Revsed IV

NCM 106
Intravenous Therapy
Judith P. Valenzuela, RN, MAN, CIVT
Faculty Member
College of Health Sciences, Department of Nursing
Mariano Marcos State University, 2906 Philippines
Intravenous (IV) Therapy
Objectives:
At the end of the session, the students should be
able to:
1. Discuss the basic foundation of IV therapy
according to the following:
• Historical background;
• Philosophy; and
• Standards of practice;
5/7/19 Judith P. Valenzuela, MMSU-CHS 2

Objectives (cont’d):
2. Differentiate IV solutions according to content, osmolarity,
and anticipated outcome following use;
3. Identify the different access sites for IV therapy;
4. Differentiate the three methods of IV delivery system;
5. Calculate IV flow rates correctly;

6. Integrate the 11 key areas in the care of patients with IV
therapy;
7. Apply correct principles of infection control in
performing IV therapy to patients*;
8. Initiate appropriate nursing care to prevent and/or
manage different complications of IV therapy*;

9. Demonstrate the correct technique in performing the
following procedures*:
• Venipuncture for peripheral IV line;
• Initiation, maintenance, and discontinuation of IV
therapy;
• Administration and/or incorporation of IV medications
in different infusion methods; and
• Documentation.

Intravenous (IV) Therapy Concept Outline
I. Basic Foundation of IV Therapy
A. Philosophy
B. Historical Background
C. Standards of Practice
II. Principles and Guidelines in IV Therapy
A. Review of Anatomy and Physiology
B. Indications of IV Therapy
C. Materials and Technique of Venipuncture in
Adult and Children

Intravenous (IV) Therapy Concept Outline
II. Principles and Guidelines in IV Therapy…
D. Common IV Access Devices and Sites
E. Principles of IV Therapy
F. Roles and Responsibilities of the IVT Nurse
G. Setting up, Starting, Maintaining, and/or
Discontinuing IV Therapy
H. Preparing and Administering medications through
the IV access device / line
I. Complications of IV Therapy
J. Documentation
K. Practice Tests
What is Intravenous (IV) Therapy?
• administration of fluids into a vein

• direct injection or through peripheral/central line
• administration set with fluid container
• saline/heparin/medicine lock
• Infusion pump
• intermittent or continuous

Why do we need to be updated in IV
Therapy?

Historical Background of IV Therapy
Nursing
Standards
on IV
Practice

Philosophy of IV Therapy (ANSAP)
• Safe and quality nursing care

• Adequately trained RNs
• Completed the training
requirements
• Certification of IVT
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Judith P. Valenzuela, MMSU-CHS
Philosophy of IV Therapy (ANSAP)
Basic Intravenous Therapy Training Framework

Standards of Practice in IV Therapy
The Objectives of these Standards are to:

1. Serve as guide for nurses in providing safe and quality
nursing care to patients relative to IVT;
2. Promote the application of principles underlying the
administration of IVT; and
3. Recognize the ethico-legal implications of IV therapy

Ethico-legal Bases of IVT
• Physician’s prescription
• RA 9173: Nursing Law of 2002
• BON Resolution #8 s1994
• Nursing Core Competency Standards (2012)
• Standards of Professional Nursing Practice
• Nursing Process
• Nursing Jurisprudence
• BON Res. # 220 s2004
• Ethical Principles
• Patient’s Bill of Rights
• Policies of the Institution

• Legal therapeutic prescription
• Physician’s prescription of a licensed physician
• Nursing Process
• BON Res. # 220 s2004


• RA 9173: Nursing Law of 2002 • “The duties and

responsibilities of
nurses include but not
• Nursing Core Competency Standards (2012) limited to…
• Standards of Professional Nursing Practice administration of
• Nursing Process written prescription
• Nursing Jurisprudence for… treatment,
• BON Res. # 220 s2004 therapies, and
• Ethical Principles parenteral medication.”


• RNs are prohibited from
administering IV injections
to a patient unless they
• Standards of Professional Nursing Practice have undergone special
• Nursing Process training in IV injection.
• BON Res. # 220 s2004

• Nursing Core Competency • specified three

Standards (2012) beginning
• Standards of Professional Nursing Practice competencies of the
• Nursing Process graduate:
• BON Res. # 220 s2004

• Nursing Process • Assessment

• Nursing Jurisprudence • Diagnosis
• BON Res. # 220 s2004 • Outcome Identification
• Ethical Principles • Planning
• Patient’s Bill of Rights • Implementation
• Evaluation
• Malpractice
• Nursing Process
• Negligence
• BON Res. # 220 s2004

