Intravenous Therapy

INTRAVENOUS THERAPY

By: Jahzeel B. AcabEnzo Miguel Bandoquillo

Definition:

- is the infusion of a fluid into a vein to treat and prevent electrolyte imbalance or to deliver medication through a needle or catheter (cannula) into the blood stream.

- The fastest way to deliver medications

Why infuse IV Solutions?

Correct volume deficiencies of blood components. Provide nutrition while resting the gastrointestinal

tract. Administer safe and effective infusions of

medications using the appropriate vascular access.

Restore acid-base balance. Monitor central venous pressure (CVP). Maintain or replace body stores of water,

electrolytes, vitamins, proteins, fats, and calories in the patient who cannot maintain an adequate intake by mouth

Physiologic Principles

Body fluids are distributed in two distinct compartments, the intracellular and extracellular compartment.

Tissue cells are surrounded by a semipermeable membrane.

Osmotic pressure

Types of Fluids

Isotonic – Same osmotic pressure of plasma

Ex. 0.9 NSS, D5W and Lr Hypotonic – Less osmotic pressure

than plasmaEx. ½ NS and 0.33 NaCl Hypertonic – Exerts higher osmotic

pressure than that of plasma.Ex. D5LR, 3% NaCl, D5NSS

Common Types of Infusions

D5W - Used to replace water (hypotonic

fluid) loss, supply some caloric intake, or administer as carrying solution for numerous medications

Normal Saline- Used to replace saline (isotonic fluid)

losses, administer with blood components or treat patients in hemodynamic shock

Lactated Ringers - Used to replace isotonic fluid losses,

replenish specific electrolyte losses, and moderate metabolic acidosis.

Phillip’s 15-step Method of Starting a Peripheral Line

Phase StepPrecannulation(Preparation)

1. Check physician’s order.2. Wash your hands for 15 to 20

seconds.3. Prepare the equipment4. Asses the patient5. Select the site and dilate the

vein

Cannulation(Venipuncture)

1. Select the needle (catheter)2. Put on gloves.3. Prepare the site.4. Enter the vein using the

direct or indirect method5. Stabilize the catheter with

tape and apply a dressing.

Postcannulation (clean-up) 1. Label the site, tubing and bag.

2. Properly dispose of used equipment

3. Educate the patient.4. Calculate the drip rate, if

applicable.5. Document the procedure

Types of IV Administration

IV Push

Equipment:

syringe of appropriate size (either a needleless system or one with a 20G or 22G 1” needle)

alcohol or povidone-iodine pads Gloves Prescribed Drug

Preparation: If drug isn’t compatible with the patient’s IV

solution, also get two 3-ml syringes with 20G or 22G 1” needles and fill them with normal saline solution

Check your facility’s policy to see if you need another 3-ml syringe with heparin flush solution

Verify the order on the patient’s chart Make sure the drug is compatible with the IV

solution Check the expiration date, and reconstitute or

dilute the drug as needed Identify the patient by checking his/her armband Wash your hands and put on gloves

Procedure: Close the flow-control clamp on the existing IV

line Clean the Y-Port closet to the venipuncture site

with an alcohol pad or a povidone-iodine pad Insert needle of the syringe or the needleless

system into the Y-Port, and inject the drug at the prescribed rate

Remove the syringe of the Y-Port, open the flow-control clamp, and set the primary flow rate as prescribed

Discard used items according to standard precautions

Patient Teaching: Tell the patient the name of the bolus

drug, why you’re giving it, and any adverse effects he may experience or should report

Advise him to report pain, redness, swelling, or other problems with the insertion site

Continuous Infusion

Equipment: pump drug administration set with the device 3 ml syringe with a needleless system

or a 25G 5/8” needle flushing solution alcohol pads patency solution (if indicated) gloves

Preparation: Verify the order on the patient’s

chart Identify the patient by checking

his/her armband

Procedure: Make sure the clamp on the

administration set is closed and the line has no air bubbles in it

Patient Teaching: Tell the patient the name of the drug, why

you’re giving it and about adverse effects he may experience or should report

Advise him to report pain, redness, swelling, or other problems with the insertion site

If the patient will receive infusions at home, make sure he or a caregiver can administer them safely and correctly. Also make sure you teach how to care for the IV site and identify certain complications

Intermittent Infusions

Equipment: volume control set prescribed fluid syringe (needleless or with an

appropriate needle) filled with the prescribed drug

alcohol pad or antiseptic specified by your facility

gloves

Preparation: Verify the order on the patient’s

chart Identify the patient by checking his

armband Wash your hands and put on gloves Remove the volume-control set from

its packaging

Procedure: Prime the set with IV fluid Clean the injection port on top of the chamber,

and inject the drug into the chamber Gently rotate the chamber to mix the drug Place the label on the chamber that identifies

the drug, dose, time, and date Fasten the tubing to the injection port of the

primary line Either stop the primary infusion or set a low drip

rate so the line will be open when the secondary infusion stops

Open the lower clamp of the volume-control set, and start the infusion at the desired rate

When the chamber is empty, allow about 10 ml of IV solution to flow into it and through the tubing to flush the system, unless contraindicated

Discard the used items according to standard precautions

Patient Teaching Tell the patient the name of the drug

why you’re giving it, and any adverse effects he may experience or should report

Advise him to report pain, redness, swelling, or other problems with the insertion site

Piggy BackEquipment: prescribed drug (usually premixed in a minibag) continuous secondary tubing or piggy back extension

tubing extension hook 20G or smaller 1” needle or needleless system medication label (if you aren’t using a premixed

solution) alcohol pads 1” adhesive tape gloves

Preparation: If the drug is incompatible with the

primary IV solution, also get two 3-ml syringes with 22G 1” needles; fill them with normal saline solution

