Intravenous Therapy

Gomer P. Ponso, RN
UC-CON Faculty
 INTRAVENOUS THERAPY
• Intravenous therapy or “IV therapy” is the
delivery of a substance directly into a vein.
• Intravenous simply means: "within a vein".
• It is the insertion of a needle or
catheter/cannula into a vein based on the
physicians written prescription
 INTRAVENOUS THERAPY
• The needle/cannula is attached to a sterile
tubing and a fluid container to provide
medication and fluids.
• An invasive procedure
• Intravenous (IV) therapy is very common
practice, particularly with patients in acute
care settings.
 LEGAL BASIS
• RA 7164 (Philippine Nurses Act of 1991)
• Sec. 27 (a) Article V which provides that intravenous
injections is with in the scope of nursing; and that in the
administration of intravenous injection special training
shall be required according to protocol established
• RA 9173 (Philippine Nurses Act of 2002)
• Article VI Section 28(a) on Scope of Nursing Practice: “It
shall be the duty of the nurse to provide nursing care
through health care techniques and procedures, and
administration of written prescription for treatment,
therapies and parenteral medication.”
 LEGAL BASIS
• BON Resolution #08, Series of 1994
• States that an RN is prohibited from administering IV
injections to a patient unless he/she has undergone a
special training in IV injections under at least a nursing
service administration, who is a member of ANSAP and
who is qualified under Sec 28, Article V of RA 7164
• Any RN with such training who administeres IV
injections to a patient whether causing or not injury or
death to the patient shall be held liable criminally or
administratively.
 PURPOSE OF IV THERAPY
• Provide fluid and electrolyte maintenance,
restoration, and replacement
• Administer medication and nutritional
feedings
• Administer blood and blood products
• Administer chemotherapy to cancer patients
• Administer patient-controlled analgesics
• Keep a vein open for quick access
 INTRAVENOUS ACCESS
DEVICES
• Peripheral venous catheter (PVC).
• Peripherally inserted central catheter (PICC).
• Central line.
• Subcutaneous injection port.
 PERIPHERAL VENOUS
CATHETER
• A device used to draw blood and give treatments,
including intravenous fluids, drugs, or blood
transfusions.
• A thin, flexible tube is inserted into a vein, usually in
the back of the hand, the lower part of the arm, or the
foot.
• A needle is inserted into a port to draw blood or give
fluids.
• This is the most common intravenous access method
in both hospitals and pre-hospital services.
PERIPHERAL VENOUS
CATHETER
PERIPHERAL VENOUS
CATHETER
PERIPHERAL VENOUS
CATHETER
PERIPHERAL VENOUS
CATHETER
 PERIPHERALLY INSERTED
CENTRAL CATHETER
• A device used to draw blood and give treatments,
including intravenous fluids, drugs, or blood transfusions.
• A thin, flexible tube is inserted into a vein in the upper
arm and guided (threaded) into a large vein above the
right side of the heart called the superior vena cava.
• A needle is inserted into a port outside the body to draw
blood or give fluids.
• A peripherally inserted central catheter may stay in place
for weeks or months and helps avoid the need for
repeated needle sticks.
PERIPHERALLY INSERTED
CENTRAL CATHETER
PERIPHERALLY INSERTED
CENTRAL CATHETER
PERIPHERALLY INSERTED
CENTRAL CATHETER
PERIPHERALLY INSERTED
CENTRAL CATHETER
 CENTRAL LINE
• It’s also called a central venous access device
(CVAD) or central venous catheter (CVC). A
small, soft tube called a catheter is put in a
vein that leads to your heart.
CENTRAL LINE
 SUBCUTANEOUS INJECTION
PORT
• Subcutaneous medication administration is a common route of
administration of medications in both the hospital and community
settings.
• Subcutaneous infusion of medications can be used in a variety of
scenarios; one such situation is in palliative care, to optimize the
delivery of medications to provide appropriate symptom
management.
• It is often used in patients who are unable to take medication by
mouth, those that have poor gut absorption, nausea and vomiting or
those that require a continuous infusion in the community.
• Indwelling subcutaneous catheter devices may assist in medication
delivery and decrease trauma, distress and discomfort for the patient.
SUBCUTANEOUS INJECTION
PORT
CONSIDERATIONS BEFORE VENIPUNCTURE

