Starting and Maintaining IV sites

Which statement indicates that Deborah (pronouns: she/her/hers) may need more education about her intravenous (IV) line?

"This won't hurt at all" indicates that the client needs more education about the IV insertion process, which can be expected to be somewhat painful initially.

Central Lines​

Because of insertion into the subclavian, a pneumothorax (collapsed lung) is always a risk, which is one of the reasons for a chest x-ray after the procedure. Otherwise, the main complication of this and most other central venous access devices include infection and bleeding.

a dressing change is needed. Which actions will reduce the risk of catheter infection?

By having the client and nurse wear a mask during the procedure, and using a sterile central line dressing change kit, the risk of infection can be reduced. Cleaning around the catheter with soap and water would contaminate the dialysis catheter. Flushing the ports has nothing to do with infection risk.

You are preparing to start an intravenous (IV) line for Doug. After placing the tourniquet, which vein demonstrated in the images above would be most ideal for starting an IV?

C: Straight vein no flexion point​. This is the most ideal vein for starting an IV.

Doug (pronouns: he/him/his) is admitted with renal failure. He is on dialysis. He has been here for 4 days and currently is in need of an intravenous (IV) catheter. There is a sign in his chart that says "No blood pressure on left arm." He has an allergy to iodine. He is currently on no medication.​

Client education, light, proper positioning, and verification of allergies are all important to ensure complication-free IV insertion. Because Doug probably has a dialysis shunt in his left arm, that site should be avoided. In addition, betadine is an iodine product and a potential allergy to him, so a substitute cleanser should be used before insertion.​

Generally, the nurse's role in a central venous device insertion is preparation Dressing changes should be done in a sterile environment. Facilities and manufacturers have general policies on when a central access device dressing change is needed. Some may be every week, others could be every 3 to 4 days. In addition, there are antibiotic or antimicrobial discs or dressings available that may allow for more time between dressing changes by reducing the risk of infection.

Facilities and manufacturers have general policies on when a central access device dressing change is needed. Some may be every week, others could be every 3 to 4 days. In addition, there are antibiotic or antimicrobial discs or dressings available that may allow for more time between dressing changes by reducing the risk of infection.

Checking Intravenous Sites​

IV secured and looped properly​ Date properly marked​ No sign of redness or edema​ Good color in the nailbeds​

Which is true regarding central venous devices with multiple ports?

Incompatible medications can be given through different ports because they do not mix within the catheter. One of the ports can be used to measure central venous pressure.

What is the most common risk associated with central line placement?

Infection (not bleeding, pneumothorax, or air embolism) is the most common and most concerning risk associated with central line placement.

Prioritize the following nursing actions as the nurse should plan to do them.

Informing the client first reduces any anxiety and prepares the client for the procedure. Bringing in a table and adding additional light gives the nurse a space to place supplies and allows them to see the environment better for any other safety issues. Gathering the supplies prepares for the IV insertion. Getting the bed to the proper height and preparing the IV site ensures proper body mechanics. Applying the tourniquet allows the nurse to identify possible veins (which they can't do as well without the tourniquet). Identify possible vein.

Internal jugular (IJ) access is inserted in the neck area and is threaded into the superior vena cava just like a central line is inserted in the subclavian. This insertion has fewer complications than a subclavian central line, with all the advantages. The main problem can be discomfort and loss of mobility of the neck

Internal Jugular Access​

Adverse Events With a Central Line

Mari could experience a pneumothorax (collapsed lung with air in the lung space) or hemothorax (collapsed lung with blood in the air space). In addition, she could experience pain or accidental puncture of an artery. Phlebitis occurs in smaller veins. While infection is a risk, this is a late adverse event that would not occur immediately during or after the procedure.

