Chapter 13: Peripheral and Central IV therapy
Which central vascular access device (CVAD) is placed in arteries, epidural space, and the peritoneal cavity?
Implanted ports
What are indications for placing a nontunneled percutaneous central venous catheter (CVC) in a patient? Select all that apply.
Impending surgery Trauma situations Administration of IV fluids
What is the maximum flow rate of contrast injection for a "Power peripherally inserted central catheter" ("Power PICC")? Record your answer using a whole number. ___ mL/sec
5 A "Power PICC" can be used for contrast injection at a maximum flow rate of 5 mL/sec and a maximum pressure of 300 psi. They can also be used in the monitoring of central venous pressure.
A patient reports pain at the intravenous (IV) therapy site, and the nurse finds redness at the site and inflammation along the length of the vein. Which nursing interventions relieve the patient's pain? Select all that apply.
Removing the catheter Using warm compresses to relieve pain Reinserting a new catheter in opposite extremity
Based on the Infusion Nurses Society (INS) infiltration scale, which piece of clinical criteria is associated with a grade 4 infiltration?
The skin is tight and leaking at the infiltration site.
The health care provider has placed a peripherally inserted central catheter (PICC) in a patient. Which technique is used to confirm the location of the catheter tip?
X-ray
What is a rare complication of peripherally inserted central catheter (PICC)?
Infiltration
The novice nurse is inserting a short peripheral catheter into a patient's median vein. The nurse is having trouble finding the vein, and when he pulls the catheter and needle out, he accidentally sticks the needle into his fingertip. What is the nurse required to do to report this incident?
Record the incident in the sharps injury log.
A patient on intravenous (IV) therapy reports shortness of breath and cough. The nurse finds that the patient has elevated blood pressure, puffiness around eyes, and distended neck veins. What does the nurse infer about the patient's condition?
The patient is showing signs of circulatory overload.
A 22-year-old patient is seen in the emergency department (ED) with acute right lower quadrant abdominal pain, nausea, and rebound tenderness. It appears that surgery is imminent. What gauge catheter does the ED nurse choose when starting this patient's intravenous (IV) solution?
18g
Arrange the steps of aseptic skin preparation for peripheral intravenous (IV) therapy chronologically.
First, the nurse should wash his or her hands before aseptic skin preparation for peripheral intravenous (IV) therapy. Next, wash the skin with soap and water if the skin is dirty. Then, the nurse should wear gloves. Finally, the skin should be cleaned with antiseptics.
Which detail is the least important factor to be considered for a patient who is prescribed peripherally inserted central catheters (PICC) for peripheral infusion therapy?
Gender of the patient
The nurse is documenting peripheral venous catheter insertion for a patient. What does the nurse include in the note? Select all that apply.
Patient's response to the insertion Date and time inserted Type and size of device Type of dressing applied Vein used for insertion
A nurse has been tasked with administering packed red blood cells to a trauma patient. The nurse has confirmed the patient's identification using two patient identifiers. What else must the nurse do before beginning the blood transfusion process? Select all that apply.
Perform strict evidence-based handwashing techniques for infection control. Receive positive patient identification from a second qualified health care professional.
A patient with severe pneumonia has been admitted to the hospital, and the physician ordered ciprofloxacin to be administered by IV infusion. Because the patient is frail and immunocompromised due to chemotherapy treatments, the entire 10-day course of antibiotics will be administered parenterally. Which type of infusion system would be best for this patient?
Peripherally inserted central catheter
Which statement made by the nurse about IV peripheral catheters needs correction?
"Small gauge peripheral catheters pose an increased risk of phlebitis."
The registered nurse (RN) is training a student nurse on the use of peripheral vascular access devices (VADs). The RN states that one patient is receiving IV antibiotics to treat a lower respiratory infection, but because he has severe lower extremity edema, they are administering the antibiotics intermittently. Which statement by the student nurse indicates an understanding of peripheral VADs?
"That means that the VAD should have a saline lock on it."
The student nurse is teaching about the activities of daily life (ADLs) for a patient with a peripherally inserted central catheter. Which teachings made by the student nurse would need a correction?
"You can walk for exercise."
The nurse is inserting a peripherally inserted central catheter (PICC) into a patient. When identifying the insertion site, which site is the nurse most likely to use?
Basilic vein in the upper arm
The nurse is providing discharge instructions for a patient who is being sent home with an ambulatory pump that will dispense regulated amounts of pain medication. What is a teaching point the nurse should include that may not apply to other types of IV pumps?
The patient will need to be taught how to replace or recharge the battery.
A physician has ordered that a patient be infused with a hypertonic solution to correct fluid and electrolyte imbalances. The solution will be infused through a peripheral IV line. Which solution does the nurse administer to this patient?
A solution that has an osmolarity of 400 mOsm/L
A student nurse notes that a patient who has just been admitted to the hospital has a hemodialysis catheter. The physician asks the registered nurse who is supervising the student nurse to draw some blood and start an IV antibiotic. Which statement by the student nurse indicates that additional teaching is needed about the use of hemodialysis catheters?
"We can draw blood and inject the drugs through the hemodialysis catheter to avoid additional needle sticks for the patient."
A patient with anemia is admitted to the hospital. The primary health care provider instructs the nurse to arrange for a blood transfusion using peripheral catheters. What is the most appropriate catheter size and approximate rate of flow?
