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IV therapy 1 – Flashcards

Marguerite Castillo

7 July 2022

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Infusion Delivery Systems

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Glass bottles, Plastic Bags, and Semi-Rigid Containers For Small Volume Infusions: Secondary Bag, Piggy Back Bag, Additive Bag, and Use-activated Container

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Administration Sets

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Primary Set, Secondary Set or Piggyback Set (includes a Hanger), Pump-Specific Set or Pump Set (sets may be vented or nonvented, but most employ a Convertible Pin that allows the set to vented or nonvented)

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IV Tubings and drip rates

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Microbore (60 gtt/mL) and Macrobore (10, 15 & 20 gtt/mL)

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Special Medication Administration Sets

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Lipid Administrations Sets [(Intravenous Fat Emulsion (IVFE)], TPN Administration Sets, and Nitroglycerine Administration Set

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Blood Administration Sets

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Y-Set, Straight Set, or Pump Set

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Administration Set Parts

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Spike or Piercing Pin, Shield/Flange, Vent or Convertible Pin, Drop Orifice (macrodrip or microdrip), Drip Chamber, Tubing (Micro or Macrobore), Clamp, Injection Ports (Y-site, Y-port), Backcheck or Check Valve, Male Luer-Lock or Slip Hub Adapter

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Clamps

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Roller, Slide, Screw and Pinch

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Filters

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Inline or Add-On (range in size from 170 microns to 0.2 microns based on purpose), Specialty Filters: (Examples: Leukocyte Depletion or Reduction Filter, Microaggregate Filters)

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Extension Tubings

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Microbore or Macrobore (in Varying Lengths with or without Injection Ports)

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Catheter Connection Devices or Catheter Extension Sets

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Straight Extension Set, Y-Connector, T-Connector, or J-Connector

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Needleless Systems

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Various systems that do not require the use needles to connect IV devices or administer infusates and medications.

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Peripheral Venous Catheters

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Scalp-Vein or Butterfly Needles, Over-the-Needle Cannula, Midline Catheter

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Central Venous Access Devices (CVADs)

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Nontunneled CVADs (Examples: Internal Jugular and Subclavian), Peripherally Inserted Central Catheter (PICC), Subcutaneously Tunneled CVADs, (Examples: Hickman and Groshong), and Implanted Vascular or Venous Access Ports (VAP)

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Needleless Connectors (Injection Caps or Injection Ports)

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Needleless Connectors are classified as either simple or complex and complex

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Complex needleless connectors can be furthered classified as:

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Negative Fluid Displacement, Positive Fluid Displacement or Neutral Displacement Devices.

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A Needleless Connector is added to

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an IV catheter or a Straight Extension Set, Y-Connector, T-Connector, or J-Connector for intermittent access.

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The combination of a Peripheral IV Catheter, Catheter Connection Device and Needleless Connector is commonly called a:

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: Saline Lock or Medication Lock and may also be referred to as a Peripheral Intermittent Infusion Device.

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Securement Devices

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Tape, Tegaderm, StatLock

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Mechanical Gravity Devices

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Volume Control Set or Volume Chamber Control Set (Volutrol or Buretrol), Dial-A-Flow

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Electronic Infusion Devices

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Volumetric pumps, Peristaltic Pumps, Syringe Pumps, Patient-Controlled Analgesia (PCA) Pumps, and Ambulatory Pumps

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Nonelectric Disposable Pumps

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Elastomeric Infusion Pumps, Spring-Powered Infusion Pumps, Negative-Pressure Infusion Pumps, and Disposable PCA Pumps

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Labels

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Additive Label, Timestrip, Tubing Label, and IV Start Label

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Misc. items

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Deadender or Dual Luer Lock Cap, Stopcock (Usually Three or Four-way Device), Huber Needle, Saline Flush

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indications for IV access

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Blood sampling, donor phlebotomy, fluid volume maintanence, fluid volume replacement, med admin, blood/blood product admin, nutritional supp, TKO (to keep open) for emergency access, hemodynamic monitoring

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advantages of IV therapy

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Available route, Faster absorption, Rapid distribution, Maximum bioavailability, Maintenance of controlled blood levels, Less discomfort than some routes, Time efficient for nursing

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Disadvantages of Intravenous Therapy

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Local discomfort, Infiltration, Needle or catheter displacement, Sepsis, Thrombosis, Embolism, Fluid overload, Hypersensitivity, Precipitation, Incompatibility, Transmission of disease

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Define accountability as it applies to IV Therapy

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It is a professional responsibility in which a nurses are answerable for their actions, inactions, decisions and judgements

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Infusion nursing code of ethics is based on

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the premise that infusion nurses individually and collectively practice with awareness, and that there are principles that guide the infusion nurse's actions

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Code of ethics for nurses

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An ethical nurse acts as a pt advocate, maintains pt confidentiality, safety, security, and respects, promotes and preserves human autonomy, dignity, rights, and diversity.

