IV Safety Alerts & IV Therapy Questions

When making round on the pediatric neurology unit, the nurse manager notes that, when giving IV medications, many of the staff nurses are disconnection the flush syringe first & then clamping the intermittent infusion device. The nurse manager is concerned that the nurse do not understand the benefits of positive pressure technique and turbulence flow flush in preventing clots. After the nurse manager discusses the problem with the staff educator, which intervention would be the most effective way to improve the nursing practice?

Create a poster presentation on the topic w/ required posttest

A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) w/ the preceptor. Which planned action by the graduate nurse should the preceptor correct?

Discarding the catheter in a trash container

A client admitted to the hospital w/ diabetic ketoacidosis is receiving a continuous infusion of regular insulin. The physician orders an IV containing 1L of dextrose 5% in water at 150 mL/hr to be started when the client's blood glucose level reaches [250mg/dL (13.9 mmol/L). The drip factor of the IV tubing is 15 gtt/mL. What is the drip rate for this IV infusion in drops per minute?

Drip rate= 150mL/60min x 15gtt/ 1mL 2250 gtt/ 60min= 37.5 gtt/min

Total parenteral nutrition (TPN) is prescribed for a client who has recently had a small & large bowel resection and who is currently not taking anything by mouth. What should the nurse do to safely administer the TPN?

Handle TPN using strict aseptic technique

The nurse finds an unopened bag of IV 50% dextrose in a sink on the nursing unit. What should the nurse do with the IV bag?

Send it to the pharmacy

A HCP prescribes IV heparin 25,000 units in 250mL of normal saline solution to infuse at 600 units/hr for a client who suffered an acute MI. After 6hrs of heparin therapy, the client's partial thromboplastin time subtherapeutic. The HCP orders the infusion to be increased to 800 units/hr. The nurse would set the infusion pump to deliver how many mL/hr?

The nurse would calculate the infusion rate using the formula: Dose on hand/Quantity on hand = Dose desired/X 25,000 units/250 ml = 800 units/hour ÷ X 25,000 units x X = 250 ml x 800 units/hour 25,000X = 200,000 ml/hour X = 8 ml/hour

The HCP's prescription for an IV infusion is 3% normal saline to infuse at 125 mL/hr. The client's most recent sodium level is 132 mEq/L (132 mmol/L). The nurse should:

consult the prescriber about the prescription

When calculating flow rates:

double check orders & your calculations especially if is exceeds 200mL/hr

A nurse may delegate adding medication to IV fluid containers to a:

pharmacist

Too rapid an infusion or inappropriate infusions can result in:

reactions that range from mild to fatal.

A nurse fails to give the evening dose of an IV antibiotic that is to be administered every 12hrs. The evening dose was scheduled for 1800; it is now 2200. The nurse should next:

report the incident to the HCP

When teaching about prevention of infection to a client w. a long-term venous catheter, the nurse determines that the client has understood discharge instructions when the client makes which statement?

"My husband will change the dressing three times per week, using sterile technique."

Which actions by the nurse will most likely ensure that the correct client receives a medication?

- Check the name on the armband w/ the name on the medication -Compare the date of birth on the client's medical record to the client's armband

When caring for a client with a central venous line, which nursing actions should be implemented in the plan of care for chemotherapy administration?

-Verify patency of the line by the presence of a blood return at regular intervals -Inspect the insertion site of swelling, erythema, or drainage -If unable to aspirate blood, reposition the client and encourage the client to cough -Contact the HCP about verifying placement if the status is questionable

IV push Meds:

1. are rapid and potent 2. administer over 1-5 minutes depending on drug guidelines 3. medications are diluted in various volumes 4. solution compatibility is verified 5. tubing needs to be flushed 6. calculate rate of push

When using Heparin remember:

1. it is a high-alert med that comes in many dosage strengths 2. concentration for a heparin lock flush is 10 units/mL OR 100 units/mL 3. Average heparin flush dosage is 10 units & NEVER exceeds 100 units 4. Always check concentration carefully

IV flow rates range from:

50-200 mL/hr if rate is exceeded, double check the orders & your calculations

A nurse is caring for a 22yo female client w/ type 1 DM and toxic shock syndrome (TSS). Which action should the nurse perform first?

Administer 5% dextrose in half-normal saline solution at 150 mL/hr IV Antibiotics will be given b/c TSS is caused by staphylococcal infection, however, fluid replacement is initiated first to treat life-threatening hypovolemic shock

The health care team has noticed an increase in IV infiltrations on the pediatric floor. As part of a "Plan, Do, Study, Act" quality improvement plan, the team should perform the actions in which order? All options must be used.

1. Decide to monitor IV gauges. 2. Perform chart audits. 3. Analyze the data. 4. Write a new IV insertion policy.

When adding potassium to an IV:

1. check compatibility & dilute well 2. monitor client during infusion b/c rapid infusion of potassium can cause DEATH 3. check IV site frequently 4. administer using infusion control device 5. NEVER administer via IV push 6. DO NOT add potassium to an IV bag that is already infusing

While making rounds, a nurse observes that a client's primary bag of IV solution is light yellow. The label on the IV bags says the solution is D5W. What should the nurse do first?

Hang a new bag of D5W, and complete an incident report

A client is receiving TPN administered through a central line. What should the nurse do to prevent complications associated w/ infusion?

Secure all connections of the system

Remember when inserting IV catheter...

advance catheter off needle if blood return shows in the back flash chamber

Which type of solution, when administered IV, would cause fluid to shift from body tissue to the bloodstream?

hypertonic