IV Therapy Module B.

1 “Fundamentals of IV Therapy” Script

Slide One

Intro slide only. There is no audio for this slide.

Slide Two

In this Unit, we will be discussing the Fundamentals of IV Therapy. This will

include a detailed look at anatomical positions for site selection. The needed
equipment, how to prepare the site, inserting the IV, maintaining the IV, and
discontinuing the IV will also be covered. This unit directly relates to your lab practice
and skill of obtaining a patent IV.

Slide Three

There are many factors in deciding which patient will require an IV, and this topic
will be discussed in a later unit, for now, just focus on the skills of completing a
successful stick. Selecting the appropriate site is a critical step in providing safe and
effective IV therapy. The IV technician must know the underlying anatomy of the
extremities, and if necessary, be able to locate landmarks for a central IV line. If an
improper site is selected, it could mean a failed attempt at an IV, induce complications
that could limit the effectiveness of the intervention, or cause the IV site to be lost. Take
notes, or have your homework sheets close by as we discuss skills to access proper site
selection.

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 IV Therapy Module B.1 “Fundamentals of IV Therapy” Script

Slide Four

How to select an IV site depends not only on vascular anatomy, but what you
want the IV to accomplish. If a patient requires a large volume of fluid, multiple IV’s, or a
site that medications may be administered through, generally the Anti-cubital region
should be assessed first. This area offers larger veins which should be easier to locate
than in the forearm or hand.
If administering in the leg, assess areas with less muscle tissue, the Popliteal
Fossa will closely resemble the anti-cubital region. Veins in the foot will also generally be
larger than that of the hand. If a patient requires less fluid, or a site that only limited
medications will be used through, assess the distal portion of the extremities. This will
include the forearms, and hands, or the feet, depending on which extremity needs to be
utilized.

Slide Five

No two patients will be the same anatomically. As an IV technician, you must be

able to access many different patient types and obtain a successful IV. The number of
successful IV’s you will start will be vastly greater if you improve two skills, visualizing
and palpating. Both of these skills must be utilized and practiced constantly to develop.
Veins should have a blue appearance; this will be easiest to spot on the back of the
hand, or inside of the wrist. This is because the blood in the veins is deoxygenated.
When palpating, a vein should feel spongy. Many practitioners say that palpating
a vein will feel like gently poking a marshmallow. You will have a chance during lab
practice to learn this feel. You should never feel a pulse in a vein, and always keep in
mind the use of the IV. If the IV is being used to push medications, dextrose 50% for
example, selecting an appropriate size vein is just as important as choosing the proper
gauge needle and catheter.

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 IV Therapy Module B.1 “Fundamentals of IV Therapy” Script

Slide Six

Sites to avoid include:

 Dysfunction or impairment: If at all possible the IV should not be placed in an
impaired arm because you do not know the vascular status of the limb…
 Mastectomy: The surgical removal of the breast and lymph nodes may change
the circulatory status of the limb in the same area. Fluid may collect in the
surrounding tissues and cause a painful, swollen extremity.
 Dialysis shunt: Never place an IV in the vicinity of a shunt or in the shunt itself.
Doing so may damage the shunt or surrounding tissue. Risks include blood clots
or damage from infection.
 Skin abnormalities: Increase the chance of bacterial infection
 Trauma: Only place IVs proximal to a traumatic injury site.
 Torturous veins: Veins that are very angled and/or constantly changing
directions. Although the IV catheter is flexible it is not that flexible.
 Previously used or injured veins: “Previous” should indicate to you an
unsuccessful attempt at cannulation. “Injured” veins may be damaged and allow
IV fluid to escape from the vessel resulting in localized swelling and pain. Working
distal to proximal allows IV fluid not to have to pass through an area that is
potentially damaged

Slide Seven

The external jugular site is only to be used by appropriately trained providers. As

an IV technician, never attempt an IV on a site you are not permitted by protocol to
stick. The external jugular is the most common central line established, and is used by
paramedics, nurses, and doctors, when the extremities are not permissible to stick.

