Intravenous (I.V.

) therapy
is the insertion of needle
or catheter/cannula into the
vein, based on the physician’s
written prescription. The
needle or catheter/cannula is
attached to sterile tubing and a
fluid container to provide
medication and fluids.
Indication of I.V. Therapy

• 1. To maintain hydration and/or correct

dehydration in patients unable to tolerate
sufficient volumes of oral fluids and
medication.
• Parenteral Nutrition
• Administration of drugs, i.e. Chemotherapy
• Transfusion of blood or blood components.
Contraindication of Peripheral IV Therapy
Administration of irritant fluids or drugs through peripheral
access(i.e. highly concentrated, high osmolarity solutions
like… Nacl. Hypertonic Kcl, etc.

Key Points prior to initiation of I.V. therapy

Physician’s prescribed treatment.The initiation of
intravenous therapy is upon the written prescription of a
licensed physician which is checked for the following:
-- Type and amount of solution
-- The flow rate
-- The type,dose and frequency of medications to be
incorporated/pushed.
-- Others affecting the procedures (x-rays,treatments to
the other extrmities,etc)
• 10 GOLDEN RULES FOR DRUGS SAFELY.
– Administer the right drug
– Administer the right drug to right person
– Administer the right dose
– Administer the right drug by the right route
– Administer the right drug at the right time
– Document each drug you administer
– Teach your patient about the drugs he is receiving
– Take a complete patient drug history. (There is a risk of
adverse drug reactions when a number of drugs are taken
or when patient is taking alcoholic drinks)
– Find out if the patient has any drug allergies.
– Be aware of potential drug- drug – or drug-food
interactions.
SELECTION OF VENIPUNCTURE SITE
The patient’s condition and age, the size
and vein condition, type and duration of
therapy and functional utilization of the
hand shall be assessed to ensure ideal
and safe IV access.
SELECTION OF PERIPHERAL IV SITE

• Veins in the hand, forearm, antecubital fossa,

scalp and feet
• Assess the veins of both arms closely before
selecting a site
• Start IV infusion distally
• Determine the clients dominant side
• Bending the elbow on the arm with IV may
obstruct the flow causing thrombophlebitis and
infiltration
• Use an armboard/splint as needed in the area of
flexion
INFECTION CONTROL
Infection at the venipuncture site is usually
caused by a break in aseptic technique
during the procedure. The following
measures reduce patient’s risk:

– Wash hands before starting an IV or before

handling any of the IV equipment.
– Use an approved antiseptic( as per hospital’s
protocol) to clean the patient’s skin.
– Cut/clip the hairs of the venipuncture site if
necessary. Do not shave
– Do not re-use a catheter or needle.
ADMINISTRATION OF IV SOLUTION

• Check the IV solution for the type amount,

percent of solution and rate of flow
• Assess the health status and medical
disorders
• Wash hands thoroughly and use sterile
technique
• Prime the tubing to remove air from the
system
ADMINISTRATION OF IV SOLUTION

• Change the IV site every 48 – 72 hrs

• Change the IV dressing every 72 hrs
especially when wet and contaminated
• Change the IV tubing every 24 to 72 hrs
• Label the tubing, dressing and solution bags
indicating the date and time when changed
• Before adding med or solutions, swab access
ports with 70% alcohol
COMPLICATIONS
• Infection – redness, swelling and drainage at site;
chills, fever, malaise, headache
• Tissue damage – skin color change, sloughing of
skin, discomfort at site
• Phlebitis – heat, redness, tenderness, not hard
and swollen
• Thrombophlebitis – heat, redness, tenderness,
hard and cordlike vein
• Infiltration – Edema, pain, and coolness at the site
• Catheter embolism – decrease BP,
pain along vein, weak, rapid pulse,
cyanosis of nail beds, loss of
consciousness
• Circulatory overload – increased BP,
distended jugular veins, rapid
breathing, dyspnea, moist cough and
crackles
• Electrolyte overload – signs depend on
the specific electrolyte imbalance
• Hematoma – ecchymosis, immediate
swelling and leakage of blood at the
site, and hard painful lumps at the site
• Air embolism – tachycardia, dyspnea,
hypotension, cyanosis, decreased level
of consciousness
( 5ml and above)
IV CONTAINERS

