Ch, 15 Concepts of Infusion Therapy

Which statement regarding the Needlestick Safety and Prevention Act is true?

- It was passed in 2001 - it includes the use of needle stick-capable devices, such as Lier-activated devices - it requires every employer to maintain a shapes injury log with details of each incident - it continues an amendment of the occupational safety and health administration guidelines

Which information would the nurse include in the documentation for a patient's peripheral venous catheter insertion?

- Patient's response to the insertion - Date and time inserted - type and size of device - type of dressing applied - vein used for insertion

Which device allows the visualization of a superficial vein on a patient who is prescribed infusion therapy?

- infrared - laser beam - transilluminator rationale: several illuminating devices are available for the visualization of veins. The use of infrared and laser beam transilluminators is employed for the visualization of superficial veins. Transilluminators include VeinViewer, Veinlite LED, and AcuuVein for the detection of deeper veins. X-ray imaging and drugs are not employed for the visualization of veins. X-ray imaging is used to confirm catheter placement

Which catheter is likely to cause venospasms if removed forcefully?

- midline - peripherally inserted central rationale: must be removed with the same slow and gently techniques used to insert them. Sudden or forced removal of the catheter results in the development of venospasms or breakage of the catheter and entry into pulmonary circulation. Short peripheral catheters do not cause venospasms because of their thin gauge size. Tunneled and non tunneled percutaneous central catheters do not cause venospasms when they are removed, because the vein diameter is large

The nurse is caring for a patient receiving a dose of IV vancomycin. Which action would the nurse take after noticing swelling and coolness around the catheter insertion site?

- remove the catheter - apply cold compresses - discontinue the infusion rationale: The patient is experiencing infiltration, which requires the nurse to discontinue the infusion, remove the catheter, and apply cold compresses to relieve pain. The nurse should not flush the catheter with saline as doing so would force more drug into the interstitial tissues. The health care provider would not need to be notified of an infiltration as this will resolve on its own

Which factor would the nurse take into account before selecting an insertion site for a short peripheral venous catheter?

- type of therapy - history of mastectomy - presence of dialysis fistula - axillary lymph node dissection

Which gauge size of peripheral IV catheter is preferred for an adult patient undergoing a routine surgical procedure?

18 gauge rationale: This gauge of catheter allows for faster flow rates of fluids and blood administration if necessary. Should an emergent situation arise, a 26-gauge peripheral catheter is not ideal for rapid fluid infusion or a blood transfusion. A 22-gauge is adequate for most therapies but not ideal for rapid fluid infusions. A 14 gauge is used for a trauma patient and surgical patients that need rapid fluid resuscitation

Which is the smallest gauge of peripheral IV catheter the nurse would use to infuse a blood transfusion without damaging the cells?

22 gauge rationale: A 22-gauge catheter is the smallest size catheter that will not damage the red blood cells. Larger catheters could also be used, such as the 16-, 18-, or 20-gauge catheters, but they are larger than a 22-gauge catheter

which flow rate is expected through a 22-gauge peripheral catheter?

38 mL/min

Tunneled central venous catheter

A vascular access device that is placed in the subcutaneous tunnel; the external catheter exits the skin on the abdomen and doesn't require the trendelenburg position. Indicated in patients who require weeks or months of infusion therapy or months of parenteral nutrition, where peripherally inserted central catheters are not a good choice

Which situation is an indication for placing a nontunnneled percutaneous central venous catheter (CVC) in a patient? A. impending surgery B. trauma situations C. renal failure D. administration of IV fluids E. prolonged parenteral nutrition

A, B, D rationale: The subclavian and internal jugular veins are the sites of choice for placing non tunneled percutaneous CVCs. They are mostly used during emergency situations such as surgery, critical care, or trauma to administer IV infusions. Renal failure requires the placement of a hemodialysis catheter. Prolonged parenteral nutrition requires the placement of a tunneled CVC

Which action would the nurse take to ensure skin antisepsis before venipuncture in an older adult?

Apply chlorhexidine for maximum antiseptic action rationale: Skin antisepsis is important before venipuncture to prevent infection and related complications in older adults, who tend to have decreased immunity because of the aging process. Chlorhexidine is the most appropriate antiseptic agent for maximum antiseptic advantage; the newer products also contain alcohol. The skin should be allowed to dry after applying the antiseptic solution for maximum effect. A minimum contact time of 2 minutes is needed when using iodophors for these to be effective.

Implants ports

Are central vascular access devices. They involve creating a subcutaneous pocket surgically to place the port body. The catheter is placed in the vein and is then attached to the port body; catheters attached to the implanted port require the patient to be in semi-fowler position for the infusion to prevent nausea caused by the infusion

Which action would the nurse take when choosing a site for placement of a short peripheral venous catheter in a patient who recently had a mastectomy?

Avoid the arm on the operative side. rationale: The nurse should avoid the arm on the side of the mastectomy when choosing a site for placement of a short peripheral venous catheter. Similarly, the arm on the side of a lymph node dissection, arteriovenous shunt or fistula, or paralysis is not considered for placement of a short peripheral venous catheter, because they alter the normal pattern of blood flow through the arm. Generally, a site should be chosen in the upper extremity for adults, but not the wrist because of the possibility of puncturing the median nerve. A vein that is hard or cordlike is not suitable for placement of the catheter. the site on the inner side of the elbow or in the area of a joint flexion is generally avoided because it causes immobilization of the arm

What is the preferred site for inserting a peripherally inserted central catheter (PICC)?

Basilic Vein in the upper arm rationale: PICCs are always inserted in the veins of the upper arm. The basilica vein is preferred over the cephalic vein, and the brachial veins are not recommended for use. Veins in the forearm, such as the median vein, are also not recommended

A patient has an arterial catheter in the right wrist. Which assessment would the nurse make to determine latency of the patient's radial artery?

