MANAGING

COMPLICATIONS OF IV
THERAPY
History of IV Therapy
in the Philippines
 September 1993– The PRC. Board
of Nursing called for a
conference.
There was a conscientious
discussion on Nursing Practice,
Article V. Section 27 especially on
I.V. Injection.
 The Board of Nursing which was then
chaired by Dr. Aurora Yapchiongco
challenged the ANSAP.
 October 1993 – A final draft of
standards on I.V. Therapy was
submitted to PRC Board of Nursing
by the Committee on Standard
before the PNA Convention in
Bacolod City.
 October 1993 – Training for Trainers
for ANSAP Board Members and
Advisers.
 February 4, 1994 – PRC-BON
Resolution No. 08
 June 9-11, 1994 – Training for
Trainers at Cagayan de Oro City.
 May 17, 1995 – Protocol Governing
Special Training on the
Administration of IV Injections for
RNs adopted ANSAP's IV Nursing
Standards of Practice.
 June 13, 1995 – Department Circular
No. 100.S.1995 was disseminated by
DOH.
2002 – Special Committee by
ANSAP in collaboration with PRC-
BON was founded.
RA 9173 – Philippine Nursing Law
of 2002.
August 25, 2006 – Nursing
Standards on Intravenous Practice
th
7 edition was released.
THE COMMITTEE ON NURSING STANDARDS
ON INTRAVENOUS THERAPY

Ma. Linda G. Buhat, RN, Ed.D.

Jovita R. Pilar, RN, MBA, DPA

Sr. Estrella L. Crisologo, SSpS

Perla B. Sanchez, RN, Ph.D., FPCHA

Leonila A. Faire, RN, MAN

PHILOSOPHY OF ANSAP
 Envisions itself to be a cohesive, pro-
active, professional Association,
committed to excellence in nursing.
 Believes that safe and quality nursing
care to patients is the primary
responsibility of nurses.
 Believesthat those who practice IV
therapy nursing are only those
registered nurses who are
adequately trained and have
completed the IV Therapy Training
Program for Nurses as prescribed by
ANSAP.
DEFINITION OF IV THERAPY
Intravenous (IV) Therapy – insertion
of a needle into a vein, based on the
physician's written prescription. The
needle is attached to a sterile tubing
and a fluid container to provide
medication and fluids.
OBJECTIVES OF THE IV THERAPY
TRAINING PROGRAM
 Gain knowledge on the history of IV
Therapy in the Philippines.
 Define the role and responsibilities, and
the ethico-legal implications of IV
therapy within the scope of nursing
practice as stated in the Philippine
Nursing Law.
 Identify the nursing accountability in
drug administration and blood
components transfusion.
 Advocate patients and family rights.

 Identify the different risk factors and

complications associated with IV therapy
and recognize the specific
interventions/nursing management.
 Identify
the importance of patient and
family education and implement the
nursing process in the practice of IV
therapy as reflected in the nurses’
documentation.
STATUS OF IV THERAPY
IN THE PHILIPPINES
SCOPE OF PRACTICE

ROLE DEFINITION
The IV nurses are registered nurses
committed to ensure the safety of all
patients receiving IV Therapy.
DESCRIPTION OF PRACTICE
ETHICO-LEGAL IMPLICATIONS:

ANSAP, Inc. upholds quality

nursing practice and is going to
continue with the IV Therapy
Training for the following reasons:
a. Nursing curriculum does not
provide in-depth training in
parenteral IV drug administration.
a.1. An in-depth IV Training maybe
included in the BSN curriculum but
without actual IV insertion to patients.

a.2. ANSAP believes that

parenteral IV drug administration
is an invasive procedure.
b. The Nurse Administrator has the
command responsibility for the
whole nursing practice in the
Health Care Facility.
c. Globally, the IV Therapy
certification is a mandatory
requirement for the nurse
practitioner
d. IV Therapy Training is voluntary; only
those nurses who are adequately
trained and have completed the training
requirements in the IV Therapy Program
for Nurses as prescribed by ANSAP will
be issued an IV Certificate of Training
and the IV Therapy card of ANSAP
TRENDS IN IV THERAPY

 81% - 85% patients in the hospital receive

some form of IV therapy
 More nursing time is spent to IV therapy

 Multi-disciplinary health care setting

WHY DO WE NEED TO BE UPDATED
REGARDING IV THERAPY?

 More medications are being administered

intravenously now than before.