Check your facility’s policy to see if you need another 3-ml syringe with heparin flush solution

You may also need infusion pump or a time tape

Verify the order on the patient’s chart Identify the patient by checking his

armband wash your hands

Procedure: If you need to add a drug to a secondary IV

solution, remove any seal from the secondary container. Most solution bags have a sealed outlet and unsealed injection ports, whereas most bottled solutions have a seal covering their dual-outlet port

Clean the injection port with an alcohol pad Inject the prescribed drug into the solution

and gently agitate the container to thoroughly mix the solution

Patient Teaching: Tell the patient the name of the drug,

why you’re giving it, and any adverse effects he may experience or should report

Tell him to report pain, redness, swelling, or other problems with the insertion site

COMPLICATIONS

Infiltration

occurs when IV fluids enters the subcutaneous space & around the venipuncture site

Cause: Dislodgement of the IV cannula from

the vein results in infusion of fluid into the surrounding tissues

Preventions: Ensure that IV and distal tubing are secured

sufficiently with tape to prevent movement Splint arm or hand as necessary Check IV site frequently for complications Proper venipuncture technique

Interventions: Stop infusion immediately and remove IV

needle or catheter Restart IV in the other arm If infiltration is moderate to severe, apply

warm, moist compresses and elevate limb Document interventions and assessment

Thrombophlebitis/Phlebitis inflammation of vein often

accompanied by clot formationCauses: Injury to vein during venipuncture,

large-bore needle/catheter use Irritation to vein due to rapid

infusions or irritating solutions Slow infusion rate due to clot

formation at the end of the needle/ catheter

Preventions: Anchor needle or catheter securely at

insertion site Change insertion site at least every 72

hours or according to hospital policy Use large vein for irritating fluid because

of higher blood flow, which rapidly dilutes irritant

Sufficient dilute irritating agents before infusion

Interventions: Apply cold compress immediately to

relieve pain and inflammation Discontinue IVF and remove

catheter/needle immediately Follow the moist, warm compresses

to stimulate circulation and promote absorption.

Document interventions and assessment

Bacteremia/Septicemia

contamination of IV site and solution which results to fever, chills and general malaise.

Causes: Incorrect insertion of catheter Contaminated equipment or infused

solution The critically ill or immunosupressed

patient is at greatest risk of bacteremia

Prevention: Practice good handwashing Use strict asepsis when inserting IV or

changing IV dressing Observe IV site routinely Provide routine care along with proper

dressing Maintain integrity of infusion systemIntervention: Discontinue IV line and restart it in

another vein as ordered Notify physician

Circulatory Overload

a condition which results when a client receives IV fluid faster than the body can distribute and excrete.

Causes Delivery of excessive amount of IV

fluids

Preventions: Always monitor intake and output

when patient has an IV line Know patient cardiovascular history Splint arm or hand if IV flow rate

fluctuates too widely with movementInterventions: Decrease IV to KVO rate- 10gtts/min Raise patient’s head to facilitate

breathing Keep patient warm to promote

peripheral circulation

Air Embolism an abnormal circulatory condition in

which air gas travels through the bloodstream and becomes lodged in a blood vessel.

Causes: Air enters the catheter during tubing

changes Air in tubing delivered by IV push or

infused by infusion pump

Prevention: Clear all air from tubing before infusion Change solution containers before they

run dry Ensure that all connections are securedIntervention: Immediately, turn patient on his/her left

side and lower head of the bed Notify the physician immediately Administer oxygen PRN Stay with the patient Document interventions and assessment

Hemorrhage/Bleeding

Causes: Loose connection of tubing or

connection port Inadvertent or accidental removal or

peripheral or central catheter Anticoagulant therapy

Preventions: Tape all catheters securely- use

transparent dressing when possible for peripheral or central catheters. Tape the remaining catheter lumens in a loop so tension is not directly on the catheter.

Keep pressure on site at least 10 minutes after removal of catheter for anticoagulated patients.

Interventions: Pressure dressing may be applied over

the site to control the bleeding Notify the physician.

Venous Thrombosis

Causes: Infusion of irritating solutions Infection along catheter may

preclude this syndrome Fibrin sheath formation with eventual

clot formation around catheter. This clot will eventually occlude vein.

Preventions: Ensure proper dilution of irritating

substances Ensure superior vena cava catheter tip

placement for irritating solutionsInterventions: Stop fluid immediately and notify health care

provider Reassure patient and institute appropriate

therapy: Anticoagulants Heat Elevation of affected extremity Antibiotics

IV Computations

Delivery System Microset – 60gtts/ml Macroset – 15gtts/ml Bloodset – 10gtts/ml

Formulas

Rate of Infusion/Flow Rate – drops of fluid to administer per minute (gtts/min)

FR= (ml of solution prescribed per hour) x (drops delivered per ml) 60min/hr

Example: An order has been written for a patient to receive 500ml

of 5% dextrose in water (D5W) over a period of 5 hours in a standard Microdrip system. Find the rate of infusion.

Hourly Volume

ml/hour = total volume total time ORHV = Flow Rate x (60min/hr) Drop FactorExamples: 

A patient is to receive 1000ml of 5% dextrose in D5LR over a period of 5 hrs. How many ml will the patient receive in an hour?

Length of Time of InfusionL = total volume HVExamples:

A patient is to remove 720ml of 5% dextrose in LR at 15gtts/min. How long will the IVF be consumed?

At 7am, #2 D5LR is at 960ml running at 20gtts/min. How long will the IVF be consumed and at what time will it be consumed?