isotonic solution have on

the intravascular volume?

it expands the volume in the intravascular space

What effect does a hypertonic solution have on

the intravascular space?

it expands the volume in the intravascular space by

shifting fluid from the intracellular and interstitial
spaces

Isotonic, Hypertonic, or Hypotonic:

hypertonic

D5 1/2 NS
Isotonic, Hypertonic, or Hypotonic:
D5NS
Isotonic, Hypertonic, or Hypotonic:
D5LR

hypertonic

hypertonic

Isotonic, Hypertonic, or Hypotonic:

25% Albumin
Isotonic, Hypertonic, or Hypotonic:

hypertonic

hypertonic

3% NaCl
Isotonic, Hypertonic, or Hypotonic:
Normosol M
Isotonic, Hypertonic, or Hypotonic:

hypertonic

hypertonic

TPN
Isotonic, Hypertonic, or Hypotonic:
PPN

hypertonic

What are 3 examples of situations where a

hypertonic solution may be ordered?

1. postoperatively to stabilize BP
2. to maintain urine output
3. to reduce edema

What are 2 examples of patients who may have

problems with hypertonic solutions?

Patients with heart and renal problems may not be

able to handle the increased intravascular volume

What effect does a hypotonic solution have on

the intravascular space?

fluid is shifted OUT of the intravascular space into the

interstitial and intracellular space

Isotonic, Hypertonic, or Hypotonic:

0.45% NaCl
Isotonic, Hypertonic, or Hypotonic:

hypotonic

hypotonic

0.25% NaCl
Isotonic, Hypertonic, or Hypotonic:
2.5% dextrose in water
Isotonic, Hypertonic, or Hypotonic:
5% dextrose in water

hypotonic

Isotonic (however it becomes hypotonic upon

admission due to the metabolic breakdown and
resulting water byproduct)

Isotonic, Hypertonic, or Hypotonic:

0.9% NaCl

Isotonic

Isotonic, Hypertonic, or Hypotonic:

Lactated Ringer's

Isotonic

What is an example of a situation that would

require the administration of hypotonic IV
fluids?

to correct cellular dehydration caused by

hyperglycemia and excessive diuresis due to diuretics

What are things that should be monitored when

administering hypotonic fluids?

monitor for edema

monitor neurological status
could worsen 3rd spacing
monitor for lowered BP

Hypotonic fluids should be used cautiously in

what type of patients?

burns
liver disease
renal failure
trauma

a solution of sterile water with added

electrolytes and non-electrolytes which diffuse
across a semi-permeable membrane; can be
hypertonic, hypotonic, or isotonic

crystalloid

a solution that contains proteins or synthetic

sugar/starch which remains in the intravascular
space for several days

plasma expanders

What are 4 types of plasma expanders?

1.
2.
3.
4.

What are 3 adverse effects of plasma

expanders?

1. allergy
2. prolonged bleeding time
3. lowered platelet and hematocrit levels

What are 7 examples of blood/blood products?

1.
2.
3.
4.
5.
6.
7.

A unit of PRBC increases hematocrit by ___-___

%.

2-3%

(def)

lipids

fat emulsion made from soybean or safflower

oil, eggyolk, phospholipid, and glycerol; used in

colloids (albumin, plasmanate)

dextran
hetastarch
Mannitol

whole blood
packet RBC
fresh frozen plasma
platelets
clotting factors
albumin 5%
albumin 25%

conjunction with TPN

(def)
decrease in ECF volume or and increase volume
in interstitial space; aka dehydration

Fluid volume deficit

A fluid volume deficit is indicated with an

osmolality greater than _____.