Slide Eight

Veins in the scalp can also be stuck, but are generally limited to use in pediatric
patients. These veins are commonly much more difficult to locate, and are extremely
fragile. Make sure you have proper training or direction before attempting to stick veins
in the scalp.

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 IV Therapy Module B.1 “Fundamentals of IV Therapy” Script

Slide Nine

The major IV sites in the arms are the digital vein, metacarpal veins, and
accessory cephalic veins. Each of these sites has advantages and disadvantages, be sure
you are familiar with these as they will be discussed in your lab sessions.

Slide Ten

As you saw in Module A.2, the anatomy of the arm is very vascular, but the major
veins include the Cephalic, median, Basilic, and Antecubital veins. These veins are the
largest veins found in the arm and are easily palpated in most patients. During your skills
labs, attempt to locate each of these veins and stick them throughout the course. Find
at least three possible stick sites and always start distally and work your way back up the
patient's arm. Once you stick at the AC, if you miss the stick, you cannot go lower in the
arm to obtain a patent IV line.

Slide Eleven

Now we will review the IV equipment. It is important to always have ALL of your
equipment gathered before attempting to stick. Some equipment will only be used for
special sticks, such as blood tubing, or pressure bags. The basic materials needed for
each stick are gloves, the IV solution, drip set, IV start kit including tourniquet, IV
catheter, 4x4s and tape.

Slide Twelve

Most types of fluid will be held in a plastic casing, or bag, and packaged in a
plastic tear away bag. A glass bottle or casing is used for specialized fluids, most often
mixed with medications such as insulin or nitroglycerin. These solutions must use vented
tubing or administer through the IV. Each solution will also have a different amount of
time it can be used before being replaced; see your protocols or guidelines for each fluid
before administering.
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Slide Thirteen

IV Administration sets vary in size based on drip factor, most are 10, 15, 30, and
60ggts. Regardless of which drip set is being used, they should be changed every 72
hours.

Slide Fourteen

We have two categories for administration sets, Macro and Micro. Macro sets are
larger and will allow more fluid to flow through the tubing and IV to the patient. The
largest is a 10 drop set. This drop set is used for rapid fluid volume for medical or
trauma patients. Micro drips are more commonly used in pediatric patients and when
administering medications, as it makes the amount of fluid being delivered easier to
control. The standard micro drip is a 60 drop set. The gtts abbreviation meaning drops
from the Latin "guttae”

Slide Fifteen

Drop factor allows you to calculate the precise fluid volumes by counting drops.
The drop factor is how many drops it takes to make 1ml of fluid.

Slide Sixteen

The administration set is comprised of the spike, drip chamber, roller clamp, and
tubing. There can also be more than one administration set used. The secondary set will
be shorter and used to ‘piggyback’ directly to the first set. You will practice spiking bags
of IV fluid during lab.

Slide Seventeen

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 IV Therapy Module B.1 “Fundamentals of IV Therapy” Script

There can be several optional add-ons to the administration set for specific
desired effects:
 Side clamps: used for quick shut off of flow
 Re-sealable Y injection ports: when placed at the bottom they are used for IV
push drugs. When placed at the top they are used for piggybacking meds and
contain a back-check valve
 Manual flow control devices: assist with gravity infusion, more constant than
adjusting a roller clamp
 Metered volume chamber sets: designed to limit the amount of fluid available to
the patient. Frequently used in pediatrics.
 Filters: used for certain IV solutions, Filters range from .2 microns to 5 microns.
Large filters retain glass or drug residue while the .2 micron filter reactions fungi
and bacteria. .2 micron filters should be used for NON-LIPID solutions that need
filtration. All filters are air eliminating. Lipid solutions and other medications that
adhere to PVC CANNOT be filtered.

Slide Eighteen

Some specialized administration sets are created with special factors designed for
specific medications or fluids. For example, nitro sets are specially coated to prevent the
medication from adhering to the tubing. And fat emulsion sets do not contain DHEP.

