Intravenous Therapy

Types of Solutions
• Isotonic
• Hypotonic
• Hypertonic
• Crystalloids (with e+)
• Colloids (Plasma expanders)
– Pull fluid from IS to IV compartment
–  vascular volume rapidly (hemorrhage or
severe hypovolemia)
– E.g. Dextran & Albumin
 IV Devices
• Cannulas (for short infusion time)
– Steel needles (Butterfly sets)
• (Plastic or rubber) Wing-tip needle with metal
cannula
• Plastic catheter or hub
• 0.5-1.5 in length, G16-26
• Infiltration is more common
• For children & older pts (small/fragile veins)
– Plastic
• Over-the-needle: preferred for rapid infusion &
more comfortable for the pt
• In-needle: can cause cath embolism
 IV Gauges
• The smaller the gauge, the larger the
outside diameter
• Large gauges: for higher fluid rate &
concentration of sol’ns
• Emergency fluid infusion, blood or
anesthetics: G 14, 16, 18 or 19
• Peripheral lipids: G 20-21
• Standard IVF: G 22-24
• Pt with small veins: G 24-25
 IV Containers
• Glass or plastic
• Squeeze the plastic bag, check
the glass bottle for cracks
before hanging
• Don’t write on the plastic IV bag
with a marking pen (ink is
absorbed), use a label
 IV Tubings
• Parts: spike end, drop chamber,
roller clamp, Y-site & adapter
• Extension tubing: for children &
restless pt
• Shorter secondary tubing: for
piggyback
• Special tubing: for meds that
absorbs into plastic
 IV Tubings
• Air vent: allows air to enter IV
container as the fluid leaves
• Vented adapter: for glass or
rigid IV container
• Nonvented tubing: may use
vented adapter, for flexible
container
 IV Tubings
• Drip chambers
–Macrodrip
• 10-20 gtts/min
• For thick sol’ns, rapid infusion
–Microdrip
• 60 mgtts/min
• For slow IV rates: <50cc/hr
• For pedia pts, titrated sol’ns
 IV Tubings
• Filters
– Prevent particles from entering the
vein
– To trap undissolved antibiotics, salt or
precipitate
– Most IVF: 0.22 m
– For lipids & albumin: 1.2 m
– For blood: Special filter
– Changed q 24-72 hrs to prevent
infection
• Needleless Sytems
–Recessed needles, plastic
cannulas, one-way valves
–No TPN & BT through one-way
valves
• Intermittent infusion sets
–For IV push meds or IV piggyback
–With IV lock, kept patent by NS
flush or heparinized NS flush
 Latex Allergy
• IV supplies may contain latex
(cath, tubings, ports, rubber
stoppers on vials, adhesive
tape & gloves)
• Use latex-safe IV supplies
• Use 3-way stopcocks rather
than IV lock/rubber injection
ports
 Selection of a Peripheral IV site
• Hand, forearm (natural support & splint)
& antecubital fossa
• LE: at risk for thrombus formation &
pooling of IVF/meds in areas with 
venous return
• Scalp & feet: for infants
• Use distal to proximal veins
• Use nondominant extremity, away from
areas of flexion
• No BP/restraints on arm with IV access
 Central Venous Catheter
• Used to: deliver hyperosmolar sol’ns,
measure CVP, infuse TPN or multiple IV
infusions or meds
• Placement is determined by x-ray
• Peripheral insertion: through basilic or
cephalic vein into SVC
• Central insertion: though internal jugular or
subclavian vein
• Surgically tunneled through SQ into
cephalic vein
 Central Venous Catheter
• May have single, double or triple lumen
• Multilumen cath: more than 1 meds can
be administered at the same time
without incompatibility problems; one
insertion site requires care
• For central line insertion, tubing change
& line removal: place the pt in
Trendelenburg or supine position,
instruct the pt to do Valsalva maneuver
(to  pressure in central veins when IV
system is open)
Tunneled Central Venous Catheter
• More permanent (e.g. Hickman,
Broviac, Groshong) for long-term IV tx
• Inserted in the OR, threaded to the
lower part of SVC at the entrance of RA
• Fitted with an intermittent infusion
device to allow access as needed & to
keep the system closed & intact
• Patency is maintained by flushing with a
diluted heparin or NSS
Vascular Access (Implantable) Ports
• Surgically implanted under the skin (e.g.