• Glass or plastic
• Do not write the plastic IV bag
with marker pen
IV TUBING

• Contains the spike end, drop chamber,

roller clamp, Y – site and adapter end
• Use of vented or non – vented tubing
• Shorter secondary tubing – use for
piggyback solutions, connecting them
to the injection site
DRIP CHAMBER

• Microdrip
– Are used if fluid will be infused at 50cc/ hr
– Used if solution contains potent medication that
needs to be titrated
– Delivers 60drops/ ml
• Macrodrip
– Use if solution is thick or need to infuse rapidly
– Delivers 10 – 20drops/ ml
FILTERS
• Filters provide protection by preventing particles
from entering the client’s veins
• Filters are used in IV lines to trap small particles
such as undissolved antibiotics or salt or
medications that have precipitated in solution
• Assess the agency policy regarding the use of filters
• A 0.22-um filter is used for most solutions, a 1.2-um
for solutions containing lipids or albumin, and a
special filter for blood components
IV GAUGES
• Gauge 14 – 25
• The smaller the gauge the larger the outside
diameter
• G14 -19 – for rapid fluid administration (blood
products or anesthetics)
• G20 - 21 – for peripheral fat infusion
• G22 - 24 – STD IV fluid and clear liquid
medication
• G24 - 25 – for very small veins
 Procedure in setting up/
changing/Discontinuing I.V. Infusion
• A. Setting up
– Verify doctor’s order and make a label.
– Observe (10) R’s when preparing & administering
IVF
– Explain procedure
– Assess patient’s vein, choose appropriate vein,
location, size and condition.
– Wash hands and maintain asepsis throughout
preparation and during therapy.
– Prepare necessary materials
• IV tray with IV solutions
• Administration set
• IV cannula
Cont.
• Alcohol swabs or cotton balls soaked with alcohol
• Plaster (micropore)
• Tournique
• Splint
• Gloves (optional)
– Check the sterility and integrity of the IV
solutions, IV set and other devices.
– Place IV label on the bottle, patients name,
room #, solutions, drug incorporation, time
started, time consumed, flow rate, # of hours
and signature.
– Open the seal aseptically of the solutions and
disinfect rubber port with cotton balls with
alcohol.
– Open administration set aseptically and close
the IV clamp
– Spike the infusate aseptically
– Fill drip chamber to at least haft and prime the
tube aseptically
– Remove air bubbles if any and put back the
cover to the distal end of the IV tubing (get
ready for insertion)
IV INSERTION
1.Verify written order for IV therapy,check prepared IVF and
other things needed(procedure setting up)
2.Explain procedures and observe the 10 R’S
3.Wash hands before and after procedure.
4.Choose site for IV.
5.Apply tourniquet 5 to 12cm(2-6 inches)above the injection
site,depending on condition of the client.
6.Prepare site with effective topical antiseptic according to
hospital policy or cotton balls with alcohol in circular
motion and allow 30 seconds to dry.(No touch technique)
7.Using appropriate IV cannula,pierce skin with needle
positioned on a 15-30 degree andle;upon flashback
visualization decrease the angle,advance the catheter
and stylet into the vein.
8.Position the IV catheter parallel to the skin.Hold stylet
stationary and slowly advance the catheter off,of the
stylet,until the hub nearly meets the puncture site.
9.Release the tourniquet,remove the stylet while applying
digital pressure over the catheter with one finger about
½ inch from the tip of inserted catheter.
10. Open the clamp and regulate the flow rate.
11.Anchor needle firmly in place with the use of;
a.) transparent tape/dressing directly on the puncture
site.
b.) tape ( using any appropriate anchoring style)
12. Tape a small lope of IV tubings for additional
anchoring;apply splint (if needle)
13. Regulate flow of infusion according to duration.
14. Label on IV tape near the IV site to indicate the date of
insertion.
15. Label with plaster on the IV tubings to indicate the
date when to change the IV tubings.
16. Observe and reassure the patient.
17. Document in the patient’s chart and endorse to
incoming shift.
18. Observe/report any untoward effect.
19. Discard sharps and waste according to hospital policy
Changing the IV Infusion

• Verify doctor’s order, countercheck IV label, IV

card, type, amount, additives (if any), duration.
• Observe (10) R’s
• Explain procedure to the patient assess IV site
for redness, swelling, pain, etc.
• Check date of IV insertion, re-site if 48-78 hours
has lapsed.
• Check date of changing IV tubing, change if due
for changing ( with in 72 hours).
Cont.

