●​ Antiseptic swabs

Assisting IV Therapy and IV ●​ Drip set

Incorporation ●​ IV pole
●​ Cannula
●​ Saline Sol’n
Definition: ●​ Adhesive plaster

​ IV therapy is a medical technique

that delivers fluids, medications, and Anatomy and Physiology
nutrition directly into the patient’s vein
when they can’t take oral fluids or feedings
by mouth (NPO). SKIN
​ IV incorporation (aka IV piggyback -​ The body’s largest organ
or IV admixture) is the process of adding
secondary solutions such as medications, Functions
fluids, or other substances to the existing IV -​ Protects the body from abrasion
solution or line. and UV light
-​ Sensation
-​ Vit D production
Purpose: -​ Temp regulation
-​ Excretion
●​ To provide water, electrolytes, and
nutrients to meet daily body
requirements;
●​ To replace water and correct
electrolyte deficits;
●​ To administer medications
●​ To administer blood and blood
products

Indication:
●​ Dehydration
●​ Surgery
●​ Malnutrition
●​ Medication administration
●​ Emergency situations LAYERS
1.​ Epidermis - thin outer layer of the
Contraindication: skin
●​ Severe Peripheral Vascular Disease 2.​ Dermis - middle layer of the skin
●​ Local Infection at the Proposed IV 3.​ Subcutaneous layer - deepest layer of
Site the skin
●​ Allergies to IV Materials
●​ Coagulopathies or Bleeding BLOOD
Disorders -​ A liquid connective tissue in the
●​ Severe Fluid Overload States circulatory system that delivers
●​ Existing Venous Thrombosis necessary substances (nutrients and
oxygen) to the cells and transports
Equipments: metabolic waste products away from
●​ Non-sterile gloves the same cells
●​ Tourniquet
 -​ It is comprised of 8% from the total ●​ Eosinophils - kill parasites,
body weight cancer cells, involved in
-​ Contains: allergic response (releases
-​ 4% formed elements histamine and heparin)
-​ 55% plasma ●​ Basophils - involved in allergic
response and reduces
Functions inflammation
-​ Nutrition, oxygen and carbon
dioxide transport AGRANULOCYTE - immune cells that has
-​ Temperature maintenance no granules; It is an adaptive immunity that
-​ Fluid, electrolyte and pH balance aids in process of digestion of cellular debris
-​ Blood loss prevention and pathogens
-​ Protection from microorganism, and
foreign bodies ●​ Monocytes - cleans up
damaged cells
●​ Lymphocytes - helps fight
COMPONENTS OF THE BLOOD virus and makes antibodies

c.​ Hematopoiesis - blood cell

1.​ Plasma
formation
a.​ A pale yellow liquid
component
b.​ It’s made up of 92% water
BLOOD VESSELS
and 8% proteins, ions,
​ A network of tubes through which
2.​ Formed elements
blood is pumpes around the body
a.​ 95% RBC
(circulation).
Red Blood Cell
2 types of Circulation
-​ Aka erythrocyte
1.​ Systemic - blood going through the
-​ Main component:
different tissues of the body
-​ Hemoglobin
2.​ Pulmonary - blood from the right
-​ Primary function:
ventricle to the lungs and back to the
-​ Oxygen and CO2
left atrium
transport

Types of Blood Vessels

b.​ 5% WBC, Platelets
●​ Arteries - carries blood away from
the heart
White Blood Cell
●​ Veins - carries blood back to the
-​ Aka leukocyte
heart
-​ Protects the body from
●​ Capillaries - the smallest blood
harmful microorganisms
vessel, connects arteries and veins
-​ Removes dead cells

LAYERS
GRANULOCYTES - immune cell that has
granules with enzymes that are released
during infection, allergic reactions, asthma;
It is an innate immunity

●​ Neutrophils - phagocytize
microorganisms
 -​ Most common IV access method
-​ Consist of short catheter inserted
through the skin into peripheral vein

