1

INTRAVENOUS
THERAPY
REPORTED BY: EMERGENCY ROOM
DEPARTMENT
 DEFINITION OF
2 INTRAVENOUS THERAPY
Intravenous (IV) therapy is the
insertion of a needle or
catheter/cannula into a vein, based
on the physicians written
prescription. The needle or
catheter/cannula is attached to a
sterile tubing and a fluid container to
provide medication and fluids.
 OBJECTIVES OF IVT TRAINING
PROGRAM

1) Define the roles and responsibilities of the

nurse in the administration of intravenous
therapy including documentation/evaluation.
2) Define the ethico-legal implication of IV
therapy within the scope of nursing practice
as stated in the nursing law.
3) Identify the appropriate sites for
venipuncture by strengthening the
knowledge of the anatomy and physiology of
the vascular peripheral and integumentary
system.
4) Observe principles of strict asepsis during
the actual implementation of the IVT
practice.
5) Recognize the clinical pathogens of
microorganisms to gain a better
understanding in the control of infectious
process as it relates to IVT practice.
6) Describe the steps in the procedure for
performing a venipuncture using various
techniques and IV catheters.
7) Identify drugs commonly administered
through IV therapy and understand the
significance of the therapeutic effects.
8) Explain the need for corrective and/or
replacement therapy in body fluids and
electrolyte disturbances.
9) Recognize the subjective and objective
symptoms which the patients may
experience during IV fluids, blood and
blood components and IV chemotherapy
administration with its potential for
anaphylaxis and execute the proper
nursing intervention.
10) Implement the nursing process in
administration of IVF, TPN, and IV
medications.
 INTRAVENOUS THERAPY
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Indications:

Fluid and electrolyte replacement

Administration of medicines
Administration of blood/blood products
Administration of Total Parenteral Nutrition
Haemodynamic monitoring
Blood sampling
 INTRAVENOUS THERAPY
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Advantages

Immediate effect
Control over the rate of administration
Patient cannot tolerate drugs / fluids orally
Some drugs cannot be absorbed by any
other route
Pain and irritation is avoided compared to
some substances when given SC/IM
Standard Policies and
Procedures
Key points prior to initiation of IVT:
1. Physicians prescribed treatment
Patients name
Type and amount of solution
The flow rate
The type, dose and frequency of
medications to be incorporated/pushed
Others affecting the procedures (x-rays,
treatments to the extremities, etc)
2. Patient assessments
Clinical status of patient
Patient diagnosis
Patients age
Dominant arm (non)
Condition of vein/skin
Cannula size
Type of solution
Duration of therapy
3. IV set and equipment preparation
Check for expiration date
Check for clarity; any presence of holes on
plastic cover (packaging); plastic container
(bag) for presence of sediments or insects
Check label against the physicians written
prescription
Label for any medication that are added:
date, time, dose of medication and amount
compatibility of drug with the solution
Functionality of infusion pump, patient
controlled analgesia (PCA)
4. Medications
Nurses administering IVT should
have a knowledge on all
medications administered
including dosages, drug
interactions and possible clinical
effects on the vascular system.
 10 Golden Rules for Administering
Drugs safely

1. Right drug
2. Right drug to right patient
3. Right dose
4. Right drug by the right route
5. Right drug at the right time
6. Document each drug you administer
7. Teach your patient about the drug he is
receiving
8. Take a complete patient drug history
9. Find out if the patient has any drug allergies
10. Be aware of potential drug drug or drug
food interactions
Choice of Cannula for
Peripheral Infusion
Factors to consider for the choice of cannula
are:
1. Purpose of the infusion
2. Type of infusion
3. Size and condition of the patients vein
4. Duration of treatment
5. Condition of patient
nursing alert: choose the shortest catheter
with the smallest gauge appropriate for the
type and duration of the infusion. The higher
the gauge number, the smaller the bore of the
catheter
 Selection of Venipuncture Site
The patients condition and age, the size
and vein condition, type and duration of
therapy and functional utilization of the
hand shall be assessed to ensure ideal and
safe IV access.

