IV THERAPY COMPLICATIONS

What is the primary purpose of IV therapy?

To correct and prevent fluid and electrolyte disturbances; provide direct vascular access for medications; and allow blood draws without repeated needle sticks.

What percentage of patients receive some form of IV therapy?

90–95% (the instructor suggests it may be nearly 100% in practice).

What must exist before an IV can be placed?

A physician or licensed practitioner order.

What is another term for the IV catheter?

Cannula.

What does IV cannulation mean?

A procedure in which a cannula (catheter) is placed inside a vein to provide venous access.

How often must an IV site be assessed?

Every one to two hours without fail.

What are the five types of vascular access devices?

Peripheral IV catheter; PICC line; non-tunneled central venous catheter; tunneled central venous catheter; and implanted port.

Where is a peripheral IV most commonly placed?

In the arms and hands.

How long can a peripheral IV remain in place?

72 hours (three days); sometimes up to 96 hours.

What does PICC stand for?

Peripherally Inserted Central Catheter.

Where is a PICC inserted?

In the upper arm just above the antecubital fossa; threaded into a larger central vein.

How long can a PICC remain in place?

Six weeks to eight months.

What does "double lumen" mean on a PICC?

Two separate tubes exit one insertion site allowing two medications to infuse simultaneously at different points without mixing.

What is a common clinical reason for a PICC line?

Long-term antibiotic therapy.

Where can a PICC be inserted?

At the bedside or in interventional radiology.

What is a non-tunneled percutaneous central venous catheter?

A catheter inserted directly through the skin into the subclavian; internal jugular; or femoral vein and threaded near the heart.

What lumen options do non-tunneled central catheters come in?

Double; triple; or quadruple lumen.

Why must every lumen of a multi-lumen catheter be monitored closely?

To prevent blood clots from forming in unused lumens which can cause serious complications.

How does a tunneled central venous catheter differ from a non-tunneled one?

It is tunneled under the skin from a lower chest entry point to the vein and is intended for longer-term use than a PICC.

What is an implanted port?

A small device implanted subcutaneously in the chest accessed through the skin; used for long-term intermittent therapy.

Where does the catheter tip of an implanted port sit?

In the lower segment of the superior vena cava near the heart.

What patient population commonly benefits from an implanted port?

Patients who need frequent IV access such as those with sickle cell disease.

What does short-term IV therapy include?

Peripheral catheters used to restore fluids; administer blood or blood products; and give medications — typically 72–96 hours.

What devices are considered long-term IV therapy?

PICC lines; central venous catheters; and implanted ports.

What is the nurse's responsibility each shift for any central line lumen?

Flushing every lumen to ensure patency and checking for signs of problems.

What gauge catheter is used for large-volume rapid fluid replacement?

14 gauge.

What gauge is used for rapid whole-blood transfusion?

16 gauge.

What gauge is used for infusion of whole blood or blood components in most ER settings?

18 gauge.

What gauge catheter is most commonly used for routine adult IV access?

20 gauge — it accommodates the widest variety of uses.

What gauge is standard for pediatric patients?

22 gauge; 24 gauge for the smallest pediatric patients.

What gauge may be necessary for elderly patients with fragile veins?

22 or 24 gauge.

What color hub identifies a 20-gauge catheter?

Pink.

What color hub identifies an 18-gauge catheter?

Green.

Why are IV catheters color-coded?

So nurses; radiology staff; EMTs; and paramedics can quickly identify the gauge without confusion.

Why is a large gauge not always ideal for pediatric patients?

It delivers fluid faster than small patients can tolerate; a smaller gauge slows the rate appropriately.

What is an IV drip (gravity flow)?

The most common type — IV solution flows by gravity from the bag into the patient without a pump.

How does the height of the IV bag affect gravity flow?

The higher the bag; the greater the gravitational force and the faster the infusion rate.

What is an IV push?

Manually injecting a medication directly into the IV line via syringe at a specified controlled rate.

Why does the rate of an IV push matter?