 Nursesare assuming greater

responsibilities related to IV medication
administration.
 Many technical improvements have
been made in equipment, and
innovative and time-saving measures
have been developed to increase the
efficacy of the therapy.
MODES OF ADMINISTRATION

 Continuous I.V. infusion

 Intermittent Infusion

 Direct I.V. infusion or I.V. push

directly into the vein

through an existing I.V. line

use of specialized device such

as PCA
INDICATIONS
 Restore and maintain body fluids
 For drug administration like
chemotherapy
 For the administration of parenteral
nutrition
 To provide an access in the
administration of dye in some
diagnostic procedures
 To monitor the hymodynamic status
of critically ill clients
 I.V. Therapy is practiced in all health care
settings
 I.V administration includes a variety of
skills e.g. starting the infusion, assessing
the patient during the therapy, knowing
the advantages/ disadvantages of
different delivery system, drug
interaction/adverse effects and many
more.
 Contemporary nursing practice could not
exist without I.V. therapy.
 I.V. therapy, should be treated as a
specialty risk area!
DEVICE AND EQUIPMENT
The selection of device or equipment is
basically dependent on:
Indication of I.V therapy
Clinical status of the client
Duration of treatment
Type of solution / drugs to be
administered
Condition of the veins
Patient’s activity level
As a general rule the shortest and
smallest gauge that can satisfy the
indication of therapy should be used
Technology should enhance quality
care not withstanding the cost
Single use devices should never be
reused
VASCULAR ACCESS DEVICES

1. Peripheral Venous Access Devices

a. Over-the-needle catheter
b. Winged steel needle set
2. Central Venous Catheters
a. Non tunneled catheters
b. Tunneled catheters
c. Peripherally inserted central
catheters
d. Implanted vascular access ports
 PERIPHERAL VAD
1. Over-the-needle catheter – long-
term therapy for the active or agitated
patient
2. Winged steel needle set – short-
term therapy for cooperative adult
patient. Used for patients with fragile
and sclerotic veins.
 OVER-THE-NEEDLE
CATHETER
 Advantages  Disadvantages
 More comfortable for  Difficult to insert.
the patient.  Extra care is
 Radiopaque thread requires to ensure
for easy location. that needle and
 Safety needles catheter are
prevents accidental inserted into the
needle sticks.
vein.
 Activity restricting
device is rarely
required.
WINGED STEEL NEEDLE SET
 Advantages  Disadvantages
 Easiest device to  Can easily cause
insert. infiltration.
 Ideal for non-
irritating IV push
drugs.
 Available with a
catheter that can
be left in place.
 NEEDLE SELECTION
Recommended Gauges:
1. Gauge 16-18 – Trauma
2. Gauge 18-20 – Infusion of hypertonic
solutions; Blood administration
3. Gauge 22-24 – Pediatric patients
4. Gauge 22 – Patients with fragile
veins
INFUSION PUMPS
Features:
 Functions based on
the programmed
delivery.
 The patient lines can
be kept to a
minimum.
 The right drug and
the right dose will be
infused.
PATIENT- CONTROLLED ANALGESIA

- Proactive Planning for all surgical patients

• Intravenous (IV) Patient Controlled Analgesia

with systemic opioids.
• Patient Controlled Epidural Analgesia with
opioids or opioid/local anesthesia mixtures (or
intrathecal opioids)
•Peripheral Nerve Blocks including (but not
limited to) intercostals nerve blocks, celiac plexus
nerve block,etc. with local anesthetic and steroid
 NEEDLELESS SYSTEM
Feature:
 Can be used for
all forms of IV
therapy.
 Completely
closed system.
 Reduces the risk
of air embolisms
and backflow.
CARE OF PATIENTS IN
IV THERAPY
 PATIENTS WITH SPECIAL
CONSIDERATIONS:

1. Pediatric Patients
2. Elderly Patients
3. Obese Patients
4. Patients undergoing Chemotherapy
5. Patients in Shock
 PEDIATRIC PATIENTS
 Best sites includes the hands, feet,
antecubital fossa, and scalp because
it has an abundant supply of veins.
 Use topical or transdermal anesthetic
at least 30 minutes to 1 hour before
insertion.
 Use mummy restraints.
 Engage mother to keep patient calm.
 ELDERLY PATIENTS
 Venous distension may take a few
moments longer due to slower venous
return.
 Skin elasticity is lost making it more
difficult to stabilize the veins.
 Veins are more fragile.
 Skin preparation materials must be at
room temperature.
 Phlebitis may develop without pain due
to decreased sensitivity of nerve
endings.
 OBESE PATIENTS

 Has excessive adipose tissues.