1.​ Tunica intima- is the innermost layer

of blood vessels.
2.​ Tunica media- the middle layer of PERIPHERALLY INSERTED
the wall of blood vessels. CENTRAL CATHETER
3.​ Tunica adventitia- the outermost -​ A thin flexible tube that’s inserted
layer of the vessel wall. into a vein in the upper arm and ble
tube that’s inserted into a vein in the
VEINS USED IN IV THERAPY upper arm and

●​ Radial and Ulnar Vein

●​ Brachial Vein
●​ Cephalic Vein
●​ Basilic Vein
●​ Median Cubital Vein
●​ Subclavian Vein
●​ External Jugular Vein
●​ Internal Jugular Vein

CENTRAL LINE
-​ Aka central venous catheter
-​ A tube that doctors place in a large
vein (neck, groin or arm)

IV ACCESS DEVICES

1.​ Peripheral Catheter

2.​ Peripherally Inserted Central
Catheter (PICC)
3.​ Central Line
4.​ Subcutaneous Injection Port SUBCUTANEOUS INJECTION PORT
-​ A subcutaneous port is a surgically
PERIPHERAL CATHETER
 implanted device that provides -​ aqueous sol’n of mineral salts
long-term access to a vein. It's made or other water-soluble
up of a reservoir that's placed under molecules.
the skin and a catheter that's inserted -​ Commonly used: Normal
into a vein. Saline
2.​ Colloids
-​ Contains large insoluble
molecules

KINDS OF IV SOLUTIONS

•Isotonic solution- such as normal saline

(NS) and lactated Ringer's initially remain in
the vascular compartment, expanding
vascular volume. Assess clients carefully for
signs of hypervolemia such as bounding
pulse and shortness of breath.
D5W is isotonic on initial administration but
provides free water when dextrose is
metabolized, expanding intracellular and
BASIC METHODS OF DELIVERING extracellular fluid volumes. D5W is avoided
IV THERAPY in clients at risk for increased intracranial
pressure (IICP) because it can increase
1.​ Direct Injection cerebral edema.
-​ Aka IV push
-​ Injecting a therapeutic dose Examples:
of medication or other fluids • 0.9% NaCl (normal saline)
directly into a vein. • Lactated Ringer's (a balanced electrolyte
2.​ Continuous Infusion solution)
-​ An infusion of parenteral • 5% dextrose in water(D5W)
fluid or medication over
several hours (continuous Indication: blood loss/hypovolemia
drip) to days.
3.​ Intermittent Infusion •Hypertonic Solution
-​ An infusion of parenteral - draw fluid out of the intercellular and
fluid or medication over a set interstitial compartments into the vascular
period of time at prescribed compartment expanding vascular volume.
intervals and then stop until Do not administer to clients with kidney or
the next dose is required. heart disease or clients who are dehydrated.
-​ Delivers necessary dose of a Watch for signs of hypervolemia.
drug very quickly providing
rapid effect Examples:
• 5% dextrose in normal saline (D5NS)
• 5% dextrose in 0.45% NaC1 (D5 1/2NS)
FLUIDS USED IN IV THERAPY • 5% dextrose in lactated Ringer's (D5LR)
Indication: regulates u/o, stabilize BP,
2 types of fluids reduce risk of edema, post-op pts
1.​ Crystalloids
●​ Hypotonic Solution
-are used to provide free water and treat
cellular dehydration. These solutions
promote waste elimination by the kidneys.
Do not administer to clients at risk for IICP
or third-space fluid shift.