Some drugs must be given over 2–5 minutes; pushing too fast can damage veins or cause serious patient harm.

What is an infusion pump?

An electronic device that regulates the amount and speed of IV fluid or medication delivery.

Why should nurses learn the specific pump model at their facility?

Pump interfaces vary between hospitals; staff must be competent on the equipment where they work.

What is primary IV tubing?

The main tubing used to spike (connect to) an IV bag; available in pump-compatible and gravity-flow versions.

What is secondary (piggyback) tubing?

A smaller bag — often containing a medication like an antibiotic — attached to the primary tubing; usually hung higher so it infuses first.

What is extension tubing?

Additional tubing attached to the end of primary tubing to allow more reach to the patient; should not be excessively long.

What makes blood transfusion tubing unique?

It contains a special filter; must be changed with every unit of blood and no later than every four hours.

How should a drip chamber be filled?

Approximately half full so drops can be visualized as they fall.

What is a roller clamp used for?

To stop or control the flow of IV fluid through the tubing.

What is an injection port?

A port on IV tubing used to administer secondary medications or IV push drugs; accessed with a needleless luer-lock syringe.

What does discoloration or cloudiness inside IV tubing mean?

The tubing is contaminated and must be discarded immediately.

How often should primary continuous-infusion tubing be changed?

Every 96 hours (4 days).

How often should intermittent/secondary medication tubing be changed?

Every 96 hours; or sooner if a different incompatible medication requires separate tubing.

How often must TPN tubing be changed?

Every 24 hours because fats and emulsifiers clog the micron filter quickly.

How often must blood transfusion tubing be changed?

Every four hours; or with every new unit of blood — whichever comes first.

What information must be written on IV tubing?

The date; nurse's initials; and time it was first started.

What is a micron filter used for on TPN tubing?

To remove tiny particles (fats; emulsifiers) from the solution; must be changed every 24 hours before clogging.

What is the general purpose of IV filters?

To remove air bubbles and particulate matter; always used with blood products.

In what sizes do IV solution bags come?

50 mL to 1;000 mL (common sizes: 50; 100; 250; 500; 1;000 mL).

Name three common IV solutions mentioned in the lecture.

Normal saline (NS); Lactated Ringer's (LR); and Dextrose 5% in Water (D5W).

Why are glass IV bottles sometimes used?

Some medications are incompatible with plastic and must be stored and infused in glass containers.

Are IV solution bags sterile regardless of how much fluid remains?

Yes — the solution is sterile no matter the remaining volume.

What does "NS with 20 mEq KCl" mean on an IV bag?

Normal saline with 20 milliequivalents of potassium chloride added; the nurse must verify the additive matches the physician's order.

Where are antibiotics most commonly found in IV bags?

In smaller 50–250 mL bags.

What is the preferred location for routine peripheral IV insertion?

The forearm — large straight veins; minimal movement; less sensitive; lower risk of dislodgement.

Why is the antecubital fossa not the first choice for IV placement?

It is positional (arm bending dislodges the catheter); uncomfortable for patients; and the catheter tends to loosen with movement.

What are the disadvantages of placing an IV at the wrist?

Many nerves; tendons; and ligaments make it painful; it is also highly positional.

What are the disadvantages of an IV in the hand?

Higher infection risk due to constant hand use; more painful; and prone to being bumped and dislodged.

What two vein features make a site unsuitable for IV insertion?

Bifurcations (branch points) and venous valves (which block catheter advancement).

What does a healthy vein feel like on palpation?

Spongy and bounces back when pressed.

What is lymphedema and why is it a contraindication for IV on that arm?

Swelling from impaired lymph drainage (often after breast surgery); placing an IV on that side worsens the condition and increases infection risk.

Why is a fractured limb a contraindication for IV placement in that limb?

It is painful for the patient and not good clinical practice to use a compromised limb.

What is an AV fistula and why can't you use that arm for IV access?

A surgically created artery-to-vein connection for dialysis; using it for IV or blood pressure can damage the fistula and cause serious harm.

