MIDTERM: IV Therapy
Basic intravenous therapy
-90 to 95% of patients in the hospital received some type of
intravenous therapy.
Intravenous therapy
-it is the infusion of fluid into vein.
-The therapeutic goal is maintenance, replacement,
treatment, diagnosing, and palliation. (Supportive treatment
which relieves but not cured disease e.g. DM)
Venipuncture
-is sterile technique that permits insertion of a needle or a
catheter into a vein.
Purposes of IV therapy
 to provide parenteral nutrition
 to provide avenue for dialysis
 to transfused blood products
 to provide avenue for hemodynamic monitoring
 to provide avenue for diagnostic testing
 to administer fluids and medications with the ability
to rapidly/accurately change blood concentration
levels by either continuous, intermittent or IV push
method.
Starting a peripheral IV
 finding a vein can be challenging
o go by "feel", not by sight. Good veins are
bouncy to the touch, but are not always visible.
o Use warm compresses and allow the arm to
hang dependently to fill veins.
o A BP cuff inflated to 10mmHg below the known
systolic pressure creates the perfect tourniquet.
Arterial flow continues with maximum venous
constriction.
 -If the patient is not allergic to latex, using a latex
tourniquet may provide better venous congestion.
o Avoid areas of joint flexion
o start distally and use the shortest
length/smallest gauge access device that will
properly administer the prescribed therapy.
IV administration
-Administer into circulatory system.
-Large volume infusions: 250 ML to 1000 ML
-Bolus injection: IV push
-Volume controlled infusions: 50 ML to 250 ML
-piggyback
-volume-control set
-mini–infusion pump
Isotonic solution
 an isotonic solution has an osmolarity equal to that
of serum. Because it stays in the intravascular space,
it expands intravascular compartment.
Isotonic: concentration most like blood!!!
Hypotonic solution
 has lower concentration than the body fluids.
 These are foods that have a m pressure than the cell.
It causes body fluids to shift out of the blood vessels
and into the cells and interstitial space.
 They are administered for cellular hydration e.g. 1/2
NS, 0.45% NaCl, 0.33% NaCl.
Hypertonic solution
 has higher concentrations in body fluids. Examples
are: D10W, D50W, D5LR, D5NS.
 Have a greater concentration of solutes than plasma.
Isotonic solutions-have an osmotic pressure equal to that of
the cells of the body.
Hypotonic solutions-have a lower osmotic pressure than that
of the body cells.
Hypertonic solutions have an osmolarity higher than that of
serum. It draws fluid into the intravascular compartment
from the cells and interstitial compartment.
Overview: IV insertion
 use needle with catheter sheath
-20 to 22 gauge typical for adult
-if blood transfusion is anticipated, use 18 or 20
gauge.
 Most IV solution sets deliver 15 drops per ML
(Macrodrop) or 60 drops per ML (Microdrop)
 IV solution should be clear; cloudy solutions may
indicate contamination.
  Antecubital fossa: suitable for blood
IV sites sampling and short-term infusion due to
 Peripheral position.
 metacarpal: top of the hand  Legs, feet and ankles: requires medical
 Basilic and cephalic typically used on approval as mobility is reduced and
forearm circulation can be compromised.
 use most distal part first  The dorsum of the food and the saphenous
 consider type of solution to be infused vein of the ankle are the best sites to try as
 Central necessary.
 IVs inserted into subclavian or jugular vein Precautions for IV sites
 avoid
Factors to consider  bony prominences
 for IV therapy that is to continue for several days,  legs and feet
start with the most distal location available and  mastectomy arm
move up as necessary.  operative arm
 For an obese patient, that hand veins may be the  injured arm
only accessible site.
 -The cephalic vein can offer a comfortable site in a Sites to avoid:
thin patient, if placed to avoid interfering with  Veins below previous IV infiltration or phlebetic sites
flexion.  sclerosed or thrombosed veins
 areas of skin inflammation, bruising or breakdown.