Anchoring of cannula and tubing

Good anchoring allows normal blood flow,
prevents movement of cannula and irritation
of vein thus protecting the puncture site.
Catheter care, use of dressing of site for
easy transparency; puncture site should be
covered with micropore or tape.
 IV Cannula removal
Peripheral IV cannulas and the site are
routinely changed aseptically or re-sited
every 72-96 hrs and IV tubings every 72 hrs
or when necessary.

Administration of IV medications,
Investigational (research) drugs, IV push,
blood and blood components, IV
chemotherapy and TPN
Prior to the administration of the above, the
indication shall be explained to the patients
and/or to the significant others.
 Quality control of Iv solutions
All IV fluids shall be inspected prior to use and
check for visible sediment, turbidity,
discoloration, leaks, cracks, damaged caps and
expiration date.

Documentation of IVT
Proper documentation provides:
An accurate description of care that can serve as
legal protection
A mechanism for recording and retrieving
information
A record for health insurers and retrieving
information documenting the insertion of a
venipuncture device or the beginning of therapy.
 The following information of care that
can serve as legal protection:
Size, type, and length of cannula/needle
Name of person who inserted the IV
catheter
Date and time of insertion

Label the IV solution specifying:

Type of IV fluid
Medication additives and flow rate
Use of any electronic infusion device
Duration of therapy and nurses signature
 In addition to the above documentation,
the following information is documented
in the patients chart:
Location and condition of insertion site
Complications, patients response and
nursing interventions
Patient teaching and evidence of patient
understanding (for example ability to
explain instructions or perform a return
demonstration)
Signature of nurse
Other observations
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 INTRAVENOUS THERAPY
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What equipment do you need?

Dressing Tray

Non Sterile Gloves / Apron

Cleaning Wipes

Gauze swab

IV cannula (separate slide)

Tourniquet

Dressing to secure cannula

Alcohol wipes

Saline flush and sterile syringe or fluid to be

administered
Sharps bin
 INTRAVENOUS THERAPY
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Preperation:
Consult with patient

Give explanation

Gain consent

Position the patient appropriately and identify

the non-dominant hand / arm

Support arm on pillow or in other suitable

manner.
Check for any contra-indications e.g. infection,

damaged tissue, AV fistula etc.

 INTRAVENOUS THERAPY
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Encourage venous filling by:

Correctly applying a tourniquet (A

tourniquet should be applied to the

patients upper arm. The tourniquet
should be applied at a pressure which is
high enough to impede venous distension
but not to restrict arterial flow)
Opening & closing the fist

Lowering the limb below the heart

Site Choice
Identify a suitable vein
 INTRAVENOUS THERAPY
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What are the signs of a good vein ?

Bouncy
Soft
Above previous sites
Refills when depressed
Visible
Has a large lumen
Well supported
Straight
Easily palpable
 INTRAVENOUS THERAPY
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What veins should you avoid ?

Thrombosed / sclerosed / fibrosed
Inflamed / bruised
Thin / Fragile
Mobile
Near bony prominences
Areas or sites of infection, oedema or phlebitis
Have undergone multiple previous punctures
Do not use if patient has IV fluid in situ
 INTRAVENOUS THERAPY
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Procedure
Wash hands prepare equipment

Remove the cannula from the packaging

and check all parts are operational

Loosen the white cap and gently replace it

Apply tourniquet

Identify vein

Clean the site over the vein with alcohol

wipe, allow to dry

 INTRAVENOUS THERAPY
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Remove tourniquet if not able to proceed

Put on non-sterile gloves
Re-apply the tourniquet, 7-10 cm above site
Remove the protective sleeve from the
needle taking care not to touch it at any
time
Hold the cannula in your dominant hand,
stretch the skin over the vein to anchor the
vein with your non-dominant hand (Do not
re palpate the vein)
 INTRAVENOUS THERAPY
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Insert the needle (bevel side up) at an

angle of 10-30o to the skin (this will
depend on vein depth.)
Observe for blood in the flashback
chamber
 INTRAVENOUS THERAPY
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Lower the cannula slightly to ensure it

enters the lumen and does not puncture
exterior wall of the vessel

Gently advance the cannula over the

needle whilst withdrawing the guide,
noting secondary flashback along the
cannula

Release the tourniquet

 INTRAVENOUS THERAPY
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Apply gentle pressure over the vein