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principles used in ethical and moral decision making

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*autonomy (right to self-determination, independence, and freedom); *beneficence (doing good for patients); *nonmaleficence (doing no harm to patients); *veracity (truthfulness); *fidelity (obligation to be faithful); *justice (obligation to be fair to all people)

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Quality management is defined by

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an organizational culture committed to achieving excellence

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Define criminal law

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relates to an offense against the general public caused by the potential harmful effect to society as a whole

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define civil law

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private law affects the legal rights of private persons and corporations.

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define tort

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a private wrong, by act or ommission

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define malpractice

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type or subset of negligence, committed by a person in a professional capavity

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The three parts of a competency-based program include: a, competency statement, goal, and return demonstration b. competency statement, criteria for learning, and evaluation c. Goal, evaluation and feed back d. assessment, problem statement, and implementation

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b. competency statement, criteria for learning, and evaluation

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Which of the following describes the benchmarking process?

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d. Comparing your unit's data on phlebitis rates to that of other organizations to identify improvement opportunities.

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The process used to evaluate sentinel events is:

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d. root cause analysis

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To differentiate between standard of care and standard of practice, the standard of practice would be defined as:

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a. Activities and behaviors of the practitioner needed to achieve patient outcomes

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A nurse walks into a patient's room and finds the I.V. solution container dry. The bag of 1000 ml of 5% dextrose and 0.9% NaCl had been hung 1 hour earlier. The nurse informs the charge nurse and the physician that this has occurred. The nurse is instructed to complete an unusual occurrence report. The report allows the analysis of adverse patient events by:

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a. Evaluating quality care and the potential risks for injury to the patient

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Characteristics of performance improvement (doing the right thing well) include which of the following? (Select all that apply)

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a. Availability of a needed test b. Documenting the quality of care received(?? not in the reading - pg 17) c. Timelines which with the test, procedure, and treatment are provided d. Continuity of the services provided

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The definition of a tort is:

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b. private wrong, by act or omission, that can result in a civil action by the harmed person

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Components of evidence-based practice include (select all that apply)

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a.evidence from research and published guidelines b.clinical expertise d.information about pt preferences

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Which of the following organizations develops clinical practice guidelines? (Select all that apply)

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c. Infusion Nurses Society d. American Nurses Association

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The assessment phase of the nursing process related to infusion therapy would include which of the following? (Select all that apply)

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a. Physical assessment b. Review of laboratory data

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A perioperative nurse is preparing clients for surgery. When preparing clients for surgical procedures, the nurse uses risk-management strategies to reduce the incidence of error and enhance client safety. Which risk-management tool would be considered a proactive strategy? a. Unusual occurrence reports b. Informed consents c. Documentation records d. Professional liability insurance

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b. Informed consents Obtaining informed consent is considered a proactive strategy. The purpose of the informed consent is to provide clients with enough information to enable them to make a rational decision regarding whether to undergo treatment. Unusual occurrence reports and documentation records are provided after the procedure and are not considered preventative measures. Professional liability insurance is for protection of the nurse, not the patient.

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A nurse is caring for clients in a hospital setting. During orientation, the nurse learned that many of the functions in the hospital are regulated by The Joint Commission (TJC). The nurse learned that the primary purpose of TJC is to: a. define the practice of professional and licensed nurses within each state. b. suspend or revoke the license of any nurse who violates professional conduct. c. establish standards of practice for the specialty practice. d. improve the safety and quality of care provided to the public.

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d. improve the safety and quality of care provided to the public. TJC is a nonprofit organization committed to helping hospitals help clients by providing standards and performance measurements, by providing accreditation and certification services to facilities, and by providing education and information. Options a and b are functions of state regulatory boards. Option c is a function of nursing specialty organizations.

