INTRAVENOUS

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THERAPY

Prepared By:
3/21/13

Melbert B. Reyes RN, RM, MAN

Intravenous therapy
Intravenous Therapy or IV therapy is the administration of liquid substances (fluids, electrolytes, nutrients, blood products, medications) directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. The word intravenous simply means within a vein , but is most commonly used to refer to IV Therapy.

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Intravenous therapy
INDICATIONS:

Establish or maintain a fluid or electrolyte

balance
Administer continuous or intermittent

medication
Administer bolus medication Administer fluid to keep vein open
Administer blood or blood components

Administer intravenous anesthetics

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Maintain or correct a patient's nutritional state

INTRAVENOUS
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FLUIDS

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Types of iv fluids
ISOTONIC
Osmolarity is similar to that of serum. These fluids remain intravascularly momentarily, thus

expanding the volume.

Helpful with patients who are hypotensive or

hypovolemic.

Risk of fluid overloading exists. Therefore, be careful

in patients with left ventricular dysfunction, history of CHF or hypertension. intracranial pathology or space occupying lesions.

Avoid volume hyperexpansion in patients with

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Types of iv fluids
HYPOTONIC
Less osmolarity than serum (meaning: in general less sodium

ion concentration than serum)

These fluids DILUTE serum thus decreasing osmolarity. Water moves from the vascular compartment into the interstitial

fluid compartment interstitial fluid becomes diluted osmolarity decreases' water is drawn into adjacent cells.

These are helpful when cells are dehydrated from conditions or

treatments such as dialysis or diuretics or patients with DKA (high serum glucose causes fluid to move out of the cells into the vascular and interstitial compartments). intravascular space to cells can cause cardiovascular collapse and increased ICP in certain patients.

Caution with use because sudden fluid shifts from the

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Types of iv fluids
HYPERTONIC
These have a higher osmolarity than serum. These

fluids pull fluid and sometimes electrolytes from the intracellular/interstitial compartments into the intravascular compartments. urine output, correcting hypotonic hyponatremia and decreasing edema.

Useful for stabilizing blood pressure, increasing

These can be dangerous in the setting of cell

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dehydration.

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INTRAVENOUS
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THERAPY

FLOW RATES
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FLOW RATES
You

will often need to calculate IV flow rates. The administration sets come in two basic sizes:
Microdrip sets: Allow 60 drops (gtts) / mL

through a small needle into the drip chamber

(Good for medication administration or pediatric fluid

delivery).

Macrodrip sets: Allow 10 to 15 drops (gtts)/mL

into the drip chamber

(Great for rapid fluid delivery. Also used for routine

fluid delivery).

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FLOW RATES
mL/hour

Infusion Rate:

Total volume to infuse Number of hours to infuse For example: If 1000mL is to infuse over 8O ?
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FLOW RATES
Actual

Infusion Rate (drops/minute)

Total volume to infuse X drop factor No. of hours to infuse X (minutes) For example: If 1000mL is to infuse over 8O given a administration set calibrated at
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FLOW RATES
Actual

Infusion Rate (drops/minute)

mL/hour infusion rate X drop factor 60 minutes For example: If 1000mL is to infuse over 8O given a administration set calibrated at
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INTRAVENOUS
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THERAPY

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VENIPUNCTURE SITES

Vein Anatomy and Physiology

Veins are unlike arteries in that they are 1)superficial, 2) display dark red blood at skin surface and 3) have no pulsation
Vein Anatomy
Tunica Adventitia

Tunica Media Tunica Intima Valves

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Tunica Adventitia
the outer layer of the vessel

Connective tissue Contains the arteries and veins supplying blood to vessel wall

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Tunica Media
the middle layer of the vessel

Contains nerve endings and muscle fibers The vasoconstrictive response occurs at this layer

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Tunica Intima
the inner layer of the vessel

nOne

layer of endothelials nNo nerve endings nSurface for platelet aggregation w/ trauma and recognition of foreign object at this level n PHLEBITIS begins here

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VENIPUNCTURE SITE:

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VENIPUNCTURE SITE:

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INTRAVENOUS
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THERAPY

preparations
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Intravenous therapy
INITIATION

Physicians Order Patient Assessment IV Set and Equipment Preparation Medications

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Physicians order
Initiation The

is based upon the written order of a licensed physician. order must indicate:
Patients name Type and amount of solution Flow rate Type, dose, frequency medications to be

incorporated/pushed.
Orders affecting the procedure
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Patients assessment
Clinical Patient

Status of the patient

Diagnosis

Patient Age Patient Weight Dominant Arm Condition Cannula Type

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of the vein/skin

size

of solution

Choosing the right vein

Prioritize Begin

the ideal veins for venipuncture

with distal veins

Watch out for bifurcated on branched veins Do not perform venipuncture at the palm side of the wrist and cephalic veins of the wrist Palpate for arterial pulse in order to avoid puncturing the arteries if the site chosen is cephalic on the inner aspect of the arm Other sites to be avoided:
below a previous IV infiltration