295

What are signs/symptoms of fluid volume

deficit? (12)

1. hypotension
2. low urine output
3. tachycardia
4. weak, thready pulse
5. restlessness
6. confusion
7. lethargy
8. flat neck vein
9. excess thirst
10. poor skin turgor
11. dry mucous membranes
12. weight loss

What effect would you expect to see on urine

SG with a fluid volume deficit?

it would be greater than 1.035

What effect would you expect a fluid volume

deficit to have on BUN, sodium, and HCT
values?

normal or high values

What are 3 orders than may be given in

attempt to correct a fluid volume deficit?

1. increase IV rate
2. give an IV bolus
3. increase oral intake as tolerated

(def)
an increase in ECF with an osmolality less than
275

What are signs/symptoms of fluid volume

excess? (14)

fluid volume excess (fluid overload)

1. irritated cough
2. SOB
3. crackles/wheezing
4. drop in O2 saturation
5. pulmonary edema
6. distended neck vein
7. tachycardia
8. bounding pulse
9. increased BP
10. polyuria
11. moist, taut skin
12. headache
13. confusion
14. weight gain in a short time

What value would you expect urine SG to be

with a fluid volume excess?

urine SG less than 1.01

Would you expect an increase or decrease in

sodium, BUN, and HCT with a patient
experiencing fluid volume excess?

decrease

What type of MD order should you anticipate

with a patient experiencing fluid volume
excess?

restrict oral/IV fluids

What are some general uses for dextrose

solutions?

1.
2.
3.
4.
5.
6.
7.

Can dextrose solutions be given to diabetic

patients?

yes, provided that serum glucose is monitored

How many grams of dextrose are in 100 mL of

water for a D5W solution?

5 grams

Given that 100mL of D5W has 5 grams of

dextrose, how many calories does one liter
provide?

170 (200)

Prolonged therapy with D5W may cause what 3

conditions?

1. hypokalemia
2. hyponatremia
3. water intoxication

provide calories for energy

prevent ketosis
spares body proteins
flush the kidneys to excrete solutes
decrease Na+ and K+
treat dehydreation
improve liver function

What are 3 signs/symptoms of hypokalemia?

1. cardiac arhythimias
2. lethargy
3. decreased bowel sounds

What are 3 signs/symptoms of hyponatremia?

1. lethargy
2. confusion
3. encephalopathy

(def)
water gained in excess of electrolytes; results in
abdominal craps, nausea, vomiting, lethargy,
and dizziness

water intoxication

What are some general uses for NaCl solutions?

(6)

1. used with blood transfusions

2. trauma and shock resuscitation
3. fluid challenges (dehydration/lack of intake, check
output/kidney function)
4. acidifying solution
5. conservative treatment for metabolic alkalosis
6. to correct sodium loss

What is a common use for Dextrose combined

with NaCl?

to replace fluid loss (vomiting, gastric suctioning,

profuse sweating)

What is a common use for Ringer's solution?

to replace fluid loss (diarrhea, fistula drainage,

drastically reduced water intake)

What are some general uses for Lactated

Ringer's solution?

1. replace fluid loss (from burns, diarrhea, bile loss)

2. alkalizing solution
3. salicylate overdose

An order for Lactated Ringer's should be

clarified for a pH of more than ____.

7.5

(def)
most common IV access method, consisting of a
short catheter that utilizes the arm and hand
veins

Peripheral IV line

What is the average length of a peripheral IV

line?

3/4 to 1 1/4 inches

How often should a peripheral IV line be

rotated?

every 96 hours or per hospital policy

an adapter fitted to an IV catheter with a resealable,

injectable port for peripheral venous access

saline lock

What is the purpose of a saline lock?

- minimizes restriction in ambulation

- access for emergency medication / intermittent
medication
- limits IV intake

What is SAS?

a code word for flushing a saline lock; stands for

(s)aline, (a)dminister, (s)aline.

What is the purpose of SAS?

- moves the medication to main circulation

- clears catheter of residual medication
- prevents occlusion

Describe in detail the procedure for SAS.

