Ch 13 Infusion Old

The nurse is attempting to insert a peripheral IV when the pt reports tingling and a feeling like "pins and needles." What does the nurse do next?

Stop immediately, remove the catheter, and chose new site.

After assessing the patency of a pt's IV catheter, the nurse attempts to flush the catheter and meets resistance. What does the nurse do next?

Stop the flush attempt and discontinue the IV.

A patient is in the hospital for his chemotherapy treatment for lung cancer. Which IV access methods are appropriate for this patient?

Peripherally inserted central catheter (PICC), Tunneled central venous catheter, and Implanted port.

A pt has been on prolonged steroid therapy. In assessing the pt for IV insertion, what finding does the nurse expect to see?

Skin and vein fragility that makes repeated venipuncture difficult.

A pt is brought to the emergency department after a serious car crash. Which factors makes the pt a candidate for intraosseous (IO) therapy?

IV access cannot be achieved within a few minutes.

The nurse is caring for the pt receiving arterial therapy via the carotid artery. What important nursing action is specific to this therapy?

Perform frequent neurologic assessments

The nurse is preparing to draw blood from a pt who has a central line. The pt's spouse asks, "Why can't you just take the blood out of that big IV line?" What information does the nurse use to explain why the central line is not used for blood draws?

-Additional hub manipulation is a major cause of CR-BSI. -Heparin used in flushing can interfere with coagulation studies. -Electrolytes in the IV fluid may alter the results of serum electrolytes. -Infusion of antibiotics can interfere with peak serum levels of the drug.

Which nursing interventions are implemented when caring for a pt with an implanted port?

-Before puncture, palpate the port to locate the septum. -Flush the port at least once a month.

Which safety measures does the nurse apply to decrease the risk of catheter-related blood stream infection (CR-BSI) related to needleless systems?

-Do not tape connections between tubing sets. -use evidence-based hand hygiene guidelines from the CDC and the OSHA. -Attend educational offerings to prevent or minimize CR-BSI.

A pt has a central line inserted in the vena cava. The nurse assesses the patient for which potential complications related to the procedure?

-Hemothorax -Air embolism -Arterial puncture

Which statements are correct about intraperitoneal infusion (IP)?

-IP can accessed by a catheter with an implanted port and large internal lumens. -Strict aseptic technique is used with IP access and supplies -IP is used for patients who are receiving chemotherapy

Hypodermoclysis can be used for a pt under which types of circumstances?

-If the pt requires palliative care -For IV fluid replacement that is less than 2000 mL -When a subcutaneous IV infusion is warranted -When short-term fluid volume replacement is warranted

The nurse is preparing to give a patient IV drug therapy. What information does the nurse need before administering the drug?

-Indications, contradictions, and precautions for IV therapy. -Appropriate dilution, pH, and osmolarity of solution. -Rate of infusion and dosage of drugs. -Compatibility with other IV medications. -Specifics of monitoring because of immediate effect.

An external long-term IV catheter is required for hemodialysis of a hospitalized pt. Which statements are true about this pt's venous access device?

-It should not be used for administration of other fluids or medications except in an emergency. -Vein thrombosis is a common problem with hemodialysis access. -A tunneled catheter with large lumen is required for hemodialysis.

The nurse is assessing a pt's IV insertion site. What features does the nurse look for in the assessment?

-Observe for redness and swelling -Check that the dressing is clean and dry -Ensure that the dressing is adherent to the skin -Observe for hardness or drainage

A pt has a local complication from a peripheral IV access with o.9% normal saline infusing at 100 mL/hr. What does the nurse assess at the insertion site?

-Red streak is present proximal to the site -Edema is present proximal to the site -The IV fluids are not infusing

A patient requires IV therapy via a peripheral line. What considerations does the nurse use when inserting the peripheral IV?

-Start with more distal sites, such as the hand veins. -Choose the pt's nondominant hand -Do not use the arm if the pt had a mastectomy on that side. -Avoid placing an IV over the palm side of the wrist.

