IV IV Therapy in Special Populations 2 — Questions and Answers
Question 1: Which IV access device is most commonly recommended for pediatric oncology patients requiring long-term IV therapy?
- Peripheral short catheter
- Midline catheter
- Implanted port (Port-a-Cath) (Correct answer)
- Scalp vein needle
Correct answer: Implanted port (Port-a-Cath)
Implanted ports are preferred for pediatric oncology patients requiring long-term, repeated IV access because they minimize infection risk and preserve vein integrity between treatment cycles.
Question 2: Why is it important to monitor blood glucose levels closely in neonates receiving total parenteral nutrition (TPN) via IV?
- Neonates have elevated glycogen stores that cause hyperglycemia
- Neonates have limited glycogen stores and immature glucose regulation, making both hypo- and hyperglycemia risks (Correct answer)
- Glucose monitoring is only relevant in diabetic patients
- IV dextrose concentrations are too low to affect neonatal glucose
Correct answer: Neonates have limited glycogen stores and immature glucose regulation, making both hypo- and hyperglycemia risks
Neonates have immature hepatic glucose regulation and limited glycogen reserves, making them vulnerable to both hypoglycemia and hyperglycemia during TPN infusion.
Question 3: When caring for an immunocompromised oncology patient with a central venous catheter, which intervention is most critical?
- Changing the catheter every 72 hours
- Strict adherence to ANTT for every access and dressing change (Correct answer)
- Routine prophylactic antibiotic flushes per physician preference
- Limiting site assessment to once daily
Correct answer: Strict adherence to ANTT for every access and dressing change
Immunocompromised patients have no immune reserve to combat CRBSI; strict ANTT for every catheter access and dressing change is the most critical protective measure.
Question 4: An elderly patient with difficult venous access has a midline catheter inserted. Which medication class is contraindicated for midline administration?
- Normal saline flushes
- Isotonic antibiotics
- Continuous vesicant infusions or parenteral nutrition (Correct answer)
- Pre-operative isotonic fluids
Correct answer: Continuous vesicant infusions or parenteral nutrition
Midline catheters terminate in the basilic or cephalic vein, not a central vein, so continuous vesicants, TPN, and hyperosmolar solutions are contraindicated due to phlebitis risk.
Question 5: Which consideration is most important when selecting an IV insertion site in a patient undergoing hemodialysis?
- Use the arm with the arteriovenous (AV) fistula for easiest access
- Avoid the arm with an AV fistula or graft to prevent thrombosis and preserve access (Correct answer)
- The dominant arm is always preferred for IV placement
- Central lines are never appropriate for dialysis patients
Correct answer: Avoid the arm with an AV fistula or graft to prevent thrombosis and preserve access
The arm with an AV fistula or graft must never be used for IV insertion, venipuncture, or blood pressure measurement to protect the patient's dialysis access.
Question 6: When calculating IV fluid requirements using the Holliday-Segar method for a 25 kg pediatric patient, what is the correct daily fluid maintenance rate?
- 1000 mL/day
- 1500 mL/day
- 1600 mL/day (Correct answer)
- 2500 mL/day
Correct answer: 1600 mL/day
Holliday-Segar: 100 mL/kg for first 10 kg (1000 mL) + 50 mL/kg for next 10 kg (500 mL) + 20 mL/kg for remaining 5 kg (100 mL) = 1600 mL/day for a 25 kg child.
IV IV Therapy in Special Populations 2
Which IV access device is most commonly recommended for pediatric oncology patients requiring long-term IV therapy?