• Nursing Process
• BON Res. # 220 s2004

• Code of Ethics for
Registered Nurses

• Nursing Process
• BON Res. # 220 s2004
• beneficence – do good
• non-maleficence – do no harm
• autonomy – self-governance
• Nursing Process
• BON Res. # 220 s2004

• Right to information
• Right to education
• Right to refuse
• Nursing Process
• BON Res. # 220 s2004
• Ethical Principles • TKO regulation
• Patient’s Bill of Rights • Drop factor
• Policies of the Institution • Blood / drug administration
Principles and Guidelines in IV Therapy
Review of A & P
Arteries
Veins
Capillaries

Review of A & P
Peripheral Venous
System

Review of A & P
Peripheral Venous
System

Review of A & P
Peripheral Venous 1
System

Review of A & P 1
Scalp veins
Frontal
2Veins
3
Review of A & P _____________________
_________________
Central Venous
System
___________

Advantages IV Site Disadvantages
Principles and Guidelines
– easily accessible
Metacarpal veins –in IVdueTherapy
painful to concentration of
– bone of hand can nerve endings
serve as splint – not commonly used in aged
patients
gauge cannula
Advantages and Disadvantages
– suitable for large Basilic veins – vein tends to roll on insertion
– uncomfortable position for
of Common IV Sites patient
– large vein Cephalic veins – vein tend to roll

– does not impair client’s
mobility
– large vein Accessory veins – difficult to position adapter
– does not require arm flush
board in children or – patient movement can cause
adult discomfort or kinking of tubing

Advantages IV Site Disadvantages
– palpable and visible in Antecubital veins – difficult to immobilize joint
children – increased risk of arterial
puncture
Advantages and Disadvantages

– last resort when other sites Median antebrachial
are not available veins
– painful venipuncture
– increased risk of nerve damage
– last resort for of Common IV Sites
Digital veins – finger needs to be splinted
administration of non- – uncomfortable for patient
irritating drugs – infiltration can occur easily
– cannot be used if metacarpal
veins are already used
– an alternative when other Great saphenous veins – interfere with mobility
IV sites have been – risk for thrombi and emboli
exhausted

Review of A & P
Fluids
Body Compartments

Review of A & P
Fluids
Intake and Output
Fluid should equal

gains and losses

Review of A & P
Fluids
Variations in Fluid Distribution
The volume of fluid in
the different
compartments varies
with age and sex

Review of A & P
Electrolytes
Sodium (Na + ) ECF
Potassium (K +) ICF
Calcium (Ca ++) ICF=ECF
Magnesium (Mg ++) ICF
Chloride (Cl -) ECF
Phosphorus (P -) ICF

Review of A & P
Fluid & Electrolyte Regulation
• Hypothalamus - osmoreceptors
• Renin-Angiotensin-Aldosterone System
• Natriuretic Peptides – ANP, BNP, CNP

Review of A & P
• Hypothalamus - osmoreceptors

Review of A & P
• Renin-Angiotensin-Aldosterone System

• Natriuretic Peptides –
Review of A & P
ANP, BNP, CNP

Review of A & P
Fluid & Electrolyte Movement
• Osmosi
• sFiltration
• Diffusion
• Active Transport

Review of A & P
• Filtration

Review of A & P
• Diffusion

Review of A & P
• Active Transport

Review of A & P
Acid-Base Balance

Types of IV
Isotonic Fluids
Hypotonic
Hypertonic

Isotonic Solutions

Hypertonic Solutions

Hypotonic Solutions


Materials for IV
Therapy

Parts of the IV Administration Set /
Tubing
1
2
3
4
5
6
7
9 IV tubing

Variations in Administration Sets




Needless injection port Three-way stop cock
IV Extension line Needle injection port

Common IV Access Devices
• Peripheral Access Devices
― for short-term use in peripheral veins

 winged/butterfly
needles
• short, sharp-tip
• with variable
length of plastic
tubing

Winged-tip Needles
Advantages Disadvantages
One time IV administration Increase risk of filtration
Blood withdrawal
Good for those allergic to
Not for use in flexor areas
teflon or nylon
Ease of insertion & securing tape

 Over-the-needle catheter
• Short PVCs
• Made up of stainless steel coated with Teflon-like
plastic catheter
• Needle is removed after penetrating vein, catheter
is left in vein


Over-the-needle Catheters
Easy to insert accidental puncture
Winged cannula: easy to tape No wings: difficult to secure
Longer patency Pressure marks from hub
Radiopaque (XR visible) Increased risk for phlebitis
Rare infiltration
Easy mobility

