Morgan LaRose
Group: 204 E
September 11, 2022
IV DISCUSSION QUESTIONS
Directions: Please complete the discussion questions on this sheet before the IV Lab and
bring the completed form to the IV Lab. Incomplete forms will be evaluated as
Inadequate clinical preparation.
1. Describe the comprehensive role of the nurse in administration of IV
Fluids/Medications.
Nurses have an important role in the preparation and administration of IV solutions such
as 0.9% sodium chloride (normal saline, [NS]), 0.45% sodium chloride (½NS), 5%
dextrose in water (D5W), and Lactated Ringer’s solution (LR) and IV compatible
medications. The nursing functions and responsibilities during IV administration
include the following:
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Assess patient for manifestations of fluid and electrolyte imbalances.
Determine if ordered IV therapies are appropriate.
Choose and insert appropriate IV catheters and infusion devices.
Give IV fluids and medications.
Monitor for adverse reactions to IV fluids or medications.
Assess for manifestations of fluid overload or hypovolemia and initiate appropriate
changes in IV fluids.
Evaluate if IV therapies are addressing patient’s fluid and electrolyte needs.
Collaborate with the pharmacist to:
• Determine appropriateness of IV therapies and need for dose adjustments.
• Prepare IV infusions and medications.
• Screen for potential problems, such as compatibility issues.
• Monitor response to therapy.
2. Describe common reasons for administration of intravenous fluids and intravenous
medications.
Patients are often unable to maintain normal fluid balance because of disease,
surgery, or trauma. As a result, it is common to replace needed fluids directly into the
bloodstream through IV administration. IV fluids are considered medications and are
given with the same caution and rights used for medication administration. There are
several advantages to using the IV route. It provides immediate access for fluid and
electrolyte maintenance or replacement; medications given intravenously have a much
faster onset and more predictable effect. The IV route provides access for supplemental
or total nutrition replacement and allows transfusion of blood and blood products to
increase oxygen-carrying capacity and reestablish normal oncotic pressure.
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3. Differentiate between a continuous infusion and an intermittent infusion. State
reasons for each type of infusion.
 Continuous Infusion: (0.9% saline solution, Insulin drip) flow continuously until the
container of solution is changed or the order for the infusion is stopped. Continuous
IV infusion replaces fluid loss, maintains fluid balance, and serves as a vehicle for IV
drugs.
 Intermittent Infusion: (IV piggyback [IVPB]) contain a larger volume of diluent
and are administered over a longer period (e.g., 30 minutes, 1 hour, 3 hours). This
type of infusion is used when continuous IV infusion is to be discontinued but the
patient still requires IV access.
4. There are different types of Venous/Vascular Access Devices (VAD). Differentiate
between the following types:
Peripheral catheter:
 Peripheral sites are used when IV therapy will be short term or intermittent or to
maintain vascular access with the use of an intermittent infusion device.
 IV catheters come in several types and sizes.
 IV catheters are sized by the diameter of the needles (gauge)
 The smaller the diameter, the larger is the gauge.
 The nurse selects the smallest size needed for IV therapy.
 The three basic types of peripheral access catheters are: Over-the needle catheter
(ONC) or Angiocath, Winged infusion needle (butterfly needle), and Midline
catheters
Midline catheter:
 Used for longer-term IV therapy
 inserted by specially trained nurses through a peripheral vein using ultrasound
guidance.
 Catheter is 3 to 8 inches long
 Inserted in the antecubital area, with the tip resting in the cephalic or basilic vein,
right below the axilla.
 Considered inside-the-needle catheters, the catheter remains inside the needle or
introducer during insertion.
 After the catheter is threaded through the vein, the needle is removed.
 Midlines are used when IV therapy is expected for less than 2 weeks.
 Midlines last longer and have lower rates of phlebitis than short peripheral catheters
 Have higher rates of non–life-threatening complications compared to PICC lines
 careful consideration should be made based on individual patient needs
Peripherally inserted central catheter (PICCs):
 Very common in patients requiring long-term IV therapy
 Inserted in a vein in the arm and has lower rates of complications compared to other
types of CVCs.
 inserted by a specially trained nurse
 can be left in indefinitely as long as there are no complications.
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inserted in the cephalic or basilic vein or antecubital space and threaded up until it
rests in the superior vena cava outside the right atrium.
Strict sterile technique is used during insertion and maintenance care of PICC lines to
prevent central-line associated bloodstream infection (CLABSI).