- Wash hands and don gloves

- disinfect the port with alcohol and let it dry
- aspirate blood to check patency (only when drawing
blood)
- slowly administer 2-3 mL saline in 3mL syringe
while feeling above catheter tip (stop if resistance or
pain/leak noted)
- administer medication
- flush with saline, using push-pause/ pulsatile
technique

How long should a port be cleaned with alcohol?

15 seconds

When flushing a line, why should you never

push against resistance?

b/c it could push a clot into circulation

What is done to confirm placement of a central

IV line?

Chest X-ray

What must be obtained prior to using a newly

placed central line?

a doctor's order

Where is the tip of a central line located?

the Superior Vena Cava

What is the average liter/min blood flow in the

superior vena cava?

1.5 to 2.5 liter/min

What is the length of a central line?

depending on type, the length can range from 8 to

30+ inches

What may be used to keep the patency of a

central IV line?

Heparin (verify MD order)

A central line is coated with what?

an antimicrobial/antiseptic agent

How long does a central line stay in place?

from several days to months

How often should a clear dressing covering a

central line be changed?

every 6 day or PRN (or per hospital policy)

How often should a gauze dressing covering a

central line be changed?

every 2 days or PRN (or per hospital policy)

What is the ml/min blood flow in the cephalic

and basilic veins?

45-95 ml/min

What is the ml/min blood flow in the subclavian

vein?

150-300 ml/min

On average, what is the ml/min blood flow in the

SVC?

2000ml/min

What are 6 examples of central venous devices?

1.
2.
3.
4.
5.
6.

What is the purpose of a pulmonary artery

catheter?

to monitor cardiac function

What are 3 reasons for flushing a Central line?

1. to move medication to main circulation

2. to clear the catheter of residual medication
3. to prevent occlusion

Describe in detail the procedure for flushing a

central line.

- wash hands and don gloves

- disinfect port with alcohol and let dry
- administer saline 5-10 mL in a 10 mL syringe (stop
if leak, resistance or pain noted)
- administer medication IVPB or IVP
- flush with saline 5-10 mL using push-pause
technique
- flush with heparin 10-100 units per mL (total
volume twice volume capacity of central line plus any
extension/ or manufacturer inst./ or hospital policy)

What is SASH?

code word for central medication administration

(s)aline
(a)dminister medication
(s)aline
(h)eparin (based on MD order)

How fast do you administer saline following a

medication administration in a central line?

the same rate as the given medication

According to the Infusion Nurses Society, how

much heparin should be used for a central line

twice the total volume capacity of the catheter plus

any extension device

non-tunneled
tunneled
pulmonary artery catheter
PICC
Midline catheter
totally implanted device

flush?

What should be monitored in patients who have

a central line that is flushed with heparin?

PTT (partial thrombolytic time)

petechiae
bleeding gums
bruising

Heparin may be contraindicated if a patient has

what type of disorder?

a clotting disorder (aka coagulopathy)

Heparin may trigger a condition known as what?

Heparin-induced thrombocytopenia
(thrombocytopenia=not enough platelets in the
blood)

What is a normal platelet count?

150000-400000

Who developed the infusion nursing standard of

practice and what is the purpose of this
standard?

The Infusion Nurses Society - designed to protect

nurses and patients

What is the preferred method of hand sanitizing,

soap and water or alcohol-based gel?

soap and water

In addition to checking the physicians order,

what are 3 additional questions you should ask
the patient prior to initiating IV therapy?

inquire about allergies to medications, iodine, and/or

latex

If a client is allergic to iodine, what should be

used as a skin preparation prior to administering
IV therapy?

70% isopropyl alcohol and 2% chlorhexidine

If the client is allergic to latex, what is your next

step?

-order non-latex gloves

-order non-latex torniquet (if not available, use a
stockinette to place a barrier between skin and latex)

How long should you wash your hands with soap

and water before equipment preparation?

20 seconds

True/False:
You should wipe down the IV pole and pump
with disinfectant solution prior to using.

