Intravenous

Fluid Therapy
 DEFINITION:

INTRAVENOUS THERAPY IS THE

ASEPTIC INSTILLATION OF FLUID,
ELECTROLYTE, NUTRIENTS
MEDICATION THROUGH A NEEDLE
INTO A VEIN.
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 “
INTRAVENOUS THERAPY

◎ - administration of fluids , electrolytes, nutrients,

or medications by venous route

◎ - for clients who can’t take food or fluid orally

◎ - dependent nursing action

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 IV Fluids

◎ solution given. It is most often clear,

but can be other colors
◎ may be in a glass bottle or a plastic
bag
◎ in a various sizes
◎ sometimes a dark colored plastic bag
may cover the IV fluid to protect it
from the light
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Types of FLUIDS

◎ isotonic fluids
◎ hypotonic fluids
◎ hypertonic fluids

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 ISOTONIC SOLUTION
◎ having the same concentration of solutes
as blood plasma
◎ remain inside the intravascular
compartment, thus expanding it.

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 HYPOTONIC SOLUTION

◎ lesser concentration of solutes

◎ dilutes the serum, which
decreases serum osmolarity

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 HYPERTONIC SOLUTION
◎ has a greater concentration of solutes
◎ pulls fluid and electrolytes from the
intracellular and interstitial
compartments into the intravascular

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SELECTED IV SOLUTIONS

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 CLASSIFICATION

1. NUTRIENT
- contains some CHO and H2O
- useful in preventing dehydration
- insufficient calories

Examples:
5% Dextrose in Water
.45% Sodium chloride

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 CLASSIFICATION
2. ELECTROLYTE
- contains varying amounts of cations and
anions
Examples:
- 0.9% Sodium chloride
- Ringer’s solutions
(sodium, chloride, potassium, calcium)
- Lactated Ringer’s solution
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 CLASSIFICATION

3. VOLUME EXPANDERS
- used to increase the blood volume following
severe blood loss or loss of plasma

Examples:
- Dextran
- Plasma
- Albumin

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 THINGS TO CONSIDER
WHEN CHOOSING IV
THERAPY SITE

◎ client’s age
◎ length of time
◎ type of solution used
◎ condition of veins

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SITES OF IV THERAPY

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 OTHER SITES

DORSAL ASPECT OF HAND

◎ CEPHALIC VEIN
◎ BASILIC VEIN
◎ DORSAL METACARPAL VEIN
LOWER EXTREMITIES
GREAT SAPHENOUS VEIN
◎ DORSAL PEXUS
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 INTRAVENOUS DEVICES
◎ Deliver small
quantities of
medicines, to deliver
fluids via the scalp
veins in infants and,
sometimes, to draw
blood samples. These
are small gauge
BUTTERFLY
needles
NEEDLES 18
PARTS OF A BUTTERFLY
NEEDLE
◎ CAP FOR NEEDLE
◎ STEM( METAL
NEEDLE)
◎ WINGS( BUTTERFLY)
◎ TUBE
◎ PLASTIC ADAPTER

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OVER-THE-NEEDLE
CATHETERS

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 PARTS OF OVER THE NEEDLE
CATHETER/ANGIOCATH USED FOR
ADULTS
◎ SHORT BEVEL INTRODUCER
◎ CANNULA( PLASTIC OVER THE
NEEDLE)
◎ TRANSLUSCENT HUB( AT TIP OF
NEEDLE)
◎ PREVIEW CHAMBER
◎ FLASHBACK CHAMBER
◎ FILTER VENT
◎ NEEDLE BEVEL POSITION INDICATOR
(ROUND) 21
INFUSION SET

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PARTS OF INFUSION SET
◎ PROTECTOR CAP FOR INSERTION
SPIKE
◎ SPIKE CONNECTOR FOR FLUID
CONTAINER
◎ DRIP CHAMBER
◎ REGULATOR CLAMP
◎ Y PORT
◎ CONNECTOR TO IV CATHETER
◎ CLAMP( TO HOLD TUBE WHEN
KSS)
◎ NOTE: OTHER HAVE DIAL A FLO
IN LINE DEVICE( BUILT IN
REGULATOR)
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MEASURED VOLUME SETS

