Intravenous Drug

Therapy
Chapter 3
 Intravenous drug
therapy
 Diagnostic
 Therapeutic

 Maintain patency of the intravenous

access
 Intravenous Infusion
Therapy
 Fluid and electrolyte balance
 Acid-base balance
 1. replace fluids, electrolytes,
calories, nutrition
 2. provide fluid, electrolytes, calories
or nutrition to maintain homeostasis
 3. transfuse blood and blood
products
 4. administer medications
 Osmotic pressure
 Hydrostatic pressure
 Force water places against vessel walls
or capillary membrane

 Osmotic pressure
 Amount of hydrostatic pressure required
to move particles and fluids in & out of
vascular volume
 Osmolality
 Measure of solute particles
 Normal human serum or plasma
 280 to 295 mOsm/kg
 Less than normal
 Fluid volume deficit
 Greater than normal
 Fluid volume excess
 According to Tonicity or
Osmolality of the Fluid
 1. Isotonic
 Intravenous solutions have the same
osmolality as body fluids and do not
alter plasma osmolality
 Fluid remains in the vascular space

 240 to 340 mOsm/kg (50)

 Replacement therapy

 Maintenance (serum osmotic pressure)

 Hypertonic Solutions
 Greater than 340 mOsm/kg
 Higher solute concentration in the
plasma
 Solutions cause fluids to be pulled
from the cells into vascular
compartments
 Increase vascular volume and
dehydrate the cells causing them to
shrink
 Hypotonic Solutions
 Less than 240 mOsm/kg
 Move out of the capillaries----cells
 Swelling
 Intravenous solutions
 1. colloids
 2. crystalloids
 3. hydrating solutions
 4. hypertonic hyperosmolar solutions
 5. blood and blood products
 Colloids
 Increase colloid osmotic pressure
(oncotic pressure) by having greater
molecular weight in protein and pull
fluids from the interstitial and
intracellular vascular spaces

 Hypertonic solutions
 Plasma or volume expanders
 Albumin, dextran, plasmanate,
hetastarch
 Colloids
 Hypotension
 Protein depletion
 Expand intravascular volume

 Disadvantage
 Cause intravascular fluid overload
 Crystalloids
 Solutions that create osmotic
pressure by the movement of
dissolved ions
 Freely cross the semi permeable
membrane of the vessel walls into
interstitial spaces
 Do not cross the cellular membranes
 Isotonic
 Volume expanders
 Hydrating Solutions
 Supply caloric intake
 Nutrients
 Electrolytes
 Dextrose
 Most common electrolytes
 Potassium and chloride
Common Intravenous
Solutions
D5 & ¼ Normal saline
5% dextrose & .2 NaCl
Dextran D5W 5%
40 & 0.9 NS dextrose in water

Dextran Dextran
40 & D5 W Isotonic 70 & 0.9 NS

NS
Lactated Ringer’s
0.9 NaCl
Ringer’s Solution
 Common Intravenous
Solutions
Plasma Expanders

Dextran 70 & 0.9%NS

308 mOsm/L

Dextran 40 & 0.9% NS

308 mOsm/L

Dextran 40 & D5 W
255 mOsm/L
Hypertonic Solutions
Hypertonic Solutions

D5 and ½ NS
D10 W
391 mOsm/L
505 mOsm/L

D20W D5 0.9 NaCl

1.011 mOsm/L 560 mOsm/L

D30W D5 Ringer’s Solution

1,510 mOsm/L 564 mOsm/L

D40W D5LR
2020 mOsm/L 524 mOsm/L

D50W
D10LR
2520 mOsm/L
779 mOsm/L

D60W D70W
3030 mOsm/L 3530 mOsm/L
 Hypotonic Solution
 ½ NS – 0.45 NaCl
 154 mOsm/L
IV Site/s
IV Site/s
IV Site/s
 Most Common
Complications
 A. Infiltration
 B. Extravasation
 C. Thrombophebitis
 D. Pain
 E. Fluid overload
 F. Pyrogenic reaction
 G. Tissue necrosis
 Infiltration
 Occurs when the needle becomes
dislodged from or pierces the vein or
from weak, overextended, stretched
veins, permitting fluid to collect in
the tissues surrounding the vein

 Discontinue the infusion and restart

using sterile needle in another site
 Infiltration
 Signs of Infiltration:
 Swelling
 Pain

 Coolness of the skin

 Loss of intravenous fluid flow

 Extravasation
 Fluid being infused escapes from the
vein into surrounding tissues
 May occur when the infusion is
running too rapidly
 Check to see if the needle is still
within the vein
 Special measures
 Vesicant/antineoplastic drugs
 Extravasation
 If extravasations occur:
 Stop infusion
 Apply cold compress

 Document the date and time of the

event
 Needle type and site (insertion site)

 Take note for the drug/fluid being

infused
 Thrombophlebitis
 Formation of blood clot and
inflammation of the vein
 Pain, heat, redness, swelling, loss of
motion in severe cases
 Discontinue infusion
 Place warm moist packs on the area
 Pain
 Occurs hen irritating drugs such as
POTASSIUM CHLORIDE are being
infused, especially when superficial
veins are used and or medications is
infused rapidly or is inadequately
diluted
 Check for tension, gently move the
hub
 Check the rate of flow
 Change to larger vein
 Fluid Overload
 Overload of the circulatory system which
may be due to he excessive fluid or too
rapid infusion of fluid
 Common in children
 Patient may have:
 Moist respiration
 Dyspnea
 Cough
 Slow the infusion
 Central venous pressure monitoring
 Pyrogenic reaction
 The development of fever and chills
 Nausea, vomiting and headache

 Results of introducing pyrogens or

substances like bacteria which
causes fever
 Tissue Necrosis
 Tissue damage with breakdown and
sloughing which occurs following
infiltration of infusions containing
some toxic drugs like
 Antibiotics
 Antineoplastics

 Norepinephrine bitartrate
 Applying The nursing
process
 1. Assessment
 Right intravenous fluids
 Date on the tubing 48-96 hours

 Right rate

 Absence of kinks

 Date on the access devise – 48-72 hours

 Check for pain, redness, warmth or

coolness & swelling
 Before administering IV
Meds:
 Right client
 Right medication
 Right dose
 Right route
 Right time
 Right documentation
 Right to refuse
 Indications of effectiveness
 Presence of adverse effects
 Need for client teaching
 Administration Through A
special Administration
Chamber
 Soluset or Buretrol
Administration by
Piggybank
 ADMINISTRATION
BY AN IV PUSH OR BOLUS
THROUGH A PRIMARY
INTRAVENOUS SETUP

 SLOWLY OVER A PERIOD OF 1 – 7

MINUTES
Administration by IV push
through an IVAD or saline
lock
 Electronic Infusion
Devices
 Maintain patency of the Intravenous
access
 Provide more accurate flow