The PICC device often has multiple lumens and can simultaneously infuse
incompatible medications, fluid, blood, or total parenteral nutrition (TPN).
Require regular assessment, flushing, and sterile dressing changes per facility policy.
Ideal devices for patients who require long-term antibiotics, or other medications,
especially patients who have a history of failed or difficult IV access with short
peripheral catheters.
Nurse must advocate to the provider if he or she thinks the patient might benefit from
a PICC line.
Nontunneled central venous catheter
 Used in patients who require short-term but extensive IV therapy (e.g., multiple IV
medications), TPN, or recurring blood transfusions.
 The CVC is inserted by the physician, usually at the bedside, using the subclavian
vein. (Avoid using the jugular and femoral veins because of the higher incidence of
catheter-related infections)
 often have double or triple lumens, allowing for simultaneous administration of
incompatible medications, fluids, and TPN.
 They are designed for short-term therapy (days to weeks)
 associated with a high risk for complications, including catheter-related infections,
pneumothorax, and pulmonary embolism.
Tunneled Central Venous Catheter:
 Used for lifelong or long-term IV therapy such as TPN, chemotherapy, and dialysis
use.
 Inserted into the subclavian or jugular vein and then pulled through (i.e., tunneled) the
subcutaneous tissue in the chest wall before exiting the skin.
 initially sutured into place
 have a cuff that the subcutaneous tissue eventually adheres to, holding the catheter in
proper position.
Implanted Port:
 AKA Medi Port
 surgically placed in the chest wall and can be used for long-term IV therapy that is
continuous or intermittent (e.g., chemotherapy, hemophilia, sickle cell disease)
 A tunneled CVC is attached to a port or access device that has been implanted into
the subcutaneous tissue in the chest wall, leaving no visible signs of the device.
 To access the site for IV infusions, the nurse inserts an angled or Huber needle
through the skin and into the port.
 After the infusion is complete, the needle is removed, leaving a closed system.
 Implanted ports have the lowest incidence of catheter-related infections.
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An implanted port should be accessed at least monthly to ensure patency with either
a heparin or saline flush.
5. What is the purpose of using “Y-type Tubing” for administration of blood
products?
Most blood product administration tubing is of a “Y type” with a macroaggregate filter
(170 to 260 microns; filters out particulate). One arm of the Y is for the isotonic saline solution
and the other arm of the Y for the blood product. This tubing permits the infusion of 0.9%
sodium chloride before and after each blood component and for the dilution of RBC that are too
viscous to be transfused at the appropriate rate.
6. Describe Total Parenteral Nutrition (TPN) and include indications for the use of
TPN.
 Total parenteral nutrition (TPN) is a hypertonic IV solution designed to meet a patient's
total nutritional needs.
 contains amino acids, glucose, lipids, vitamins, minerals, electrolytes, and trace
elements.
 TPN provides the calories, protein building blocks, and fluid needed to promote wound
healing and meet metabolic requirements
 used when the patient is unable to meet nutritional and metabolic demands through oral
intake or when disease (e.g., pancreatitis, ulcerative colitis, bowel obstruction) or surgery
requires complete bowel rest.
 Indications for TPN include:
 debilitating illnesses lasting longer than 2 weeks
 loss of more than 10% of pre-illness weight
 serum albumin levels less than 3.5 g/dL
 nitrogen loss due to extensive burns or draining wounds.
7. What is the formula for calculating an IV flow rate in mL/h?
8. What is the formula for calculating an IV flow rate in mL/h when the infusion time
is less than 60 minutes?
9. What is the formula for calculating an IV flow rate in gtt/min?
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10. Complete the table below by describing isotonic, hypotonic and hypertonic
solutions.
IV Solutions and Osmolarity
Crystalloid:
Isotonic Solution
Hypotonic Solution
Hypertonic Solution
Osmolarity
Physiologic
effect
Indications
SAME approximate
osmolality as ECF or
plasma.
Exerts LESS osmotic
pressure than ECF, which
allows water to move into
the cell
Exerts GREATER
osmotic pressure than
ECF, resulting in
higher solute
concentration than the
serum
"Osmotic
equilibrium" water
does not enter or
leave the cell;
therefore, there is no
effect on red blood
cells (RBCs).
 Isotonic solutions
are primarily used
for hydration and
to expand ECF
volume, because
the fluid remains
in the
intravascular
space.
 LR provides
electrolytes and is
used for
rehydration in all
types of
dehydration and
FVD.
