Intravenous Therapy

Ma. Victoria J. Recinto RN, USRN

University of the Philippines Manila
Philippine General Hospital

Types of Solutions

Isotonic
Hypotonic
Hypertonic
Crystalloids (with e+)
Colloids (Plasma expanders)
Pull fluid from IS to IV compartment
vascular volume rapidly (hemorrhage or
severe hypovolemia)
E.g. Dextran & Albumin

IV Devices
Cannulas (for short infusion time)
Steel needles (Butterfly sets)
(Plastic or rubber) Wing-tip needle with metal cannula
Plastic catheter or hub
0.5-1.5 in length, G16-26
Infiltration is more common
For children & older pts (small/fragile veins)
Plastic
Over-the-needle: preferred for rapid infusion & more
comfortable for the pt
In-needle: can cause cath embolism

IV Gauges
The smaller the gauge, the larger the
outside diameter
Large gauges: for higher fluid rate &
concentration of solns
Emergency fluid infusion, blood or
anesthetics: G 14, 16, 18 or 19
Peripheral lipids: G 20-21
Standard IVF: G 22-24
Pt with small veins: G 24-25

IV Containers
Glass or plastic
Squeeze the plastic bag, check
the glass bottle for cracks
before hanging
Dont write on the plastic IV bag
with a marking pen (ink is
absorbed), use a label

IV Tubings
Parts: spike end, drop chamber, roller
clamp, Y-site & adapter
Extension tubing: for children &
restless pt
Shorter secondary tubing: for
piggyback
Special tubing: for meds that absorbs
into plastic

IV Tubings
Air vent: allows air to enter IV
container as the fluid leaves
Vented adapter: for glass or
rigid IV container
Nonvented tubing: may use
vented adapter, for flexible
container

IV Tubings
Drip chambers
Macrodrip
10-20 gtts/min
For thick solns, rapid infusion

Microdrip
60 mgtts/min
For slow IV rates: <50cc/hr
For pedia pts, titrated solns

IV Tubings
Filters
Prevent particles from entering the vein
To trap undissolved antibiotics, salt or
precipitate
Most IVF: 0.22 m
For lipids & albumin: 1.2 m
For blood: Special filter
Changed q 24-72 hrs to prevent infection

 Needleless Sytems
Recessed needles, plastic cannulas,
one-way valves
No TPN & BT through one-way valves
Intermittent infusion sets
For IV push meds or IV piggyback
With IV lock, kept patent by NS flush
or heparinized NS flush

Latex Allergy
IV supplies may contain latex
(cath, tubings, ports, rubber
stoppers on vials, adhesive tape
& gloves)
Use latex-safe IV supplies
Use 3-way stopcocks rather than
IV lock/rubber injection ports

Selection of a Peripheral IV site

Hand, forearm (natural support & splint) &
antecubital fossa
LE: at risk for thrombus formation & pooling
of IVF/meds in areas with venous return
Scalp & feet: for infants
Use distal to proximal veins
Use nondominant extremity, away from
areas of flexion
No BP/restraints on arm with IV access

Central Venous Catheter

Used to: deliver hyperosmolar solns, measure
CVP, infuse TPN or multiple IV infusions or
meds
Placement is determined by x-ray
Peripheral insertion: through basilic or cephalic
vein into SVC
Central insertion: though internal jugular or
subclavian vein
Surgically tunneled through SQ into cephalic
vein

Central Venous Catheter

May have single, double or triple lumen
Multilumen cath: more than 1 meds can be
administered at the same time without
incompatibility problems; one insertion site
requires care
For central line insertion, tubing change &
line removal: place the pt in Trendelenburg or
supine position, instruct the pt to do Valsalva
maneuver (to pressure in central veins
when IV system is open)

Tunneled Central Venous Catheter

More permanent (e.g. Hickman, Broviac,
Groshong) for long-term IV tx
Inserted in the OR, threaded to the lower
part of SVC at the entrance of RA
Fitted with an intermittent infusion device
to allow access as needed & to keep the
system closed & intact
Patency is maintained by flushing with a
diluted heparin or NSS

Vascular Access (Implantable) Ports

Surgically implanted under the skin (e.g.
Port-a-Cath, Mediport, Infusaport) for
long-term, repeated IV tx
For access, requires palpation &
injection through the skin into the selfsealing port with a noncoring needle
(Huber-port needle)
Patency is maintained by flushing with a
diluted heparin or NSS

