The nurse is assessing the client with an IV line. The nurse notes tha

The nurse is assessing the client with an IV line. The nurse notes that the IV insertion site is red, edematous, and painful. The nurse’s first action should be to:

1. Immediately discontinue the IV line and remove the cannula
2. Put cool compresses on the IV site to decrease the edema
3. Notify the health care provider of the situation
4. Put warm compresses on the IV site to decrease the pain

ANSWER

ANS: 3
The nurse should notify the health care provider to determine if the health care provider would like to culture the IV cannula. (Confirm before removal of IV line.) Wrapping the extremity in a warm, moist towel for 20 minutes promotes venous return, increases circulation, and reduces pain and edema. Heat therapy can be repeated three to four times during the day.