(beyond the cannula tip) remove the
white cap from the needle
 INTRAVENOUS THERAPY
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Remove the needle from the cannula

and dispose of it into a sharps container

Attach the white lock cap

Secure the cannula with an appropriate

dressing
 INTRAVENOUS THERAPY
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Flush the cannula with 2-5 mls 0.9%

Sodium Chloride or attach an IV giving
set and fluid
 INTRAVENOUS THERAPY
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Finally
Document the procedure including
Date & time
Site and size of cannula
Any problems encountered
Review date (cannula should be in situ no longer than 72
hours without appropriate risk assessment.)
Note: some hospitals have pre-printed forms to record
cannula events

Thank the patient

Clean up, dispose of rubbish

 INTRAVENOUS THERAPY
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Possible Complications:

The intravenous (IV) cannula offers direct

access to a patient's vascular system and
provides a potential route for entry of
micro organisms into that system. These
organisms can cause serious infection if
they are allowed to enter and proliferate in
the IV cannula, insertion site, or IV fluid.
 INTRAVENOUS THERAPY
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IV-Site Infection: Does not produce

much (if any) pus or inflammation at the
IV site. This is the most common
cannula-related infection, may be the
most difficult to identify
 INTRAVENOUS THERAPY
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Cellulites: Warm, red and often tender

skin surrounding the site of cannula
insertion; pus is rarely detectable.
 INTRAVENOUS THERAPY
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Infiltration or tissuing occurs when the

infusion (fluid) leaks into the surrounding
tissue. It is important to detect early as
tissue necrosis could occur re-site
cannula immediately
 INTRAVENOUS THERAPY
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Thrombolism / thrombophlebitis
occur when a small clot becomes
detached from the sheath of the cannula
or the vessel wall prevention is the
greatest form of defence. Flush cannula
regularly and consider re-siting the
cannula if in prolonged use.
 INTRAVENOUS THERAPY
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Extravasation is the accidental

administration of IV drugs into the
surrounding tissue, because the needle
has punctured the vein and the infusion
goes directly into the arm tissue. The
leakage of high osmolarity solutions or
chemotherapy agents can result in
significant tissue destruction, and
significant complications
 INTRAVENOUS THERAPY
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Bruising commonly results from failed

IV placement - particularly in the elderly
and those on anticoagulant therapy.
 INTRAVENOUS THERAPY
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Air embolism occurs when air enters

the infusion line, although this is very
rare it is best if we consider the
preventive measures Make sure all
lines are well primed prior to use and
connections are secure
 INTRAVENOUS THERAPY
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Haematoma occurs when blood leaks

out of the infusion site. The common
cause of this is using cannula that are not
tapered at the distal end. It will also occur
if on insertion the cannula has penetrated
through the other side of the vessel wall
apply pressure to the site for
approximately 4 minutes and elevate the
limb
 INTRAVENOUS THERAPY
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Phlebitis is common in IV therapy and

can be cause in many ways. It is
inflammation of a vein (redness and pain
at the infusion site) prevention can be
using aseptic insertion techniques,
choosing the smallest gauge cannula
possible for the prescribed treatment,
secure the cannula properly to prevent
movement and carry out regular checks
of the infusion site.
 INTRODUCTION

Children vary from neonate to

adolescent in physiologic as well as
developmental level, special
consideration and increased time may
be necessary to provide effective IVT.

Assisting families of choice of IV sites,

as well as follow up care and teaching
have become integral roles for IV
nurse.
 Common Reasons for IV Therapy in
Pediatric Client
Maintenance of fluid and
electrolyte balance
Antibiotic Therapy
Medication Therapy
Anti- cancer drugs
Nutritional Support
Transfusion Therapy
Two of the main
considerations in
administration of IV therapy to
children are emotional
preparation of the child and
initiation of IV cases.
 EMOTIONAL
CONSIDERATIONS
Even though children of varied
ages and intellectual capacities all
receive similar IV therapies, pre- and
post- IV therapy education must be
given, taken these variables into
account. A childs capacity for
understanding the significance of IV
therapy. Including importance of not
manipulating IV site. Explanation of
all procedures must be given to the
child and the parent.
1. ESTABLISHING TRUST
Usually it is best to tell the child that the venipuncture will hurt but
only for a short time
Inform the child that even though this therapy may be painful
initially, should make him or her feel better like before the illness.
Always be honest with a child.
Give the child the opportunity to cry, providing as much as privacy
as possible.
If old enough, let the child participate in the therapy; a child\s
ability to rip tape, open alcohol swabs, and hold tubing may
provide tasks and distraction, particularly in the school-age group.
2. PLAY THERAPY