• Wash hand before and after the procedure.

• Prepare necessary materials (IV sols, IV label,
disinfectant, IV tray)
• Check sterility and integrity of IV solutions
• Place label on IV bottle
• Open and disinfect the rubber port of IV
• Close the IV clamp or kink the tubing and spike
the container aseptically.
• Regulate the flow rate based on duration of
infusion. Remove air bubbles.
• Reassure patient and significant others.
• Discard all waste materials according to MMDA
ordinance #16
• Document accordingly and endorse to incoming
shift.
Discontinuing an IV infusion
• Verify doctor’s order to discontinue the IV
• Observe (10) R’s
• Assess and inform the patient.
• Prepare the necessary materials
• Wash hand
• Close IV clamp of the tubing.
• Moisten adhesive tapes and remove plaster
gently.
• Remove IV catheter then immediately apply
pressure over the venipuncture site.
• Inspect IV catheter for completeness
• Place dressing or tape over the
venipuncture site
• Discard all waste materials according to
MMDA ordinance # 16
• Reassure patient
• Document and endorse accordingly.
DOCUMENTATION OF IV THERAPY

• Proper documentation provides:

• an accurate description of care that can
serve as legal protection
• a mechanism for recording and retrieving
information
INFORMATION WRITTEN ON
IV TAPE
• size, type and length of cannula/
needle
• name of person who inserted the IV
catheter
• date and time of insertion
Label the IV solution specifying

• type of IV fluid
• medication additives and flow rate
• use of any electronic infusion device
• duration of therapy and the nurse’s
name and signature
Procedural Problems Associated with IV
therapy
• Fluctuating flow rate
• Runaway IV
• Sluggish IV
• Tubing disconnection
• Blood back-up in tubing
• IV line obstruction/kinking of IV
• Clogged filter
• Break in aseptic technique
• Leaks due to inappropriate device
Computation
• Common Formula
Gtts/min = Vol. in cc X drop factor
# of hours X 60 min.
CC/hour = Vol. in cc
# of hours

# of hours = Vol. in cc X drop factor

Gtts/min X 60
Calculation of oral drugs

• Formula
– D x Q or Desired dose x Quantity
S Stock
Example:
Ampicillin 500mg PO BID, the stock dose is
250mg.
500mg x 1 capsule = 2 capsules
250mg
Calculation of IVF flow rate

• Formula
– gtts/min = Total vol. in cc X drop factor
 # Of HOURS X 60
Example
 Order 1,000ml of D5w to run for 8hrs. The
drop factor is 15 gtts/min. What is the
regulation?
1,000 x 15 = 15,000 = 31.25gtts/min.
8hrs. X 60
Is there such a ! Of Course
thing like Fluid mr.President
types??? …Actually
there are 3
fluid types

MR.FLORENCE V QUINTANA
RN
FLUID TYPES

3 TYPES OF
SOLUTION

1.Isotonic Solution
2.Hypotonic
Solution
3.Hypertonic
solution MR.FLORENCE V QUINTANA
RN
Isotonic Solution
• Have equal solute
concentration
• In adjacent
compartment result
in NO NET FLUID ECF

SHIFT

• EXAMPLE : ICF
– Normal saline solution
(PNSS,PLR)
– Na in solution = MR.FLORENCE
Na in V QUINTANA
Blood RN
Hypotonic Solution
• ICF Has lower solute
concentration than other
solutions
• In adjacent compartments
result in fluid shifting from
the compartment of lower
concentration to higher
concentration
– Fluid From ECF  ICF thus
cell will burst or swell

