ch 6 Peripheral IVs

vein entry: insert needle into skin at what angle?

30 degrees

The vein that follows the ulnar side of the forearm is the: a. metacarpal b. cephalic c. basilic d. median cubital

c. basilic

A nurse is preparing to initiate IV therapy for an older adult client. Which of the following actions should the nurse take? a. use a disposable razor to remove excess hair on the extremity b. select the back of the client's hand to insert the IV catheter c. distend the veins by using a blood pressure cuff d. direct the client to raise his arm above his heart

c. distend the veins by using a blood pressure cuff ATI

PIV

(peripheral intravenous catheter) catheter inserted into the peripheral veins for delivery of short-term infusion therapies

4 techniques for the older pt with fragile veins (3)

-apply tourniquet over gown or sleeve to decrease shearing force or use BP cuff instead -pull the skin taut to stabilize the vein throughout venipuncture -decrease angle of entry to 15 degrees (lower angle of approach into the vein)

How often should you flush peripheral catheters?

-every 12 hrs if catheter is not in use -before and after medication administration

How often should you assess a peripheral IV site?

-every 4 hrs for alert and oriented adult pts -every 1-2 hrs for pts who are critically ill, have sensory/cognitive deficits, or are receiving sedatives and can't alert the nurse to symptoms -every hr for pediatric and neonatal pts

When would you use a 16-gauge catheter?

-pts who have trauma -rapid fluid volume (ATI)

The vein that follows the radius side of the forearm is the: a. metacarpal b. cephalic c. basilic d. median cubital

b. cephalic

Which of the following areas for peripheral venous access should be avoided in the adult pt? a. mid-forearm b. inner aspect of wrist c. dorsum of the hand d. upper forearm

b. inner aspect of wrist

4 methods to promote venous distention

1. gravity (position extremity below heart) 2. clenching/pumping fist 3. stroking the vein 4. warm compress

macrodrip rate

10-20 gtt/mL

Which gauge would you use for blood administration?

18- to 20-gauge

How many sticks is allowed before the nurse should ask for help with an unsuccessful IV administration?

2

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to insert the spike end of the IV tubing into the IV bag, the tubing drops and the spike end hits the top of the medication cart. The nurse should take which action? 1. Obtain a new IV bag. 2. Obtain new IV tubing. 3. Wipe the spike end of the tubing with Betadine. 4. Scrub the spike end of the tubing with an alcohol swab.

2. Obtain new IV tubing. NCLEX

The nurse has a prescription to hang a 1000-mL intravenous (IV) bag of 5% dextrose in water with 20 mEq of potassium chloride. The nurse also needs to hang an IV infusion of piperacillin/tazobactam. The client has one IV site. The nurse should plan to take which action first? 1. start a second IV site 2. check compatibility of the medication and IV fluids 3. mix the prepackaged piperacillin/tazobactam per agency policy 4. prime the tubing with the IV solution and back-prime the medication

2. check compatibility of the medication and IV fluids -if fluids and medications are compatible, the nurse should hang them together -if fluids and medications aren't compatible, it would be appropriate to start a second IV site NCLEX

For most adults, the catheter gauge for infusing fluids and medication is:

20- to 22-gauge (20-gauge is most common according to PowerPoint)

Which gauge would you use for pediatric pts and older adult pts?

22- 24-gauge

Which gauge would you use for neonates?

24- 26-gauge

The nurse plans to administer a medication by intravenous (IV) bolus through the primary IV line. The nurse notes that the medication is incompatible with the primary IV solution. Which is the appropriate nursing action to safely administer the medication? 1. Start a new IV line for the medication. 2. Flush the tubing after the medication with sterile water. 3. Flush the tubing before and after the medication with normal saline. 4. Call the health care provider for a prescription to change the route of the medication.

3. Flush the tubing before and after the medication with normal saline. NCLEX

The nurse is preparing to infuse (piggyback) a 50-mL dose of a compatible medication through the primary intravenous (IV) line. How should the nurse correctly attach the medication bag? 1. Hanging the medication bag level with the primary IV bag 2. Hanging the medication bag lower than the primary IV bag 3. Hanging the medication bag higher than the primary IV bag 4. Disconnecting the primary IV solution and plugging in the medication

3. Hanging the medication bag higher than the primary IV bag (For an intermittent IV infusion that is piggybacked to the primary IV line, the bag for the intermittent infusion is placed higher than the primary solution bag. This allows gravity to assist in infusing the medication.) NCLEX

Place the discontinuing a peripheral IV steps in order: 1. Remove IV site dressing and any stabilization devices 2. Inspect catheter and for intactness after removal 3. Place sterile gauze over venipuncture site 4. Check HCP orders 5. Keep gauze in place and continue to apply pressure for 2-3 minutes 6. Explain to patient 7. Keep catheter hub parallel to skin during withdrawal 8. Apply light pressure while withdrawing catheter away from insertion site 9. Perform hand hygiene and don clean gloves

