Question 1

Local Complications

Accepted Answer

...

Question 2

Mechanical

Accepted Answer

Identify and correct problem early: adjusting tourniquet insertion site swelling above, below or over catheter site catheter against vessel wall, kinked or bent at flexion point or patient position IV tubing or IV pump malfunction

Question 3

Ecchymosis/Hematoma

Accepted Answer

Occurs during IV insertion causing local discoloration and may advance to form a hematoma Contributing factors: unskilled practitioner, use of fragile veins, multiple entries into vein, tourniquet on fragile skin, IV attempt to impalpable veins, patient use of steroids, anticoagulants

Question 4

Ecchymosis/Hematoma Interventions

Accepted Answer

Remove catheter Adjust tourniquet Apply slight pressure to site Area will be sore but not painful Discoloration: resolve in 1-2 weeks If hematoma: remove catheter, apply direct pressure, elevate limb, dry dressing, ice to prevent further swelling, document, check frequently

Question 5

Infiltration

Accepted Answer

Usually caused by dislodged catheter, causing fluid and medications to infiltrate surrounding tissue  Blanching, coolness, tenderness, skin taunt at insertion site, difficult to flexor extend extremity

Question 6

infiltration

Accepted Answer

Common and can be minor Hypertonic, acid, and alkaline fluids can cause necrosis (if not detected early) Edema occurs resulting in delay in patient receiving the correct amount of fluid as prescribed, limits veins for IV therapy Can predispose patient to infection

Question 7

Infiltration

Accepted Answer

. To confirm infiltration apply tourniquet proximal to IV site and if infusion continues with venous obstruction then infiltration is confirmed Intervention is to remove catheter and restart IV in another site

Question 8

Extravasation

Accepted Answer

Edema at site of infusion Blood return may be noted confirming placement in vein, however, not a reliable method, the catheter end may be in the posterior wall of vein but greater portion of catheter in tissues and infusion rate causes leakage and edema at catheter point Drugs contribute to necrosis from extravasations, cause direct cellular toxicity and ischemia Mechanical compression of site can cause increased damage, or infection of the wound Result can be superficial tissue loss Deep structure wound can be severe and lead to wide excision, debridement, grafting or amputation

Question 9

Phlebitis

Accepted Answer

Common inflammation of the vein from IV infusion Pain and tenderness along the vein, erythema, swelling, warmth at the site & streak formation 3 types: mechanical, chemical,& bacterial Factors influencing inflammation: duration of infusion, solution type, site, veni-puncture technique

Question 10

Mechanical Phlebitis

Accepted Answer

Catheter placement: areas of flexion increase risk of vein irritation causing injury and phlebitis To evaluate check tourniquet, site, catheter, solution bag, tubing, and involved extremity

Question 11

Chemical Phlebitis

Accepted Answer

Veins response to chemicals in IV infusion causing inflammation More acidic the admixture, greater the risk Additives such as KCL, Vancomycin, & neoplastic agents Improperly diluted meds or administered too quickly, catheter material or extended dwell time

Question 12

Bacterial Phlebitis

Accepted Answer

Cause of vein inflammation from bacterial infection Can become systemic if not treated early Hand-washing single most important intervention for preventing nosocomial infection  Aseptic technique in IV insertion and care of site

Question 13

Post-Infusion Phlebitis

Accepted Answer

Presents 48-96 hours after IV catheter is removed Factors are: poor insertion technique, poor vein condition, debilitated patient, hyper tonic or acidic solutions, infiltration, large bore catheter in small vein, failure to change: tubing, dressing\'s, site caps or catheter as per policy

Question 14

Thrombosis

Accepted Answer

An area that roughens or traumatizes the vein wall allows platelets to adhere and form a thrombus Thrombi form at the tip of the IV catheter in the vein, obstructing blood flow Creates a trap for bacteria that may cause an infection