Mari had a peripherally inserted central catheter (PICC) line placed last week. According to the policy, her central line dressing should be changed every 5-7 days. In addition, the line should be flushed after each access or every 24 hours if unused. The flush solution should be 0.9% sodium chloride 10 mL

Mari had a peripherally inserted central catheter (PICC) line placed last week. According to the policy, her central line dressing should be changed every 5-7 days. In addition, the line should be flushed after each access or every 24 hours if unused. The flush solution should be 0.9% sodium chloride 10 mL

Which indication would best support the insertion of a central venous access device?

Mari will need an extended course of antibiotics lasting weeks to months. She currently has an IV, so venous access is not a problem.

Where is the distal portion of a central line ideally located after insertion?

Most central venous access devices are threaded so the tip is located in the superior vena cava (not a basilic artery, subclavian vein, or inferior vena cava).

While flushing, the nurse is unable to inject anything into the saline lock. Which nursing actions should the nurse take to handle this intravenous (IV) line?

Never force fluid through an apparently occluded IV. The first step to take is to assess the site for any signs of occlusion. If none is seen, the IV is likely clotted and will need replacement. There is no need to inform the healthcare provider in this case.

Peripheral IV: Alice has poor and unreliable venous access. However, she is taking fluids well and probably will not need an IV long-term. The provider should consider discontinuing the fluids instead of starting a central line. ​ Central line: Mari will need long-term antibiotic therapy. She will benefit from a central line. Central line: Doug cannot have an IV placed in either arm and will need dialysis. A central venous access dialysis catheter would be appropriate.​ Peripheral IV: Latika only needs a short course of intravenous antibiotics, so the risk of central line insertion is not worth the benefit.​

Peripheral IV: Alice has poor and unreliable venous access. However, she is taking fluids well and probably will not need an IV long-term. The provider should consider discontinuing the fluids instead of starting a central line. ​ Central line: Mari will need long-term antibiotic therapy. She will benefit from a central line. Central line: Doug cannot have an IV placed in either arm and will need dialysis. A central venous access dialysis catheter would be appropriate.​ Peripheral IV: Latika only needs a short course of intravenous antibiotics, so the risk of central line insertion is not worth the benefit.​

The nurse reviews the to-do list for intravenous (IV) catheter insertion. Prioritize the following nursing actions, starting from the first step.

Prepare the room and client for IV insertion. Cleanse the area with chlorhexidine IV prep cleanser. Insert the IV tip (bevel up). When seeing the flash, hold the needle still and thread the catheter into the vein. Take the needle out while holding pressure above the catheter. Apply saline lock to hub and flush with normal saline. Secure IV with transparent dressing and secure IV loop. Return the bed and rail to a safe position. Clear and dispose of supplies and document the insertion information.

Which statement indicates that Deborah (pronouns: she/her/hers) may need LESS education about her intravenous (IV) line?

The client is correct when stating that the IV will be removed after 3 days and, if needed, a new IV will be started. It's important that the client stays as still as possible during insertion and is often encouraged to look the other way to avoid pulling back on their arm during insertion. The client should report any ongoing discomfort at the site or any redness or inflammation.

Which items should the nurse know could contain latex?

The exam gloves, IV catheter, and tourniquet are the items most likely to contain latex.

Which part of the intravenous catheter does the "gauge" refer to?

The gauge refers to the outer diameter (not the length, inner diameter, or thickness) of the catheter.

most appropriate intravenous (IV) catheter gauge for each client

The gauge should be equivalent to the size of the individual with consideration given to weight. While a smaller catheter (larger gauge) can be used on most clients, a nurse should strive to use the largest catheter (smallest gauge) that the client's veins can handle. Sara is the smallest, making the size of 24 g the most appropriate. The nurse should attempt to use a 22 g catheter on Gabby. The nurse should use a 20 g catheter for Jordan. The 18 g is best for adults, depending on how fast their fluid is flowing and other considerations.​

Although it appears to be working, what are some concerns you might have?