 In-the-needle catheter
• With large-bore needle
• With smaller gauge plastic catheter
• Catheter is advanced into the vein through
the needle

Inside The Needle Catheter
Percutaneous Intravenous Catheter


In-the-needle Catheter
Permits insertion in the SVC Increased Catheter embolism
Less likely to damage vein Risk of Shearing
Reduces risk of Increased Risk for Phlebitis
touch contamination

• Midline Catheters
― IV access for
― rotation of site is every
― flushed with saline or heparin solution
• Central Catheters
― advanced into central veins
― used when maximal mixing with large volume
of blood is needed

• Central Catheters…
― peripheral access sites have been exhausted or is
poor
― long term / home therapy / emergency situations
― common sites:
** Peripherally Inserted Central Venous Catheters (PICCs)

• easier to maintain than short PVCs
• with fewer complications
• could remain in place for

Peripherally Inserted Central Venous Catheters (PICCs)

• Implantable Infusion Ports
― long term therapy and when intermittent access
to the central vein is needed
― may remain in place for

PICC line

Principles of IV Therapy
• Use appropriate barrier precautions
• Dispose needles and other sharps properly.
• Care should be taken not to contaminate the IV
administration set and devices.

Principles of IV Therapy…
• Be aware of institutional policy and/or
manufacturer’s instructions related to IV therapy
• Ensure that IV medications are thoroughly
dissolved in the correct volume and type of
solution.
• DO NOT administer drugs/IV solutions that are
hazy, cloudy, or with foreign particles or precipitate.

Principles of IV Therapy…
• DO NOT use topical antibiotic ointment or creams
on insertion sites
• DO NOT administer drugs in IV solutions with
unknown compatibility or with blood and blood
products


• Generally, drugs given by IV push or bolus follow
the SASH guideline.
• Once mixed, determine length of stability of
solutions.
• IV solutions should be properly labeled

• Follow proper procedure for BT and TPN
procedures
• Never “speed up” an IV flow rate when the volume
to be infused has fallen behind.
• Monitor client while on IVT.

Roles of Nurses in IV Therapy
1. Communicator
2. Coordinator and Collaborator
3. Educator
4. Manager and Supervisor
5. Researcher

Responsibilities of Nurses in IV Therapy
 Initiate IV Therapy as prescribed.
 Select the most appropriate IV system
equipment:
1. gravity flow infusion
2. infusion pump
3. single luer-lock/saline/medlock.

Gravity Flow Infusion
• Indicated for
 short-term medication
administration
 emergency fluid
resuscitation
 blood and blood products
administration
 and colloid administration.

Reminders: IV fluids flow by gravity

Reminders: Secondary Line
(Piggyback Set)
• Infusion of medications
• Intermittent
• IVPBs hang higher than primary bag
• IVPB set includes an extender to be used
on the primary bag
• When IVPB complete, primary bag will
begin its flow automatically

Infusion Pump
• Features:

Syringe Pump

Single luer-lock/ saline/ heparin/

medlock

Responsibilities of Nurses in IV
Therapy…
• Select the appropriate administration set and size
of catheter.

Therapy…
• Choose the most appropriate IV site.

Therapy…
 Check for the fluid and other equipment for
infusion
 Use aseptic technique in assembling the infusion
& during insertion

Therapy…
 Regulate IVF into desired flow rate.
 Know when to change or discontinue the
infusion.
 Monitor for signs of complications.
 Document the procedure

Setting Up IV Infusion
1. Check doctor’s order and make IV label.
2. Explain procedure to patient.
3. Do hand hygiene before (and after) the
procedure.
4. Prepare the materials.
5. Check the sterility of the IV solution, set and
other materials.
6. Put the IV label of the IV fluid bottle.

Setting Up IV Infusion…
7. Remove the seal of the IV solution and disinfect the
rubber port.
8. Open the administration set aseptically and close the
roller clamp.
9. Spike the rubber port of the IV fluid container
aseptically.
10. Hang the IV fluid bottle using the IV stand. Open the
roller clamp and fill the drip chamber to at least half.
11. Prime the IV tubing while maintaining the sterility of
the needle adaptor.
12. Expel air bubbles from the tubing
Starting an IV line
1. Obtain a doctor’s order and explain procedure to
patient.
2. Wash hands before (and after) the procedure.
3. Gather needed materials.
4. Select a good vein.
5. Apply tourniquet using a slipknot proximal to the
IV site.

Starting an IV line…
6. Cleanse the site.
7. Approach the vein from the top or side and insert
the cannula/needle at ____degrees angle bevel
up while applying traction on the vein distal to the
point of entry.