22 gauge with 2280 mL/hr
Which parameters of intravenous (IV) therapy should the nurse document? Select all that apply.
Vein that was used for insertion Date and time of the vascular access device insertion Name of the nurse who inserted the vascular access device
A patient is admitted to the emergency department with severe injuries to the neck and upper body from a motor vehicle accident. The physician has ordered the registered nurse to insert a catheter to infuse fluids and antibiotics. The student nurse who is trailing the registered nurse suggests inserting a nontunneled percutaneous central venous catheter (CVC). What should the registered nurse tell the student nurse?
"The CVC is not appropriate for this patient because trauma to the neck or chest prohibits the use of these devices due to injury of the insertion site."
A patient with severe traumatic brain injury enters the hospital in a coma. Because of the severity and location of the injury, the physician suspects that the patient may never recover from the coma. However, the patient's family insists on full medical treatment. Therefore, the physician orders insertion of a tunneled central venous catheter to support long-term total parenteral nutrition. A family member approaches the nurse with concerns that long-term catheter insertion will cause an infection that may speed the patient's death. How should the nurse respond?
"Tunneled central venous catheters have a low rate of infection and are the best catheters to use for long-term intravenous treatment."
Which gauge of peripheral intravenous (IV) catheter would the nurse use for rapid fluid resuscitation in a patient with severe blood loss following a motor vehicle accident?
14-gauge
In what order should the nurse prepare the skin for insertion of a peripheral venous catheter?
All nursing interventions should begin with appropriate hand-washing techniques. Once the nurse's hands are clean, the insertion site should be identified by palpating to locate a good vein. When the insertion site has been located, hair should be clipped if needed and the area should be cleaned with soap and water if dirty. Once the site is clear and clean, the nurse should put on gloves before cleansing the skin with antiseptic. The nurse should not touch the insertion site again once it has been cleaned with antiseptic.
What point should the nurse keep in mind to ensure skin antisepsis prior to venipuncture in older adults?
Apply chlorhexidine for maximum antiseptic action.
The nurse is starting a peripheral IV catheter on a recently admitted patient. What actions does the nurse perform before insertion of the line? Select all that apply.
Apply povidone-iodine to clean skin, dry for 2 minutes. Clean the skin around the site. Prepare the skin with 70% alcohol or chlorhexidine.
Which central venous access device (CVAD) is indicated in patients who require IV therapy for more than a year?
Implanted ports
What are the causes of phlebitis after the venous puncture? Select all that apply.
Improper antiseptic technique Improper catheter securement devices Osmolarity and pH of the medication used
A nurse has been asked to insert a short peripheral venous catheter in an older adult patient. The patient is right handed and has had a mastectomy and lymph nodes removed on her left side. Where is the best site for the nurse to insert the catheter?
In the median vein of the right arm
Which condition indicates infiltration?
Leakage of nonvesicant intravenous (IV) solution into extravascular fluids
A chemotherapy nurse is planning to give a patient their next dose of chemotherapeutic agent through their implanted BARD PowerPort. What technique will the nurse use to identify the location of the port and the site for puncture?
Palpate three bumps that indicate the location of the septum.
A patient with a history of cancer is prescribed an intravenous (IV) infusion of chemotherapeutic agents through a peripherally inserted central catheter (PICC). The primary health care provider instructs the nurse to flush the catheter before and after medication administration. What solution should be used for flushing?
Rate of infusion Length of infusion Route of administration
Which nursing interventions will bring relief to a patient reporting tingling, feeling pins and needles in the extremities, and numbness during vein puncture? Select all that apply.
Removing the catheter Choosing a new site for the catheter insertion Stopping the intravenous insertion procedure immediately
Which devices allow the visualization of a vein for a patient who is prescribed infusion therapy? Select all that apply.
Transilluminator Laser beam Infrared
A physician is planning to insert a nontunneled percutaneous central venous catheter into a patient in preparation for surgery. The nurse has been asked to provide patient education about the insertion procedure. During the patient teaching session, the nurse should include information about which of the following positions?
Trendelenburg position
The nurse is attending to a patient with a peripherally inserted central catheter (PICC). What action does the nurse take to maintain patency of the PICC?
Use 10-mL barrel syringes to flush all PICC lines.
The nurse is preparing a child for a tonsillectomy. Which peripheral catheter does the nurse anticipate the anesthesiologist will use?
20-gauge
A patient with renal failure has to use a hemodialysis catheter. What concentration of heparin is used to lock the catheter?
5000 units/mL
Which central catheter insertion requires the patient to be in the Trendelenburg position for catheter insertion?
Nontunneled percutaneous central venous catheter
A patient was admitted to the hospital after a motor vehicle accident. The primary health care provider instructed the nurse to provide rapid infusion of fluids peripherally. What could be the possible size of the catheter used for infusion?
16 gauge
Which gauge (g) size of peripheral catheter is preferred for a patient undergoing a routine surgical procedure?
18-g
A patient admitted to the intensive care unit (ICU) is expected to remain for 3 weeks. The nurse has orders to start an IV. Which vascular access device is best for this patient?
Midline catheter Midline catheters are used for therapies lasting from 1-4 weeks. PICCs are typically used when IV therapy is expected to last for months. Short peripheral catheters are allowed to dwell (stay in) for 72-96 hours, but they then require removal and insertion at another venous site. Tunneled central catheters must be inserted by a health care provider; the nurse typically is not qualified to start this type of IV.
