Professional Documents
Culture Documents
Intravenous Therapy
Intravenous Therapy
Marjorie Wiltshire, RN
:OBJECTIVES
Define key terms related to intravenous therapy.
Demonstrate the procedure for IV insertion,
conversion to a saline lock,
administration of IV fluids, discontinuation of the
IV
Identify possible complications of intravenous
therapy and nursing interventions to treat each.
Describe the nursing care of a patient that has a
saline lock, a continuous IV infusion, and
intermittent IV medication administration.
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
1. Peripheral catheter.
2. Peripherally inserted central catheter
PICC.
3. Central line.
4. Subcutaneous injection port.
Peripheral catheter
This is the most common intravenous access method in
both hospitals and pre-hospital services. A peripheral IV
line consists of a short catheter (a few centimeters long)
inserted through the skin into a peripheral vein (any vein
that is not inside the chest or abdomen). This is usually
in the form of a cannula-over-needle device, in which a
flexible plastic cannula comes mounted on a needle. Any
accessible vein can be used although arm and hand
veins are used most commonly, with leg and foot veins
used to a much lesser extent. On infants the scalp veins
are sometimes used.
Peripheral catheter
Peripheral catheter
The caliber of cannula is commonly indicated in gauge,
with 14 being a very large cannula (used in resuscitation
settings) and 24-26 the smallest. The most common
sizes are 16-gauge (midsize line used for blood donation
and transfusion), 18- and 20-gauge (all-purpose line for
infusions and blood draws), and 22-gauge (all-purpose
pediatric line). 12- and 14-gauge peripheral lines actually
deliver equivalent volumes of fluid faster than central
lines, accounting for their popularity in emergency
medicine. These lines are frequently called "large bores"
or "trauma lines".
IV site assessment
Note the location (hand, wrist, forearm, antecubital fossa?).
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.
Intervention
Stop IV infusion immediately and remove IV Catheter
Elevate Extremity
If noticed within 30 minutes of onset, apply ice to the site (this will decrease
inflammation)
If noticed later then 30 minutes of onset apply warm compress (this will encourage
absorption)
Notify Supervisor/Physician as per individual hospital policy
Document findings and actions
Restart IV in an alternative location (opposite extremity if possible)
Complications
Plebitis
Assessment
Redness
Swelling
Warmth
Pain along vein route
Vein is hard cordlike
IV may be sluggish
Interventions
Stop IV infusion immediately and remove IV Catheter
Elevate Extremity
If noticed within 30 minutes of onset, apply ice to the site (this will decrease inflammation)
If noticed later then 30 minutes of onset apply warm compress (this will encourage absorption)
Notify Supervisor/Physician as per individual hospital policy
Document findings and actions
Restart IV in an alternative location (opposite extremity if possible)
Complications
Infection - Local, Systemic
Assessment
Redness, swelling, pain at site
Pus at site
Fever, chills
Interventions
Prevention!! Adhere to policy for site change and site
care.
Use appropriate technique for IV starts and site care.
Once it occurs, involve physician, discontinue IV and
Rx infection per physician order
Complications
(systemic)
Air embolus:
Signs and Symptoms of Air Embolism include:
Abrupt drop in blood pressure
Weak, rapid pulse
Cyanosis
Chest Pain
Immediate corrective action for suspected Air Embolism includes:
Notify Supervisor and Physician immediately
Immediately place patient on left side with feet elevated (this allows
pulmonary artery to absorb small air bubbles)
Administer O2 if necessary
Preventive Measures to avoid Air Embolism includes:
Clear all air from tubing before attaching it to the patient
Monitor solution levels carefully and change bag before it becomes empty
Frequently check to assure that all connections are secure
Complications
(systemic)
speed shock
a sudden adverse physiologic reaction to IV medications or drugs
that are administered too quickly.
Some signs of speed shock are a flushed face, headache, a tight
feeling in the chest, irregular pulse, loss of consciousness, and
cardiac arrest.
Nursing interventions: notify physician immediately, patent IV for
fluids, reversal, emergency equipment and monitoring.
Six Rights of IV Fluid
Administration
IV push
Intermittent venous access device
Intermittent infusion (or piggyback)
Continuous infusion
Electronic pumps and controllers
Patient-controlled analgesia
Saline lock
Protocol:
Flush before and after each use
Flush every shift
Flush PRN
Basic IV Fluid set up
IV tubing
Microdrip:an apparatus for delivering relatively small
measured amounts of IV solutions at specific flow rates
over time, as when it is necessary to keep a vein open.
The size of the drops is controlled by the fixed diameter
of the plastic delivery tube. With a microdrip, 60 drops
delivers 1 mL of solution.
Macrodrip: an apparatus that is used to deliver
measured amounts of IV solutions at specific flow rates
based on the size of drops of the solution. The size of
the drops is controlled by the fixed diameter of a plastic
delivery tube. Different macrodrips deliver 10, 15, or 20
drops per milliliter of solution.
General guidelines for tubing
Change IV tubing, including piggyback
tubing, no more frequently than at 72 hour
intervals.
Change tubing used for blood or blood
products within 24 hours of completing
infusion.
Do not leave TPN fluids hanging more
than 24 hours