8. If backflow of blood is present, position the
cannula almost parallel to the skin then advance
the cannula/needle in any of the four techniques,
until hub is 1 mm to the puncture site:
a. Floating
b. two handed
c. one step
d. pushing

9. Slip a sterile gauze under the hub, release the
tourniquet then remove the stylet while applying
gentle pressure 1-2 in. from the cannula tip.
10. Connect the IV catheter aseptically to the tubing of
the prepared IV fluid
11. Open the clamp and check the IV flow rate.
12. Anchor the needle firmly in place. Apply splint as
needed.
13. Regulate flow of infusion as ordered.
14. Document the procedure and monitor for client’s
response.
Methods of anchoring the IV cannula
1. Chevron method
2. H method
3. U method
4. X method




Preparing and Administering
Medications through IV lines and other
Devices
1. Verify doctor’ order and explain the procedure to
the patient
2. Observe precautionary measures to prevent
transmission of microorganisms
3. Always check for the patency of the IV line
4. Check for skin test result, possible interactions,
incompatibilities, and drug computation
5. Prepare the medication aseptically

Preparing and Administering
Medications through IV lines and other
Devices…
6. Close the roller clamp or pinch the IV tubing above
the injection port of the IV tubing, disinfect the
injection port then push drug aseptically at a rate
recommended by the manufacturer.
7. If the drug and the IV solution are not compatible,
stop the infusion and inject 2 ml of PNSS. Administer
the drug at prescribed rate and inject another 2 ml of
PNSS. When all the medication is administered,
open the infusion and readjust flow rate to
correspond with physician’s order
Adding Medications to an IV bag, bottle
or
volumetric chambers
 Drugs should be added immediately before
administering the IV fluid.
 Do not add the drug while the infusion is running
unless the drug in the container is dispersed
throughout the solution.
 Be sure that the drug and the IV solution are
compatible.
 Label the IV container.

Adding Medications to an IV bag, bottle
or
volumetric chambers…
 For volumetric chambers, verify the type and amount
of IV fluid and the drug to be incorporated.
 Open the clamp from the bottle while keeping the
clamp from the volumetric chamber closed.
 Disinfect the injection port of the chamber and
incorporated the drug.
 Mix gently.
 Open the clamp at the volumetric chamber and
regulate the flow as ordered

Changing Bottles of IV Solution
1. Always check doctor’s order for the follow up IV
solution.
2. Clamp the tubing and quickly exchange the new
container for the empty container by spiking the
new container aseptically.
3. Unclamp the tubing and regulate the infusion as
ordered
4. IV tubings and cannula are generally changed
after _____ hours.

Discontinuing an IV Infusion
1. Prepare tape/plaster for use on venipuncture site
2. Close the roller clamp of the IV set
3. Loosen the plaster on the IV site (moisten with
wet cotton ball) while stabilizing the catheter to
prevent possible venous damage.
4. Check hospital policy regarding the use of
tourniquet

Discontinuing an IV Infusion
5. Using a gauze pad (or cotton ball), apply gentle
pressure to the IV site with the nondominant
hand while the dominant hand withdraws the
catheter parallel to the skin
6. Apply pressure over the IV site until bleeding
stops.
7. Inspect the catheter for completeness
8. Apply dressing over the site

Troubleshooting Infusion
Interruptions
CHECK the _______.
Keep calm and CHECK for _______.
troubleshoot.

Problems / Complications Associated
with IV Therapy

with IV Therapy
PROBLEM CAUSES S/S INTERVENTIONS
COMPLICATIO
N
Air in the tubing – container is left visible air in  clamp the tubing,
empty the tubing disinfect the injection port
– improper closest to the air bubble
priming of tubing and withdraw the air
– air is introduced pocket using a needle
in the tubing and syringe
during IV drug  Prevention: do not allow
administration the container to run
empty, prime tubing
properly, expel air
bubbles in syringe before
administering the drug

with IV Therapy
COMPLICATIO
N
Dislodged – loosened tape catheter  remover the IV catheter
catheter or tubing backed out of and restart infusion in
snagged in bed the vein another site
– catheter pulled solution  Prevention: Securely
out by confused infiltrating the tape the venipuncture
patient tissue device during insertion