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A nurse is assigned to work on an inpatient vascular access team. The hospital has a competency-based performance program to ensure competent practice. What are the three key components of a competency-based performance program? a. Competency statement, goal, and return demonstration b. Competency statement, criteria for learning, and evaluation c. Goal, evaluation, and feedback d. Cognitive criteria, written test, and goal

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b. Competency statement, criteria for learning, and evaluation The competency-based performance program observes employee performance and focuses on psychomotor skills. The three-part competency model is an effective tool for ensuring competent practice. The competency statement directs the observable behavior, criteria for learning, or performance criteria and establishes minimum standards of performance, and the evaluation provides the employee with feedback.

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A pediatric nurse is caring for children admitted to a pediatric step-down unit. The nurse is aware that client care must meet minimum, established standards of care for this population. Which statement regarding "standards of care" is most accurate? a. Standards of care focus on written laws enacted by a legislative body. b. Standards of care focus on the results of the performance of a function or process. c. Standards of care focus on the provider, and define the activities and behaviors needed. d. Standards of care focus on the recipient of care and describe outcomes of care.

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d. Standards of care focus on the recipient of care and describe outcomes of care. pg 19 in the book

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A client who is staggering and verbally abusive is admitted to an emergency department. A nurse obtains leather restraints and threatens to place them on the client while starting an IV line. Which charge(s) can be filed against the nurse if he or she follows through with the threat? a. Assault and battery b. Negligence c. Invasion of privacy d. Slander

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a. Assault and battery Assault is an intentional wrongful statement or action performed by one person that causes another person immediate and actual fear, or reasonable apprehension, of being touched against his or her will in an injurious or offensive manner. Battery is the intentional physical contact with another person in an injurious or offensive manner.

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A nurse is caring for a client with a peripherally inserted central catheter (PICC). Which action by the nurse places the nurse at risk for a potential malpractice suit? a. Assessing the PICC site b. Flushing the PICC with normal saline c. Using the PICC while waiting for verification of placement by x-ray d. Cleaning a 2-inch area around PICC site before accessing the port

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c. Using the PICC while waiting for verification of placement by x-ray Using a central venous access device, such as a PICC, before proper placement has been verified by x-ray is contraindicated and may place a nurse at risk for a potential malpractice suit. Malpractice is negligence on the part of a professional only while he or she is acting in the course of professional duties. A tort of negligence results when an individual fails to fulfill a required duty of care that results in an injury to another individual.

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A nurse receives physician's orders for a newly admitted client. The nurse thinks critically about the physician's orders before implementing the orders because the rule of personal liability implies that: (SELECT ALL THAT APPLY.) a. The nurse is a knowledgeable professional who is capable of independent judgment. b. The nurse has a legal responsibility to fulfill an obligation. c. The nurse must follow all orders received from physicians. d. The nurse must be able to evaluate medical orders as they apply to the client.

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a. The nurse is a knowledgeable professional who is capable of independent judgment. b. The nurse has a legal responsibility to fulfill an obligation. d. The nurse must be able to evaluate medical orders as they apply to the client. The rule of personal liability implies that a professional is capable of independent judgment, has a legal responsibility to fulfill obligations, and must be able to evaluate medical orders. The basic premise of the rule is that every person is liable for his or her own conduct or wrongdoing.

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During a hospital orientation, a newly hired nurse learns that infectious waste must be incinerated as mandated by the U.S. Environmental Protection Agency (EPA). The nurse understands that the main focus of the EPA is on: a. risk-assessment strategies. b. performance-improvement strategies. c. quality management. d. occupational safety.

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a. risk-assessment strategies. The EPA is one agency that performs risk assessment. Risk assessment takes different approaches depending on what information is available. Some assessments look back to try to assess effects after an event. Other assessments look forward to anticipate effects before a new product is approved for use.

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A registered nurse is asked to be an expert witness in a lawsuit regarding infusion-related clinical practice. According to the Infusion Nurses Society's Infusion Nursing Standards of Practice (2006), which credentials should a registered nurse possess to qualify as an expert witness? a. Masters in Science in Nursing b. Certification in Critical Care c. Certification in Infusion Nursing d. Licensed Vocational or Practical Nurse

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c. Certification in Infusion Nursing A nurse functioning as an expert witness for the purpose of infusion therapy-related litigation shall be a registered nurse who is certified in IV therapy (CRNI). The expert educates judges, attorneys, and jury members regarding infusion-related clinical practice and the infusion nursing standards of practice.

