IV Therapy Indications

fluid volume maintenance, fluid

volume replacement, med
administration, blood administration,
TPN, emergency line,  
Advantages of IV Therapy  

faster absorption, rapid distribution,

emergency access, unconscious patient  
 Infection Control in IV  

 70% isopropyl alcohol inhibits bacterial

growth, apply with friction; Iodine, inhibits
bacterial growth, penetrates cell wall  
 IV and Dressing Changes  

 PICC-every 6 weeks, IV inserted by paramedic

w/in 24 hours, Peripheral site every 72 hours,
Blood and TPN every 24 hours, CVC every 48-
72 hours or 3xper week.  
Nursing Responsibilities for IV Sites  

 assess site whenever in room, document at

least every 8 hours, site CDI (clean, dry,
intact), sterile technique, changine tubing and
solution, awareness of complications,
awareness of fluid types, 5 rights  
 Complications of IV Therapy  

 Pain and irritation, infiltration and exravasion,

occlusion, loss of patency, phlebitis, fluid
overload  
 Pain and Irritation of
IV-intervention  

 increase amt of dilutent, arm board  

 Infiltration  

 seepage of IV fluids into tissue when IV cath

penetrates vein  
 Extravasion  

 escape of irritating agent into tissue  

 Extravasion and Infiltration
Assessment  

 swelling, pain, cool to touch, decreased flow,

wet dressing, no back flow.  
Causes of Infiltration and Extravasion
 
 catheter permeates vein, poor taping of site,
over manipulation  

Intervention for Infiltration and

Extravasion  
 Remove IV, cold compress  
 Occlusion Causes  
 kinked tubing, patient lying on tubing,
infusion too slow  

Occlusion Assessment  
 IV stops dripping  
 Occlusion Intervention  

 milk IV, aspirate, irrigate (if no resistance OK,

if resistance may be clot>  
 Occlusion Prevention  

 don't let IV run dry, flush periodically with 1-

5 cc of NSS and before and after any
intermittent IV therapy.  
 Phlebitis Causes  
 bacterial, chemical, mechanical  

Phelebitis Intervention  
 remove IV, cold compress  
 Phlebitis Assessment  

 erythemia, pain or burning, warmth, edema,

cordlike vein.  
Bacterial Phlebitis possible cause  
 IV left in too long  

Chemical Phlebitis Cause  

 irritating fluids  
 Mechanical Phlebitis  

 clot at tip of cannula, cath too large for vein.  

 Crystalloids  

 clear fluids, dextrose of saline, can be Iso,

Hypo or Hyper tonic  
 Colloids  
 cloudy, yellowish, used to raise osmotic
pressure, Dextran is clearish  
 Indications for Isotonic IV  

 Hypotension (increases BP), Hypovolemia  

Complications of Isotonic IV  

 fluid overload  
 Examples of Isotonic Solutions  

 0,9% NSS, D5W(isotonic in bottle, hypotonic

in body), Lactated Ringers  
 Indications for Hypotonic IV  

 Will cause fluid to shift from intravascular to

intracellular space.  
Indications for Hypotonic IV   

 dehydration  
 Hypotonic Solutions  

 .45% sodium chloride, 5%dextrose water

(becomes hypotonic in body)  
Complications of hypotonic solution  

 May cause edema  

 Indications for hypertonic IV  

 low bp, slight edema but not w/CHF, pulls

fluid from intracellular space to intravascular
space  
 Hypertonic IV Solution  

 Not as strong as Albumin, 10% Dextrose in

Water D10W, 5% normal saline, D5 Ringers
Lactate  
 Complications of Hypertonic IV  

 more fluid in bloodstream can cause

circulatory overload.  
 PCA  

 Patient Controlled Analgesia  

 3 settings of PCA  

 drug dosage, lockout period, basal rate  

Central Venous Therapy Indications  

 inadequate vascular access, complex

treatment regimes, hyperosmolar infustions
ie parenteral nutrition, irritating or vesicant
druges, (ie. dopamine cancause necrosis)
rapid absorption, long term therapy.  
Contraindications for Central venous
therapy  

 altered skin integrity, anomalies of central

vasculature, cancer in area, coagulopathies,
fractured clavicle, septicemia, radiation to
insertion site  
 Common insertion pathways for
Central Venous Therapy  

 subclavian, jugular, femoral vein, cephalic

vein(is peripheral but the line runs to central
area)  
 Risks and Complications of Central
Venous Therapy  

 Air embolism, pneumothorax, sepsis,chest

pain, confusion, hypotension, dyspnea,
pallor, tachycardia, tachypnea,
unresponsiveness  
 Components of Intravenous
Nutritional Support  

 amino acids, carbohydrates, electrolytes,

minerals, vitamins, lipids, other (ie insulin
 Lipids in Intravenous Nutritional
Support  

 lipids are administered via Piggy back. (white,

thin liquid)  
Cautions for IV nutritional support  

 not refrigerated, observe for spoilage (fat on

top, discoloration), expiration dateNo filter. ,
must be infused on IV pump, glucose
monitored, gradual weaning. Daily weights,  
 Complications for IV nutritional
support  

 hypoglycemia, hyperglycemia, dehydration,

infection  
Indications for IV Nutritional Support
 

 bowel surgery, chronic weight loss, bowel

rest, coma, excess nitrogen loss, hepatic or
renal failure, malnutrition, low serum
albumin, hypermetabolic states