 Create a visual image of the venous
anatomy.
 Select a longer catheter.
 PATIENTS UNDERGOING
CHEMOTHERAPY
 Veins may be hard and sclerosed due
to frequent drug therapy.
 Select unused veins.
 Maintain strict asepsis.
 Know each drug’s potential for
damaging tissue. Chemotherapeutic
drugs are classified as vesicants,
irritants or nonvesicants.
 PATIENTS IN SHOCK

 Create a visual image of the venous

anatomy.
 Use larger veins and secure
adequately.
 Do cut-down method as the last resort.
RISKS ASSOCIATED
WITH IVT
 RISKS
1. Needlestick
injury
2. Infectious
organism
exposure
 NEEDLESTICK INJURY
An AIDS patient became agitated and tried to
remove the intravenous catheters. Hospital staff
struggled to restrain the patient. During the
struggle, an IV infusion line was pulled,
exposing the connector needle. A nurse
recovered the connector needle at the end of
the IV line and attempted to reinsert it. The
patient kicked her arm, pushing the needle into
the hand of the second nurse. Three months
later, the nurse who sustained the needlestick
injury tested positive for HIV1.
 PREVENTION:
 Avoid the use of needles where safe
and effective alternatives are available.
 Avoid recapping needles.
 Report all needlestick and other sharps
related injuries to ensure that you
receive appropriate follow-up care.
 Create/maintain a safe, comprehensive
disposal system.
 INFECTIOUS ORGANISM
EXPOSURE
Prevention:
 Do proper hand hygiene.
 Do not reuse tourniquets.
 Wear gloves.
 Cleanse insertion sites with the
recommended solutions.
 IV THERAPIST, HOW SAFE ARE
YOU?
 In a CDC study, 89 percent of HCW
exposure to HIV were caused by
percutaneous injuries.
 As many as 40 percent of HCW who
sustain needlesticks become infected
with HBV
 In 2004, more than 1,000 HCW became
infected with HBV
 OCCUPATIONAL RISKS
ASSOCIATED WITH IV THERAPY

 Physical
hazards;
Accidents , abrasions, contusions
and chemical exposure
 Exposure to Infectious Agents
 Thefollowing list is a summary of
some of the rules to be observed in
the workplace:
HEPATITIS B vaccine
STANDARD PRECAUTIONS
SHARPS AND WASTE DISPOSAL
PROTECTIVE
DEVICE/EQUIPMENT
GLOVES
LAUNDRY
COMMUNICATING HAZARDS
 ECONOMIC CONCERN