MR.FLORENCE V QUINTANA
RN
HYPERTONIC SOLUTION
• Have higher solute
concentrations than other
solutions
• Adjacent compartments result
in fluid shifting from
compartment with the lower
concentration to the higher
concentration.
– Fluid From ICF  ECF = cell
will shrink
• EXAMPLE : D5 NSS
D5LR,D5NM,D5NR,D5IMB
MR.FLORENCE V QUINTANA
RN
 FLUIDS and ELECTROLYTES

IV FLUID REPLACEMENT THERAPY

Types of Solutions
• ( CRYSTALLOIDS)

 Isotonic
 0.9% sodium chloride (NSS)
 Lactated Ringer’s sol’n (PLR)
 Hypotonic
 5% dextrose and water (D5W)
 0.45% sodium chloride
 0.33% sodium chloride
 Hypertonic
 D5 NaCl
 Protein sol’ns
 Colloids
 Salt poor albumin, Dextran 40

MR.FLORENCE V QUINTANA
RN
• D10W - 10% Dextrose in water hypertonic (505 mOsm/L)
• D10W - 20% Dextrose in water hypertonic (1011
mOsm/L)

• D50W - 50% Dextrose in water hypertonic (1700

mOsm/L)

• D5NS - 5% Dextrose & 0.9NaCl hypertonic (559

mOsm/L)

• D10NS - 10% Dextrose & 0.9NaCl hypertonic (812

mOsm/L)

• D5LR - 5% Dextrose in Lactated Ringers hypertonic

(524 mOsm/L

MR.FLORENCE V QUINTANA
RN
TONICITY OF IV FLUIDS
• 0.45% SALINE (1/2 NS) Hypotonic
• 0.9% NS Isotonic
• 5% dextrose in water D5W Isotonic
• D5 ¼ NS Isotonic
• Lactated Ringer’s solution Isotonic
• D5LR Hypertonic
• D5 ½ NS Hypertonic
• D5 NSS Hypertonic
• D10W Hypertonic
Types of Blood Component
• Packed RBC
– Replaces erythrocyte and resolution of anemia,
usually a unit of packed RBC’s are supplied in 250 ml
unit bag
– Each unit increases the hemoglobin by 1 g/dl and hct
by 2-3% which will change in 4-6 hours after
completion of blood transfusion
• Whole Blood
– Rarely used, used to resolve Hypovolemic shock from
Hemorrhage
– Each unit normally contain 500ml
• Platelets
– Used to treat Thrombocytopenia and Platelet
dysfunction
– Cross-matching is not required but may done,
bags contains 50-70 ml per unit to 200-400 ml
per unit
– Administered immediately on receipt from
blood bank and may be given rapidly over 15
to 30 minutes
• Fresh Frozen Plasma
– Provides Clotting factors or Volume expansion;
NO PLATELETS
– Infused within 6 hours, Rh and ABO compatibility
test required
– About 200-250 ml per unit
– PT and PTT is a done post transfusion for
resolution of Coagulation defects or Hypovolemia
• Albumin
– Prepared in plasma and can stored for 5 year
– Treat Hypovolemic shock or Hypoalbunemia
• Cryoprecipitate
– Are prepared from Fresh Frozen Plasma and
can be stored for 1 year
– Used to replace clotting factors, especially
Factor VIII and Fibrinogen
COMPATIBILITY
• Clients blood sample are drawn and labelled at
the bedside when drawn, the client is asked to
state his or her name, which compared with the
name of the client’s identification band or
bracelet.
• The recipient’s ABO and Rh type are identified
• An Antibody screen is done to determine the
presence of antibodies other than anti-A and
Anti-B
• Cross-matching is done in which donor
RBC are combined with recipient’s serum
and Coomb’s serum; Crossmatching is
compatible if NO RBC Coagulation occurs
• The Universal RBC donor is O negative,
The Universal recipient is AB positive
Infusion Controllers and Pumps

