King Fahad Specialist Hospital

NURSING EDUCATION DEPARTMENT

Nursing Orientation Program

INTRAVENOUS THERAPY
Equipment/Materials

Tourniquet Alcohol swab Tape (1/2 in wide)

Tegaderm Clean gloves

KFSH- Intravenous Therapy Course & Sterile winged needle
Workshop for Nurses
Equipment/Materials

Over the needle catheter Sterile injection cap Sterile syringe

KFSH- Intravenous Therapy Course &

Workshop for Nurses
POLICY
• Intravenous fluid therapy is
prescribed by the attending
physician. However, in an
emergency situation such
as shock, a staff nurse may
initiate an infusion with
Normal saline.

KFSH- Intravenous Therapy Course &

Workshop for Nurses
• Only a Qualified nurse who passed the IV
therapy course may initiate IV therapy.
• Strict aseptic technique must be observed in
intravenous therapy.

KFSH- Intravenous Therapy Course &

Workshop for Nurses
• Disposable non-sterile gloves should be worn
as per standard precautions for:
– Blood sampling
– All IV related procedure with risk of exposure to
blood and body fluids.
• Gloves shall be changed and discarded
between patient contacts.

KFSH- Intravenous Therapy Course &

Workshop for Nurses
• Infusions pumps must be
used for the following:
–Central venous
catheter.
–ICU patient.
–Medications/Fluids
that has to be
accurately titrated
KFSH- Intravenous Therapy Course &
Workshop for Nurses
 Intravenous Cannulation
• Only two attempts of cannulation shall be made by one
person.
• Assistance from a senior nurse or Head Nurse must be sought.
• Always start cannulation on the distal branches before using
the proximal veins.
• Avoid veins in areas of flexion or veins which are damage.
• Never reinsert stylet back into catheter once it has been
removed because of the tendency of the catheter to be
punctured or severed.
• Blood specimen may be drawn at the time of catheter
insertion.
• Apply IV Cannula Tag with IV Cannula Gauge no. Date
Inserted, Inserted By, Dressing Due with Staff Signature.
 INTRAVENOUS FLUID TAG
• Must be labeled with Patient’s Name, Medical
Record Number, Type of IV Fluid, ml /H,
Medication Added (if any), Duration of
Infusion, gtts / min, Date & Time Started, Date
&Time to be consumed, Date IV Tubing Due
for Changed, Name of Staff Nurse.
• SAMPLE TAG

7 1700 H
 Changing of IV Tubing
Every 24 hour:
•Lipid infusion tubing
•Solusets/ burette
•TPN tubing
•Continuous infusion
chemotherapy
Changing of IV Tubing

Propofol Tubing
change every 6 – 12
hours/Manufacturers'
recommendation
Changing of IV Tubing
Peripheral Venous Catheters
and IV Fluid tubing

every 72 -96 hours in

adult and or according to
manufacturer, for
children only when
clinically indicated. Any
peripheral venous
catheter inserted in
emergency should be
changed within 48 hours.
 Changing of IV Tubing
Arterial and central venous
catheter to be change only when
there is a clinical indication. NO
ROUTINE REPLACEMENT.
 Changing of IV Tubing
Pressure Monitoring
Systems (Transducers, tubings,
continuous flush devices, Flush solutions)
should be changed every 96 hours.
Changing of IV Tubing

Blood administration
set for packed red
blood cells is changed
after one (1)
unit of blood have
been administered.
Changing of IV Tubing
72 to 96
hours
or
as needed

IV site dressing for peripheral line to

be change when ever cannula is
change or as needed.
Changing of IV Tubing
Dressing for Central Venous
Catheter to be change:
Every seven days (7days) for
transparent dressing (tagaderm).
•Identification labels are reviewed before
administering solutions to ensure that the intended
delivery route is correct.
• All IV tubing must be label accordingly and any
certain high – risk catheters (epidural, intra-thecal,
arterial).
•All lines are traced back to their point of origin to
verify that correct connections are made.
Fluids and Medication Administration

• Medications/IV solutions, which have to be

accurately titrated, must be administered via
infusion pump (e.g. Heparin, insulin, morphine
and inotropes).
Fluids and Medication Administration

TPN solution shall

be administered via
infusion pump
• NO infusion
with
medication
shall hang for
longer than 24
hours
KFSH- Intravenous Therapy Course &
Workshop for Nurses
 IV therapy must not be administered via
hemodialysis fistulae or catheter
unless there is an order from Nephrologist or
in emergency situations.
 What to monitor?
• Observe the patient strictly for the following:
• Check for correct amount of fluids infused.
• Count drip rate or check rate on infusion
pump.
• Check for signs of discomfort from patient.
• Check insertion site for color, redness, pallor,
any swelling, and if skin warmth or cold.
 Check for any complications
Fluid
volume
Fluid
deficit
volume
Infiltrati
excess
on
Phlebitis
Bactere
mia
Embolis
m
Speed
shock
Out of
vein
Observe closely for patients receiving IV therapy of TPN, dextrose solutions and
additives as these can cause irritation of tissues once infiltrated.
• Patient refusal for IV reinsertion, attending
physician must be informed and seek Social
Worker for assistance. Explanation should be
documented in nurse’s notes by assigned
nurse.