Results in an increased
solute concentration in the
intravascular space,
causing fluid to move into
the intracellular and
interstitial spaces
Pulls water from the
interstitial space to
the ECF via osmosis
and causes cell
shrinkage
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Replaces cellular fluid
by treating intracellular
dehydration (diabetic
ketoacidosis,
hyperosmolar
hyperglycemic state)
Provides free water to
allow excretion of body
wastes
Dextrose provides
some calories
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Increases serum
osmolality
Corrects severe
hyponatremia
Decreases ICP in
patients with
cerebral edema
Dextrose provides
some calories
Higher
concentrations of
dextrose (>10%)
must be given
through a central
venous access
device; may be
added to amino
acid solutions as
total parenteral
nutrition.
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Examples of
IV Solution
LR (lactated ringers)
0.9% NaCl (normal
saline//NS)
5% Dextrose in water
(D5W)
0.45% NaCl (1/2 NS)
0.33% NaCl (1/3 NS)
0.225% NaCl (1/4 NS)
3% NaCl
5% NaCl
5% Dextrose in
0.45% NaCl
5% Dextrose and
0.9% NaCl
5% Dextrose in LR
10% Dextrose in
Water (D10W)
11. Complete the table below by describing complications of IV therapy.
Complication
Catheter related
infection (local or
systemic): Local infection
that occurs at insertion
site, if not recognized, can
become systemic
(septicemia) and possibly
life-threatening; usually
caused by poor aseptic
technique during inserting
or dressing or tubing
changes; can occur when
peripheral site has been in
use for longer than 4 days.
Assessment Findings
Local symptoms:
Pain at site, tenderness, erythema
(redness), swelling, increased
temperature, purulent drainage
Systemic symptoms:
Fever, chills, tachycardia,
hypotension, complaints of
headache, backache
Prevention:
 Use aseptic technique during
insertion and site care.
 Rotate sites per agency protocol
or when clinically indicated.
 Assess site frequently for signs of
infection.
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Tenderness, redness,
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swelling at site
Pain, burning, heat along
the vein, especially during 
infusion
Palpable venous cord
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Phlebitis: Inflammation
of the vein caused by poor
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insertion and care
technique, frequent
manipulation of IV
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catheter, size and length of
the catheter, use of
Scale to grade severity:
0: No symptoms
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Nursing Action
 DISCONTINUE peripheral IV,
and restart in another location.
 Place used catheter in sterile
container and send to laboratory
for culture and sensitivity testing.
 Notify PCP of findings.
 Replace old IV tubing and
solution with new.
 Do not discontinue a CVC
without a physician's order.
rev. 8/28/19
DISCONTINUE catheter
IMMEDIATELY (if infection
suspected)
send catheter tip for culture and
sensitivity testing.
Clean insertion site with
disinfectant.
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irritating medications or
fluids, and infection
Infiltration: Infusion of
IV solution and/or
nonvesicant medications
into surrounding tissues,
caused by puncturing of
the blood vessel through
improper insertion or
frequent manipulation of
IV catheter
1: Redness at site with or without
pain
2: Pain with erythema
3: All the above plus red streak
along vein and palpable venous
cord
4: All the above plus purulent
drainage
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Swelling, tenderness,
coolness, and firmness of
extremity; blanching of skin.
Scale to grade severity:
0: No symptoms
1: Skin blanched, edema <1 inch,
cool to touch, may have pain
2: All the above plus edema of 1
to 6 inches
3: All the above plus extremity
translucent, edema >6 inches,
mild to moderate pain, possible
numbness
4: All the above plus tight,
leaking skin, deep pitting edema,
circulatory impairment, moderate
to severe pain (typically
considered extravasation)
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Apply warm moist compresses
for 20 min three or four times per
day.
When inserting new IV catheter,
use opposite extremity if
possible.
Prevention:
 use smallest gauge possible (22
or 24 gauge)
 stabilize catheter securely to
minimize movement
 rotate sites according to agency
policy or when clinically
indicated.
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DISCONTINUE infusion and
remove catheter.
Apply pressure at site to stop
bleeding.
Apply warm compresses to
increase circulation for isotonic
or hypotonic fluids.
Apply cold for infiltration of
hyperosmolar fluids.
Outline the area of visible
damage with a marker to assess
changes.
If leaking of tissues occurs, cover
area with sterile dressing until
leaking subsides.
Report grade 3 or 4 infiltrations
to PCP.
Use opposite extremity when
inserting new IV catheter.