Capillary refill rationale: Capillary refill distal to the site should be assessed to ensure that the arterial line is not occluding the artery. Blood pressure and neurologic function are not pertinent in the patient's arterial line. Although the patient's comfort level is important with an arterial line, it is not a determinant of patency of the line

Which IV insertion site would the nurse choose for an older adult being admitted to a same-day surgery unit?

Cephalic vain of the forearm rationale: for same-day surgery, the cephalic or basilic vein allows for insertion of a larger IV catheter while allowing movement of the arm without impairing IV infusion flow. Peripheral venous catheters should never be inserted into the back of the hand in an older adult, because the veins are brittle. Peripheral venous catheters should never be inserted into the lower arm on the same side as a radial mastectomy, because they interfere with limited circulation. Catheters are typically inserted into the subclavian vein by the health care provider, not the nurse

18-gauge catheter

Has a flow rate of 110 mL/min

26-gauge catheter

Has a flow rate of 24 mL/min

A 20-gauge catheter

Has a flow rate of 65 mL/min

Which central vascular access device (CVAD) can be placed for access to arteries, the epidural space, and the peritoneal cavity?

Implanted port rationale: Implanted ports are CVADs and may be placed inn arteries, epidural space, and the peritoneal cavity. Catheters may also be places in arteries, epidural space, and the peritoneal cavity, but catheters are central venous catheters (CVCs).

Which central vascular access device (CVAD) is indicated in patient who require IV therapy for more than a year? A. implanted port B. tunneled central venous catheter C. peripherally inserted central catheter D. non tunneled percutaneous central venous catheter

Implanted port rationale: Implanted ports are a kind of CVAD that is indicated in patient who require long-term IV therapy for more than a year

Grade 3

Indicated pain at the access site with erythema and/or edema and streak formation with a palpable cord

Grade 1

Indicates only erythema with ot without pain

Grade 2

Indicates only pain at the access site with erythema and/or edema

Grade 4

Indicates pain at the access site with erythema and/or edema, streak formation, a palpable venous cord longer than 1 inch, and purulent drainage.

Which complication of peripherally inserted central catheters (PICC) happens rarely?

Infiltration rationale: infiltration is a rare complication of PICC

Peripherally inserted central catheter

Inserted through a vein on the antecubutal fossa or the middle of the upper arm; the Trendelenburg position is not requires, because it does not play any role in peripherally inserted central catheters

Which central catheter insertion procedure requires the patient to be in the Trendelenburg position?

Nontunneled percutaneous central venous catheter rationale: Insertion of the nontunnneled percutaneous venous catheter requires the trendelenburg position. This is a position in which the patient's head is low and the body and legs are in the inclined plane which helps ensure that the catheter exit site is at or below the heart. Nontunneled percutaneous central venous catheters are used for trauma situations, critical are, and surgery and are used for short durations

As the nurse assesses the insertion site in the right arm of a short peripheral venous catheter, which finding indicates the presence of phlebitis?

Palpable cord rationale: Phlebitis is an inflammation of a vein that presents with redness and a palpable cord. Bruising occurs from blood leaking into the surrounding tissue. Swelling and skin coolness occur during infiltration of fluids into the surrounding tissues. Blistering occurs with extravasation

A chemotherapy nurse is planning to give a patient the next dose of a chemotherapeutic agent through the implanted BARD PowerPort. Which technique would 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 rationale: Bard power ports have three bumps on the top of the septum that indicate the location of the septum. The nurse should palpate these three bumps lightly to identify the location for puncture. The port does not contain a ridge to identify the septum. Inspection is not through enough to identify the exact location of the septum. Percussion will not provide adequate information about the location of the reservoir or the exact site needed for puncture

The nurse determines the patient has an infection from the short peripheral IV catheter used for treatment. Which action would the nurse take to determine the offending organism?

Sent the catheter tip for culture rationale: The nurse should send the catheter tip for culture to determine which microorganism is causing the infection. The nurse should clean the site with alcohol after the peripheral catheter is removes and cultures are obtained. The nurse should apply cold compresses to alleviate pain

The nurse is caring for a patient admitted with dehydration secondary to influenza who is prescribed 0.9% sodium chloride. Which vascular access device would be appropriate for the nurse to insert?

Short peripheral catheter rationale: The nurse should insert a short peripheral catheter as the patient is receiving an isotonic solution that will not harm the tissues. A midline catheter would be used if the patient had poor skin integrity or limited peripheral veins. A tunneled central catheter and a peripheral inserted central catheter are used for long-term treatment

Which statement is accurate about the special needs of older adults receiving IV therapy?

Skin integrity can be compromised easily by the application of tape or dressings rationale: skin in older adults tends to be thin. Tape or dressings used with IV therapy can compromise skin integrity. Placement on the back of the dominant hand is contraindicated because hand movement can increase the risk for catheter dislodgment. An angle smaller than 25 degrees is required for venipuncture success in older adults. This technique is less likely yo puncture through the older adult patient's vein.

Which condition is a common and serious complication of a peripheral inserted central catheter?

Thrombophlebitis rationale: Thrombophlebitis is the most serious complication of PICC. Phlebitis is a common complication of PICC but is not as serious as thrombophlebitis. Infiltration is a rare complication of PICC. Thrombosis is common but not a serious complication of PICC

Which device is commonly used to identify superficial veins and assist in the placement of short peripheral catheters?

Transilluminator rationale: Veins transilluminators use infrared or laser to visualize veins immediately under the skin's surface. Because these are the veins most commonly used for short peripheral catheters, vein transilluminators are used most commonly to aid in the placement of these catheters.