What extra care is needed for patients on blood thinners regarding IV insertion and removal?

Always ask about anticoagulant use; anticipate prolonged bleeding; and hold pressure longer after removal.

Why should you ask about mastectomy or breast surgery before choosing an IV site?

To avoid the affected arm and reduce the risk of lymphedema.

What should a nurse compare on both arms when assessing for infiltration?

Size — asymmetry where one arm looks larger than the other indicates a problem.

What are the key elements to assess and document at every IV site?

"Location; type of IV; fluid and rate; saline-lock status; swelling; skin temperature; dryness or leaking; pain; skin color; streaking; dressing integrity; and whether it flushes."

What does "saline locked" mean?

No fluid is actively infusing; the IV is capped and maintained with a flush to keep it patent.

What does coolness around an IV site indicate?

Infiltration — IV fluid leaking into subcutaneous tissue (fluid is cooler than body temperature).

What does warmth around an IV site indicate?

Infection or phlebitis at the insertion site.

What does redness with streaking radiating from an IV site indicate?

Phlebitis or early infection — red lines traveling up or down the vein from the insertion site.

What is Tegaderm?

A transparent adhesive film dressing placed over the IV site that secures the catheter while allowing direct visual inspection without removal.

What should you do if a Tegaderm dressing is peeling?

Change it immediately to maintain site stability and infection control.

What is the nursing student's IV scope of practice in Nursing 1?

Monitor only — assess the site; verify correct fluid and rate; report problems to the primary nurse. Do not flush; adjust; or manipulate the IV.

What should a nursing student do if a pump alarm sounds?

Assess the patient and immediately notify the primary nurse; do not independently silence or adjust it.

What is infiltration?

Unintended administration of IV fluid into the surrounding subcutaneous tissue instead of the vein.

Name three causes of infiltration.

Catheter puncturing through the vein during insertion; catheter dislodgement from patient movement; and poorly secured infusion device.

List five signs and symptoms of infiltration.

"Coolness of skin at the site; pallor or blanching; edema above or below the insertion site; absent blood return; pain (may be delayed); arm size asymmetry; slowed infusion rate."

What does an occluded pump alarm potentially signal about an IV site?

The pump senses resistance because the catheter may no longer be in the vein — a possible sign of infiltration.

What nursing interventions are taken for infiltration?

"Stop the infusion; remove the IV; elevate the extremity; apply warm or cold compress for 20 minutes 3–4 times per day; and start a new IV in a different vein."

What is extravasation?

Infiltration of a vesicant (tissue-damaging) medication into subcutaneous tissue; can cause blistering and tissue necrosis.

What is a vesicant?

An agent that causes blistering and destruction of tissue when it leaks outside the vein.

Name four vesicant medications mentioned in the lecture.

"Chemotherapy agents; vasopressors; vancomycin; and concentrated potassium chloride."

What is the key symptom that distinguishes extravasation from simple infiltration?

A burning sensation at the site.

What should the nurse do immediately if a patient reports burning at an IV site?

Stop the infusion immediately and assess the site.

What does extravasated tissue look like?

Blanching; blistering; and eventually tissue necrosis — the chemical destroys tissue from the inside out.

What is one strategy to reduce burning from a vesicant IV medication?

Slow the infusion rate dramatically (e.g.; to 25 mL/hr) to reduce vein irritation.

What is phlebitis?

Inflammation or irritation of the vein wall.

Name three mechanical causes of phlebitis.

"Catheter too large for the vein; poorly secured catheter causing movement; and placement at an area of flexion with a rapid infusion rate."

Name one chemical cause of phlebitis.

Irritating IV solutions or medications (e.g.; certain antibiotics or Demerol).

Name one bacterial cause of phlebitis.

Poor aseptic technique or poor hand hygiene during insertion or care.

List four signs and symptoms of phlebitis.

"Redness and tenderness at the site; increased warmth; red streak along the vein; and a palpable cord along the vein."