Question 15

Thrombophlebitis

Accepted Answer

Thrombosis and inflammation both occur Site: tender, erythema, swelling, pain along path of vein If catheter left in place thrombosis obstructs blood flow, vein becomes hard & tortuous, tender and painful Pain may persist indefinitely, incapacitate patient and limit veins for future therapy

Question 16

Phlebtothrombosis

Accepted Answer

Thrombosis and inflammation not obvious Thrombus is poorly attached to the vein wall  Associated with potential embolism

Question 17

Interventions/Prevention

Accepted Answer

Hand-washing Gloves and gown Mask, eye wear, facial shield Patient care equipment Environmental control Linen Occupational health and blood borne pathogens Patient placement

Question 18

Occluded Peripheral Catheter

Accepted Answer

Catheter is filled with blood or precipitant and prevents infusion flow Infusion rate slows or stops Resistance is met when flushing catheter Factors: positional catheter, kinked catheter, IV solution bag empty, administration of incompatible meds cause precipitant formation

Question 19

Occluded Peripheral Catheter

Accepted Answer

Interventions Do not flush or force occluded catheter: may push embolism into circulation Remove catheter: insure intact

Question 20

Local Infection

Accepted Answer

Infection at the skin catheter entry point Can occur in the absence of phlebitis Pain, swelling, inflammation at catheter entry point Discolored tissue and purulent drainage May occur with IV in site or after removal Intervention: remove catheter & culture site, notify Physician, apply antibiotic ung as ordered, IV antibiotics may be indicated, sterile dressing and assess

Question 21

Venous Spasm

Accepted Answer

Sudden involuntary contraction of vein Results in temporary cessation of blood flow through vein Numbness to extremity, cramping, pain at catheter site, recognized by patient Pain usually due to tissue damage Factors: administration of cold or irritating meds or solutions

Question 22

Interventions venous spasm

Accepted Answer

Catheter not discontinued Decrease infusion rate or further dilute medication Apply warm compresses to promote vasodilatation and increase blood flow Infuse cold solutions with blood warmer, if indicated, for rapid infusions

Question 23

Systemic Complications

Accepted Answer

Occur in circulation Potential to affect all body systems Serious, require immediate intervention Include: Septicemia, pulmonary embolism, air embolism, catheter embolism, pulmonary edema, speed shock, allergic reaction

Question 24

Septicemia

Accepted Answer

Pathogen enters the bloodstream causing a systemic illness First signs and symptoms: chills fever, general malise, and headache Increased HR, flushed face, backache, nausea, vomiting, hypotension Severe symptoms cyanosis, increased RR vascular collapse, shock and death

Question 25

septicemia

Accepted Answer

Preventive Measures Hand-washing Check solutions and equipment before use Cleanse site for catheter placement Clip excess hair at insertion site, no shaving Secure catheter to prevent in and out movement Apply sterile dressings over catheter insertion site, change IV tubings, dressings, and site as per protocol.

Question 26

Pulmonary Embolism

Accepted Answer

Occurs when a mass of undissolved matter floats to the right side of the heart occluding a pulmonary vessel Signs and symptoms: cardiac disturbances, pulmonary hypertension, dyspnea, pleuritic pain, restlessness, cough, sweats, tachypnea, tachycardia, cyanosis

Question 27

Interventions PE

Accepted Answer

Place patient in semi-fowlers position Monitor V/S notify physician orders may include give oxygen, blood work, heparin infusion, lung scan Preventive measures: use filters if indicated for solutions with large particles, avoid veins in lower legs for IV therapy, use good judgment when flushing IV lines

Question 28

prevention PE

Accepted Answer

Catheter placement by skilled practitioner Use smallest catheter required Use large veins for irritating fluids, and medications Secure properly

Question 29

Air Embolism

Accepted Answer

Occurs when a bolus of air enters the vascular system Signs and symptoms chest pain, SOB, shoulder or back pain, cyanosis, hypotension, weak rapid pulse, churning sound over precordium, faint feeling, shock and arrest if not recognized or treated

