INTRAVENOUS
THERAPY
- MARICHU NAIRA UMAYAM, RN
OBJECTIVES
At the end of this module, the student will be able to:
a. Explain the purposes of starting and IV infusion
b. Assess the patient prior to IV insertion
c. Plan to initiate IV infusion
d. Prepare the necessary equipment needed for IV
insertion
e. Implement the IV insertion
f. Do a sample documentation
INTRODUCTION
IV stands for “intravenous” or “inside the vein”. It means that the patient
receives substances directly to their veins through a tube called a cannula.
This could be either medication or nutrition.
Although the primary care provider is responsible for ordering IV therapy
for clients, nurses initiate, monitor and maintain the prescribed care facilities
but increasingly in community-based settings such as clinics and client’s
homes. This module talks about IV therapy concerning: Purposes,
Assessment, Planning, Delegation, Equipment, Implementation, Preparation,
Performance, Sample Documentation and Evaluation
INTRAVENOUS THERAPY
- a treatment that infuses
intravenous solutions,
medications, blood, or
blood products directly
into a vein.
PURPOSES OF IV THERAPY
1. To replace fluids and electrolytes
and maintain fluid and electrolyte
balance
2. To administer medications
3. To administer blood or blood
products
4. To deliver nutrients and nutritional
supplements
CONTRAINDICATION
No absolute contraindications for IV
cannulation exist.
TYPES OF FLUIDS
1. Crystalloids - contain
small particles that that
pass easily from the
bloodstream to cells and
tissues.
TYPES OF CRYSTALLOIDS
1. Hypotonic
2. Hypertonic
3. Isotonic
TYPES OF FLUIDS
[Link]
- contain larger insoluble
molecules, blood itself is a colloid.
- have large particles in them so they
are not as easily absorbed into the
vascular bed.
ASSESSMENT
Vital signs
Skin turgor
Allergy
Bleeding tendencies
Disease or injury to
extremities
Status of veins to determine
appropriate venipuncture site
NURSING DIAGNOSES
Deficient Fluid Volume
Impaired Skin Integrity
Risk for Injury
Risk for Deficient Fluid Volume
Risk for Infection
PLANNING
The access device is inserted
using sterile technique on the first
attempt.
The patient experiences minimal
trauma, and the IV solution
infuses without difficulty.
IMPLEMENTATION
1. Verify the doctor’s
order
2. Gather equipments.
3. Identify the patient.
4. Maintain privacy
5. Hand hygiene, PPE
EQUIPMENTS
PRIME THE TUBING
a. Compare IV fluid with that of the
doctor’s order. Check the expiry
date. Label the IV fluid with patient’s
name.
b. Maintain aseptic technique when
opening the IV fluid and sterile
packages.
PRIME THE TUBING
Close the roller clamp
PRIME THE TUBING
Hang the IV fluid and prime the tubing
TECHNIQUES ON VEIN ACCESS
Gravity
Fist clenching
Tapping
Warm Compress
Scalp for infants
Tourniquet
METHODS OF VEIN ENTRY
a. direct
b. indirect
INITIATE VEIN ACCESS
INITIATE VEIN ACCESS
Open the roller
clamp and
regulate the IV
fluid according to
the doctor’s order
(flow rate)
REGULATING IV FLOW RATE
a. Standard Formula
drops/minute = volume (mL) X drop factor
time (minutes)
b. drops/minute= mL per hour X drop factor
time (60 mins)
COMPLICATIONS
PHLEBITIS
- inflammation of the vein in
which the endothelial cells of
the venous wall become
irritated and cells roughen,
allowing platelets to adhere
and predispose the vein to
inflammation-induced.
SIGNS AND SYMPTOMS
redness or tenderness
at the site
warmth around the
insertion site
swelling over the
vein
pain
PREVENTION
proper venipuncture technique
Use of proper dilution
Secure properly
minimize movement
Avoid joints when placing catheter
Monitor administration rates and
inspect the I.V. site frequently.
Change the infusion site.
NURSING INTERVENTION
Stop the infusion
No to massaging the site
Apply warm, moist
compress
Reinsert at a different
site
EXTRAVASATION
- occurs when a peripheral catheter
erodes through the vessel wall at
a second point, when increased
venous pressure causes leakage
around the original venipuncture
site, or when a needle pulls out
of the vein.