Examples:
• 0.45% NaCI (half normal saline)
• 0.33% NaCI (one-third normal saline)

Indication: dehydration, DKA/HHNK

____________________________________

COMPLICATIONS

Systemic Complications

●​ Fluid overload
-​ Overloading the circulatory
system with excessive IV fluids
causes increased BP and central
venous pressure
-​ s/s: moist crackles on upon lung
auscultation, cough, restlessness,
distended neck vein, edema, wt
gain, dyspnea, rapid and shallow
respirations
-​ NSG Intervention:
-​ Decrease IV rate
-​ Monitor VS frequently
-​ Assess breath sounds
-​ Position pt in semi
fowler’s position
-​ Document pt condition
and management
●​ Air embolism
 -​ Rare but ever present -​ s/s: reddened, warm area around
-​ Air enters into central veins gets the insertion site, bulging over the
to the right ventricle and lodges vein
against pulmonary valve blocking -​ NSG Intervention:
the flow of blood ventricle into -​ Stop infusion immediately
the pulmonary arteries -​ Apply warm compress
-​ s/s: palpitations, dyspnea, -​ If IV therapy is still required,
continues coughing, JVD, insert a new one on a
wheezing, cyanosis, hypotension, different vein on the opposite
weak rapid pulse, altered mental arm
status, chest, shoulder and low -​ Document pt condition and
back pain management
-​ NSG Intervention: ●​ Infiltration
-​Immediate clamping of -​ When IV cannula is dislodged or
cannula perforates the wall of the vein
-​Position pt left side in -​ s/s: edema around the site, leakage of
trendelenburg position IV fluid from the site, discomfort,
-​Assess VS and breath coolness in the area
sounds -​ NSG Intervention
-​Administer O2 -​ Stop the infusion
-​Document pt condition immediately
and management -​ Remove IV catheter
●​ Infection -​ Apply sterile dressing to the
-​ Pyogenic substances in site
infusion sol’n or IV administration -​ A warm compress is given
set can cause infection in the if small volumes of
bloodstream noncaustic sol’n have
-​ s/s: abrupt temp elevation infiltrated over a long period
shortly after infusion started, of time
headache, increased HR and RR, NV, -​ If isotonic sol’n is used with
diarrhea, chills, shaking, general normal pH, elevate affected
malaise. Erythema, edema, and extremity to promote
induration of drainage at insertion absorption of fluid
site -​ If hypertonic sol’n is used
-​ NSG Intervention: with high pH, cold
-​ Stop infusion compress may be applied on
immediately the area
-​ Remove cannula -​ Document pt condition and
-​ Clean site of infection management
-​ Administer antibiotics ●​ Extravasation
as prescribed -​ Similar to infiltration with an
-​ Document pt inadvertent administration of
condition and vesicant or irritant sol’n or
management medication into surrounding
tissue
Local Complications -​ s/s: discomfort, blanching
and/or burning sensation at
●​ Phlebitis site, blistering
-​ Inflammation of a vein -​ NSG Intervention
-​ Stop infusion
 -​ Notify HCP promptly
-​ Administer antidote CALCULATION
specific to the
medication
-​ Remove IV cannula
-​ Apply warm compress
from alkaloids
-​ Apply cold compress example:
from alkalyting and
antibiotic vesicants
-​ Don’t use the affected
extremity for further
cannula placement
-​ Document pt condition
and management

●​ Hematoma
-​ When blood leaks into the
surrounding tissues of IV site
(perforation during puncture)
-​ s/s: ecchymosis, immediate swelling
of the site, leakage of blood at the
site
-​ NSG Intervention:
-​ Remove the cannula Example:
-​ Apply light pressure with
sterile, dry dressing
-​ Apply ice for 24 hrs to the
site to avoid extension of
hematoma
-​ Elevate extremity to
maximize venous return
-​ Do not massage affected
area
-​ Document pt condition and
IV SITE ASSESSMENT
management

1.​ Site should be visually inspected and

CLEARING AIR FROM THE LINE
palpated every 2 hrs
2.​ IV site should be free of redness,
1.​ Tap the tubing while holding it
swelling, tenderness
2.​ Curl the tubing around the pen
3.​ IV dressing should be clean and
3.​ Lower the IV sol’n bag below the
secure
level of pt’s heart
4.​ For adults, change catheter and rotate
4.​ Use a needle and syringe to remove
site every 48-72 hrs
the air at the Y connector
5.​ Inject sol’n into the Y connector
6.​ Flush IV line
PATIENT’S RIGHTS