Question 30

Contributing Factors AE

Accepted Answer

Open port or leak in infusion system Solution containers run dry, IV tubing and connections become disconnected Failure to remove air from IV tubing or syringe before administration of fluids, or medications

Question 31

Interventions AE

Accepted Answer

replace leaning or open infusion sets Place patient on left side with head lower than heart Asses V/S, notify physician, give oxygen, be prepared for emergency care

Question 32

Preventive Measures AE

Accepted Answer

Clamp IV tubings before changing lines Change solution containers while solution remains in container, do not let containers run dry Change leaking set immediately Remove air from infusion sets before use

Question 33

Catheter Embolism

Accepted Answer

Occurs when a piece of catheter is severed and enters circulation Caused by defective catheters, shearing of catheter during insertion, catheter rupture from forced injection, inappropriate clamping of silicone catheter Most common cause, withdrawal of catheter after insertion of a through the needle catheter causing catheter shearing

Question 34

Signs and Symptoms

Accepted Answer

Local: catheter and hub separation Severed catheter noted on withdrawal Systemic: cyanosis, hypotension, weak rapid pulse, fainting, cardiac arrest Severity depends on location of embolism Severe symptoms can appear suddenly

Question 35

Interventions

Accepted Answer

Interventions Notify physician, orders may include tourniquet placement above catheter insertion site, strict bed rest, radiographic studies, surgical intervention, continuous monitoring of patient Documentation: date and time, s/s and severity, cause if known, interventions and patient response

Question 36

Prevention

Accepted Answer

Check catheter for integrity before use Avoid pulling through the needle catheters back through the needle during insertion Withdraw ONC stylets only when veni-puncture is complete

Question 37

Pulmonary Edema

Accepted Answer

Occurs when there is more fluid volume than the circulatory system can manage, causes increase in venous pressure Danger of heart failure, shock, cardiac arrest if unrecognized or untreated Signs and symptoms early: restlessness, slow increase in pulse, headache, SOB, cough, progresses to hypertension, severe dyspnea, productive cough, severe engorged neck veins, moist rales

Question 38

Interventions

Accepted Answer

Goal is to decrease the workload of the heart Decrease infusion rate, place patient in high fowlers position, assess V/S, notify physician, orders may include give oxygen, morphine, diuretics, vasodilators (nitro)

Question 39

Preventive Measures

Accepted Answer

Assessment of patient before IV initiation  Review patient cardiac and respiratory history Monitor patient for tolerance of IV infusion Maintain infusion rates as ordered

Question 40

Speed Shock

Accepted Answer

A systemic reaction occurs when a foreign substance is rapidly introduced into the circulation, has been confused with pulmonary edema Signs and symptoms: early dizziness, facial flushing, headache, associated with medication administration Progressive symptoms: chest tightness, hypotension

Question 41

Allergic Reaction

Accepted Answer

Immediate or delayed response to med, blood/ blood products or IV solution Signs and symptoms: chills, fever, erythema and itching, SOB with or without wheezing

Question 42

interventions

Accepted Answer

Provide patient comfort Notify physician, orders Administer meds: antihistamines, epinephrine, cortisone, or aminophylline Preventive measures: know patients allergies on admission and check before administration of therapies Adequate screening of donor and recipient blood

Question 43

Risk factors for IV catheter related blood stream infections:

Accepted Answer

Immuno-suppression or deficiency Severe underlying chronic disease Administration of multiple infusions Extended hospital stay Leukopenia Presence of concurrent infection Age Burns

Question 44

Extrinsic Factors Means of contamination

Accepted Answer

Extrinsic occurs after manufacturing process; occurs in clinical most common

Question 45

...