The nurse is caring for a pt with a central venous catheter. What measures does the nurse use to prevent air emboli when changing the administration set or connectors?

-The pt lies flat so the catheter site is below the heart. -Use the pinch clamp that can be closed during the procedure. -Ask the pt to perform the Valsalva maneuver by holding the breath and bearing down.

A pt is to be discharged to home with an implanted port and needs discharge instructions on prescribed medication administration. Which instructions does the nurse give to the pt and family member who will be assisting the pt?

-The skin will be punctured over the port when the port is assessed. -When the port is not accessed, no dressing needs to be applied. -The port must be flushed after each use.

Which items does the nurse include in the documentation after completing the insertion of a peripherally inserted central catheter (PICC)?

-Type of dressing applied -type of IV access device used -Location and vein that was used for insertion

Which nursing interventions are key in preventing an infection in a pt with a central line?

-Use aseptic technique when administering medications and changing tubing. -Use sterile technique when inserting a central line. -Use proper hand washing and nonsterile gloves before coming into contact with a central line.

The charge nurse is reviewing IV therapy orders. What information is included in each order?

-specific type of solution -Rate of administration -Specific drug dose to be added to the solution

A patient has peripherally inserted central catheter (PICC) inserted and is ordered to receive IV cisplatin (Platinol). The drug has infiltrated into the tissue and redness is observed in the right lower side of the neck. What interventions, in order of priority, will the nurse preform?

1. Stop the infusion and disconnect the IV line from the administration set. 2. Aspirate the drug from the IV access device 3. Apply cold compress to the site of swelling 4. Monitor the patient and document

The nurse is assessing a pt's IV site and identifies signs and symptoms of infiltration. What are the nursing actions, in order of priority, the nurse implements for this pt?

1. Stops the infusion 2. Removes the IV access 3. Elevates the extremity 4. Applies a sterile dressing if weeping from the tissue has occurred.

The nurse is flushing a pt's short peripheral IV catheter. What does the nurse typically use for this procedure?

3 mL of normal saline.

Where does this step take place in the process of removing a peripheral catheter?: Hold pressure on the site until hemostasis is achieved.

5th

The home health nurse is adjusting the rate for a hypodermoclysis treatment. What is the usual maximum rate for this therapy?

80 mL/hr

A pt has PICC line placed by an advanced-practice nurse at the bedside. Before using the catheter, how is its placement verified?

A chest X-ray is taken which shows the catheter tip in the lower superior vena cava.

The nurse is helping the physician insert a central line when the patient develops chest pain and shortness of breath with decreased breath sounds and restlessness. What does the nurse do next?

Administer oxygen, remove the catheter, place an occlusive dressing, and order a stat chest x-ray.

A 65-year-old pt has been receiving IV fluids at 100 mL/hr of D5 1/2% NS for the past 3 days, along with IV antibiotic therapy. After receiving the new antibiotic, the pt reports general itching and difficulty catching his breath. The nurse notes audible wheezing and rhonchi over the lung fields bilaterally and a rash over his back and chest. What complication do these assessment findings indicate?

Allergic reaction

The nurse is preparing to start a hypodermoclysis treatment on a pt. What is the preferred insertion site?

Area under the clavicle

The nurse is adding a filter to an IV administration setup. Where is the best place to add the filter to the IV line?

As close as possible to the catheter hub.

The nurse is assessing a short peripheral catheter after removal and it appears that the catheter tip is missing. What does the nurse do next?

Assess the pt for symptoms of emboli.

A pt's central venous IV site is covered with a transparent membrane dressing. How often does the nurse change this dressing?

At least every 7 days

The home health nurse is caring for a pt receiving hypodermoclysis therapy. How often are the subcutaneous sites rotated?

At least once a week

A pt is ordered to receive peripheral parenteral nutrition (PPN). What type of access device is appropriate for this pt?

Peripherally inserted central catheter (PICC)

When using an intermittent administration set to deliver medications, how often does the Infusion Nurse's Society recommend that the set be changed?