True

What is the protocol for an IV bag that does not

have an outer wrap?

Do not use - return to pharmacy or dispose of per

hospital policy

True/False:

False- The bag may be moist due to the process of

sterilization (or humidity). Squeeze the bag to check
for leaks

If an IV bag is moist when you remove it from

the outer wrapping, you should dispose of it

immediately.

What are some things you should do to help

prepare the patient for IV therapy?

- explain the procedure

- educate them re: the purpose, reasons, and
possible signs/symptoms of complications
- Provide privacy
- Check for allergies

What is the rule of thumb when selecting the

size of the cannula that will be used for IV
therapy?

use the smallest cannula that will accommodate the

vein and will achieve the purpose of the infusion

If a fluid is hypertonic (such as KCl), what type

of location is preferred?

a large vein in the forearm, as distal as possible

If IV treatment is for a life threatening condition,

what type of vein location is preferred?

a vein that will remain open during hypoperfusion

True/False:
A soft, straight vein is the ideal choice for IV
therapy.
True/False:
The veins in the hands of the elderly are the
ideal location for IV therapy.
The veins of the hand should only be used for
what types of solutions?

True

False- the veins in the hands of the elderly are a poor

choice b/c hematomas occur readily in these small,
thin veins

Those that are non-irritating b/c of the proximity of

the tendons and ligaments that control its function

True/False:
A doctor's approval is required to attempt a
venipuncture on the lower extremities. Why or
why not?

True- this increases the risk of thrombophlebitis and

embolism

Where should a cannula be placed for patients

using walkers/crutches?

above the wrist so that the hands can still be used

Can you ever administer IV therapy into a vein

in an area of flexion?

yes, although it is undesirable, you can immobilize

the area; additionally, these should be reserved for
peripheral, central and midline access as well as
blood drawing

List examples of ways to dilate veins. (7)

1. position the extremity lower than the heart for

several minutes
2. open and close fist several times
3. using thumb and second finger, flick the vein
(releases histamine)

4.
5.
6.
7.

apply warm towel on vein for 10 minutes

pump a BP cuff up slightly (30mmHg)
apply a tourniquet 6-8 inches above the site
use penlight / venoscope for dark skin

Which presents a greater risk for injury, a plastic

or steel cannula?

steel

How often do peripheral IV catheters need to be

changed?

every 96 hours or per hospital policy

How many attempts at venipuncture are

recommended?

Why is stabilization of the catheter important?

reduces the risk of infiltration, catheter migration,

phlebitis, and sepsis

How often must gauze dressing over an IV site

be changed? How about a clear dressing?

gauze = every 2 days

clear = every 6 days
(or PRN)

What are the 3 spots an IV setup must be

labeled?

1. venipuncture site (date/time, gauge/length of

catheter, initials)
2. tubing (per hospital policy)
3. IV solution container (solution type, additive,
initials of nurse, date/time of infusion)

Documentation of an IV procedure generally

consists of what 10 parts?

1. date and time of insertion

2. name, gauge, and length of device
3. specific name and location of the assessed vein
4. name of solution and rate of flow
5. infusing by gravity or pump
6. number of attempts
7. condition of extremity prior to procedure
8. patient's comments re: procedure
9. assessment findings with each nurses round
10. signature

How long do you apply direct, firm pressure

after removing a peripheral IV catheter?

2 minutes (5 if patient is on an anticoagulant)

What should you do if you remove a peripheral

IV catheter and notice that it is chipped?

Notify MD STAT

What must be maintained during insertion of IV

access, during its use, and upon discontinuing IV
access?

asepsis

True/False:

FALSE- looping is not acceptable. A sterile cap must

be obtained

If a sterile cap is unavailable, the next best

option is to loop the tube into another port of
the same tubing
How often do you assess a patient receiving an
IV fluid with an additive? without an additive?

with additive = every 1-2 hours

without additive = every 2 hours

How long should you remain at the bedside of a

patient who is receiving an IV antibiotic they
have never received in the past?

