Chapter 7: IV

 Continuous infusion - a large volume infusion of solution or medications administered

over 2 to 24 hours. Ordered in Milliliters.
 Intermittent infusion - IV medications, such as antibiotics, need to be infused over a
short period of time
o Piggyback and primary intermittent
 Piggyback medications can be infused using EID, Mechanical controller, or roller clamp
 To maintain patency of a cannula, flush the cannula after each use or at least every 12
hours if not in use.
 Flush the cannula with sodium chloride for peripheral intermittent devices and
Heparin for flushing central venous access devices
 An IV push is injected slowly, between 1 and 10 minutes via a syringe into an IV site
 When using gravity to administer a solution into a vein, position the solution 3 feet
above the infusion
 Three types of IV solutions:
o Isotonic, Hypotonic, Hypertonic
 Normal Saline is an isotonic solution
 Sodium Chloride solutions (crystalloids):
o Used: fluid replacement, treatment of shock, hyponatremia, metabolic alkalosis
o Disadvantages: Circulatory overload, acidosis, and hypernatremia
 Dextrose solutions (crystalloids):
o Used: provide carbohydrates
o Disadvantages: Vein irritation and thrombosis
 Isotonic solutions:
o Used: Dehydration, fluid loss, and hyponatremia
o Disadvantage: possible fluid overload
 Hypotonic solutions: Dextrose 2.5% water and 0.33%/0.45% Sodium Chloride
 Hypotonic solutions can worsen hypotension, cause cardiac collapse, and increase
intracranial pressure.
 Hypotonic solutions have a lower osmolality (less concentration)
 Hypertonic solutions:
o Used: Expanding plasma volume, replacing electrolytes, hypovolemia, heat
exhaustion.
o Disadvantages: possible circulatory overload
 Hypertonic solutions: 5% dextrose in 0.9% sodium chloride, calcium chloride 10%, 5%
dextrose in lactated ringer’s
 Hypertonic solutions have a higher osmolality (more salt or less water)
 Assess IV site every 4 hours
 Systemic complications of IV’s:
o Circulatory overload, septicemia, venous air embolism, and speed shock
 A patient receiving IV lipid emulsions, should be checked for an allergy to eggs
Hematoma:
Signs and symptoms:
 Ecchymosis
 Swelling
 Inability to flush cannula
 Resistance during flushing
Treatment:
 Remove cannula
 Apply pressure
 Elevate extremity
Thrombosis:
Signs and symptoms:
 Slowed/stopped infusion
 Fever
 Inability to flush cannula
Treatment:
 Discontinue cannula
 Assess for circulatory overload
 Possible impairment
Phlebitis:
Signs and symptoms:
 Redness or warmth at site
 Local swelling
 Pain
 Sluggish infusion rate
Treatment:
 Discontinue cannula
 Apply cold compress then warm
Infiltration/extravasation:
Signs and symptoms:
 Coolness of skin at site
 Taut skin
 Edema in extremity
 Sluggish infusion
Treatment:
 Elevate extremity
 Have antidote available
Local Infection:
Signs and symptoms:
 Redness
 Swelling at site
 Possible exudate
 Elevated WBC and T lymph
Treatment:
 Discontinue cannula
 Apply sterile dressing
Venous Spasm:
Signs and symptoms:
 Sharp pain at site
 Sluggish infusion
Treatment:
 Apply warm compress
 Restart infusion at new site
Septicemia:
Signs and symptoms:
 Fever and chills
 Profuse sweating
 Nausea
 Backache
 Hypotension
 Tachycardia and tachypnea
Treatment:
 Obtain culture
 Monitor patient closely
 Restart new IV system
Circulatory overload:
Signs and symptoms:
 Rapid weight gain
 Puffy eyes
 Edema
 Shortness of breath
 Distended neck veins
Treatment:
 Call for help
 Place patient in high fowlers
 Administer oxygen
Venous Air Embolism:
Signs and symptoms:
 Light headedness
 Dyspnea
 Cyanosis
 Tachypnea
 Chest pain
 Mental status change
Treatment:
 Call for help
 Place patient in Trendelenburg left side
 Administer oxygen
Speed Shock:
Signs and symptoms:
 Dizziness
 Facial and neck flushing
 Tightness in chest
 Hypotension
 Irregular pulse
Treatment:
 Call for help
 Stop infusion
 Give antidote