Slide Nineteen

We have reviewed the use of different gauge IV catheters before, so this should
be review. The IV gauge size will go from largest to smallest based on number, the lower
digit the number, the larger the diameter of the needle, the higher the digit, the smaller
the diameter. Each of these has certain circumstances they should be evaluated for use.
If a patient has experience trauma or a large loss of blood, a larger gauge needle should
be considered for a more rapid fluid resuscitation. Or perhaps you want to use a smaller
gauge when you are dealing with a pediatric or elderly patient with more fragile veins
that are difficult to stick.

Slide Twenty

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 IV Therapy Module B.1 “Fundamentals of IV Therapy” Script

The catheter length also plays an important role in establishing a patent IV.
Typically, the longer the catheter, the greater the resistance to the movement of IV fluid
through it, resulting in slower IV infusion into the patient. A longer catheter will also
mean a longer needle which may interfere with sticking the patient, and increasing the
chance of kinking the IV catheter, or hitting a valve.

Slide Twenty-One

You will also be exposed to several catheter types. A few that you will use as an
IV technician are the winged, also called butterfly, the over the needle, and midline or
central catheters. Each of these has a specific use, and will be discussed later in the
course or during skills labs. The winged infusion sets are commonly used for blood
draws or lab results, the over needle catheter is used for standard IV’s and midline
catheters are used for central lines which can stay in place for weeks at a time.

Slide Twenty-Two

IV tubing is also a crucial piece of equipment that must be selected specific to the
use of the IV. At times, after establishing the IV, you may have to add extension tubing
to the original tubing. If the patient has to be moved or further procedures performed,
extension tubing allows the IV fluid or medications to continue to be administered and
allow space for other actions to happen simultaneously. It also allows the tubing to be
changed for macro or micro use.
Buretrol sets allow for more precise fluid administration, generally if medications are
being given over time. Blood tubing is special tubing used when administering blood or
blood products. This tubing is filtered and has a separate spike to be used with IV fluid.

Slide Twenty-Three

IV site prep involves several steps. Each step must maintain aseptic technique to
decrease the chance of infection. Make sure you have your IV start kit prepared, and
your tape ready before IV attempt is made. First, visualize the site. Apply a tourniquet
above the selected site, preferably 5-6 inches. Palpate the vein. Cleanse the site with
70% isopropyl alcohol. Select the appropriate catheter based on patient need.

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 IV Therapy Module B.1 “Fundamentals of IV Therapy” Script

Slide Twenty-Four

Apply traction. Position needle at a 15° to 30° angle and insert. Once flash is
observed, drop needle to 15° or less. Advance catheter into vein. Release the
tourniquet. Remove the needle. Secure the IV site.

Slide Twenty-Five

Once an IV site has been established, it will be the responsibility of the medical
professional who is responsible for the continued care of that patient, to observe the
site. Dressing securing an IV site should be replaced at least every 48 hours. Site should
be observed for an infiltration, redness, swelling, leaking or bleeding.

Slide Twenty-Six

Continued care of the IV site is necessary and flushing saline or heparin locks is
crucial to keeping a patent line. It should be flushed with at least 10cc of fluid every 8
hours. If it becomes difficult to flush the IV site, make sure the IV line is not kinked by
the patient’s position. If the IV site will still not flush, the catheter could be occluded by
a blood clot. This IV site is no longer viable and should be discontinued. Whenever
medications are being administered through an IV, the IV should first be flushed with
saline.

Slide Twenty-Seven

To discontinue the IV, first identify the reason you are discontinuing. Gather all
appropriate supplies; and, wash your hands before and after the procedure. You will
first clamp the tubing. Open gauze. Remove tape/dressings. Hold gauze over site.
Withdraw cannula straight back in a continuous motion. Apply pressure for at least
three minutes. Inspect cannula to ensure it is intact and not damaged. Recheck site for
bleeding that must be controlled and document. Have your checklist handy during lab
practice to make sure you are following

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Slide Twenty-Eight

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Slide Twenty-Nine

Credits slide only. There is no audio on this slide.