10 minutes to observe for any adverse reactions

What is the formula for calculating a patient's

plasma osmolality?

(2NA) + (Glucose/18)

How is a patient's fluid status assessed?

- weight
- intake and output

A gain of 1 kilogram is equal to a gain of ___

liters of fluid.

If an ordered IV rate is equal to or greater than

____ ml/hour closely monitor

125

What type of glove should be used for

peripheral IV care? central?

peripheral = clean
central = sterile

True/False:
You should never administer medication into a
TPN line.

True

Why should you avoid giving Lactated Ringer's if

the pH exceed 7.5?

b/c the liver converts lactate to bicarbonate

Why would you avoid giving D5W to a patient at

risk for intracranial pressure?

b/c it acts as a hypotonic solution and could swell the

cells in the brain further increasing pressure (cerebral
edema)

Why would you not administer a hypotonic

solution to a patient at risk for third-space fluid
shift (ex. burns, trauma, low serum protein,
uncontrolled diabetes, kidney disease,
malnutrition)

b/c these solutions have the potential to cause

cellular swelling

Why would you avoid giving a hypertonic

solution to a patient experiencing cellular
dehydration?

b/c these solutions pull fluid out of cells and into the
intravascular space

Why would you avoid giving a hypertonic

their system cannot handle the excess fluid pulled

solution to a patient with impaired heart and

kidney function?

into the intravascular space

What measurement unit is used for the pressure

exerted by IV pumps?

PSI (lbs per square inch)

When infusing by gravity, the IV pole should be

___ inches above heart level.

36

IV fluid must be replaced every ____ hours.

24

IV tubing must be replaced every ____ hours.

72

When discussing complications of IV therapy, it is

fair to say that local problems can become ______
problems.

systemic

leakage of a nonvesicant solution into surrounding

tissues when an IV catheter is no longer inside the
lumen of a vein.

infiltration

Infiltration Scale: (what grade?):

No signs or symptoms

Infiltration Scale: (what grade?):

skin blanched, edema less than 2 inches in any
direction

1+

Infiltration Scale: (what grade?):

with/without pain; cool to touch, skin blanched;
edema 2-3 inches in any direction

2+

Infiltration Scale: (what grade?):

With/without pain; cool to the touch, skin
blanched/translucent; gross edema 3-6 inches in
any direction

3+

Infiltration Scale: (what grade?):

Cool to touch; mild-severe pain; skin
blanched/tranluscent, tight and/or leaking,
discolored and/or bruising; deep, pitting edema
greater than 6 inches, circulatory impairment

4+

leakage of a vesicant solution into surrounding

tissue outside of a vein

extravasation

What are 3 possible consequences of infiltration

and/or extravasation?

1. blister formation, ulceration, or possible tissue

necrosis
2. compartment syndrome
3. reflex sympathetic dystrophy syndrome

inflammation of the inner most lining of the vein

phlebitis

What are 3 types of phlebitis?

1. mechanical
2. chemical
3. bacterial

Phlebitis can lead to what 2 problems?

1. thrombophlebitis
2. sepsis

What is the most common complication of

peripheral infusion? What is the second?

1st = infiltration
2nd = phlebitis

Phlebitis Scale: (what grade?):

no clinical symptoms
Phlebitis Scale: (what grade?):

redness at site, with/without pain

Phlebitis Scale: (what grade?):
redness at site, with pain, with/without edema

Phlebitis Scale: (what grade?):

redness at site, with pain, with/without edema,
streak formation, palpable venous cord

Phlebitis Scale: (what grade?):

redness at site, with pain, with/without edema,
streak formation, palpable venous cord, purulent
drainage
Which grades of the phlebitis scale require that you
call the MD?

