What is the mission of the INS? What 4 ways do they complete their mission?
Infusion Nurses Society: Develops standards in infusion nursing
- Provides opportunities and quality education
- EVB research
- Certify = CRNI
Select the gauge size for each:
1. pediatric and geriatric
2. Caths for most adults
3. For large volume, rapid infusion
1. pediatric and geriatric: 22-24
2. Caths for most adults: 20-22
3. For large volume, rapid infusion: 18-20
List equipment needed for starting an IV
IV start kit
Over the needle start Kit
IV extension tubing (pig tail)
Needleless connector
Securement device
Antimicrobial disc
Flush
Towel
Label and pen
According to OSHA, what must you always do when starting or DCing IV sites, changing tubing or needleless connectors?
Wear gloves
List OSHA guidelines for Facilities regarding sharps
Hep B vaccine available
Training and education regarding safe practice
Have an infection control plan
Facilities need procedures to eliminate or minimize employee exposure (Quality Improvement)
T or F: some practices will require you to apply a topical antimicrobial ointment to insertion site of a peripheral IV
False: it is an old practicev
Fill in: According to CDC, unless contraindicated by agency policy, you will want to replace IV tubing every __a__ hours for a continuous infusion, but every __b__ hours for intermittent ones.
You will also want to change IV solution bags every __c__ hours.
a. 96 hours
b. 24 hours
c. 24 hours
With a Phlebitis Scale Score +1, list s/s and tx
s/s:
- erythema
- w/ or w/out pain
- no palpable cord or streak formation
tx:
- D/C IV and restart
- apply heat
- assess site q4h
- document
With a Phlebitis Score 2+, list s/s and tx:
s/s:
- pain
- edema possible
- no streak or palpable vein
tx:
- D/C, and restart
- notify MD
- apply heat
- Analegesia PRN
- assess and document
With phlebitis score 3+, list s/s and tx
s/s:
- Erythema with pain
- Edema possible
- Streak formation
tx:
- DC ASAP, save the tip for culture
- Notify MD and order for culture
- Restart IV
- apply heat and treat pain
- Assess site q2h
Define Infiltration and s/s
Infiltration: non-vesicant solution into surrounding tissue
s/s:
- swelling
- possible pitting edema
- pallor and coolness
- pain
- reduced flow rate
List risks for infiltration complication
Very young or elderly fragile skins
Lowered LOC
Poorly secured device
Traumatic venipuncture
High infusion rate
Cath too big
Pts with neuro deficits (dm or pvd)
List skin signs of score 1 and 2 with an infiltration
Score 1: skin blanched, edema <1"
- skin cool to touch
- possible pain
Score 2: skin blanched, edema 1-6"
- skin cool to touch
- possible pain
List skin signs of severe infiltration with a score of 3 and 4
Score 3: skin blanched, edema >6"
- cool to touch
- mild to moderate pain and possible numbness
Score 4: skin blanched, tight and leaking, edema >6"
- Pitting edema (+3-4)
- circulatory impairement
- Moderate to severe pain
How do you treat all scores for infiltration
Stop IV and remove
Restart
Elevate extremity
Apply warm or cold compress for comfort
Report and notify MD
Assess q4h x 24 hours
List tx for Severe Infiltrations
Tx for pain
Encouragement of affected extremity
Assess q2h x 24 hours
Notify MD of severity, size, and pain
Note for changes after D/C of site (non-healing or skin breakdown)
Define Extravasation and its s/s
Extravasation: Vesicant solution into surrounding tissue
s/s:
- pain, burning, tenderness
- discoloration
- necrosis
- blisters, edema, blanching, leaking
- Palpable cord
- temp
List examples of Vesicant agents
Chemo
Hyperosmolar agents including: calcium chloride or cluconate 10%
- x-ray contrast media
- Parenteral nutrition
Vascular regulators: dopamine or vasopressin
Acid and alkaline agents:
- phenytoin, vanco, diazepam, erythromycin
List tx of extravasation
Stop infusion and leave cannula in place
- aspirate remaining fluid
- Remove cannula afterwards
Cold compress for contrast media or hyperosmolar fluids
Notify MD immediately
Photograph area per policy
elevation of extremity (to promote reabsorption of vesicant)
What do you want to document IV sites and infusions?
How often do you want to assess site?
IV insertion site, size and type of cath, dressing used and solution infusing
Shift IV fluid totals, including IVPB
Assess site q4h
Document qshift or more
What will you tell pt. prior to IV access?
Explain purpose
"Stinging sensation"
Can admin topical or ID anesthetic
Encourage pt to relax and stabilize arm
How pt can protect site
List most appropriate IV site locations for each
1. Most adults
2. Infants
3. Elderly
1. Adults: cephalic, basilic, and median cubital of forearm
2. Infants: veins in scalp and feet
3. Elderly: upper forearm better than hands
T or F: you should avoid using BP cuffs as a tourniquet when starting an IV on them
False: it will be gentler than a regular tourniquet in preventing rupture of fragile veins
List places to avoid when inserting a PIV
Avoid bony prominence areas
Use most distal portion of vein first
Avoid joints
Avoid on arm with dominant hand if possible or dominant hand itself
Watch for compromised extremity in any way
List ways to assess and pick the best PIV insertion site
Look at both arms, and typicalily basilic vein very accessible
Use warm pack on extremity if needed
With needle-phobia, can give mild sedative with order request
List how you will setup your equipment during venipuncture
Get extension tubing with needleless connector and unclamp it
Attach flush and prime connector and extension
Prep and position tape or securement device
How will you prep the extremity for a PIV before puncture?
How will you apply a tourniquet?
Place extremity in dependent position
Clean with Chloraprep and let dry
Place tourniquet 10-12 cm above insertion site
- enough pressure so veins become engorged
- can stroke vein and gently tap to encourage engorgement
- no razor, but clip hair
Fill in: you will hold the ONC or butterfly at __a__ to __b__ degree angle with bevel side __c__ (up/down)
To stretch out the vein, you will use your thumb approximately __d__ inches below insertion site
a. 15
b. 30
c. up
d. 2-3"
How will you label and document once a PIV insertion is made?
Label dressing: date, time RN initial
Document:
- IV start site
- cath size and gauge
- site appearance
- # of attempts
- pt. response
- flush type
Match:
1. This kind of needle is used for small, tortuous (twist and turns) or fragile veins
2. This kind of needle is used for clearly visible, and non-fragile palpable veins
a. straight needle
b. butterfly needle
1. Butterfly needle
2. straight needle
How will you assess site after lab draw and document it?
Assess: inspect puncture site and confirm bleeding has ceased
Document:
- date, time, and test specimens obtained
- dispensation of specimens to lab
- appearance of venipuncture site post draw
- pt. resposne
What must you do after doing a blood draw from a central line?
After following with a 10 ml NS flush, you change the needless connector
T or F: when drawing blood cultures, and there are two ordered draws you need to take, you must draw each one from a different site.
