IV Therapy and Safety Notes 172 EXAM#2

Safety - Extravasation

• Extravasation is similar to infiltration but involves a vesicant. Vesicants include calcium chloride, calcium gluconate, dextrose, contrast, and vancomycin.
• Extravasation can lead to prolonged healing, potential infection, necrosis, debridement surgeries, disfiguration, and amputation.
• If extravasation occurs:
  • Stop the infusion.
  • Leave the IV in place until checking with pharmacy for a possible antidote.
  • Remove the IV.
  • Consult the doctor or pharmacist for treatment.

Safety - Venous Spasm

• Venous spasm is a sudden involuntary contraction of a vein, temporarily impeding blood flow.
• Causes include infusing cold fluid or infusing too rapidly; symptom is sharp pain above the IV site.
• Prevention:
  • Remove IV fluids from the fridge and allow them to warm to room temperature before infusion.
  • Ensure the infusion rate is accurate.
• Treatment:
  • Apply a warm compress to the site.
  • Slow or stop the infusion until the spasm subsides.

Safety - Venous Air Embolism

• Venous air embolism is lethal but preventable.
• Could occur during placement or removal of a Central Venous Access Device (CVAD), catheter fracture, disconnection, failure to prime the line, or allowing the line to run dry.
• Signs and symptoms (S/S) include lightheadedness, pulmonary symptoms, cardiac symptoms, seizures, anxiety, and altered speech.
• Treatment (TX):
  • Place the patient on their left side in Trendelenburg position.
  • Initiate rapid response.
  • Administer 100% oxygen.
  • Monitor vital signs.

Safety - Speed Shock

• Speed shock results from infusing fluids too rapidly.
• S/S: dizziness, face/neck flushing, severe pounding headache, chest tightness, hypotension, tachycardia.
• TX:
  • STOP the infusion.
  • Call a code.
  • Begin CPR if needed.

Central Line Bundle

• Key components:
  • Hand hygiene prior to catheter insertion.
  • Maximal sterile barrier precautions.
  • Chloraprep for skin antisepsis.
  • Avoid the femoral site, if possible.
  • Daily review of necessity of the central line.

Phlebitis

• Phlebitis is the inflammation of the lining of the vein.
  • Mechanical causes: Needle stabilization issues, using a needle that is too large.
  • Chemical causes: Dextrose, failure to allow antiseptic to dry.
  • Bacterial causes: Not maintaining aseptic technique.
• Graded on a scale from 0-4.
• Treatment:
  • Remove the IV.
  • Apply a warm compress.
  • Elevate the limb.
  • Administer oral analgesics.
  • Address the underlying etiology.

Sepsis (CVC and Peripheral)

• S/S: fever, chills, nausea, hypotension, tachycardia, tachypnea, decreased urine output (UO), elevated white blood cell count (WBC).
• TX:
  • Prompt recognition.
  • Blood cultures.
  • Culture the catheter tip.
  • Remove the existing IV and start a new one.
  • Administer antibiotics and IV fluids.
  • Administer oxygen (O2).
  • May require transfer to the ICU.

Precautions - Airborne

• For diseases such as TB, varicella, and measles.
• Requirements:
  • Single room.
  • Negative pressure room.
  • Healthcare workers must wear an N-95 or HEPA respirator.

Precautions - Droplet

• For diseases such as mumps, rubella, influenza, adenovirus, rhinovirus, and pertussis.
• Requirements:
  • Private room.
  • Wear eye protection and a mask.
  • Patient wears a mask if they leave their room.

Precautions - Contact

• For conditions such as VRE, C. diff, noroviruses, and RSV.
• Requirements:
  • Gloves and gown at a minimum.
  • Don personal protective equipment (PPE) before entering the room and remove it right before exiting the room.

WHO Guidelines

• World Health Organization (WHO) recommendations:
  • No rings with stones.
  • No artificial nails.
  • Wear gloves when contact with blood or body fluids is possible, or when in contact with non-intact skin.
  • Handwashing is essential.
  • Keep nails short ( \frac{1}{4} inch or less).
  • Do not blow on or fan skin to speed up drying after handwashing.
  • Chlorhexidine (Chloraprep) is the preferred antiseptic.

CVC Dressing Changes

• Dressing can stay in place for up to 7 days if there is no gauze over the insertion site.
• If there is gauze over the insertion site, the dressing should be changed every 48 hours.
• Sterile procedure.
• Flush with saline or low-dose heparin.
• Use of a Biopatch is recommended.

PICC Lines

• Peripherally Inserted Central Catheter (PICC) lines are the most common type of central line.
• Associated with a risk of venous thrombosis.
• Can be placed at the bedside by a trained RN.
• Licensed Practical Nurses (LPNs) can change dressings on patients of any age.
• LPNs can only flush PICC lines on patients 18 years and older.
• Any age patient can have a PICC line, and it can remain in place for up to and over 1 year.

Administration Sets

• Primary IV tubing should be changed every 96 hours or when contaminated.
• Secondary (IVPB)/intermittent tubing should be changed every 24 hours.
• Blood tubing should be changed every 4 hours.
• Stopcocks have a high rate of infection and their use should be minimized.
• Use stabilization devices to secure IVs.
• LPNs are not permitted to change needleless connectors.