3 and 4

True/False:
Ecchymosis and hemotoma result from infiltration
of blood around the IV site

true

clot results from vein trauma

thrombosis

presence of a clot and inflammation of the vein

thrombophlebitis

redness, swelling, purulent exudate at the IV site;

fever and elevated WBC

local infection

sudden contraction of a vein due to

cold/irritating/viscous solution or rapid infusion

vasospasm

What are 3 possible systemic complications caused

by IV administration?

1. fluid overload and pulmonary edema

2. air embolism
3. speed shock

If fluid overload/pulmonary edema are not correct, it

could lead to _____ and _____.

CHF and shock

What is the outcome of an air embolism?

causes obstruction to the blood flow to the right

ventricle; lethal

What is speed shock?

rapid infusion of an IV medication that leads to

toxic proportions

a piece of catheter breaks off, travels through the

circulatory system, and reaches the heart

catheter embolism

an immediate, hypersensitve reaction (often

unpredictable)

anaphylaxis

Practitioner-related factors that lead to IV therapy

complications are numerous, however all of them
are related to a lack of following what standard?

Standards of Care

What should be documented if a complication

arises?

1. type of vascular access device

2. date of insertion and site of insertion
3. appearance of site (color, temp, capillary refill,
size, etc.)
4. name of med/solution, amount, how given, and
rate
5. describe how patency was assessed
6. time of complaint and when infusion was
stopped
7. treatment measures
8. reassessments
9. picture of site at time of complication and
follow up pictures as treatment progresses
10. time MD was notified and additional
treatment ordered
11. incident report according to policy & notify
supervisor

True/False:
administering undiluted KCl is fatal.

True

What should you know prior to administering KCl

replacement therapy?

serum K levels

How is KCl diluted for peripheral IVs?

10meq in 100ml of D5W or NS over 1 hour

What type of monitor should be observed during

the administration of KCl replacement therapy?

cardiac monitor

How is KCl diluted for central lines?

10 or 20 meq in 100 ml of D5W or NS over 1 hour

administration of nutrients by a route other than

the GI tract

Parenteral Nutrition

type of parenteral nutrition where nutrients are

delivered using a central venous route

Central parenteral nutrition

What are the 3 primary goals of parenteral

nutrition?

1. meet the patient's nutritional needs

2. to allow growth of tissues
3. to provide calories for resting energy
expenditure (REE)

Parenteral formulations of nutrition are _____

(more/less) nutritional than enteral formulations?

less

Parenteral Nutrition is known by what other 2

names?

TPN (total parenteral nutrition)

intravenous hyperalimentation

What are 7 common indications for a person to be

on TPN?

1. chronic severe diarrhea and vomiting

2. complicated surgery or trauma
3. gastrointestinal obstruction, anomalies, and
fistula
4. severe malabsorption
5. severe burns
6. malnutrition
7. severe wounds (decubitus, etc.)

Commercial prepared base solutions of TPN

contains dextrose in a range of what percent? and
amino acids in a range of what percent?

dextrose = 5-70%
amino acids = 2.75-15%

What are 4 things that pharmacies add to

commercially prepared base solutions of TPN?

Where do pharmacists typically prepare TPN

solutions?

under a laminar flow hood

A ___% dextrose solution and amino acids ____-_____

% is the highest concentration that can be infused
through a large peripheral vein.

10% dextrose
2.75-3.5% amino acids

True/False:
A dextrose solution of 20% and higher must be
infused through a peripheral vein.

False- a dextrose solution of 20% or more must be

infused through a central vein.

Regardless of whether the patient is receiving TPN

or PPN, both lines require what special adaptation?

a 0.22 micron filter

TPN starts with hypocaloric delivery of dextrose.

Why is this done?

To avoid refeeding syndrome and caloric overload

True/False:
TPN therapy usually begins slowly with a
hypocaloric delivery, and it is gradually increased.

True

electrolytes
vitamins
trace elements
regular insulin

How are daily fluid requirements met when a person

is on TPN?

the total calories are administered in a volume

consistent with total fluid needs

What are the minimum caloric needs of a normal

adult for basic physiologic function?