◎ Delivers
specifically
measured
volumes- burette
sets and dial and
flow sets
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ELECTROMECHANICAL
INFUSION DEVICES

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STANDARD FORMULA

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 FACTORS THAT AFEECT FLOW
RATE
◎ Flow is directly proportional to the height
of the liquid column.
◎ Flow is directly proportional to the
diameter of the tubing.
◎ Flow rate is inversely proportional to the
length of tubing.
◎ Flow is inversely proportional to the
viscosity of the fluid
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 OTHER FACTORS AFFECTING FLOW
RATE
◎ Age
◎ Condition of patient
◎ Solution used
◎ Manufacturer’s drop factor
◎ Patency of the needle
◎ Position of the site
◎ Height of the IV pole
◎ Kinking of the tube
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 COMMON COMPLICATIONS
OF IV THERAPY
INFECTION:
occur from the entry of microorganism
into the body through venipuncture.
S/s: redness, swelling and drainage at the
IV site
Nursing Care:
Strict aseptic technique, monitor signs of
systemic infection, discontinue IV
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INFILTRATION
When a non-vesicant solution or medication
enters the surrounding subcutaneous tissue.
Cause : Cannula dislodgement or perforation of wall of vein.
Signs & symptoms :
Leakage of IV fluid, discomfort, fluid flow becomes
slow or ceased, sometimes absence of blood
backflow.
NURSING CARE
• Stop infusion & remove cannula, elevate limb,
apply warm or cold compressors.
• Using appropriate size & type of cannula & a
good fixation 32
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EXTRAVASATION
It is similar to infiltration, with an advertent
administration of vesicant solution or
medication into the surrounding tissue
e.g. chemotherapeutic agents, dopamine,
calcium preparation, this can lead to blisters
inflammation necrosis of tissue.
NURSING CARE, Signs & Symptoms
Similar to infiltration, use of antidote
according to the policy, throughout
neurovascular assessment of affected
extremity must be performed frequently.
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PHLEBITIS:
Inflammation of a vein related to a chemical or
mechanical irritation or both.
Cause : Risk of Phlebitis increases with the length of
time IV line is in place, site of cannula inserted,
micro-organism at the time of insertion.
Signs & Symptoms
Redness, warm area, pain, tenderness
NURSING CARE
• Discontinue the IV apply cold compressors ( later
on warm compressor), keep the site elevated.
• To avoid phlebitis, use strict aseptic techniques,
rotate IV site every 72 hours as per policy or as
needed. Daily dress the site or as needed
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INTRAVENOUS SOLUTION

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 VEIN SELECTION GUIDELINES
◎ Use distal veins of the arms first
◎ Non dominant hand whenever possible
◎ Avoid using veins that are
1. areas of flexion
2. highly visible
3. damage by previous use
4. continually distended
5. surgically compromised or injured
extremity
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STARTING AN INTRAVENOUS SOLUTION

EQUIPMENT:
◎ IV TRAY CONTAINING THE FF:
◎ IV SOLUITON ORDERED,NEEDLE(
BUTTERFLY/VASOCAN) TOURNEQUET, ROH
SWAB/CBWITH ROH, PLASTER, SCISSOR,
MEDICINE TICKET, IVF LABEL AND
ARMBOARD ( IF NEEDED)
◎ IV POLE

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 PROCEDURE

1. CHECK THE IV SOLUTION MEDICATION ADDITIVES WITH

DOCTORS ORDER ( COMPARE TICKET WITH THE CHART)
2. WASH HANDS AND GATHER EQUIPMENT. PREPARE IV
SOLUTION AND TUBING.
◎ Clamp tubing, uncap spike, and insert into iv solution
(incorporate additives if with order before insertion of spike)
◎ Suspend IV solution, press drip chamber, remove cap at the
end of tubing, allow fluid to move through tubing (priming)
Note: remove all air bubbles. Close cap and recap tubing to
maintain sterility

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 PROCEDURE
3. NOTIFY PHYSICIAN /NURSE WHO WILL INSERT THE
IV THEN BRING PREPARATION TO THE BEDSIDE.
4. IDENTIFY PT AND EXPLAIN PROCEDURE. POSITION
CLIENT(LOW FOWLERS OR SUPINE). SUSPEND IVF TO
IV POLE.
◎ HAND TOURNIQUET, SWAB AND NEEDLE TO THE
MD OR NURSE. OBSERVE
◎ RELEASE TOURNIQUET( IF WITH RETURN FLOW),
START FLOW OF SOLUTION PROMPTLY( WHILE
OBSERVING FOR SIGNS OF INFILTRATION)

