Editing Reduction of Risk Potential – LPN Flashcards (section)

== Intravenous Site and Transfusion Safety ==

;Signs of intravenous infiltration
:Swelling, coolness, pallor at the site, and a slowed infusion rate. Stop the infusion, remove the catheter, and elevate the extremity.

;Signs of phlebitis
:Redness, warmth, tenderness, and a firm cord-like vein. Discontinue the site and report. Do not massage the area.

;First action when a transfusion reaction is suspected
:Stop the transfusion immediately, keep the vein open with normal saline using new tubing, then take vital signs and notify the registered nurse, provider, and blood bank.

;Findings that suggest a serious transfusion reaction
:Fever, chills, low back or flank pain, hives and itching, shortness of breath, wheezing, hypotension, dark or red urine, and a sense of impending doom.

;How long the nurse stays with the client at the start of a transfusion
:The first 15 minutes, because most severe reactions begin early. The rate is started slowly, and normal saline is the only compatible solution.