1200-1500 cal/day

Patients with severe injury/malnutrition have

_________ (increased/decreased) nutritional needs.

increased

Carbohydrates are given in the form of what

substance for TPN?

dextrose

Fats are given in the form of what substance for

TPN?

fat emulsion

For TPN therapy, what is the daily calorie

distribution (in percentage) of amino acids, glucose,
and fat?

15-20% from amino acids

30-70% from glucose
15-30% from fat

For TPN therapy, amino acids should be tapered

_____ (up or down) with a rising BUN.

down

For TPN therapy, amino acids should be tapered

_____ (up or down) with a rising blood ammonia.

down

Glucose administered via TPN is adjusted to blood

glucose level until what point?

until blood glucose levels are persistently

euglycemic

What are 3 advantages of lipids as a calorie source

in TPN therapy?

1. fewer problems with glucose metabolism/controls

hyperglycemia
2. CO2 production is lower
3. hepatic tolerance is improved

What concentrations of lipids are available for TPN

therapy, and how can these be infused?

10% and 20%, can be infused peripherally or

centrally

10% lipids provide ___cal/ml.

What are the contents of lipid infusions?

safflower or soybean oil, egg yolk phospholipids,

glycerol

What should be monitored with lipid infusions? (4)

triglyceride levels
nausea
fever
vomiting

Lipid infusions should be used with caution for what

2 types of patients?

- allergies to egg
- those at risk for danger of a fat emboli (such as
a fractured femur)

What are 12 possible adverse reactions to lipid

infusions?

1. back pain
2. chest pain
3. dizziness
4. dyspnea
5. headache
6. flushing
7. fever
8. nausea
9. vomiting
10. lethargy
11. sweating
12. seizure

Lipid infusions require the use of what type of

tubing?

non-reactive tubing

When inspecting a bag of lipids prior to infusion,

what is a good indicator that the contents are good?

contents are milky, uniform

When you must piggyback into a TPN, the

piggyback must be _______ (above/below) the TPN
filter so not to cause occlusion.

below

What type of patient is at risk for complications

from TPN infusions containing aluminum? What are
these complications?

patients with impaired kidney function are at risk;

complications include CNS and bone damage

What does it mean if you see that "oiling out",

"breaking out", or any identifiable yellowish
streaking/drops in a lipid container?

It means that the fat emulsion is separating. Do

not use.

A normal, healthy adult requires ___-___ grams of

protein daily.

45-65

Protein intake levels of ___-___ gm/kg/day is

suggested for patients with moderate to severe
stress.

1.5-2

A nutritionally depleted patient's requirement can

exceed ____ gm of protein daily to ensure a positive
nitrogen balance.

150

What determines any changes a physician will make

to electrolytes added to TPN?

daily serum chemistry and the patient's condition

What are 3 general complications to parenteral

nutrition?

1. infections
2. metabolic problems
3. mechanical problems

What are 2 types of 'infections' seen with parenteral

nutrition?

bacterial and fungal

What type of metabolic problems are seen with

parenteral nutrition?

1.
2.
3.
4.
5.
6.
7.

True/False:
TPN bags must be refrigerated and administered
immediately after removing them.

False- they must be refrigerated, however they

need to be removed from the refrigerator one
hour prior to administration

How often must a new bag, new tubing, and new

filter be administered when a patient is on TPN?

every 24 hours

How often must an accucheck be done when a

person is on TPN?

every 4 hours (check against an insulin sliding

scale)

How often must blood chemistry be drawn for a

person on TPN?

daily

How often must CBC, triglyceride, and liver function

tests be drawn for a person TPN?