I.V. therapy is more costly than oral,

subcutaneous, or intramuscular
methods of delivering medications.
 COMPLICATIONS
ASSOCIATED WITH IVT
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
1. Phlebitis *Clotting at the *Redness at *Remove the *Restart the
catheter tip the tip of the device infusion using
(thrombophlebitis) catheter and *Apply a warm a larger vein
*Device left in the along the vein pack for initiating
vein too long *Tenderness *Notify the infusate, or
*Friction from at the tip of physician restart with a
catheter device and *Document the smaller-gauge
movement in the above patient’s device to
vein *Vein hard on condition and ensure
*Poor blood flow palpation your adequate
around the interventions blood flow
device *Tape the
*Solution with device
high or low pH or securely to
high osmolarity prevent
movement
 Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
2. Infiltration *Device *Blanching at *Remove the *Check the
dislodged site venipuncture IV site
from vein or *Continuing device frequently
perforated fluid infusion *Periodically (especially
vein even when vein assess when using
is occluded, circulation by an IV pump)
although rate checking for *Don’t
may decrease pulse and obscure the
*Cool skin capillary refill area above
around site *Restart the the site with
*Discomfort, infusion in tape
burning, or pain another limb *Teach the
at site *Notify the patient to
*Feeling of physician observe the
tightness at site IV site and
*Slower flow report
rate discomfort,
*Swelling at and pain or
above IV site swelling
(may extend
along entire
limb)
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
3.Catheter *Loosened tape *Catheter *Remove the *Tape device
dislodge- or tubing backed out of catheter securely on
ment snagged in the vein insertion
bedclothes, *Infusate *Use armboard
resulting in infiltrating into
partial retraction tissue
of the catheter
*Dislodged by a
confused patient
attempting to
remove it
 Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
4. Severed *Catheter *Leakage *If the broken *Avoid using
catheter inadvertently cut from the portion of the scissors around
by scissors catheter shaft catheter is the IV site
*Reinsertion of visible, attempt *Never reinsert
the needle into to retrieve it. If the needle into
the catheter unsuccessful, the catheter
notify the *Remove the
physician unsuccessfully
*If the broken inserted
portion of the catheter and
catheter enters needle together
the
bloodstream,
place a
tourniquet
above the IV
site to prevent
its progression
*Notify the
physician and
radiology
department
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
5. *Leakage of *Bruising *Remove the *Choose a vein
Hematoma blood into tissue around venipuncture that can
*Vein punctured venipuncture device accommodate
through ventral site *Apply the size of the
wall at time of *Tenderness pressure and intended
venipuncture at cold venous access
venipuncture compresses to device
site the affected *Release the
area tourniquet as
*Recheck for soon as
bleeding successful
*Document the insertion is
patient’s achieved
condition and
your
interventions
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
6. Venous *Administration *Blanched *Apply warm *Use a blood
spasm of cold fluids or skin over the soaks over the warmer for
blood vein vein and blood or
*Severe vein *Pain along surrounding packed red
irritation from the vein area blood cells
irritating drugs or *Sluggish *Slow the flow when
fluids flow rate rate appropriate
*Very rapid flow when the
rate (with fluids clamp is
at room completely
temperature) open
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
7.Nerve, *Improper *Delayed *Stop *Don’t
tendon, or venipuncture effects, procedure repeatedly
ligament technique, including *Notify the penetrate
damage resulting in paralysis, physician tissues with
injury to numbness, and the
surrounding deformity venipuncture
nerves, *Extreme pain device
tendons, or (similar to *Don’t apply
ligaments electric shock excessive
*Tight taping or when nerve is pressure
improper punctured) when taping
splinting with *Numbness or encircling
arm board and muscle the limb with
contraction tape
*Pad the arm
board and, if
possible, pad
the tape
securing the
arm board
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures

8.Circulatory *Flow rate too *Crackles *Raise head of *Use a

overload rapid *Discomfort the bed pump,
*Miscalculation *Increased *Administer controller, or
of fluid blood oxygen as rate minder
requirements pressure needed for elderly or
*Roller clamp *Large *Notify the compromise
loosened to positive fluid physician d patients
allow run-on balance *Administer *Recheck
infusion (intake is medications calculations
greater than (probably of fluid
output) furosemide) as requirements
*Neck vein ordered *Monitor the
engorgement infusion
*Respiratory frequently
distress
 Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
9. Systemic *Failure to *Contaminated *Notify the *Use
infection maintain aseptic IV site usually physician scrupulous
technique during with no visible *Administer aseptic
insertion or site signs of prescribed technique
care infection medications when handling
*Immunocompro *Fever, chills, *Culture the site solutions and
mised patient and malaise for and the device tubings,
*Poor taping no apparent *Monitor vital inserting the
that permits the reason signs venipuncture
access device to device, and
move, which discontinuing
can introduce the infusion
organisms into *Secure all
the bloodstream connections
*Prolonged *Change IV
indwelling time solutions,
of device tubing, and the
*Severe access device
phlebitis, which at
can set up ideal recommended
conditions for times.
organism
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
10.Air *Empty solution *Decreased *Discontinue the *Purge the
embolism container blood pressure infusion tubing of air
*Secondary *Increased *Place the completely
solution central venous patient in before
container pressure Trendelenburg’s infusion
empties; next *Loss of position to allow *Use the air-
container consciousness air to enter the detection
(primary) pushes *Respiratory right atrium and device on the
air down line distress disperse pump or the
*Disconnected *Unequal through the air-
tubing breath sounds pulmonary eliminating
*Weak pulse artery filter proximal
*Administer to the IV site
oxygen *Secure
*Notify the connections
physician
*Document the
patient’s
condition and
your
interventions
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
11.Allergic *Allergens such *Bronchospas *If reaction *Obtain the
reaction as medications m occurs, stop the patient’s
*Itching infusion allergy
*Tearing eyes immediately history. Be
and runny *Maintain a aware of
nose patent airway cross-
*Urticarial rash *Notify the allergies
*Wheezing physician *Assist with
*Administer an test dosing
RED FLAG: antihistaminic *Monitor the
An steroid, an anti- patient
anaphylactic inflammatory, carefully
reaction can and antipyretics during the
occur within drugs, as first 15
minutes after ordered minutes of
exposure, *Give 0.2 to 0.5 administratio
including ml of 1:1,000 n of a new
flushing, chills, aqueous drug
anxiety, epinephrine
agitation, subcutaneously
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
generalized *Repeat the
itching, epinephrine
palpitations, dose at 3-
paresthesia, minute intervals
throbbing in and as needed,
ears, as ordered
wheezing, *Administer
coughing, cortisone if
seizures, and ordered
cardiac arrest
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
12. *Blood backup in *IV flow *Use mild flush *Maintain IV
Occlusion the line when the interrupted pressure during flow rate
patient walks injection *Flush
*Hypercoagulabl *Don’t force the promptly
e patient flush after
*Intermittent *If unsuccessful, intermittent
device not reinsert the IV piggyback
flushed device administratio
*Line clamped n.
too long *Have the
patient walk
with his arm
folded to his
chest to
reduce the
risk of blood
backup
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
13. *Thrombosis and *IV Reddened, *Remove the *Check the
Thrombophl inflammation swollen, and device; restart site
ebitis hardened vein the infusion in frequently
*Severe the opposite *Remove the
discomfort limb if possible device at the
*Apply warm first sign of
soaks redness and
*Watch for IV tenderness
therapy-related
infection
(thrombi provide
an excellent
environment for
bacterial growth
*Notify the
physician
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
14. *Injury to the *Painful, *Remove the *Use proper
Thrombosis endothelial cells reddened, and device; restart venipuncture
of the vein wall, swollen vein the infusion in techniques to
allowing platelets *Sluggish or the opposite reduce injury
to adhere and stopped IV limb if possible to the vein
thrombus to form flow *Apply warm
soaks
*Watch for IV
therapy-related
infection
(thrombi provide
an excellent
environment for
bacterial growth
*Notify the
physician
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
15. Vein *Solution with a *Pain during *Slow the flow *Dilute
irritation at high or low pH or the infusion rate solutions
the IV site high osmolarity, *Possible *Try using an before
such as 40 blanching if electronic flow administratio
mEq/L of vasospasm device to n. For
potassium occurs achieve a example,
chloride, Rapidly steady give
phenytoin, and developing regulated flow antibiotics in
some antibiotics signs of a 250-ml
(such as phlebitis solution
vancomycin and *Red skin over rather than
nafcillin) the vein during 100 ml
infusion *If the drug
has a low
pH, ask a
pharmacist if
it can be
buffered with
sodium
bicarbonate
(refer to
facility policy)
Mechanical Possible Signs/ Nursing Prevention
Risks Causes Symptoms Interventions Measures
*If long-term
therapy of an
irritating drug
is planned,
ask the
physician to
use a central
IV line
 PROCEDURAL
PROBLEMS
ASSOCIATED WITH IV
THERAPY
Fluctuating flow rate
Runaway IV

Sluggish IV

Tubing / loose connection/

disconnection
Blood back up in tubing
IV line obstruction/kinking
of IV tubing
Clogged filter

Break in aseptic technique

Leaks; due to
inappropriate device
TROUBLESHOOTING
PROMPTLY AND
EFFECTIVELY
 I.V. therapy is the preferred mode of
treatment because of its rapid onset.
 Nurses are assuming more nursing
responsibilities in I.V. therapy.
 More nursing time is allotted to I.V.
therapy
 I.V. Therapy is a risk specialty area.
 WHAT TO DO WHEN
INFUSION SLOWS DOWN OR
STOPS
1. Assess the I.V. system to locate the
problem. Start at the insertion side.
Check for infiltration, extravasation,
or phlebitis.
2. Check for patency. Obstruction of
flow is caused or affected by the
following factors:
 2.1 Patients limb is flexed;
patient lying on the side.
Reposition limb to release venous
pressure.
 2.2 Tip of needle or cannula is
against the vein wall. Lift or pull-
back the needle or cannula a little.
 2.3 Adhesive taping maybe too
tight, release every apply tapes.
 2.4. Small cannulas or tubing may kink or
fold, gently adjust.
 2.5. Local edema or poor tissue perfusion
from disease can block venous flow.
Transfer I.V. line to an unaffected site.
 2.6. Presence of precipitates in solution
either from incompatibility of fluids and
medications or from infusion. Replace the
entire venipuncture device and solution. It
may expose the patient to embolism.
 3. Check the clamps. Some sets have
two:
 the roller clamp and the side clamp.
Check if both are open or if these are
properly adjusted.
 4. Check the patency of the air vent;
reposition it if needed.
 5.Check fluid level: if empty replace
as prescribed. If solution is too cold, it
may cause venous spasm and
decrease the flow; keep room
temperature regulated. Check the
spike of the set; push it more inside
the fluid bag or adjust it.
 6.Check filters: ordinary sets usually
do not have in-line filters. If it has,
follow the manufacturer’s guide
instructions. Blood transfusion filters
retain blood product debris. If flow
rate decreases or stops after more
than one unit has been transfused
you may have to change the set.
• 7. Check tubings: if patient is lying on
it or if it is kinked or it may be
crimped with too tight roller clamps,
release and round-up the tubing to its
original shape
• 8. Is gauge of the needle too small?
Is fluid container too low above the
venipuncture site? Adjust it around
36-48 inches above the site.
Patient and Family
Education and
Documentation
 PATIENT AND FAMILY
EDUCATION
Before insertion:
 Describe the procedure.
 Tell the patient about how long the
catheter will stay in place.
 Provide information that the
procedure may hurt a little.
 Tell that the IV fluid may feel cold at
first.
During therapy:
 Instruct to report any discomfort.
 Explain any restrictions as
ordered.
 Teach the patient how to care for
his IV line.
 Inform them that the presence of
blood in the tubings is normal.
At removal:
 Explain that removing a
peripheral IV line is a simple
procedure.
 Teach patient on how to apply
pressure until the bleeding stops.
 DOCUMENTATION
Purposes:
 For communication