• Infusion controllers and Pumps

– Used to administer blood products if they are
designed to function with opaque soln’
• Special manual Pressure Cuff
– May be used to increase the flow rate but
should not exceed 300 mmHg
BLOOD WARMERS

• To prevent HYPOTHERMIA and adverse

reactions when several units of blood
being administered
• Do not warm blood products in the
microwave or in hot water
Precautions and Nursing
Interventions and
Responsibilities
General Precautions
• Avoid large vol. of refrigerated blood infused
rapidly which can cause cardiac dysrhythmias
• No other soln’ other than NSS should be added
to blood components
• Medications are NEVER added to blood
components or piggy backed into a blood
transfusion
• Infusions (1 Unit) shout NOT exceed 4 hours to
avoid Septicemia
• Blood administration set should be changed
every 4-6 hours
• Always check the blood bag for the expiration
date
• Inspect the blood bag for leaks, abnormal color
clots and bubbles
• Blood must be administered as soon as possible
(within 20-30 mins.) from receiving from the
blood bank
• Never refrigerate blood, if blood is administered
within 20-30 mins. Return it to the blood bank
• Blood is infused as quickly as the clients
condition allows
• Components containing few RBC and
Platelets may be infused rapidly but caution
must be taken to avoid circulatory overload
• The nurse should measure the vital signs
and assess the lung sounds before the
transfusion and again after the 1st 15 mins
and every hour until 1 hour after the
transfusion is completed
Blood Bank Precaution
• Blood will be released from the Blood Bank only
by recognized personnel
• The Name and the identification number of the
intended recipient must be provided to the blood
bank and a documented permanent record of
this information must be maintained
• Blood should be transported from the blood
bank to only one client at a time to prevent
blood delivery to the wrong patient
Client Identity and Compatibility
• The most critical phase of the transfusion is
Confirming product compatibility and verifying
clients identity
• Two registered nurses are needed to check the
physician’s order, the clients identity, and the
client’s identification band or bracelet and
number, verifying that the name and number
are identical to those on the blood component
bag
• At the bedside, the nurse ask the client to state his
or her name, the nurse compares he name with
the name on the identification band or bracelet
• The nurse checks the blood bag tag, label, blood
requisition form to ensure that ABO and Rh type
are compatible
• If the nurse notes any unconsistencies when
verifying client identity and compatibility, the nurse
notifies the blood bank immediately
Client Assessment

• Assess for any cultural or religious beliefs

regarding blood transfusion (Jehovah’s
witness)
• Ensure that an Informed consent is signed
• Determine any previous reaction to blood
transfusion
• Check the clients VS, assess renal,
circulatory and respiratory status and the
client’s ability to tolerate intravenously
administered fluids
• If the client’s temperature is elevated,
notify the physician before beginning the
transfusion, a fever may be a cause for
delaying the transfusion in addition to
masking a possible symptoms of an acute
transfusion reaction
Administration of the Transfusion