Veins 3/21/13

EQUIPMENT preparation
Check Check Check Label

for expiration date for clarity

label against physicians written prescription any medications added of equipment

Functionality

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VENIPUNCTURE TECHNIQUES
Vein Site

Dilatation Insertion the Catheter

Preparation

Catheter Securing

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REMINDER
Always

apply a label after securing the

catheter
On

the label, write the following:

Date of insertion Time Type of catheter used

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INTRAVENOUS
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THERAPY

equipment
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INTRAVENOUS
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THERAPY

PROCEDURES
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SETTING up:
Verify written prescription and make IV label. Observe ten (10) Rs when preparing and administering IVF.
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SETTING up:
Explain procedure to reassure patient and/or significant other, secure consent if necessary. Assess patients vein; choose appropriate site, 3/21/13

SETTING up:
Do hand hygiene before and after procedure. Gather and Prepare necessary materials for the procedure. (IV Therapy Tray) 3/21/13

SETTING up:
Check the sterility and integrity of the IV solution, IV set and other devices. Place IV label on IVF bottle signed by 3/21/13

SETTING up:
Open IV administration set aseptically following the infection control. Open the IV administration set aseptically and close the 3/21/13

SETTING up:
Fill drip chamber to at least half and prime it with fluid aseptically. Expel air bubbles if any and put back the cover to the distal end of the IV 3/21/13

IV insertion:
Verify the written prescription for IV therapy; check prepared IVF and other things needed. Explain procedure to 3/21/13

IV insertion:
Do hand hygiene before and after the procedure. Apply gloves. Choose site for IV. Promote vein dilatation.
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IV insertion:
Apply tourniquet 5 to 12cm. (2-6 inches) above injection site depending on condition of patient. Check for radial pulse below tourniquet. 3/21/13

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IV insertion:
Prepare site with effective topical antiseptic according to hospital policy or cotton balls with alcohol in circular motion and allow 30 seconds to dry. (No 3/21/13 touch technique)

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IV insertion:
Upon backflow visualization, continue inserting the catheter into the vein. Position the IV catheter parallel to the skin. Hold 3/21/13

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IV insertion:
Slip sterilize gauze under the hub. Release the tourniquet; remove the stylet while applying digital pressure over the catheter with one finger about 1-2 inches from the 3/21/13 tip of the inserted

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IV insertion:
NOTE: When steel-winged needle is used: Connect the IV tubing to the steel-winged needle connector and prime the needle with IV fluid. Using the steel-winged 3/21/13

IV insertion:
Open clamp and regulate the flow rate. Reassure patient. Anchor needle firmly in place with the use of: (a) transparent tape/dressing 3/21/13

IV insertion:
NOTE: Never place unsterile tape directly on the IV insertion site. Instead, place a small piece of sterile OS and then secure it with adhesive
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IV insertion:
Tape a small loop of IV tubing for additional anchoring. Apply splint, if needed. Calibrate the IVF bottle and regulate flow of 3/21/13

IV insertion:
Label on IV tape near the IV site to indicate the date of insertion, type and gauge of IV catheter and countersign. Label with plaster on the 3/21/13

IV insertion:
Observe patient and report any untoward effect. Document in the patients chart and endorse to incoming 3/21/13

Changing an iv solution:
Verify doctors prescription in doctors order sheet; countercheck IV label, IV card, infusate sequence, type, amount, additives (if any), and duration of 3/21/13 infusion.

Changing an iv solution:
Explain procedure to reassure the patient and significant others and assess IV site for redness, swelling, pain, etc. Change IV tubing and 3/21/13

Changing an iv solution:
Prepare necessary materials; place on an IV tray. Check sterility and integrity of IV solution.
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Changing an iv solution:
Wash hands before the procedure. Calibrate new IV bottle according to duration of infusion as per prescription. 3/21/13

Changing an iv solution:
Open and connect the IV tubing into the solution bottle. Close the roller clamp.
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Regulate the flow rate

Changing an iv solution:
Reiterate assurance to patient and significant others. Discard all waste materials.
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discontinuing an iv solution:
Verify written doctors order to discontinue IV including IV medications. Observe 10Rs
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Assess and inform the

discontinuing an iv solution: Prepare the necessary materials.

Wash hands before and after the procedure.
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Close the roller clamp of

discontinuing an iv solution: Moisten adhesive tapes around the IV catheter with cotton ball with alcohol; remove plaster gently.
Using pick-up forceps to 3/21/13

discontinuing an iv solution: Inspect IV catheter for completeness.

Place dressing over the venipuncture site.
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Discard all waste

discontinuing an iv solution: Reassure patient.

Document time of discontinuance, status of insertion site and integrity of IV catheter and endorse accordingly. 3/21/13

END.

THANK YOU!!!

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