 Proficiency is achieved by:  An arm infected lymphedema, node dissection after
 practicing on real patients and all types of mastectomy, thrombosis, cellulitis or infection.
arm sites.
 Observe the procedure several times, then Documentation IV start
try to yourself under supervision.  number of attempts
 Ask for feedback  type of fluid/saline lock
 do not be discouraged by feel euros you may  insertion site
have a few.  type and size of catheter or needle
 Cardinal rule: do not persist after 2 unsuccessful  flow rate
attempts on the same patient. Get a more  response to IV
experienced member of staff to help.  record response to IV fluid, amount refused integrity
and patency of system every 1 to 2 hours.
Choosing the site:
ADULT PATIENT Preparation for IV
 veins in the hands may be a good 1st choice. 1. Check physician order
Allows for availability of most proximal sites 2. Check fluid, electrolyte, and nutritional status baseline
(dorsal and metacarpal veins) information to make comparison IV effectiveness
 lower arm veins are good for short term IV 3. Assess client understanding of reasons for procedure.
therapy. Leaves the patient's hands-free,  Assess clothing appropriateness (need wide sleeves)
larger armed veins do not become phlebetic  Assess veins
as quickly (cephalic & basilic veins). IV equipment
 Upper arm veins should only be used as a 4. Obtain Equipment
3rd choice, when all other veins have been -safety catheter needle
used. -tourniquet
-alcohol swabs
Factors to consider: -gloves
 Veins used as a last resort: -towel
 the inner aspect of the arm: painful site, -transparent dressing
prone to bruising, phlebetis and infiltration. -tape
-IV tubing and solution bag
-IV pole and or pump
Procedure for hanging IV fluid
 remove IV bag from protective cover
 check expiration date and assessment cloudiness
or leaks.
 Hang the IV bag on a pole
 remove the IV tubing from its bag
 close roller clamp
 spike the bag
 fill drip chamber 1/2 full
 open the roller clamp and prime tubing Starting IV
 close roller clamp and replace protective cap 1. Check client's ID bracelet
 label the tubing with date to be changed 2. Wash hands
 adjust roller clamp to appropriate drip or place into 3. Organize equipment at bedside within reach
IV pump and set rate 4. Set bed height for ease of nurse
5. Put towel under arm
6. Place tourniquet around upper arm
7. Palpate dilated veins
-hang arm down to dilate vein
-select site low on arm first

Prepare site and insert IV

-put on gloves
-clean the site (alcohol, then betadine-let dry)
-secure vein by placing some 2 to 3 inches below site and
gently stretching skin
-stick vein (15 to 30° angle) with bevel up
-watch for flashback in chamber

Insert catheter
-stabilize stylet and advance catheter
-loosen stylet from catheter
-release tourniquet
-hold thumb over vein above catheter tip
-remove stylet and attach IV tubing and put stylet in sharps
container
-connect tubing

Start IV
 start IV fluid at slow rate
 secure catheter
 transparent dressing over insertion site
  tape over hub of catheter (no tape near site of -frequent checking of the insertion site.
insertion) Intervention:
 label site with date, time and initials -remove IV cannula immediately
 label tubing with date to be changed -apply ice (early) or warm compress (late) to aid absorption.
 chart -Use recommended antidote or treatment for specific drug
 date, time, type and each of catheter, dressing extravasations.
type
 fluid attached as IV HEMATOMA
 clients reaction to procedure Definition: localize collection of extravasated blood, usually
clotted, in an organ or tissue.