4, 6, 9, 1, 3, 8, 7, 2, 5 -Check HCP orders -Explain to patient -Perform hand hygiene and don clean gloves -Remove IV site dressing and any stabilization devices -Place sterile gauze over venipuncture site -Apply light pressure while withdrawing catheter away from insertion site -Keep catheter hub parallel to skin during withdrawal -Inspect catheter and for intactness after removal -Keep gauze in place and continue to apply pressure for 2-3 minutes

A health care provider has written a prescription to discontinue an intravenous (IV) line. The nurse should obtain which item from the unit supply area for applying pressure to the site after removing the IV catheter? 1. Elastic wrap 2. Povidone iodine swab 3. Adhesive bandage 4. Sterile 2 × 2 gauze

4. Sterile 2 × 2 gauze NCLEX

The nurse is inserting an IV line to a pt's vein. After the initial stick, the nurse would continue to advance the catheter in which situation? 1. the catheter advances easily 2. the vein is distended under the needle 3. the pt does not complain of discomfort 4. blood return shows in the backflash chamber of the catheter

4. blood return shows in the backflash chamber of the catheter NCLEX

Where to place tourniquet

5 to 6 inches above venipuncture site

microdrip rate

60 gtt/mL

A nurse is demonstrating how to insert an IV catheter. Which of the following statements by a nurse viewing the demonstration indicates understanding of the procedure? A. "I will thread the needle all the way into the vein until the hub rests against the insertion site after I see a flashback of blood." B. "I will insert the needle into the client's skin at an angle of 10 to 30 degrees with the bevel up." C."I will apply pressure approximately 1.2 inches below the insertion site prior to removing the needle." D."I will choose a vein in the antecubital fossa for IV insertion due to its size and easily accessible location."

B. "I will insert the needle into the client's skin at an angle of 10 to 30 degrees with the bevel up." ATI

What else can the nurse use if skin is too fragile for a tourniquet?

BP cuff

The most appropriate equipment for an infant receiving IV fluids includes: a. microdrip tubing connected to a 50-mL infusate container b. microdrip volume-controlled cylinder (VCC) attached to a 250-mL infusate container c. macrodrip tubing connected to a VCC d. any tubing or container provided it is regulated with an electronic infusion device

b. microdrip volume-controlled cylinder (VCC) attached to a 250-mL infusate container

Which of the following infusate characteristics is appropriate for infusion through a PIV catheter? a. osmolarity > 600 mOsm/L b. pH = 6 c. pH = 4 d. pH = 10

b. pH = 6

In a dark-skinned person, a good method for locating an accessible vain is: a. multiple tourniquets b. tangential lighting c. direct overhead lighting d. light application of a tourniquet

b. tangential lighting

IV gauge colors: 22g

blue 16g - Gray 18g - Green 20g - Pink 22g - Blue 24g - Yellow 26g - Purple

Which of the following are techniques to dilate a vein for venipuncture in the older adult with fragile veins? (Select all that apply) a. apply the tourniquet loosely over the pt's sleeve b. apply multiple tourniquets c. use digital pressure to enhance vein filling d. use warm compresses before venipuncture

a. apply the tourniquet loosely over the pt's sleeve d. use warm compresses before venipuncture

PIV therapy labels should be applied to: a. catheter site, tubing, and solution container b. tubing, solution container, and chart c. solution container, catheter site, and pt's armband

a. catheter site, tubing, and solution container

The layer of the vein that contains smooth muscle, fibrous tissue, and nerve fibers for vasoconstriction and vasodilation is the: a. tunica media b. tunica adventitia c. tunica intima d. hypodermis

a. tunica media

When might you need to avoid using a tourniquet?

When dealing with fragile veins, as with the elderly

Which of the following is the most appropriate cannula size for use on a 2-month-old infant? a. 18-gauge, over-the-needle catheter b. 23- to 25-gauge scalp vein needle c. 16-gauge scalp vein needle d. 22- to 24-gauge, over-the-needle catheter

d. 22- to 24-gauge, over-the-needle catheter

The preferred antiseptic solution for skin asepsis is: a. povidone iodine b. tincture of iodine c. 70% alcohol d. chlorhexidine/alcohol

d. chlorhexidine/alcohol

how often to change peripheral IV site?

every 72-96 hrs

how often to change IV tubing?

every 96 hrs

IV gauge colors: 16g

gray 16g - Gray 18g - Green 20g - Pink 22g - Blue 24g - Yellow 26g - Purple

IV gauge colors: 18g

green 16g - Gray 18g - Green 20g - Pink 22g - Blue 24g - Yellow 26g - Purple

Why is a tourniquet used when starting an IV?

it distends the veins - increases blood volume and systemic vascular resistance

how long can an IV bag hang?

no more than 24 hrs (bacterial contamination)

IV gauge colors: 20g

pink 16g - Gray 18g - Green 20g - Pink 22g - Blue 24g - Yellow 26g - Purple

IV gauge colors: 26g

purple 16g - Gray 18g - Green 20g - Pink 22g - Blue 24g - Yellow 26g - Purple

IV gauge colors: 24g

yellow 16g - Gray 18g - Green 20g - Pink 22g - Blue 24g - Yellow 26g - Purple