Coping basket, filled

with items for various age
groups is easy and
inexpensive to put together.
An adolescent may finds
a portable stereo with
headphones useful as a
distraction during IV
insertion.
3. Establishing Rapport

IV therapy is establishing rapport with the family and child through good
communication. Communication differs with all, groups according to childs
intellectual level.

Nursing assessments should include developmental level of the child,

influence of the disease process and IV therapy on the childs psyche and
body image, previous experience with venipuncture and desire of parents or
parenteral figures to be present during IV initiation.

Parents may provide emotional support and represent security during an

actual procedure.

Provision of comfort and praise after an IV insertion provide an ideal means

of parenteral involvement after the procedure is completed.
4. PAIN REDUCTION
By using pain reduction
techniques, such as
imagery and the coping
basket, the anxiety
associated with IV
insertion can be reduced.
Local anesthetics, such as
topically applied Emla
cream or intradermal
saline at IV site may
decrease pain sensation
in children.
From infancy to adolescence,
children go through different
developmental stages,
preparation for IV insertion in
children should be geared
toward developmental stages as
follows:
Infant (0-12 months)

Provide comfort with pacifier.

Avoid inserting IV immediately after feeding or
aspiration may occur.

Toddler (1-3 yrs)

Prepare for IV insertion immediately before
procedure with simple explanations.
Do not offer choices. Say Were going to do your IV
now.
Provide comfort by allowing child to hold favorite toy
or security blanket.
Usually need an assistant to help restrain a toddler.
Pre-school (4-5 yrs)
Prepare child just prior to IV
Allow child to touch equipment
Use medical play
May need help to hold still; use a fellow caregiver.

School Age (6-11 yrs)

Prepare child same day as procedure.
Child may help set up equipment
Allow for privacy.
Do not force child to be brave.
Allow child to cry.

Adolescent (12-18yrs)
Choices for example, Can the IV be started after I go out on pass
Maintain privacy and consider body image in choice of site whenever
possible.
 Determining Rate and Amount of Fluid Administration

Because childrens heart and circulatory systems are smaller than those of
adults, IV fluid flow must be at a slower rate.
If administered at an adult rate, the childs cardiovascular system would
quickly become overloaded.
Automatic rate flow infusion pumps facilitate the infusion of potent
medications.
Overloading of IV fluid in infants and children can also be prevented by use of
IV pump chambers.
Even if the pump fails, with these in place, only the amount in the drip
chamber will be allowed to enter the childs circulation, not the entire contents
of the bag suspended above the childs head.

SIGNS OF FLUID OVERLOAD:

1.Increase in pulse rate and blood pressure.
2.Changes in vital signs.
Preferred
Intravenous
Sites for
Pediatric
Client
STABILIZING THE INTRAVENOUS LINE
Stabilization is essential, primarily in the younger child whose
level of comprehension concerning the importance of not
manipulating the IV site is minimal.
Sites requiring stabilization include the hand and the arm,
both of which require arm board support. An important aspect of IV
access in the foot involves maintenance of normal join configuration
by placing padding under the foot, thus maintaining the natural bend
at the ankle and avoiding foot drop or contracture injuries.

USE OF RESTRAINTS
In general, restraints are seldom used at childrens medical
centers because it is not confining but also creates a sense of
frustration and mistrust in the child. With an extremely uncooperative
child or a child who may injure himself or remove the IV, restraints
may be used.
 POST INSERTION CARE OF THE IV

Dressing changes are usually only done,

when the IV site is changed, every 48 hrs as
recommended.

Removal of the IV should be done carefully,

without the use of scissors near the site.

Flushing techniques can be done carefully per

hospital protocol.

Watch out and monitor for possible

complications of IV therapy.
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