Every 24 hours

The nurse is caring for a pt with a Groshong catheter. According to the manufacturer's recommendations, which technique does the nurse use in maintaining this type of catheter?

Flush the catheter with saline.

The nurse must insert a short peripheral IV catheter. In order to decrease the risk of deep vein thrombosis or phlebitis, which vein does the nurse choose for the infusion site?

Forearm

A triple lumen catheter central line is inserted in a patient. What does the nurse do immediately after the procedure?

Get a portable chest x-ray immediately and hold IV fluids until results are obtained.

The nurse is attaching an administration set to a central venous catheter. Which type of equipment decreases the risk of accidental disconnection or leakage?

Luer-Lok connector

A pt requires an infusion of packed red blood cells (PRBCs). Which factor allows the nurse to infuse the PRBCs through the patient's PICC line?

Lumen size of the PICC is 4F or larger.

A pt is receiving epidural medication therapy. The nurse assesses for which potential problem specific to this type of therapy?

Meningitis

A pt is receiving IV therapy via an infusion pump. What is a nursing responsibility related to the therapy and equipment?

Monitor the pt's infusion site and rate.

A pt with an implanted port is discharged to home and will receive long-term therapy on an outpatient basis. How frequently must the port be flushed between courses of therapy?

Monthly

The nurse has removed the dressing from a pt's central venous catheter site. In order to monitor the catheter position, what does the nurse do?

Note the length of the catheter which is external to the insertion site.

A pt is admitted with a small bowel obstruction and is on a mechanical ventilator with a tracheostomy for respiratory failure. A resident physician orders placement of a right internal jugular central line for total parenteral nutrition infusion. What is the nurse's response to this order?

Notify the physician that placement of a line in the femoral vessel will reduce the risk of infection.

The nurse is preparing to start an infusion of 10% dextrose. Why does the nurse infuse the through a central line?

Osmolarity of the solution could cause phlebitis or thrombosis.

A pt requires a 2-month course of antibiotics to treat a resistant infection. Which device is chosen for this therapy?

PICC

The nurse is preparing to deliver IV infusion therapy through an implanted port. What technique does the nurse use to access the port?

Palpate the port to locate the septum, scrub, and access with a Huber needle.

A pt requires a non-tunneled percutaneous central catheter. What is the nurse's role in this procedure?

Place the pt in Trendelenburg position

After a tubing change to patient's central line, the line is later found to be disconnected from the catheter. The pt develops chest pain and restlessness, HR of 120 beats/min, BP drops to 90/40, and pulse oximetry is 89%. What does the nurse do next?

Place the pt in Trendelenburg position on the left side, clamp the catheter, and notify the physician.

The nurse is caring for a pt receiving intrathecal pain medication. Which agent is preferred for cleaning the access site?

Povidone iodine

Which pt is the most likely candidate for a tunneled central venous catheter?

Pt in need of IV permanent parental nutrition.

During intraperitoneal therapy, a pt reports nausea and vomiting. What does the nurse do next?

Reduce the flow rate and give antiemetics

The nurse is selecting a site for peripheral IV insertion. Which pt condition influences the choice of left versus right upper extremity?

Regular renal dialysis with a shunt in the left upper forearm.

In what position does the nurse place a pt before starting intraperitoneal therapy?

Semi-Fowler's

The nurse is supervising a student nurse who is preparing an IV bag with IV administration tubing. Which action by the student nurse causes the nurse to intervene?

The student touches the tubing spike.

A pt has an IO needle in place. Why does the nurse advocates for removal of the device withine 24 hrs after insertion?

There is an increased risk for osteomyelitis.

The nurse is attempting to remove a PICC line and feels resistance. What technique does the nurse use first to attempt to resolve this problem?

Use the simple distraction techniques and deep breathing.

The nurse is preparing to give IV infusion therapy to a pt. When is the choice of using a glass container appropriate?

When the drug is incompatiable with a plastic container.

Under what circumstances does the nurse elect to use only one secondary set rather than a secondary set for each medication?

When the medications are compatiable.