Accepted Answer

Primary Causes:   Inadequate hand hygiene,  Improper admixing of medications,  Veni-puncture procedure: contaminated site prep solution or catheter; failure to apply dressing or rotate sites

Question 46

Infection Control

Accepted Answer

Infusion system failure to:  Replace, maintain sterile closed system, accidental disconnection, blood in tubing  Medication administration: using admixed meds, use of injection access ports, use of multi-dose vials

Question 47

Preventive Strategies

Accepted Answer

Proper hand-washing Correct storage of admixture supplies Close inspection of fluids and equipment Maintain aseptic technique Routine rotation of sites (as per policy) Proper skin preparation Routine change of IV tubing and dressings Maintain dry and intact dressing and sterile closed infusion system

Question 48

Intrinsic Factors

Accepted Answer

Occur during manufacturing process: Low rate of occurrence Regulatory process by industry Preventive Measures

Question 49

Preventive Measures

Accepted Answer

Inspection of equipment before use for: Discoloration, torn packages, missing or improperly fitting port covers, expiration dates Inspection of fluids before use for: Clarity, particulate matter, puncture holes or cracks, loss of vacuum, damage to bag or bottle closures, expiration date

Question 50

Exogenous Contamination

Accepted Answer

Caused by transmission of organisms from other than the intrinsic or extrinsic factors Occurs frequently Primary causative organisms staphylococci aureus Prevention: hand-washing and aseptic technique

Question 51

Endogenous Contamination

Accepted Answer

Caused by patient\'s own normal flora Occurs frequently in high risk severely ill patients Primary causative organism: staphylococcus aureus and others Prevention: proper site prep, aseptic technique, and rotation of insertion sites

Question 52

Occupational Safety Compliance

Accepted Answer

Hand hygiene Universal precautions for blood and body fluids Use of protective equipment: gloves, face masks, gowns, eyewea Safety IV catheters Disposal of sharps

Question 53

...

Accepted Answer

Protocols for safe handling of blood or body fluids, infectious waste, and sharps need to be adhered to for your safety and the safety of others

Question 54

9. Identify the most appropriate veins selected for IV insertion in adults

Accepted Answer

...

Question 55

Considerations for Vein Selection

Accepted Answer

Suitable location Condition of the vein Purpose of the infusion Duration of the therapy

Question 56

Vein Location

Accepted Answer

Distal areas of upper extremities: *Refer to vein chart Selection after initial puncture is proximal to previous insertion site -Most common: Dorsal metacarpal veins, cephalic, accessory cephalic, median basilic and median cubital -Antecubital veins are poor choice for routine IV therapy (location, high risk dislodging, mechanical phlebitis) best for emergency care

Question 57

elderly

Accepted Answer

Dorsal metacarpal veins poor choice for elderly, thin walled and thin skin and lack of support tissue makes it difficult to secure IV. Also may not be 1st choice in hypovolemia veins will not fill and distend for puncture.

Question 58

Vein Location-Basilic vein

Accepted Answer

difficult to access- need to stabilize during puncture

Question 59

Upper cephalic

Accepted Answer

difficult to visualize - good site for confused patients

Question 60

Median antebrachial -

Accepted Answer

nerve endings prevent cannulation Always consider patient comfort when selecting location

Question 61

Avoid

Accepted Answer

Wrists - b/c of close proximity to nerves Lower extremities in adults-small & distal to heart Below a previous IV infiltration or phlebitic area Sclerosed or thrombosed veins

Question 62

avoid

Accepted Answer

Arm affected by edema, mastectomy, arteriovenous (A/V) shunt or fistula, blood clot or infection

Question 63

avoid

Accepted Answer

Area of bruising, skin inflammation, disease or breakdown Other - fracture or CVA paralysis of arm

Question 64

Condition of Vein

Accepted Answer

Palpate vein for depth, size & length Vein should feel soft, elastic & engorged Should NOT feel hard, bumpy, flat or palpate a pulse A large vein not visible but palpable may be a more suitable choice rather than a superficial vein with less blood

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