• Maintain standard, transmission based, and

other precautions as necessary
• Insert an IV line and infused normal saline;
maintain the infusion at KVO
• An 18 or 19 gauge IV needle will be needed to
achieved maximum flow rate of blood products
and prevent damage to RBC; if a smaller gauge
needle must be used, RBC must be diluted with
normal saline
• Always check the bag for the volume of the
blood component
• Blood products should be infused through
administration set designed specifically for
blood; use a Y tubing or straight tubing blood
administration set that contains a filte designed
to trap fibrin clots and other debris that
accumulate during blood storage
• Premedicate the client with Acetaminophen or
Diphenylhydramine as prescribed if the client
has a history of adverse reactions 30 minutes
before the transfusion is started if orallly or
immediately before transfusion if IV
administered
• Instruct the client to report anything unusual
immediately
• Determine the rate of infusion by physician
order
• Begin the transfusion slowly under close
supervision; if NO reaction is noted within the 1st
15 mins. The flow can be increased to the
prescribed rate
• During the transfusion, monitor the client for
signs and symptoms of transfusion reaction, the
1st 15 mins of the transfusion are the most
critical, and the nurse must stay with the client
• If a major compatibility exist or a severe
allergic reaction occurs, the reaction is
usually evident within the 1st 50 ml of the
transfusion
• Document the clients tolerance to the
administration of the blood products
• Monitor appropriate laboratory values and
document the effectiveness of treatment
related to the specific type of blood
products
Reactions to the Transfusion
• If a transfusion reaction occurs, stop the
transfusion, the change in IV tubing down to the
IV site, keep the IV line open with normal saline,
notify the physician and blood bank and return
blood bag and tubing in the blood bank
• Do not leave the client alone and monitor the
client for nay life life threatening symptoms
• Obtain appropriate: laboratory samples, such as
blood and urine samples (free hemoglobin
indicates the RBC cell are hemolyzed)
 COMPLICATIONS OF
BLOOD TRANSFUSION
TRANSFUSION REACTION
• Signs: chills and diaphoresis, muscle aches, back
pain, or chest pain, rashes, hives, itching
swelling, rapid thready pulse, dyspnea, cough,
wheezing or rales, pallor, cyanosis,
apprehension, tingling and numbness,
headache, nauses, vomiting, abdominal
cramping and diarrhea
• Unsconscious client: weak pulse, fever,
tachycardia or bradycardia, hypotension, visible
hemoglobinuria, oliguria or anuria
• Delayed Transfusion reaction: occurring days to
years after a transfusion
• Nursing Interventions:
– Stop the transfusion
– Keep the intravenous line open with 0.9% normal
saline
– Notify the physician and the blood bank
– Remain with the client, observing signs and
symptoms and monitoring vital signs as often as
every 5 minutes
– Prepare to administer Emergency medications such as
antihistamines, vasopressors, fluids, corticosteroids as
prescribed
– Obtain urine specimen for laboratory studies
– Return blood bag, tubing attached labels, transfusion
record to the blood bank
CIRCULATORY OVERLOAD
• Signs: Cough, dyspnea, chest pain, and rales,
headache, hypertension and tachycardia and a
bounding pulse, distended neck veins
• Nursing Interventions:
– Slow the rate of Infusion
– Place the client in an Upright position, with the feet in
a dependent position
– Notify the physician
– Administer O2 diuretics, morphine, SO4 as prescribed
– Monitor for dysrythmias
– Phlebotomy also may be a method of prescribed
treatment in a severe case
SEPTICEMIA

• Signs: Rapid onset of chills and a high

fever
• Nursing Interventions:
– Notify the physician
– Obtain blood cultures and cultures in the
blood bag
– Administer O2, IV fluids, antibiotics,
vasopressors and corticosteroids as ordered
IRON OVERLOAD
• Signs: Vomiting, diarrhea, hypotension,
altered hematological values
• Nursing Interventions:
– Deferoxamine (Desferal) administered IV or
SubQ, removes accumulated iron via the
kidneys
– Urine turns red as iron is excreted aa
administration of deferoxamine; treatment is
discontinued when serum iron level return to
normal
DISEASE TRANSMISSION
• Signs: A disease commonly transmitted is Hepatitis C
which is manifested by anorexia, nausea, vomiting, dark
urine, and jaundice; the symptoms usually occur within
4-6 weeks after the transfusion
• Other infectious agents transmitted include Hepatitis B
virus, HIV, HHV6, Epstein-Barr Virus, Human T-cell
Leukemia, Cytomegalovirus and Malaria
• Nursing Intervention:
– Donor screening
– Antibody testing of donors for HIV
Hypocalcemia and Citrate
Intoxication
• Description: Citrate is transfused, blood
binds with Calcium and is exercised
• Nursing Intervention
– Assess serum Calcium before and after the
transfusion
– Monitor for signs of Hypocalcemia
– Slow the transfusion
– Notify physician if signs og Hypocalcemia occurs
HYPERKALEMIA
• Description: Stored blood liberates K+ through
Hemodialysis
• Nursing Intervention:
– The older blood the greater risk of hyperkalemia;
therefore patient at risk such as those with renal
insufficiency or renal failure, should receive fresh
blood
– Assess the date on the blood and the serum
potassium level before and after the transfusion and
notify the physicians if signs of Hyperkalemia occur