 For history and legal purposes

 For audit

 For research purposes

 For quality management

RECORD THE FOLLOWING:
 Date, time and venipuncture site.
 Equipments used.

 Rates of solution.

 Patient’s tolerance to the procedure.

 Health teachings given.

 Update your records as often as needed.

 Must be clear, concise and consistent.

 INFUSION SHEET
Date Time # of Site of IV Insertion / Date Time Full
Started Started Infusion Type of Cannula / Dose / Terminated Terminated Signature
Rate / Drug of RN
Incorporation Present
(IV Fluids/Blood
Products/Chemo/TPN)

31 8:10 #1 L metacarpal vein, 31 Aug. 2PM Maristiel

Aug. AM Introcan Safety G. 22, 2008 A. Sas,
2008 D5NM 1L X 6 hours at RN
42 gtts/min
31 2PM #2 L metacarpal vein,
Aug. Introcan Safety G. 22,
2008 PNSS 1L X KVO at 11
gtts/min
 MULTI-DISCIPLINARY
PROGRESS NOTES
08/31/08 For IV D – for IV insertion of D5NM 1L as ordered.
6-2PM insertion A – assessed patient.
8AM - explained the procedure and addressed
patient’s concerns.
- materials prepared aseptically.
8:10AM R – IV line inserted; patient tolerated the
procedure well
- instructed patient on how to prevent
catheter dislodgement.
8:15AM - used materials discarded accordingly.

Maristiel A. Sas, RN
TROUBLESHOOTING
SKILLS
SCENARIO One: Arm is
swollen, cool to touch,
but with blood return.
SCENARIO Two: Vein is
hard, skin is red, swollen,
and warm to touch, but
good infusion, and good
blood return
 SCENARIO Three:
Infusion is sluggish, I.V.
site looks phlebitic
SCENARIO Four: Infusion
ran too fast.
SCENARIO Five: Blood
pressure drops quickly
and pulse rate increases
after tubing change.
 SCENARIO Six:
Unsuccessful insertion,
catheter tip is gone.
SCENARIO Seven: New
I.V. with red streak over
the vein, pain at site.
SCENARIO Eight: I.V. site
suddenly turns red,
patient complains of
itching and develops
rashes.
 REFERENCES
 Association of Nursing Service
Administrators of the Philippines, Inc.
(ANSAP). 2000. Nursing Standards on
Intravenous Practice 7th EDITION.
 Cahil, Matthew. I.V. Therapy made
Incredibly Easy. Springhouse
Corporation, Pennsylvania.
 Dionne, Lynn. Manual of I.V.
Therapeutics. Philips, F.A., Davis Co.
Philadelphia.
 Intravenous Nursing Society, Supplement
to Journal of Intravenous Nursing,
Jan./February 1998 vol.21, Fresh Pond
Square, 10 Faucett street, Cambridge,
MAO 218.
 Lippincott Williams and Wilkins. 2005.
JUST THE FACTS I.V. Therapy.
 Nursing Journal May and July 2000.
 Let’s
call it
a
DAY!