Port-a-Cath, Mediport, Infusaport) for
long-term, repeated IV tx
• For access, requires palpation &
injection through the skin into the self-
sealing port with a noncoring needle
(Huber-port needle)
• Patency is maintained by flushing with a
diluted heparin or NSS
Peripheral-Inserted Central Catheter
(PICC) line
• For long-term IV tx especially at home
• The basilic vein is usually used, median cubital &
cephalic veins in the antecubital area can be used
• The catheter is threaded up to the subclavian vein
or the SVC
• A small amt. of bleeding may occur at the time of
insertion & may continue for 24 hrs
• Common Cx: phlebitis
• Air embolism is not common (insertion is below
heart level)
 Administration of IV sol’ns
• Use sterile technique
• Change venipuncture site q 48-
72 hrs, IV dressing q 72 hrs
(when wet & contaminated), IV
tubing q 24-72 hrs, IV bottle q
24 hrs
• Label tubing, dresing & sol’n
bags clearly (date & time
changed)
 Precautions for IV lines
• Check for drug & IVF
incompatibilities
• CHF pt: no plain NS
• DM pt: no dextrose (glucose)
sol’ns
• RF: no plain LR
 Complications: Infection
• With prolonged the IV tx
• At risk: immunocompromised pt
• Local S/Sx: redness, swelling, drainage at
site
• Systemic S/Sx: chills, T, HR, malaise,
HA, N/V, backache,
• Use antimicrobial ointment at the IV site
• d/c IV, place at sterile gauze over device
for possible culture, notify MD
• Restart IV in the opposite arm to
differentiate systemic from local infection
 Complications: Tissue Damage
• Involves skin, veins & SQ
• S/Sx: skin color changes,
sloughing of the skin, discomfort
at site
• Be careful & gentle when using
tourniquet
• Don’t tap the skin over the vein
during IV insertion
• Check for latex or tape allergies
 Complications: Phlebitis &
Thrombophlebitis
• Phlebitis: from mechanical or chemical
trauma or from local infection
• S/Sx (Phlebitis): heat, redness,
tenderness at site, not swollen or hard,
sluggish IV infusion
• S/Sx (Thrombophlebitis): hard, cord-like
vein
• Use an IV cannula smaller than the vein
• Avoid using small veins for
administrating irritating solutions
 Complications: Phlebitis &
Thrombophlebitis
• Avoid using LE as IV access area
• Avoid venipuncture over area of
flexion
• Use an armboard or splint if pt is
restless or active
• If phlebitis occurs: never irrigate IV
catheter, remove IV access &
restart it in the opposite extremity
• Apply warm, moist compress
 Complications: Infiltration
(Extravasation)
• Seepage of IVF out of the vein & into
surrounding interstitial spaces
• Occurs when IV access becomes
dislodged or perforates the vein
• S/Sx: edema, pain & coolness at site,
with or without blood backflow
• If it occurs, remove IV access, elevate
the extremity, apply warm or cool
compress as ordered
• Don’t rub the area to prevent hematoma
 Complications: Catheter embolism
• Tip of catheter breaks during IV
insertion or removal
• S/Sx: BP, LOC, pain along vein,
weak rapid pulse, cyanosis
• Remove & inspect the catheter carefully
• If it occurs, place a tourniquet high
above the limb, notify MD, obtain an x-
ray & prepare the pt for surgical
removal of the catheter pieces as
prescribed
 Complications:
Circulatory Overload
• Rapid administration of IVF to high risk pts
• S/Sx: HTN, JVD, RR, dyspnea, moist
cough & crackles
• Calculate & monitor the flow rate
frequently, add a time strip to IV bag/bottle
• Use an infusion pump
• If it occurs, IV rate to KVO,  head of
bed, keep the pt warm, assess lung
sounds & for edema & notify MD
 Complications:
Electrolyte Overload
• Rapid administration or inappropriate IVF
• S/Sx depends on e+ imbalance
• Assess lab results
• Verify correct sol’n, place a meds sticker
to bottle if with additives (e.g. KCL)
• Calculate & monitor the flow rate
frequently, add a time strip to IV bag/bottle
• Use an infusion pump
 Complications:
Hematoma
• Collection of blood in the tissues
• S/Sx: ecchymosis, immediate swelling &
leakage of blood & hard, painful humps at
the site
• Do not apply tourniquet to the extremity
immediately after an unsuccessful
venipuncture
• When removing IV access, apply pressure
for at least 1 min, elevate extremity &
apply ice as ordered
 Complications: Air Embolism
• A bolus of air that enters the vein through an
inadequately primed IV line, from loose
connection, during tubing change or removal
of IV access
• S/Sx: BP, HR, LOC, dyspnea, cyanosis
• Prime tubing with fluid before use, monitor for
air bubbles in the tubing
• Secure all connections
• Replace IV fluid before bag or bottle is empty
• If it occurs: clamp the tubing, turn the pt on
the L Trendelenburg position & notify MD