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A graduate nurse is orienting to a new job on a medical-surgical unit. As part of the orientation process, the nurse must demonstrate competency with regard to IV therapy. The elements of IV nursing competency include: (SELECT ALL THAT APPLY.) a. Accountability b. Communication c. Autonomy d. Risk assessment

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a. Accountability b. Communication c. Autonomy The elements of IV nursing competency include accountability, communication, and autonomy. Accountability implies that the nurse is astute and knowledgeable enough to adjust interventions to accomplish short- and long-term care goals, and communication implies that the nurse can effectively exchange information with everyone involved in the client's care. The nurse also demonstrates autonomy by making certain decisions independently. Risk assessment is not one of the competency elements.

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A clinical education specialist is often responsible for observing staff nurses to ensure competency with regard to the initiation of IV therapy. When observing staff nurses for competency, what should be the primary focus of the educator? a. Essential, mandatory aspects of performance b. Cognitive mastery of a defined subject c. All aspects of an observable performance d. A combination of both skill and cognitive mastery

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a. Essential, mandatory aspects of performance The educator should focus on essential, mandatory aspects of performance. Competency-based education has specific goals for observing essential criteria related to an observable performance. Cognitive mastery could not be evaluated by observation alone.

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match the term in with the definition: A. Cannula B. Drip Chamber C. Lumen D. Hub E. Port a. A female connection point of an I.V. cannula where the tubing or other equipment attaches b. Point of entry c. Area of the I.V. tubing usually found under the spike where the solution drips and collects d. Space within an artery, vein, or catheter e. A tube or sheath used for infusing fluids

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A - e B - c C - d D - a E - b

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When using a flexible plastic system, what type of administration set could you choose?

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b. nonvented

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A disadvantage of the glass solution containers is that it:

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a. is breakable and difficult to store

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Which of the following situations would be appropriate for a 0.22-micron filter? (Select all)

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c. Infusion of 10% dextrose and amino acids via central line

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The standard blood administration set has a clot filter of how many microns?

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a. 170

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Microaggregate filters are used to:

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b. reinfuse shed autologous blood

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New research supports which of the following techniques to prevent infections with needleless connectors?

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b. Use of alcohol disinfection caps

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Which of the following reduce risk for needlestick injuries?

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c. needleless systems

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The limit to operating pressure at which an alarm is triggered on an electronic infusion device is known as the:

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c. Occlusion alarm

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The nurse identifies errors in programming an infusion pump. What should the nurse do? (Select all)

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a. Report the device malfunction to the supervisor. b. Fill out appropriate hospital form. d. Notify the Risk Manager.

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A nurse is preparing to infuse an antibiotic IV piggyback. Which connection should the nurse use to secure the piggyback administration set to the primary administration set? a. Slide clamp b. Luer lock c. Slip lock d. Taping with paper tape

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b. Luer lock The male Luer lock has threads that secure and lock the connectors. Taping connectors is not acceptable practice. The slide clamp does not secure connectors but regulates the rate. A slip lock is a type of male adapter that slips into the female end of the equipment; however, there is no mechanism to secure the two pieces of equipment.

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A nurse specialist is performing placement of a midline catheter. Midline placement refers to a: a. peripherally inserted catheter with the tip location in the superior vena cava. b. peripheral catheter less than or equal to 3 inches in length. c. peripheral catheter that is between 3 and 8 inches in length with the distal tip dwelling in the basilic, cephalic, or brachial vein at or below the level of the axilla. d. catheter surgically placed into a vessel, body cavity, or organ and attached to a reservoir that is placed under the skin.

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c. peripheral catheter that is between 3 and 8 inches in length with the distal tip dwelling in the basilic, cephalic, or brachial vein at or below the level of the axilla. Midline placement of a peripheral catheter is designed for intermediate-term therapies from 1 to 4 weeks.