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 PROCEDURE
5. LOOP TUBING NEAR THE SITE OF
INSERTION AND ANCHOR WITH PLASTER.
ANCHOR TO ARMBOARD
6. ADJUST FLOWRATE ACCDG TO MD’s
ORDER, COMPLETE LABEL AND TAPE TO IVF
BOTTLE
7. DO AFTER CARE, WASH HANDS, DOCUMENT
8. MONITOR AT LEAST EVRY 30 MINUTES TO
CHECK FLOW RATE AND OBSERVE FOR
INFILTRATION AND UNTOWARD SYMPTOMS
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 WHAT TO DOCUMENT?
NURSES NOTES:
◎ PROCEDURE
◎ TIME STARTED
◎ SITE OF INSERTION
◎ DEVICE USED
◎ SOLUTION
◎ RATE OF FLOW
◎ PHYSICIAN OR NURSE WHO
INSERTED
◎ PATIENT’S REACTION

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 NURSING ALERT

◎ IF INFUSION IS NOT FLOWING WELL,

LOWER THE BOTTLE/ BAG TO CHECK
IF THE LINE IS STILL PATENT. NEVER
FLUSH OR PINCH IV TUBINGS OF
INFUSION

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 DISCONTINUING AN IV INFUSION

◎ WHEN THE PATIENT NO LONGER NEEDS IV

FLUIDS, IV MEDICATIONS, OR ACCESS TO
EMERGENCY DRUGS, THE CANNULA IS
REMOVED, STANDARD PRECAUTIONS MUST
BE FOLLOWED WHEN REMOVING AN IV
CANNULA BECAUSE THERE IS ALMOST
ALWAYS A SLIGHT AMOUNT OF BLEEDING
THAT OCCURS.

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 INDICATIONS

◎ ORAL AND FLUID INTAKE AND

HYDRATION STATUS OF PATIENT ARE
SATISFACTORY
◎ THERE IS A PROBLEM WITH THE
INFUSION THAT CANNOT BE FIXED
◎ MEDICATION VIA IV ROUTE ARE NO
LONGER REQUIRED

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 EQUIPMENTS

TRAY CONTAINING THE FF:

◎ DRY CB
◎ PLASTER/ BAND AID
◎ CB WITH ALCOHOL/ ALCOHOL SWAB
◎ WORKING GLOVES
◎ EMPTY BOX FOR RECEPTACLE
◎ IVF TICKET

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 PROCEDURE

1. CHECK PHYSICIANS ORDER, WASH

HANDS, ASSEMBLE EQUIPMENT
2. IDENTIFY AND EXPLAIN THE PROCEDURE
3. RELEASE ANCHORAGE OF ARM, TUBING
AND NEEDLE. LOOSEN TAPE AT
VENIPUNCTURE SITE WHILE HOLDING
NEEDLE FIRMLY AND APPYING
COUNTERTRACTION TO THE SKIN

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 PROCEDURE
4. DON GLOVES CLAMP INFUSION.
5. HOLD SWAB ABOVE VENIPUNCTURE SITE,
WITHDRAW NEEDLE QUICKLY, APPLY
PRESSURE TO SITE USING SWAB FOR 2-
3 MINUTES. HOLD PATIENTS ARM
ABOVE BODY IF BLEEDING PERSIST.
6. CHECK NEEDLE OR CATHETER IF INTACT(
REPORT BROKEN NEEEDLE, APPLY
TOUNIQUET ABOVE INSERTION SITE)
7. APPLY DRY CB OR BAND AID

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 PROCEDURE

8. DISCARD USED SUPPLIES APPROPRIATELY.

REMOVE GLOVES AND WASH HANDS
9. DOCUMENT;
- AMOUNT OF FLUID TO I AND O SHEET
- NURSES NOTES: TYPE OF SOLUTION
TIME AND REASON FOR
DISCONTINUING AND PATIENT’S
RESPONSE.

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THANK YOU
FOR
LISTENING
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