KFSH- Intravenous Therapy Course &

Workshop for Nurses
• Tube and catheter having different purposes
are routed in different, standardized
directions (e.g. IV lines routed toward the
head, enteric lines toward the feet). This is
especially important in the care of neonates.

KFSH- Intravenous Therapy Course &

Workshop for Nurses
• Cap all stopcocks when not in use, A new
sterile cap should be used every time the
tubing is capped.
• IV cannula must be patent, flush with Normal
Saline after medication administration.
INTRAVENOUS
FLUID
CALCULATIONS
3 FACTORS MUST BE KNOWN:

Amount of solution ordered

Duration of Infusion

Drop Factor
 V
ml/hr
T
The doctor ordered to give Normal Saline 800 ml in 9
hours. How much ml will you give in an hour?

800ml
88.89 ml/hr
9 hrs
 V
ml/min
T 60
• The doctor ordered to give Normal Saline 800
ml in 9 hours. How much ml will you give in a
minute?

800ml
1.48 ml/min
9 hrs 60
 V R gtts/min
T 60
• The doctor ordered to give Normal Saline 800
ml in 9 hours. How much gtts will you give in
a minute?

800 ml 20 gtts/ml 29.6

9 hrs 60 min gtts/min
 DRUG
CALCULATIONS
 DOPAMINE
Infusion using RULE OF SIX

Stock: 200 mg/ 5 ml (40 mg/ml)

Order: start Dopamine 10 mcg/kg/min

FORMULA

Desired dose= weight (kg) X 6 (constant)

Amount of Dopamine Desired Dose

to be infused = X Quantity
Stock

ml/ hr Doctor’s Order (mcg) X Body Weight (kg) X 60 min/ hour

to be =
infused Body Weight (kg) X 6 X 1000 / 50 ml
 DOPAMINE
Infusion using RULE OF SIX

Stock: 200 mg/ 5 ml (40 mg/ml)

Order: start Dopamine 10 mcg/kg/min Body weight 60 kg

FORMULA

Determine Body Weight 60 kg X 6 (constant) = 360 Dopamine

360 mg
9 ml = X 5 ml
(Mixed with normal saline) 200 mg

10 mcg X 60 kg X 60 min/ hour

5 ml/ hr =
60 kg X 6 X 1000 / 50 ml
 DOBUTAMINE
Infusion using RULE OF SIX

Stock: 250 mg/ 5 ml (50 mg/ml)

Order: start Dobutamine 6 mcg/kg/min

FORMULA

Determine Body Weight = weight (kg) X 6 (constant)

Amount of Dopamine Desired Dose

to be infused = X Quantity
Stock

ml/ hr Doctor’s Order (mcg) X Body Weight (kg) X 60 min/ hour

to be =
infused Body Weight (kg) X 6 X 1000 / 50 ml
 DOBUTAMINE
Infusion using RULE OF SIX

Stock: 250 mg/ 5 ml (50 mg/ml)

Order: start Dobutamine 6 mcg/kg/min Body weight- 55 kg

FORMULA

Determine Body Weight 55 kg X 6 (constant) = 330 mg Dobutamine

6.6 330 mg
X 5 ml
To be mixed with normal saline =
250 mg

6 mcg X 55kg X 60 min/ hour

3 ml/ hr =
55 kg X 6 X 1000 / 50 ml
 NORADRENALINE
Stock: 4 mg/ 2 ml

Order: start Noradrenaline 15 mcg/min

FORMULA

ml/ hr Doctor’s Order (mcg) X 50 ml D5 W X 60 min/ hour

to be =
infused Stock on hand (mg) X 1000
 NORADRENALINE
Stock: 8 mg/ 4ml

Order: start Noradrenaline 15 mcg/min

FORMULA

5.62 = 15 mcg X 50 ml D5 W X 60 min/ hour

ml/hr 8 mg X 1000 mcg

IPP-GNR-IVT-001-09
IV Therapy