IV flow rate Cause:
 nurse responsible for flow rate maintenance -blood leaking out of the vein into the tissue due to puncture
 can result in fluid overload leading to cardiovascular, or trauma.
renal or neurological impairment S&S:
 controlled by roller clamp, controller device for IV -swelling, tenderness and discoloration
pump, and affected by client position Prevention:
 controller device and roller clamp work with gravity -proper device insertion
(must be 36 inches above site) -pressure oversight on removal
Intervention:
Prevention of IV site infection -apply appropriate pressure bandage, monitor
-wash hands
-use sterile technique PHLEBITIS
-change IV solution every 24 hours Definition: inflammation of the vein
-change IV site every 48 to 72 hours Cause:
-change IV tubing every 48 hours -poor aseptic technique
-use gloves and sharps container -high osmolarity IV infusions or drugs
-check agency policy -trauma to the vein during insertion/incorrect cannula gauge
-prolonged use of the same site
Client education Symptoms:
TEACH -tenderness, redness, heat, and oedema
-S&S of infection or problems -advanced-induration, palpable venous cord.
-when to call for help Prevention:
-how to prevent IV from clotting or being pulled out -smooth insertion
-arm positioning -aseptic technique
-walk with IV pole -stabilization and secure taping of all tubing
-rotation of the site
INFILTRATION/EXTRAVASATION -replace loose and contaminated dressings
-dilution of drugs
-the most common cause is damage to the wall during Intervention:
insertion or angle of placement -remove cannula and apply warm compresses.
-Observe for signs of infection
Definition: diffusion or accumulation of inject of fluid into -if phlebitis is advanced antibiotics may be required
the subcutaneous space.
Cause: THROMBOPHLEBITIS
-cannula displaced out of the vein wall. Definition: formation of a thrombus and inflammation in the
S&S: vein, usually occurs after phlebitis
-swelling and pain Cause:
-slowing of the infusion -injury to the vein
-coolness of the skin -infection
Prevention: -chemical irritation
-appropriate selection of site and cannula -prolonged use of the same vein
-proper stabilization of the cannulation and tubing
S&S: -avoid increased venous pressure proximally to the cannula
-tenderness/redness (BP cuff)
-heat/edema Interventions:
-cord like appearance of the vein -check for kink in cannula
-slowing of the IV infusion -raise IV flask higher
Prevention: -remove cannula
-smooth insertion
-asepsis INFECTION
-stabilization of IV cannula from tubing Definition: pathogen in the surrounding tissue of the IV site
-correct administration of drugs Cause:
-change cannula frequently -lack of asepsis
Intervention: -prolonged use of the same site
-remove IV cannula S&S:
-observe for signs of infection -tenderness and swelling
-erythema/purulent drainage
VENESPASM Prevention:
Definition: spasm of the vein wall -frequent checking of the site
Cause: Intervention:
-anxiety -remove cannula
-cold IV fluids -antibiotics may be required
-drug irritation -documentation
-trauma to the vein during cannula insertion
S&S: CELLULITIS
-pain -inflammation of loose connective tissue around insertion
-slowing of the IV infusion site
-blanching of the insertion site -caused by poor insertion technique
-vein difficult to palpate -red swollen area spreads from insertion site
Prevention: outward in a diffuse circular pattern
-warm arm bath prior to cannula insertion -treated with antibiotics
-reassurance
-allow infusions to come to room temperature. SEPTICEMIA/PULMONARY EDEMA/EMBOLISM
Interventions:
-warm compress SEPTICEMIA:
-slow infusion rate -severe infection that occurs to the system or entire body
-reassurance -most often caused by poor insertion technique or poor site
care
OCCLUSION -discontinue device immediately, culture and treat
Definition: appropriately
-slowing or cessation of fluid infusion due to:
-fibrin formation in or around the tip of the cannula PULMONARY EDEMA-caused by rapid infusion
-mechanical occlusion (kink) of the cannula
Cause: PULMONARY EMBOLISM-caused by _____ free-floating
-cannula not flushed substances that required thrombolytic therapy for severe
-kinking of the cannula _____. Increased risk with lower ext.
-backflow or interrupted flow
S&S: AIR EMBOLISM-caused by air injected into IV system. Keep
-IV not running insertion site the low level of heart
-blood in the line
-discomfort
Prevention:
-check IV site regularly
-flushing of cannulae frequently