Pharmacology IV Therapy #3

Question

The charge nurse teaches the novice nurse to flush a peripheral intermittent intravenous (IV) every 4 to 8 hours, per on facility protocol. Which is the correct reason for this nursing action?

Answers

  1. To prevent extravasation
    • Rationale:

      This is not the correct answer because extravasation only occurs when a vesicant is infusing and leaks out into the tissue. This IV is an intermittent IV for use as needed. A peripheral IV should be flushed according to the facility protocol, generally with 3-5 mL of normal saline or saline hep lock solution. This is done to maintain a patent IV.

  2. To assess catheter patency
    • Rationale:

      This is the correct answer because an intermittent IV is flushed to assess and maintain a patent IV. A peripheral intermittent IV should be flushed according to the facility protocol, generally with 3-5 mL of normal saline or saline hep lock solution.

  3. To increase hydration status
    • Rationale:

      This is not the correct answer because a peripheral intermittent IV should be flushed according to the facility protocol, generally with 3-5 mL of normal saline or saline hep lock solution. This is not enough fluid to increase or maintain hydration status.

  4. To increase the lumen of the catheter
    • Rationale:

      This is not the correct answer because flushing peripheral intermittent IVs are performed to assess and maintain a patent IV. The catheter of the IV should not have enough flexibility that it would increase lumen size with appropriate flushing.

Overview

Assessment and maintenance of intravenous (IV) therapy is an important responsibility of the nurse. Follow the facility’s protocol when caring for clients with IV access.

Explanation

Learning Outcomes

Standard nursing care of an intermittent IV is to flush it, per protocol, to assess and maintain a patent IV. For an intermittent peripheral IV, the facility protocol generally involves flushing with 3-5 mL of normal saline or saline hep lock solution. For central lines, the amount is 10-12 mL. An IV is useless if it is not patent or open. Having IV access in the hospital setting is imperative since IV therapy includes giving life-saving therapy, such as fluid resuscitation, nutrition, antibiotics, and emergency treatment.

Test Taking Tip

Know the difference between what is standard nursing care and when you follow the facility protocol. For example, if a client has a blood infusion reaction, the standard nursing care is to stop the infusion. The details of what follows may be laid out in a facility’s policies and procedures, such as how to notify the blood bank and filling out incident reports

Video Rationale