3x's a week or as ordered

Describe the procedure when drawing blood from a

central line. What is the importance of following this
procedure exactly as described?

hypo/hyperglycemia
prerenal azotemia
essential fatty acid deficiency
electrolyte/vitamin deficiency
trace mineral deficiency
hyperlipidemia
refeeding syndrome

1. stop the pump for a minute

2. aspirate 10mL of blood and discard
3. aspirate the require mL of blood as ordered
If this is not done properly, the lab results will not
be accurate due to the presence of IV additives.
The MD will be treating erroneous results with
probable fatal consequences

What should be done if the next TPN bag is not

available? (3)

1. hang 10% dextrose in water

2. follow up call to pharmacy
3. fingerstick glucose every 4 hours

The MD has discontinued TPN for your patient. Why

is it important to wean the patient over several
hours rather than stopping abruptly?

to prevent rebound hypoglycemia and

hyperinsulinemia

Once TPN is discontinued, it is important that you

monitor your patient closely. What things will you
be observing/looking for?

- monitor oral/enteral intake

- monitor for complication
- look for signs of infection @ the site
- look for signs of systemic infection
(hypo/hyperthermia, elevated WBCs, chills)

There are many complications that may arise from

IV therapy. While some are unavoidable, the nurse
is at risk for accused negligence when these actions
occur?? (8)

1.
2.
3.
4.

failure to assess patient in a timely manner

failure to foresee outcome of action or inaction
failure to supervise and/or monitor patients
incorrect and improper administration of

medication/fluid
5. error or lack of reporting and documentation
6. failure to question medical orders that are
incorrect or inappropriate
7. failure to provide patient safety
8. lack of updated knowledge and skill
True/False:

False-

If an act of negligence does not cause injury, legal

action cannot occur and the nurse cannot be
terminated.

Although legal action cannot be initiated, the

employer can terminate the employee.

An RN delegating IV therapy to an LPN must verify

what 5 things?

1.
2.
3.
4.
5.

As an RN delegating IV therapy function to an IV

certified LPN, you must do what 3 things?

1. assess the patient every 8 hours

2. be available to supervise the performance of
the delegated task
3. be available to assess the patient's response to
therapy

What 7 things "can" a LPN certified in IV therapy

(with sufficient IV experience) do re: IV therapy?

1.
2.
3.
4.
5.
6.
7.

What 3 things can a LPN not do regarding IV

therapy?

1. hang a blood transfusion, TPN, PPN,

Procalamine, chemotherapy, investigational drug,
or a drug requiring titration
2. access a portacath
3. IV push

Regarding IVs, what are 3 common reasons fluid will

not infuse?

1. clamp closed
2. catheter dislodged/kinked
3. clot

In reference to IVs, what are 3 common causes for

fluid leaking?

1. loose connection
2. tear in catheter or dislodged
3. lymph fluid leaking

In reference to IVs, what are 4 common causes

when you are unable to aspirate blood?

1.
2.
3.
4.

LPN is certified in IV therapy

LPN has been adequately trained
LPN can verbalize the intervention learned
LPN can perform intervention safely
Patient is stable

start a peripheral access

flush a peripher line and central line with NS
hang a solution/calculate rate
hang IV piggyback
change tubing and dressings
discontinue a peripheral IV
verify blood product with another nurse

clamp closed
catheter dislodged/kinked
clot
catheter pressing against the vein wall

In the elderly, homeostatic mechanisms become

_______ (more or less) efficient.

less

What are 3 reasons that the elderly are predisposed

to deficient fluid volume?

1. 6% less fluid than a young adult

2. decreased thirst sensation
3. decreased ability to concentrate urine

True/False:
The elderly have a decreased ability to adapt to
rapid increases in intravascular volume.

True

In the elderly, the tunica intima thickens. What effect

does this have on the vein?

increases resistance and decreases compliance

The loose skin seen in the elderly predisposes them (and

allows space for) to what condition related to IV therapy.

infiltration

How could short term memory loss (as seen in the

elderly) relate to fluid problems?

memory of fluid intake is impeded