The insertion site is covered and there is no marking indicating the time and date of insertion. In addition, the IV tubing is not looped and secured, causing it to be a higher risk for accidental removal.

The purpose of flushing an IV ensures that the IV site is patent (open and unobstructed) and allows for the healthcare professional to make sure there are no leaks or signs of infiltration. Flushing the catheter is not needed when discontinuing the IV. Flushing of the catheter should only be done for maintenance and if there is concern about function. It should not be done to reassure the client unless symptoms of malfunction are suspected.

The purpose of flushing an IV ensures that the IV site is patent (open and unobstructed) and allows for the healthcare professional to make sure there are no leaks or signs of infiltration. Flushing the catheter is not needed when discontinuing the IV. Flushing of the catheter should only be done for maintenance and if there is concern about function. It should not be done to reassure the client unless symptoms of malfunction are suspected.

Debra (pronouns: she/her/hers) is admitted with severe pneumonia. Because of her high fever and positive blood cultures, sepsis is a concern. The medical resident has decided to place a central line because Debra will require additional medication. After placement, a chest x-ray is ordered. Which are the reasons for the chest x-ray?

The x-ray was ordered to verify the placement of the central line in the superior vena cava and to evaluate for pneumothorax.

Arterial Line

These are specialized catheters that go into an artery (usually the radial artery). They are specifically for monitoring and drawing blood. Medication is never delivered through these catheters. They are only used in surgery and intensive care.

Swan Ganz Catheter

This catheter is utilized in surgery and intensive care units. This catheter allows for the measurement of pressures inside the heart, and its main purpose is to assist healthcare providers with the use of certain medications during critical periods.

During the intravenous (IV) catheter insertion, the nurse accidentally drops the needle and catheter onto the blanket. Which nursing action is most appropriate?

When infection control procedures are broken, it is always best to get a new IV catheter and dispose of the old one.

intravenous (IV) catheter sites on your clients. You review a client's IV that is demonstrated in the image to the right, and note that it was started 2 days ago. Which nursing actions will you take with this IV?

While the IV looks great, there is blood in the tubing. This could be caused by a number of things, but at this time the best course of action would be to flush the IV with normal saline to ensure it is patent (open).

What is the purpose of the flash chamber on an intravenous (IV) catheter?

area where blood appears when the needle pierces the vein. so the practitioner is able to verify venous access without significant amounts of blood blocking the field of view.

Doug (pronouns: he/him/his) is admitted with renal failure. He is on dialysis. He has been here for 4 days and currently has an intravenous (IV) catheter in his right upper arm. He is in need of another. There is a sign on his chart that says "No blood pressure on left arm." After observing the picture, what challenges can you anticipate in starting a second IV line on Doug

challenges, which include a lack of space, lighting, and a bed position too low for the proper positioning of the nurse. In addition, there could be a conflict with an IV in his upper right arm. He likely has a shunt in his left arm given the sign on his chart.​

What is the purpose of flushing an intravenous (IV) line with normal saline? Select all that apply.

ensure the IV site is open and unobstructed ensures no leaks or signs of infiltration

Central venous catheters that are not in use may require the ports flushed. This is usually accomplished with 10 mL of saline every 24 hours, but sometimes, depending on the catheter, saline with heparin (a blood thinner) is used. This heparinized solution (also called a heparin lock) is to ensure there is no clotting that develops blocking the device and making it unusable The amount of heparin typically used is 100 units/ml. The dose of heparin to maintain the line patency is much lower than a heparin dose that would be used therapeutically as a blood thinner.​ If the catheter does clot, the device needs to be replaced.

heparin lock

Which actions are used to reduce the risk of central line infection?

risk of infection can be reduced by changing the dressing per facility policy and by marking the dressing with the date of the last dressing change.

Dialysis Catheters

they are special in the fact that they need to maintain a high flow rate for dialysis. They are usually used for short- or intermediate-term dialysis until a shunt or a fistula can be surgically completed