SIGNS AND SYMPTOMS
Burning sensation
Swelling
edema
blanching and coolness
pain or a feeling of tightness
PREVENTION
Know the antidote and other recommended treatment for the
vesicant drug you're giving.
Ensure the drug is properly diluted before infusion or injection
Use the smallest needle possible suitable for the patient and fluid
being administered
Select the venipuncture carefully by choosing the distal vein.
Avoid wrist, fingers, antecubital fossa and dorsum of the hand
Don’t administer a vesicant in a 24 hour old IV site
Secure the IV site properly
Assess the site 1-2 hours after administration of the vesicant drug
to check for patency of the IV line.
Check for infiltration before administering the drug.
During the infusion, instruct the patient to report any pain or
burning sensation to the site for conscious patients
NURSING INTERVENTION
1. Stop the infusion and disconnect the
tubing.
2. Remove the catheter without placing
pressure on the site.
3. Elevate the affected arm.
4. Apply either ice packs or warm
compresses to the affected area.
5. Continue regularly assessing and
documenting the appearance of the site and
associated signs and symptoms.
AIR EMBOLISM
- a bubble, or bubbles, of gas
trapped within the blood vessels.
The bubbles will, at some point,
cut off the blood supply to a
particular area of the body.
SIGNS AND SYMPTOMS
blue hue on the skin
low blood pressure
Weak pulse
difficulty of breathing
PREVENTION
Prime the tubing prior
to connecting to the
IV catheter
NURSING INTERVENTION
Position the patient to the left
side with head down
Administer oxygen
Monitor vital signs
Refer
HYPERVOLEMIA
- abnormal increase in the
blood volume. More likely
happen to pregnant women,
young children, elderly or
with people with kidney
problems.
SIGNS AND SYMPTOMS
Tachycardia
Distended neck veins
PREVENTION
Ensure the correct fluid rate
Monitor intake and output
NURSING INTERVENTION
Slow down the infusion
Notify the physician
Verify correct fluid rate of administration
INFECTION
If the IV line, port, or skin on the
site of injection are not properly
clean prior to inserting the IV.
SIGNS AND SYMPTOMS
Redness and discharge at
the I.V. site
Elevated temperature
Swelling, localised
induration
Skin discoloration
Pain
PREVENTION
Perform hand hygiene, don gloves, and use aseptic
technique during I.V. insertion.
Clean the site with approved skin antiseptic before
inserting I.V. catheter.
Ensure careful hand hygiene before any contact
with the infusion system or the patient.
Clean injection ports before each use.
Follow your institution’s policy for dressing
changes and changing of the solution and
administration set.
NURSING INTERVENTION
Stop the infusion and notify the
prescriber.
Remove the device, and culture the
site and catheter as ordered.
Monitor the patient's vital signs.
OTHER NURSING INTERVENTIONS
Fluid does not easily flow into the vein:
Reposition the extremity
If the IV is a free-flowing IV, raise the height of the IV pole.
Attempt to flush the IV with 2 to 3 mL of saline in a
syringe. Check the IV connector to ensure that clamp is
fully open.
OTHER NURSING INTERVENTIONS
Fluid does not flow easily into the vein, and the skin around the
insertion site is edematous and cool to the touch:
Reinsert.
A small hematoma is forming at the site while you are inserting the
catheter:
Reinsert. Remove and discard the catheter and choose
an alternate insertion site.
OTHER NURSING INTERVENTIONS
IV infusion set becomes disconnected from IV:
Discard IV tubing. Attempt to flush IV with 3 mL of
normal saline.
IV catheter is partially pulled out of insertion site:
Do not reinsert the catheter.
OTHER NURSING INTERVENTIONS
check IV equipment before usage
don’t shave hair
don’t reuse needles or catheter
secure tubings, cannula, connections
change IV fluid every 24 hrs
change Iv dressing every 24 hours/PRN
Change IV cannula every 48 hrs
OTHER NURSING INTERVENTIONS
change IV tubing every 72 hours
apply gentle palpation on site - to check for intact dressing
observe IV fluids for cracks and cloudiness
any part that is disconnected - do not reconnect
blood specimens should not be withdrawn on the IV
tubing except emergencies
injection site for heparin lock – site change every 72 hrs
even if there’s no s/s of infection
THANK YOU!