IV THERAPY

● Hypertonic- solutions that are more

Administration of F/E, Nutrients or medicines concentrated than body fluids, causes
through/ within the vein shrinking
Example: 3% NaCl, dextrose 5%
-Giving of substance directly into the vein

Purposes & Uses: ● Crystalloids -solutions that contain

electrolytes,may be used for fluid
◆ Sustain clients who are unable to take volume replacement
substance orally (eg. Unconscious
Ex: NaCl, LR
patients.)
● Colloids- also called plasma Expanders,
◆ Replace Water, electrolytes and
used to increase the volume rapidly,
nutrients (treat/ prevent nutrition
such as in Hemorrhage or severe
imbalance, fluid volume maintenance
hypovolemia
and replacement)
INTRAVENOUS DEVICES:
◆ Provide immediate access to the
vascular system. (faster absorption) ◆ STEEL NEEDLES OR BUTTERFLY SETS

OSMOLALITY- the measure of solute -0.5 to 1.5 in length gauge: 16 to 26; used when
concentration infusion time is short; commonly used in
children and elderly; infiltration is more
OSMOSIS- The passage of solvent from a less
common
concentrated solution through a
semipermeable membrane
◆ PLASTIC CANNULA
OSMOTIC PRESSURE- the pressure by which
water is drawn into a solution through a -preferred for rapid infusion; can cause catheter
semipermeable membrane embolism

Types of Solutions:
● Isotonic solution- same osmolality as
body fluids (eg. Serum); increase ECF IV CATHETERS:
volume ex: Normal Saline, Lactated
Ringer's solution, D5W 5%, Dextrose ◆ The smaller the number, the larger the
2.5%, 0.45% saline
outside diameter of cannula
● Hypotonic- More dilute or have lower
osmolality than body fluids, these ◆ IV Catheters
solutions should be administered slowly
to prevent cellular edema …ex: 0.45 -Red: G. 14 - Pink: G20
NaCl -Gray: G. 16 - Blue: G 22

-Green: G. 18 - Yellow: G 24
Intravenous tubing
◆ Veins in scalp and feet are suitable for
◆ Bag or bottle, drip chamber, roller infants
clamp, Y-tube, Adapter end.
◆ Veins in the lower extremities are not
◆ Add extensions for children and restless suitable
patients (so that movement is not
◆ Determine the patient’s dominant side
restricted)
and select the opposite site for
◆ Drip Chambers: Microdrip and venipuncture
Macrodrip
◆ Avoid checking the BP on the arm
Microdrip-infusion at slow rate receiving the transfusion
Macrodrip-solution is infused rapidly ◆ Do not place restraints over the
Filters: venipuncture
◆ Provide protection ◆ Use an arm board when the site is
◆ Used to trap small particles located in the area of flexion

◆ Should be changed every 24 to 72 hours

◆ Intermittent Infusion sets:

Piggyback: a way to administer med. Through
an iv line. The med in a piggy back is mixed in a
small amount of compatible fluid.
◆ When administering solutions flush 1 to
2 ml of nss
Selection of Peripheral IV Site:
◆ Veins in the hand, forearm and
antecubital fossa
 ◆ Change the iv tubing every 24 to 72
hours
◆ Do not let iv bag or bottle hang for
more than 24 hours
◆ Before adding medications or solutions,
swab access ports with 70% alcohol
IV Precautions:
◆ Insertion can cause initial pain or
discomfort
⮚ Iv provides a route of entry for micro
organisms
⮚ Adverse reactions to the solution and
medications may occur abruptly
⮚ Fluid and circulatory overload may
occur
⮚ Incompatibilities of the solution and
medication can occur
⮚ Client with congestive heart failure is
Adding Medications on the IV
usually not given a solution containing
◆ Assess for compatibility of medication saline-due to the possibility of edema
◆ When adding meds on the bag, mix the ⮚ Client with DM does not typically
bag end to end (ex. Oxytocin) receive dextrose (glucose content)
◆ Ensure that the med can be mixed in ⮚ LR solution contains potassium and
soft plastic should not be administered to clients
Administering IV Solutions with renal failure
COMPLICATIONS
◆ Iv solution should be checked against
the doctor’s order (type, amount, rate ◆ INFECTIONS
of flow) -microorganisms enter
the body through the venipuncture site-
◆ Identify contraindications of a particular
observe aseptic technique, clean the site,
IV solution change the dressings when necessary. Monitor
◆ Use sterile technique when inserting an for signs of local infection (Redness, Swelling
IV and when changing dressing and Drainage at the IV site) , Monitor for signs
of systemic infection ( chills, fever, malaise,
◆ Change the venipuncture site every 24 headache, nausea, vomiting, backache and
to 72 hours tachycardia)
◆ Change iv dressing every 72 hours ✔ monitor WBC count
 ✔ -check containers for cracks, leaks ◆ Use iv cannula smaller than the vein
cloudiness or other evidences of ◆ Avoid using the lower extremities
contamination
( thrombus formotion usually occurs at
✔ -use antimicrobial ointment on the site this site)
(bactroban) ◆ Avoid venipuncture over an area of
✔ -label the IV site, bag or bottle and flexion
tubing with the date and time. ◆ Anchor the cannula and loop of tubing
✔ -if infection occurs, d/c the IV. securely with a tape
◆ Use an arm board or splint if client Is
✔ -prepare for blood cultures
restless
✔ -restart the iv on the opposite side to ◆ If phlebitis occurs REMOVE the Iv device
differentiate sepsis immediately and notify the physician
✔ Document the assessment ◆ Document the assessment
Tissue Damage Infiltration:
◆ Includes the skin, veins and the ◆ Seepage of the IV fluid out of the vein
subcutaneous tissue. and into the surrounding interstitial
spaces
◆ Implementation:
-use careful and gentle approach when applying ◆ Prevention:
a tourniquet -avoid venipuncture over an area of flexion
-avoid tapping the skin -anchor the cannula and tubing secure with a
-monitor for ecchymosis (bruise) tape
-assess for allergy (latex allergy) -use arm board or splint
-monitor for skin color changes, sloughing of -assess iv site: pain, edema, or coolness
the skin or discomfort on the IV sites -monitor the IV for a decrease or stop in flow
-notify the physician -lower the IV fluid container over the IV site
-document the assessment -elevate the extremity and apply compress
-document the assessment
Phlebitis & Thrombophlebitis Catheter Embolism
◆ An inflammation of the vein that can ◆ Tip of the catheteer break of during the
occur from either mechanical or insertion or removal, resulting in the
chemical trauma or as result of a local possibility of embolus
infection ◆ Prevention:
◆ Phlebitis- inflammation of the wall of a -monitor for : decreased BP, pain along the vein,
vein, commonly seen in legs, as a weak and rapid pulse, cyanosis of nailbeds and
complication of varicose veins. LOC
-remove the catheter carefully
◆ Thrombophlebitis- inflammation of the
-inspect the catheter when removed
wall of vein with secondary thrombosis -when the catheter breaks: place a tourniquet
occurring in the affected segment of the on the limb of the iv site, notify the physician
vein. immediately, prepare for xray
Circulatory overload/fluid overload
◆ Results from administration of fluids
too rapidly. Client at risk for fluid
overload
◆ Prevention:
-identify the client t at risk
-calculate and monitor the flow rate frequently
-use an infusion controller device
-add a time strip to the IV bag or bottle
◆ Monitor for: increased bp, distended
jugular veins, rapid breathing, dyspnea,
moist cough and crackles
◆ Regulate IV to KVO

◆ Document the assessment

Electrolyte overload
◆ Electrolyte imbalance caused by too
rapid or excessive infusion or by use of
an inappropriate IV solution
◆ Prevention:
-assess lab value reports
-verify correct solution
-calculate and monitor the flow rate
-use infusion controller device
-label IV properly
-place sticker (color code)