Intravenous therapy

Francia C. Toledano
Clinical Instructor
objectives

Define Intravenous Therapy

Determine the purposes of IV therapy
Demonstrate the procedures in IV insertion and drug administration
Enumerate the complications of IV therapy and drug administration
Discuss the immediate nursing interventions intended for each
complications
 Definition

 Intravenous therapy or IV therapy is the infusion of liquid substances directly into

a vein
 It is also referred as ‘IV therapy” constitutes the administration of liquid
substances directly into a vein and the general circulation through venipuncture
Reasons for iv infusion

 Replace fluids and replace imbalances

 Maintain fluid, electrolyte and acid – base
balance
 Administer blood and blood products
 Administer medication
 Provide parenteral nutrition
 Allows for immediate and predictable effects
 Provide avenue for diagnostic testing
 Provide avenue for dialysis
Administration set
Parts of an IV set
 IV solutions

Two categories of IV solutions (Volume Expanders):

Crystalloid and Colloids
 Crystalloids are solutions with small molecules that
flow easily from the bloodstream into cells and
tissues. Could be isotonic, hypotonic and hypertonic
solutions.
 Colloids are solutions with larger molecules used to
expand plasma in patients who don’t respond to
crystalloids. It pulls fluid into the bloodstream. It is
always hypertonic. Types include albumin, dextran,
blood and plasma protein factor.
Crystalloids :
Isotonic Solution

 250 – 375 mOsm/L

 Solutions that have concentration of dissolved
particles equal to that of intracellular fluid
 Osmotic pressure is the same both inside and
outside the cell
 Cells neither shrink nor swell with fluid movement
 Same tonicity as plasma
 Contain electrolytes such as NaCl, KCl, CaCl and
sodium lactate
Isotonic fluids and uses

Nursing Intervention
 Use cautiously in patients who
are fluid – overloaded or who
would be compromised if
vascular volume will increase,
such as renal and cardiac
patients.
 If serum pH is 7.5 above
(alkalotic) don’t give lactated
ringers conversion to
bicarbonate by the liver causes
further alkalosis
 D5W can increase intracranial
pressure
Hypotonic solutions

 < 250mOsm/L
 Have less particles than does intracellular fluid.
 Water is drawn into the cells from the ECF causing them
to SWELL and BURST
 Can cause cardiovascular collapse due to sudden shift of
water from blood vessel to the cell and increase
intracranial pressure due to sudden shift of water to brain
cells
 NOT for head injury, head trauma, or neurosurgery
patients are at higher risk to have increase ICP
 NOT for burns, trauma, low serum protein levels,
malnutrition or liver disease due to high risk for third –
spacing (shifting of fluid to interstitial compartment or
body cavity)
Hypotonic solutions and uses
Hypertonic solution

 >375mOsm/L
 Have greater concentration of dissolved particles than does
intracellular fluid.
 Fluid is pulled out from the cells
 Water is drawn from the cells to equalize the concentration,
which causes the cells to SHRINK causing DEHYDRATION
 Nursing responsibility: closely monitor for circulatory
overload greatly expand the intravascular compartment
 NOT for patient with DKA, impaired heart or kidney functions
Summary of IV fluids
Summary of Water movement in solutions
Remember to check this
 Site selection for iv insertion

 Veins are classified as superficial, deep and

venous sinuses
 For peripheral IV therapy SUPERFICIAL
veins instead of arteries are used because:
 Wall thickness is less
 Veins can expand to accommodate a large volume
of fluid
 Obstruction of blood flow as a result of spasm is
less likely
 Veins are located near the surface
 Injury is not as serious

Upper extremity common sites

 Cephalic, Basilic and Median Cubital vein are

the three main veins of antecubital fossa
frequently used.
 Usually large, easy to find, and accommodating
of larger IV catheters. They are ideal sites when
large amounts of fluids must be administered.
 However, their location in a flexor region is a
drawback, as bending of the elbow can be
uncomfortable to the patient and may occlude
the flow of the intravenous solution.
Lower extremity

 A physician’s order must be obtained if a

vein in the lower extremity must be used
as a last resort.
 Veins in the lower extremity are not used
because:
 Close proximity to arteries/nerve
 Union with superficial vein
 Increased possibility of pooling/stasis of blood
 Increased pain
 Increased risk of infection
Consideration for selecting the
infusion site

 Location and condition of the vein

 Purpose and duration of therapy
 Type of solution to be infused
 Location of previous I.V sites
 Patient’s age
 Type of procedure patient will have
Vein locator for a difficult insertion
Neonates, infants and
children
 In neonates, vascular access can be
obtained via the umbilical vein, although
this has been associated with portal vein
thrombosis.
 In infants, scalp veins are often amenable
to cannulation, and central catheters can
also be inserted by this route.
 Intraosseous infusions have also been
used for fluid administration in
hemodynamically compromised children,
although care must be taken with needle
placement in order to avoid injury to
epiphyseal growth plates
Intraosseous site

Intraosseous Powered
Driver
Common restraint use
for pediatric patient
Needle/catheter selection