Peripheral-Inserted Central Catheter

(PICC) line
For long-term IV tx especially at home
The basilic vein is usually used, median cubital &
cephalic veins in the antecubital area can be used
The catheter is threaded up to the subclavian vein
or the SVC
A small amt. of bleeding may occur at the time of
insertion & may continue for 24 hrs
Common Cx: phlebitis
Air embolism is not common (insertion is below
heart level)

Administration of IV solns
Use sterile technique
Change venipuncture site q 48-72
hrs, IV dressing q 72 hrs (when
wet & contaminated), IV tubing q
24-72 hrs, IV bottle q 24 hrs
Label tubing, dresing & soln bags
clearly (date & time changed)

Precautions for IV lines

Check for drug & IVF
incompatibilities
CHF pt: no plain NS
DM pt: no dextrose (glucose)
solns
RF: no plain LR

Complications: Infection

With prolonged the IV tx

At risk: immunocompromised pt
Local S/Sx: redness, swelling, drainage at site
Systemic S/Sx: chills, T, HR, malaise, HA,
N/V, backache,
Use antimicrobial ointment at the IV site
d/c IV, place at sterile gauze over device for
possible culture, notify MD
Restart IV in the opposite arm to differentiate
systemic from local infection

Complications: Tissue Damage

Involves skin, veins & SQ
S/Sx: skin color changes, sloughing
of the skin, discomfort at site
Be careful & gentle when using
tourniquet
Dont tap the skin over the vein
during IV insertion
Check for latex or tape allergies

Complications: Phlebitis &

Thrombophlebitis
Phlebitis: from mechanical or chemical
trauma or from local infection
S/Sx (Phlebitis): heat, redness, tenderness
at site, not swollen or hard, sluggish IV
infusion
S/Sx (Thrombophlebitis): hard, cord-like vein
Use an IV cannula smaller than the vein
Avoid using small veins for administrating
irritating solutions

Complications: Phlebitis &

Thrombophlebitis
Avoid using LE as IV access area
Avoid venipuncture over area of flexion
Use an armboard or splint if pt is
restless or active
If phlebitis occurs: never irrigate IV
catheter, remove IV access & restart it
in the opposite extremity
Apply warm, moist compress

Complications: Infiltration
(Extravasation)
Seepage of IVF out of the vein & into
surrounding interstitial spaces
Occurs when IV access becomes dislodged
or perforates the vein
S/Sx: edema, pain & coolness at site, with or
without blood backflow
If it occurs, remove IV access, elevate the
extremity, apply warm or cool compress as
ordered
Dont rub the area to prevent hematoma

Complications: Catheter embolism

Tip of catheter breaks during IV insertion or
removal
S/Sx: BP, LOC, pain along vein, weak
rapid pulse, cyanosis
Remove & inspect the catheter carefully
If it occurs, place a tourniquet high above
the limb, notify MD, obtain an x-ray &
prepare the pt for surgical removal of the
catheter pieces as prescribed

Complications:
Circulatory Overload
Rapid administration of IVF to high risk pts
S/Sx: HTN, JVD, RR, dyspnea, moist cough
& crackles
Calculate & monitor the flow rate frequently,
add a time strip to IV bag/bottle
Use an infusion pump
If it occurs, IV rate to KVO, head of bed,
keep the pt warm, assess lung sounds & for
edema & notify MD

Complications:
Electrolyte Overload

Rapid administration or inappropriate IVF

S/Sx depends on e+ imbalance
Assess lab results
Verify correct soln, place a meds sticker
to bottle if with additives (e.g. KCL)
Calculate & monitor the flow rate
frequently, add a time strip to IV bag/bottle
Use an infusion pump

Complications:
Hematoma
Collection of blood in the tissues
S/Sx: ecchymosis, immediate swelling &
leakage of blood & hard, painful humps at the
site
Do not apply tourniquet to the extremity
immediately after an unsuccessful venipuncture
When removing IV access, apply pressure for
at least 1 min, elevate extremity & apply ice as
ordered

Complications: Air Embolism

A bolus of air that enters the vein through an
inadequately primed IV line, from loose connection,
during tubing change or removal of IV access
S/Sx: BP, HR, LOC, dyspnea, cyanosis
Prime tubing with fluid before use, monitor for air
bubbles in the tubing
Secure all connections
Replace IV fluid before bag or bottle is empty
If it occurs: clamp the tubing, turn the pt on the L
Trendelenburg position & notify MD