Prevention:
 Assess for signs of infiltration at
least q2h
Extravasation:
Inadvertent infusion of
vesicant (causing blisters,
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Similar to infiltration
Burning and discomfort
Blistering is a late sign
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DISCONTINUE INFUSION
IMMEDIATELY
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ulceration, sloughing) or
irritating solution or
medication into
surrounding tissues. This
can lead to permanent
tissue damage and/or
nerve damage.
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Notify PCP and obtain orders for
extravasation treatment and/or
antidote.
Use a skin marker to outline area
of visible damage to assess
changes.
Cautious use of cold or warm
compresses and elevate the
extremity.
Never apply pressure to the area.
Use opposite extremity when
inserting new IV.
Prevention:
 Know which medications are
considered vesicants, including
dopamine, norepinephrine, high
concentrations of electrolytes,
and several antibiotics.
 Vesicant and irritating solutions
or medications should be infused
slowly and through a larger vein
or CVC.
Fluid Overload and
pulmonary edema:
Occurs when the volume
infused is greater than the
cardiovascular system can
tolerate; can lead to heart
failure, shock, and cardiac
arrest
Early signs: Restlessness,
gradual increase in heart rate,
headache, dyspnea,
nonproductive cough
Late signs: Hypertension, severe
dyspnea, gurgling respirations,
productive cough of frothy
sputum, crackles in lung bases,
increased jugular vein distention
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provide bed rest in high Fowler
position
slow infusion rate to keep vein
open
notify PCP immediately
provide oxygen as needed
administer diuretics and pain
medications as ordered.
Prevention:
 slower infusions for patients with
underlying heart or renal disease
 Monitor for early signs and
symptoms of fluid excess.
 Use an electronic infusion device
for patients at risk, such as those
with cardiac disease history or
the elderly.
 Measure daily weights, intake,
and output.
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Speed Shock:
Systemic reaction when
medication is
administered too quickly
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Sudden onset of dizziness
facial flushing
headache
irregular heart rate during
medication administration
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Frequently assess IV infusion and
ensure it is not infusing too
rapidly.
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STOP INFUSION
IMMEDIATELY maintain IV
access with IV solution that does
not contain medication
notify PCP immediately
and monitor vital signs.
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Prevention:
 Follow recommended infusion
rate for medication.
 Monitor gravity-flow sets closely
during medication administration.
 Use electronic infusion devices
whenever possible for medication
administration.
Air Embolism:
Accidental entry of air
into bloodstream due to
improper preparation of
IV tubing or loose
connections
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Chest pain
shoulder or low back pain
dyspnea
cyanosis
hypotension
tachycardia
syncope
decreased level of
consciousness
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place patient in Trendelenburg
position on left side.
Locate the source of air and close
off.
Notify PCP immediately.
Administer oxygen as needed.
Have emergency resuscitation
equipment available.
12. Describe techniques that are used to prevent air embolism during IV tubing set
changes.
Ensure that catheter and tubing are clamped closed when changing tubing.
Use Luer-Lok connections on all tubing.
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Prime all tubing with IV solution before attaching to catheter.
Follow agency protocol when removing a CVC.
If IV bag has run dry, inspect tubing closely for air.
13. Order: Vancomycin 0.5 g IVPB q.6h. Pt has a continuous IV infusion of D5NS with
40 mEq of potassium chloride running at 125 mL/h
Supply: Vancomycin 500 mg vial (powder)
You will need to use a nursing drug guide to answer the following questions. Use
either the Davis’s Drug Guide for Nurses (available online using the CCRI Library in
the Nursing Reference Center, the Gahart’s Intravenous Medications book (a
recommended resource for N 1020) or a nursing drug reference book of your own.
a. What solution and amount (of solution) will you use to reconstitute this
medication?
b. Will the D5NS & the potassium chloride be compatible with Vancomycin at
the Y-site?
c. In order to prepare this medication for infusion as a piggyback (secondary
infusion), what IV solution and what amount (size of IV secondary/mini bag)
will you utilize?
d. What is the suggested rate for this intermittent infusion
14. Review the IV Bolus (Push) Drugs section on pp. 315-320 in Clinical Nursing
Calculations 2nd ed.
Practice IV Push Problem
Order: Ativan 2 mg IV push
Supply: Ativan 4 mg/mL
Ativan guidelines indicate the IV infusion should not exceed 2 mg/min.
a. Calculate the amount (in mL) of Ativan you should prepare in order to
administer the ordered dose
b. Use ratio proportion to calculate the time required to administer the drug
dosage ordered
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c. Calculate the amount (in mL) you should administer every 15 seconds.
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