5 patient rights
 1.​ Right Patient 5.​ Tubing and solution changes
2.​ Right Drug/fluid 6.​ Pt teaching and evidence of
3.​ Right Dose understanding
4.​ Right Route
5.​ Right Time Documenting discontinuation of IV
therapy
1.​ Time and date of d/c
DOCUMENTATION 2.​ Reasons for d/c of therapy
3.​ Assessment of venipuncture site
Importance: 4.​ Complications, pt reaction, nursing
1.​ Accurate description of care that management
serves as legal protection
2.​ Mechanism for recording and
retrieving information Procedure:
3.​ Record for healthcare insurers of
equipment and supplies used ASSISTING IN IV INFUSION

May be documented on: Setting Up an IV:

-​ Special IV therapy sheet or flow
sheet 1.​ Check the doctor’s order to verify
-​ NCP on pt’s chart the solution, rate and frequency
-​ Intake and Output sheet 2.​ Perform hand hygiene
3.​ Gather and prepare all supplies
What to document in the initiation of IV needed
therapy? 4.​ Identify the patient and explain the
1.​ Size and type of device need for IV and the procedure
2.​ Name of person who inserted the
device 5.​ Remove IV solution from outer
3.​ Date and time packaging and gently squeeze
4.​ Site a.​ Check the expiry date
5.​ Type of solution b.​ Assess the precipitates or
6.​ Any additives cloudiness
7.​ Flow rate 6.​ Open the plastic cover of the
8.​ Use of an electronic infusion device infusion port and avoid touching the
9.​ Complications, pt’s response, exposed area.
nursing intervention 7.​ Open and prepare the infusion set,
10.​Number of attempts (both failed and using septic technique
successful)
8.​ Close the roller clamp
What to label on the dressing? 9.​ Uncap the spike and pierce firmly to
1.​ Date of insertion the infusion port of the IV solution
2.​ Gauge of venipuncture site bag/container until secure
3.​ Date and time of dressing change 10.​Hang the IV solution bag/container
4.​ Nurse’s initials on the IV pole

Documenting IV maintenance 11.​Squeeze the drip chamber to allow

1.​ Condition of site the fluid to drip into it and fill it at
2.​ Site care provided least halfway
3.​ Dressing changes 12.​Prime the tubing
4.​ Site changes
 a.​ With the distal end of tubing tubing and readily hand it in
over a basin, sink, or any to the therapist
liquid container, remove its c.​ Once the tubing is securely
cap and slowly open the attached to the IV port, open
roller clamp to prime the IV the roller clamp to let the
tubing. Allow fluid to flow solution flow to start the
until all air bubbles are infusion promptly
present
b.​ Check the valve and port as 21.​Assist in securing the catheter using
the fluid passes through the the prepared non-allergic tape placed
tubing sticky side up under the hub and
c.​ Gently tap the tubing to crossed it over the top of the hub
remove air and fill it with
fluid 22.​Place sterile dressing over the
venipuncture site using either gauze
13.​Check the entire length of tubing to or transparent dressing. Loop the
ensure that no air bubbles are tubing
present.

14.​Close the roller clamp After insertion

23.​Regulate the IVF flow to previously
15.​Recap the end of the tubing with calculated drop rate
sterile dead-ender or sterile
protective cover. Hang it in the IV 24.​Label the IV solution bag using an
stand, ensuring that no part of the IV tag indicating the
tubing drops lower or touches the a.​ Type and volume of the
floor to maintain sterility of set-up solution
b.​ Drop rate
16.​Position the patient (semi-fowler’s c.​ Date and time of infusion
on bed or sitting in a chair with an d.​ Number of the ongoing
arm). Place protective towel or pad infused solution
under the patient’s arm e.​ Name and signature of the
nurse
17.​Assess the possible sites for insertion
and allay patient’s anxiety 25.​Mark the date, time, site, and type
and size of the catheter used for the
18.​Don clean gloves infusion on the tape anchoring the
tubing