1. Physician’s Order – based on the written order

2. Patient Assessment – Preparedness for the
procedure. Provide privacy.
3. IV Equipment Preparation
4. Medications – must have a working knowledge
of medication he/she will administer
5. Policy and Procedural Manual – serves as a
guide for the administration of IV therapy
 CATHETERS (CANNULAS)
• TYPES
1. Over-the-needle catheter
• Long-term therapy for the active or agitated patient
2. Winged steel needle set
• Short term therapy for cooperative adult patient and
used for patients with fragile and sclerotic veins
 NEEDLE SELECTION
• The larger the gauge number, the smaller the
catheter bore
• A smaller gauge causes fewer trauma to veins
allowing greater blood floe around the tips and
reduces clotting risk
1. Gauge 16-18: Trauma, major surgery, OB
2. Gauge 18-20: Infusion of hypotonic solutions, Blood and
TPN administration
3. Gauge 22-24: Pediatric patients
4. Gauge 22: patients with fragile veins
 VEIN SELECTION
• Start with distal veins and work proximally
• Veins that feel bumpy are usually thrombosed
or extremely valvular
• Watch out for arterial pulse if site chosen is
cephalic or inner aspect of forearm
• Sclerotic veins are common among narcotic
addicts
 VEIN SELECTION
• Avoid the following sites:
– Vein below a previous IV infiltration/phlebitis area
– Sclerosed or thrombosed veins
– Areas of skin inflammation, disease, bruising
– Arm affected by radial mastectomy, edema, blood
clot infection
– Arm with AV fluid shunt or fistula
 CHOOSE AN IV SYSTEM
TO IV CONNECTION
• Type of infusion
• Age and condition of patient
• Characteristics of the solution
• Rate of the fluid administration
 CHOOSING THE IV SITE
• Patients medical history
• Age, body size, weight
• Conditions of veins
• Type of fluid or medications to be infused
• Duration of therapy
• Skill at venipuncture
 IV SITE ASSESSMENT
• Note the location
• Site should be visually inspected and palpated
every 2hr.
• The IV site should be free of redness, swelling,
tenderness.
• The IV dressing should be clean and secure.
 VEIN DILATION
• Tourniquet – place 6 to 8 inches above the
venipuncture site
• Gravity – position the extremity below the
heart
• Fist clenching – open and close fist
• Warm compress – maximum of 10 mins
• Multiple tourniquet technique – use of 2-3
tourniquets (if needed)
 SITE PREPARATION
• Do not shave site. Remove hair with clippers
only
• Cleanse with one of the following solutions:
– 2% chlorhexidine gluconate
– Povidone-iodine
– 70% isopropyl alcohol
 CATHETER INSERTION
• Grasp the cannula or cannula wing
• Insert the cannula at 15˚ - 30˚ angle
• If with back flow, lower the cannula almost parallel to the skin
• Advance it slightly until the tip is in the lumen of the vein
• Release tourniquet
• Apply digital pressure beyond the cannula tip
• Stabilize the hub
• Withdraw needle with a swift continuous motion parallel to
the skin
• Dispose of needle immediately into sharp container
 SECURING THE CATHETER
1. Chevron Method
• Cut a strip of tape then place under the cannula
parallel to the hub, across the end of the tape
over the cannula
2. U Method
• Cut a strip of tape and place it under the hub of
the cannula. Bring each side of the tape up,
folding it over the wings of the cannula in a U-
shape
 SECURING THE CATHETER
3. H Method
• Cut 3 strips of tape and place one strip over each
wing of the cannula. Place the 3rd strip over the
wings perpendicular to the 1st and 2nd strip.
 COMPLICATIONS FROM
IV THERAPY
1. Infiltration
2. Thrombophlebitis
3. Circulatory overload
4. Air embolism
5. Catheter embolism
6. Infection of venipuncture site
7. Systemic infection
8. Speed shock – too fast giving IV bolus/IV push
9. Allergic reaction – tape burn
10.Pulmonary congestion
 PROCEDURAL PROBLEMS
ASSOCIATED WITH IV THERAPY
1. Fluctuating flow rate
2. Runaway IV
3. Sluggish IV
4. Tubing loose connection/disconnection
5. Blood back up in tubing/Back flow
6. IV line obstruction/kinking of IV tubing
7. Clogged filter
8. Break in aseptic technique
9. Leaks due to inappropriate device
 10 GOLDEN RULES FOR
DRUG ADMINISTRATION
1. Administer the right drug
2. Administer the right drug to the right patient
3. Administer the right dose
4. Administer the right drug by the right route
5. Administer the right drug at the right time
6. Document each drug you administer
7. Teach your patient about the drugs he is receiving
8. Take complete drug history
9. Find our if patient has any drug allergies
10.Be aware of potential drug-drug or drug-food interaction
Thank you all for listening!
Do you have any questions?