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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.