 The smaller the gauge number, the larger

the diameter of the shaft.
 As a general rule, select the smallest –
gauge needle for the infusion (taking into
account the viscosity or thickness of the
solution and the size of the vein), unless
subsequent therapy will require a larger
device.
 Smaller gauge needle cause less trauma to
the veins and allow greater blood flow
around the tips, reducing the risk of
clotting.
IV Cannula
 universal
Precaution

Guidelines for protecting

healthcare due to emergence of
HIV & other bloodborne
pathogens
 Are good hygiene habits e.g., hand
washing, use of gloves & other
barriers, correct sharps handling,
aseptic techniques
 ALL patient must be considered
infective at all times
Equipment needed
Procedure in
setting up an iv
Procedure in
inserting iv
Tips in Initiating IV therapy in a pediatric
patient
Tips in Initiating IV therapy in a pediatric
patient
Changing iv solution
Administering IV Drug through iv push
Administering IV Drug to IV Bottle
Discontinuing IV
Abutting means touching
or pinching off
Common Complications
of IV therapy

INFILTRATION
 Fluid leaks from the vein into surrounding tissue.
Occurs when IV access device becomes
dislodged from a vein.
 WOF: pain, swelling and leakage, coolness at the
site, sluggish flow and peripheral nerve damage
 What to do: Stop the infusion, elevate the
affected extremity and remove the catheter,
reinsert it using other site.
 Prevention: use smallest catheter, avoid
placement at joint areas, anchor properly and
don’t use IV pump for a small IV catheter in a
small vein
Common Complications
of IV therapy

INFECTION
 Occurs because the puncture for venous access disrupts
the integrity of the skin, the body’s barrier to infection
 WOF: Drainage, tenderness, redness and warmth at the
IV site, Hardness on palpation, Fever and chills,
Elevated WBC count
 What to do: Monitor the patient’s vital signs and notify
the doctor. Swab the site for culture and sensitivity
testing as ordered. Remove the catheter as ordered.
 Prevention: maintain sterile technique, change catheter
hubs routinely. Rotate peripheral IV catheter sites every
72 hours
Common Complications
of IV therapy

PHLEBITIS and THROMBOPHLEBITIS

 Phlebitis is an inflammation of the vein and can be mechanical, chemical or bacterial
 Thrombophlebitis is an irritation of the vein with clot formation
 Cause: poor insertion technique, use of solution or drug with an inappropriate pH or osmolality, a peripheral
IV catheter remaining in place for too long.
 WOF: Pain, redness, swelling or induration at the site, sluggish flow of the infusing solution, Fever
 What to do: Remove the IV line, monitor the VS and refer, apply warm soaks to the site
 Prevention: Choose large bore veins, change catheter every 72 hrs when infusing drug or solution with high
osmolality, Treat a central line occlusion with fibrinolytic as prescribed., flush the catheter and dilute the
drug and infuse at a slower rate.
Phlebitis and thrombophlebitis

Phlebitis at a
propofol infusion
site
Common Complications
of IV therapy

EXTREVASATION
 Leakage of vesicant fluid into surrounding tissue.
 Cause: Drugs seep through veins and produce blistering and necrosis
 WOF: discomfort, stinging, and burning at infusion site, skin tightness, blanching and lack of blood return,
inflammation and pain in 3 to 5 days, ulcers and necrosis in 2 weeks
 What to do: STOP the infusion, notify the doctor, infiltrate the site with an antidote as prescribed, apply ice
to IV site initially followed by warm soaks. Elevate the affected extremity, Assess circulation and nerve
function of the affected extremity.
 Prevention: Know the drugs that may extravasate and administer carefully following hospital policy in drug
administration
Severe extravasation
following administration of
potassium chloride
Common Complications
of IV therapy

AIR EMBOLISM
 Air enters the vein. More likely to occur in central lines (placed above the heart) than peripheral lines
 Cause: inadvertent injection or infusion of an air bubble along with the fluid or drug
 WOF: Increased pulse rate, decreased blood pressure, Respiratory distress, Increased ICP, Loss of
consciousness
 What to do: Clamp the IV line, Notify the doctor immediately , Place the patient on his LEFT SIDE in
TRENDELENBURG’s position which will allow air to enter the right atrium where it can be removed more
easily by pulmonary artery
 Prevention: Prime tubing completely, tighten connections securely and use an air detection device on the IV
pump
Air embolism
Common Complications
of IV therapy

FLUID OVERLOAD
 Can occur gradually or suddenly, depending on the patient’s
circulatory system and its ability to accommodate fluid
 Cause: Inappropriate IV fluid for patients condition, too much
giving of fluid more than the patient’s required amount
 WOF: Increased BP, Jugular vein distention, Increased
respirations, Shortness of breath, crackles on auscultation, cough
 What to do: Slow the IV infusion rate, Notify the doctor, monitor
VS, Keep patient warm, elevate the head of the bed, Give
supplemental O2 and drugs as prescribed
 Prevention: Always use an infusion pump to administer solutions,
Always clamp the catheter when changing the IV solution,
Consider the patient’s size and age and adjust fluid administration
as needed.
Thank you!