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A committee is asked to investigate ways to reduce needlestick injuries in a hospital. Which technology best assists in the reduction of needlestick injuries? a. Luer locks b. Elastomeric pumps c. Needleless systems d. Three-way stopcocks

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c. Needleless systems The needleless system has taken the place of 80% of needles used in IV therapy for piggyback, accessing ports, and accessing locking devices. Elastomeric pumps primarily deliver medications in the home-care environment. Luer locks help maintain integrity of connectors, and three-way stopcocks provide access options into the IV system. Stopcocks are add-on devices and should be used with caution because of the risk of contamination.

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Which of the following features of positive-pressure pumps according to Infusion Nurses Society (INS) Standards of Practice should be used to prevent free flowing of the solution. a. Two-pump mechanism assembly b. Dose error reduction systems c. Anti-free-flow alarm d. Use of in-line filter

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c. Anti-free-flow alarm To ensure safe, efficient operation, all literature that accompanies the pump must be reviewed by the nurse. Newer positive-pressure pumps should have an anti-free-flow alarm to alert the nurse to free flow of solutions.

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A nurse is initiating IV therapy for a client using a Teflon over-the-needle catheter. The primary disadvantage of Teflon over-the-needle catheters for peripheral infusion is: a. the risk for phlebitis. b. the risk for infiltration. c. the risk for septicemia. d. the fact that they can be used for only 24 hours.

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a. the risk for phlebitis. Teflon or polyurethane material used for over-the-needle catheter tends to increase the risk for mechanical phlebitis (most thrombogenic). Silicone is the least thrombogenic.

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A critical-care nurse is using a 0.22-μm filter for the delivery of infusion therapy. According to the Infusion Nurses Society Standards of Practice (2011), for nonlipid-containing solutions that require filtration, a 0.2-μm filter should be a. air eliminating. b. particulate retentive. c. fat emboli reducing. d. bacterial retentive.

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a. air eliminating. b. particulate retentive. d. bacterial retentive. A 0.2-μm filter is considered a bacterial/particulate retentive air-eliminating filter and is recommended. Lipid filters are 1.2 μm.

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A nurse is attaching a microaggregate filter to a client's IV infusion set. The nurse is most likely using the microaggregate filter for which purpose? a. Administration of protein solutions b. Removal of bacteria from the solution c. Filtering of air from the set d. Administration of whole blood and packed cells that have been stored more than 5 days

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d. Administration of whole blood and packed cells that have been stored more than 5 days Microaggregate filters are designed to remove 20- to 40-μm particles, which filters out the microaggregates that develop in stored blood. Microaggregates consist primarily of degenerated platelets, leukocytes, and strands of fibrin.

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A nurse is preparing to administer 5% dextrose and .045% sodium chloride at 100 mL/hr to a client using a volumetric pump. Which essential item should the nurse use when operating a volumetric pump? a. A 170-μm filter b. A 0.22-μm filter c. Microdrip tubing d. Special cassette (cartridge) tubing

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d. Special cassette (cartridge) tubing Volumetric pumps have a cartridge that pumps the solution that needs to be delivered, thus allowing blood and red blood cells to be administered without receiving damage.

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A nurse is caring for a client who is receiving an IV infusion via an electronic infusion device when the client's infusion alarm sounds. The nurse responds to the alarm knowing that the alarm is most likely sounding because of increased: a. system pressure. b. needle pressure. c. occlusion pressure. d. resistance pressure.

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c. occlusion pressure. A standard alarm type for infusion pumps and controllers is the occlusion pressure alarm. With an occlusion alarm, pumps and controllers are able to indicate upstream or downstream occlusions by the absence of flow.

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A nurse is preparing to administer blood to a client using a standard blood administration set. The nurse knows that the standard blood administration set has a clot filter of: a. 170 μm. b. 40 μm. c. 20 μm. d. 0.22 μm.

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a. 170 μm. Blood filters have a pore size of 170 μm and are designed to remove debris that accumulates in stored blood. It is necessary to completely fill the filter chamber to use all the surface area of the filter. One filter is used per unit of blood.

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A critical-care nurse is using an IV filter that can withstand 50 mm Hg of pressure. How much pressure per square inch (psi) can this filter withstand? a. 1 psi b. 3 psi c. 5 psi d. 6 psi

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a. 1 psi Pressure exerted by the unit is expressed in pressure per square inch (psi) or millimeters of mercury (mm Hg). One psi is equivalent to 50 mm Hg. The psi should not exceed the pressure that a filter can withstand.

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