Intravenous

therapy
Intravenous therapy

 It is a efficient and effective method of

supplying fluids directly into the
intravascular fluid compartment and
replacing electrolyte losses
Indication


 Establish or maintain a fluid or electrolyte balance

  Administer continuous or intermittent medication
  Administer bolus medication
  Administer fluid to keep vein open (KVO)
  Administer blood or blood components
  Administer intravenous anesthetics
  Maintain or correct a patient's nutritional state
  Administer diagnostic reagents
  Monitor hemodynamic functions 
The Proportion of Body Fluids
vIntracellular fluid

-40%
vInterstitial

-15%
vIntravascular

-5%
vTranscellular

-1-2%
The Intracellular Fluid

vFound inside the cell surrounded by

a membrane.
v
vThis is compartment with the
highest percentage of water in
adults.

The Extracellular Fluid
ØFluid found outside the cells



1. INTERSTITIAL FLUID
ØFound in between the cells

2. INTRAVASCULAR FLUID
ØFound inside the blood vessels
and lymphatic vessels

3. TRANSCELLULAR FLUID
ØFound inside body cavities like
pleura, peritoneum, CSF
The Concept of TONICITY
vThis is the concentration of solutes in a
solution.
vA solution with high solute concentration
is considered as HYPERTONIC.
vA solution with low solute concentration
is considered as HYPOTONIC.
vA solution having the same tonicity as
that of body fluid or plasma is
considered ISOTONIC.
v
Helpful Hints

 In a HYPERTONIC solution, fluid

will go out from the cell, the cell
will shrink.
In a HYPOTONIC solution, fluid will
enter the cell, the cell will swell.
In an ISOTONIC solution, there
will be no movement of fluid.

Isotonic
having same concentration of solute
as blood plasma
use to restore vascular volume
examples ( 0.9 Nacl/Normal Saline
Solution, Lactated Ringer’s/ a
balanced electrolyte solution, 5%
dextrose in water

visotonic solutions such as NSS and LR
initially remain in the vascular
compartment, expanding vascular
volume . assess clients carefully for
signs of hypervolemia (bounding pulse
and shortness of breath
vD5W is isotonic on initial administration
but provides free water when dextrose
is metabolized , expanding intracellular
and extracellular fluid volumes. Avoid in
clients at risk for increase ICP because
it can increase cerebral edema.
v
vHave a greater concentration of solutes
than plasma
vIt draw fluid out of the intracellular and
interstitial compartments to vascular
compartment, expanding vascular
volume. Do not administer to clients
with kidney or heart disease or clients
who are dehydrated. Watch for signs
and symptoms of hypervolemia
vExamples; 5% dextrose in normal
saline/D5NSS, 5% dextrose in 0.45%
Nacl, 5% dextrose in lactated Ringer’s /
D5LR
Hypotonic
vHave lesser concentration of
solutes
vUsed to provide free water and
treat cellular dehydration
vIt promote waste elimination by the
kidneys. Do not administer to
client at risk for IICP or third-
space fluid shift.
vExamples ( 0.45% NaCl, 0.33 Nacl)
v
Volume expanders
vUsed to increased the blood volume
following severe loss of
blood(hemorrhage), loss of plasma
from bloodstream (e.g., severe
burns, draw large amount of
plasma from the bloodstream to
the burn site)
vExamples of expanders are
dextran, plasma, and albumin
Venipuncture site


vIt varies with client’s age, length of time the

infusion is to run, type of solution used, and
the condition of veins.
vFor adults, vein in the hand and arm are
commonly used
vFor infants, veins n the scalp and dorsal foot
are often used
vLarger veins are preferred for infusions that
need to be given rapidly and for solutions that
could be irritating. (e.g., medications )
v
Vein selection


vUse distal veins of the arm first

vUse the client’s nondominant arm
whenever possible
vSelect a vein that is
vEasily palpated and feels soft and full
vNaturally splinted by bone
vLarge enough to allow adequate
circulation around the catheter
v
vAvoid using veins that are
vIn areas of flexion (atecubital fossa)
vHighly visible, because they tend to roll away
from the needle
vDamaged by previous use, phlebitis, infiltration,
or sclerosis
vContinually distended with blood, or knotted or
tortuous
vIn a surgically compromised or injured
extremity (e.g., following a mastectomy),
because of possible impaired circulation and
discomfort for the client
Veins of the Hand

1. Digital Dorsal
veins
2. Dorsal Metacarpal
veins
3. Dorsal venous
network
4. Cephalic vein
Veins of the
Forearm

1. Cephalic vein
2. Median Cubital vein
3. Accessory Cephalic
vein
4. Basilic vein
5. Cephalic vein
6. Median antebrachial
vein

Equipment
vInfusion set
vSterile parenteral solution
vIv pole
vAdhesive or nonallergic tape
vClean gloves
vTourniquet
vAntiseptic swabs
vIntravenous catheter
vSterile gauze
vArm splint, if required
vTowel pad
Starting an infusion
vPrepare the client
vPerform hand hygiene
vOpen and prepare the infusion set
vSpike the solution container
vApply a medication label to the solution
container if a medication is added
vApply the timing label on the solution
container
v
Starting an infusion
 Hang the solution container on the
polePartially fill the drip chamber with
solution
 Prime the tubing
üAir bubbles smaller than 0.5ml usually do not
cause problems in peripheral lines
 Perform hand hygiene again just prior to
client contact
Starting an infusion
 Select the venipuncture site
üUse the non dominant hand


 Dilate the vein



 Put on clean gloves and clean the

venipuncture site

Starting an infusion
 Insert the catheter and initiate the infusion
 Tape the catheter
 Dress and label the venipuncture site and
tubing according to agency policy
 Ensure appropriate infusion flow
 Label the IV tubing

48-72 hours
 Document relevant data, including
assessment
Monitoring an intravenous
infusion
 Ensure that the correct solution is being
infused
 Observe the rate of flow every hour
 Inspectthe patency of the IV tubing and
catheter
 Inspect the insertion site for fluid
infiltration
 If the infiltration involves a vesicant drug, it
is called extravasation, consider an
emergency. Stop the infusion
 If infiltration is not evident but the infusion
is not flowing, determine whether the
needle is dislodge from the vein
 Inspect the intravenous site for bleeding
 Teach the client ways to maintain the
infusion system
 Document all relevant data
Systemic complication
 Fluid overload
 Air embolism
 Septicemia and other infection

Fluid overload
 Decrease the IV rate
 Monitor vital sign
 Assess breathsounds
 Place the patient in a high fowler’s position
 Refer to physician

Air embolism
 Immediate clamping of cannula
 Place he patient on left side in
trendelenberg position
 Assess the vital sign
 Administer oxygen
Septicemia and other infection
 Treatment is symptomatic
 Culturing of the cannula
 Administer new IV site for medication or
fluid administration
 Prevention includes;
üCareful hand hygiene before every
contact with any part of the infusion
üUse strict aseptic technique