During Insertion 26.​Use arm board (splint and anchor

19.​Offer the physician or the therapist a arm for support, if needed)
pair of clean gloves
27.​Do aftercare of all the equipment
20.​Assist the doctor or the IV therapist.
Anticipate the needed assistance: 28.​Remove the gloves and perform
a.​ Once backflow is seen, hand hygiene
release the tourniquet
b.​ When the therapist removes 29.​Record the necessary information,
the needle, remove the sterile including the patient's reaction to the
dead-ender/cover of the IV procedure
 date and time it is
30.​Return after 30 minutes to check the incorporated
flow rate and observe for infiltration b.​ Adding medications to IV
and to assess the patient’s response solution before the infusion:
to infusion i.​ Carefully remove any
protective cover and
INCORPORATION OF MEDICATION locate the injection
INTO THE IVF CONTAINER port and clean with an
antimicrobial swab
1.​ Check the doctor’s order ii.​ Uncap the needle and
2.​ Check if the medication is insert into the port
compatible with the IVF and inject the
3.​ Gather all the needed supplies medication
4.​ Perform hand hygiene iii.​ Withdraw and insert
5.​ Check for the drug’s compatibility spike into the proper
with primary infusing solution entry site on the bag
6.​ Check the medication according to or bottle
the seven rights iv.​ With tubing clamp,
7.​ Identify the patient using the two gently rotate the IV
identifiers solution in the bag or
8.​ Explain the procedure to the patient bottle
9.​ Add the medication to the IV v.​ Hang the IV solution
solution
a.​ Adding the medication to an 10.​Dispose of the equipment according
infusing IV solution to agency policy
i.​ Check if the volume 11.​Document in the patient’s chart the
in the bag is adequate procedure
to dilute the drug 12.​Observe for 5-10 minutes for any
ii.​ Close the roller clamp drug interaction while reassuring the
iii.​ Clean the medication patient; monitor vital signs
port with an
antimicrobial swab
iv.​ Steady the container
and uncap the needle
and insert it into the ADMINISTERING MEDICATION VIA
port IVTT
v.​ Remove the container
from the IV pole and 1.​ Check the doctor's order.
gently swirl the 2.​ Perform hand hygiene.
solution bag/bottle to 3.​ Prepare all the needed supplies.
mix the drug with IV 4.​ Prepare the medication as prescribed
solution by the physician.
vi.​ Rehang the container, 5.​ Check for the drugs compatibility
open the clamp, and with the primary infusing solution.
readjust the flow rate 6.​ Check medication according to the
vii.​ Attach to the seven rights.
container the label 7.​ Take the medication to the patients
with the name and bedside.
dose of the 8.​ Identify the patient using the two
medication and the identifiers.
 9.​ Explain the procedure to patient.
10.​Obtain vital signs if indicated
11.​Cleanse the primary tubing injection
port close to the patient with an
alcohol swab.
12.​Insert the needle cannula of the
syringe into the port or y-port.
13.​Pinch the primary tubing on the part
between the port and the IV solution
bag while injecting the medication
slowly in calculated increments.
14.​After injecting small increments,
release primary tubing to allow
flushing of the medication.
15.​Observe the patient for any adverse
reaction.
16.​Inject the remaining medication in
the same increments.
17.​Withdraw the syringe when
medication injection is complete.
18.​Release the tubing and regulate the
IV flow.
19.​Dispose of the equipment according
to agency policy.
20.​Perform hand hygiene.
21.​Document medication administration
including the patient’s reaction.

SOURCES:
Hinkle, J. (2021). Brunner & Suddarth’s

Textbook of Medical-Surgical Nursing.

Lippincott Williams & Wilkins.

Tate, P. (2011). Seeley’s Principles of

Anatomy and Physiology. McGraw-Hill

Europe.

Wikipedia: The Free Encyclopedia. (2002).

Reference Reviews, 16(6), 5.

https://doi.org/10.1108/rr.2002.16.6.5.273

Clinical Nursing Skills and Techniques by

Potter and Perry 10th edition Copyright

2022

Tuttle, K. (2023). The Complete Nursing School

Bundle®. NurseInTheMaking LLC.