with IV Therapy
COMPLICATIO
N
Severed catheter – catheter  leakage  retrieve broken part if
inadvertently from the possible, if not notify the
cut by scissors catheter physician
– reinsertion of shaft  if the broken portion
the needle to enters the bloodstream,
the catheter apply tourniquet
 Prevention: never
attempt to cut catheter,
do not reinsert needle in
the catheter, remove
unsuccessfully inserted
catheter and needle
together
with IV Therapy
COMPLICATION
Infiltration – catheter coolness of skin  Remove the infusion
– escape of fluid penetrating around IV site device and restart in
into the SQ the vessel taut skin another site
tissue wall swelling of the  Prevention: Check the
area site often, limit movement
negative or of the extremity with IV
pinkish blood site, Instruct client to
backflow report pain or swelling,
pallor, pain at avoid tightening the area
infusion site above the site with tape
continuous flow
even if vein is
occluded

with IV Therapy
COMPLICATION
Nerve, tendon, – improper  extreme  Stop the procedure
ligament damage venipuncture pain  Prevention: avoid repeatedly
technique  numbness penetrating the tissues with
– tight taping  paralysis infusion device, avoid
– improper  deformity excessive pressure when
splinting securing the site, pad splints
Hematoma – punctured vein  bruised area  Remove the infusion
formation – leakage of around the  Apply pressure and cold
blood into site compress to the affected site
tissues  tenderness  Prevention: Choose a vein
that can accommodate the
size of the catheter

with IV Therapy
COMPLICATIO
N
Thrombosis – tissue trauma pain  Disconnect IV infusion
– formation of swelling and restart in another site
blood clot sluggish/  Apply warm compress
stopped IV  Do not massage the area
flow  Prevention: observe
correct technique in
venipuncture

with IV Therapy
COMPLICATIO
N
Emboli – thrombus that depends on the  Discontinue the infusion
– foreign breaks loose whether  Position patient in left lateral
material, blood – injection of embolism causes Trendelenburg position
clot or air in foreign matter, obstruction or  Administer oxygen and
the circulation precipitate or infarction at any notify physician
medication that site in the  Prevention: Prime tubing
is not properly circulation before starting the infusion,
dissolved chest pain check IV solution for
– air in the tubing dyspnea presence of precipitate and
that is not respiratory foreign matter, do not cut IV
removed distress catheters, dissolve
– container left weak, rapid pulse medications completely,
empty altered avoid using the veins in the
– disconnected consciousness lower extremities, use in-
5/7/19 tubings line filters
Judith P. Valenzuela, MMSU-CHS 117
with IV Therapy
COMPLICATIO
N
Speed Shock – too rapid  pounding  Discontinue the infusion
– body’s reaction infusion of the headache  Report to physician and
to a drug/ drug into the  flushed face monitor vital signs
substances circulation  chest tightness  Prevention: Check
that is injected – improper  rapid, irregular infusion guidelines
too rapidly administration pulse before giving drugs,
of a bolus  syncope dilute drug with
infusion  apprehension compatible solution only,
 shock use proper tubing to all
 cardiac arrest pediatric patients

with IV Therapy
COMPLICATION
Fluid overload – inappropriate  engorged  Raise the head of the bed
– when too large infusion set neck vein  Slow the rate of infusion
volume of fluid – miscalculatio  hypertension  Monitor vital signs
is infused in the n of fluid  dyspnea  Administer drugs as
circulatory requirement  respiratory ordered
system – loosened distress  Prevention: Monitor
roller clamp  crackles infusion frequently, verify
– too rapid flow  increased calculations, use rate
rate / difference controller devices
inaccurate between
monitoring of intake and
flow rate output

with IV Therapy
COMPLICATIO
N
Allergic Reactions – exposure to  itchiness  Stop the infusion
allergen such  redness  Maintain patent airway
as drug  rashes  Notify physician
 bronchospasm  Administer emergency
 wheeze drugs as ordered
 cardiac arrest

with IV Therapy
COMPLICATIO
N
Infection – non-sterile fever, chills  Notify physician
– invasion of technique malaise  Administer medications as
pathogenic during discharge at prescribed
microorganism venipuncture IV site  Culture site and device as
into the body or site care ordered
– contaminated  Prevention: always
IV solution observe aseptic technique
– severe during venipuncture and
phlebitis site care, when handling
solutions, and when
discontinuing infusion

Infection Control

Infection Control

Practice Tests

Revsed IV

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• administration of fluids into a vein

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• Safe and quality nursing care

Basic Intravenous Therapy Training Framework

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The Objectives of these Standards are to:

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Ethico-legal Bases of IVT

• RA 9173: Nursing Law of 2002 • “The duties and

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• BON Resolution #8 s1994

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• Nursing Core Competency • specified three

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• Nursing Process • Assessment

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• BON Res. # 220 s2004

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• Patient’s Bill of Rights

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Review of A & P _____________________

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– large vein Cephalic veins – vein tend to roll

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Advantages and Disadvantages

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Fluid should equal

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