INTRAVENOUS

THERAPY
By: Jahzeel B. Acab
Enzo Miguel Bandoquillo
Definition:

is the infusion of a fluid into a vein to treat

and prevent electrolyte imbalance or to
deliver medication through a needle or
catheter (cannula) into the blood stream.
The fastest way to deliver medications
Why infuse IV Solutions?

 Correct volume deficiencies of blood components.

 Provide nutrition while resting the gastrointestinal
tract.
 Administer safe and effective infusions of medications
using the appropriate vascular access.
 Restore acid-base balance.
 Monitor central venous pressure (CVP).
 Maintain or replace body stores of water, electrolytes,
vitamins, proteins, fats, and calories in the patient who
cannot maintain an adequate intake by mouth
Physiologic Principles

 Body fluids are distributed in two distinct

compartments, the intracellular and
extracellular compartment.
 Tissue cells are surrounded by a
semipermeable membrane.
 Osmotic pressure
Types of Fluids

 Isotonic – Same osmotic pressure of plasma

Ex. 0.9 NSS, D5W and Lr
 Hypotonic – Less osmotic pressure than
plasma
Ex. ½ NS and 0.33 NaCl
 Hypertonic – Exerts higher osmotic pressure
than that of plasma.
Ex. D5LR, 3% NaCl, D5NSS
Common Types of Infusions

D5W
Used to replace water (hypotonic fluid) loss,
supply some caloric intake, or administer as
carrying solution for numerous medications
Normal Saline
Used to replace saline (isotonic fluid) losses,
administer with blood components or treat
patients in hemodynamic shock
Lactated Ringers
- Used to replace isotonic fluid losses, replenish
specific electrolyte losses, and moderate
metabolic acidosis.
Phillip’s 15-step Method of
Starting a Peripheral Line
 Phase Step
Precannulation 1. Check physician’s order.
(Preparation) 2. Wash your hands for 15 to 20
seconds.
3. Prepare the equipment
4. Asses the patient
5. Select the site and dilate the
vein

Cannulation 1. Select the needle (catheter)

(Venipuncture) 2. Put on gloves.
3. Prepare the site.
4. Enter the vein using the
direct or indirect method
5. Stabilize the catheter with
tape and apply a dressing.

Postcannulation (clean-up) 1. Label the site, tubing and

bag.
2. Properly dispose of used
equipment
3. Educate the patient.
4. Calculate the drip rate, if
applicable.
5. Document the procedure
 Types of IV
Administration
IV Push

Equipment:

 syringe of appropriate size (either a

needleless system or one with a 20G or 22G
1” needle)
 alcohol or povidone-iodine pads
 Gloves
 Prescribed Drug
Preparation:
 If drug isn’t compatible with the patient’s IV solution,
also get two 3-ml syringes with 20G or 22G 1” needles
and fill them with normal saline solution
 Check your facility’s policy to see if you need another 3-
ml syringe with heparin flush solution
 Verify the order on the patient’s chart
 Make sure the drug is compatible with the IV solution
 Check the expiration date, and reconstitute or dilute
the drug as needed
 Identify the patient by checking his/her armband
 Wash your hands and put on gloves
Procedure:
 Close the flow-control clamp on the existing IV line
 Clean the Y-Port closet to the venipuncture site with
an alcohol pad or a povidone-iodine pad
 Insert needle of the syringe or the needleless system
into the Y-Port, and inject the drug at the prescribed
rate
 Remove the syringe of the Y-Port, open the flow-
control clamp, and set the primary flow rate as
prescribed
 Discard used items according to standard precautions
Patient Teaching:
 Tell the patient the name of the bolus drug,
why you’re giving it, and any adverse effects
he may experience or should report
 Advise him to report pain, redness, swelling,
or other problems with the insertion site
Continuous Infusion

Equipment:
 pump
 drug administration set with the device
 3 ml syringe with a needleless system or a 25G
5/8” needle
 flushing solution
 alcohol pads
 patency solution (if indicated)
 gloves
Preparation:
 Verify the order on the patient’s chart
 Identify the patient by checking his/her
armband

Procedure:
 Make sure the clamp on the administration
set is closed and the line has no air bubbles in
it
Patient Teaching:
 Tell the patient the name of the drug, why
you’re giving it and about adverse effects he
may experience or should report
 Advise him to report pain, redness, swelling,
or other problems with the insertion site
 If the patient will receive infusions at home,
make sure he or a caregiver can administer
them safely and correctly. Also make sure you
teach how to care for the IV site and identify
certain complications
Intermittent Infusions

Equipment:
 volume control set
 prescribed fluid
 syringe (needleless or with an appropriate
needle) filled with the prescribed drug
 alcohol pad or antiseptic specified by your
facility
 gloves
Preparation:
 Verify the order on the patient’s chart
 Identify the patient by checking his armband
 Wash your hands and put on gloves
 Remove the volume-control set from its
packaging
Procedure:
 Prime the set with IV fluid
 Clean the injection port on top of the chamber, and inject
the drug into the chamber
 Gently rotate the chamber to mix the drug
 Place the label on the chamber that identifies the drug,
dose, time, and date
 Fasten the tubing to the injection port of the primary line
 Either stop the primary infusion or set a low drip rate so the
line will be open when the secondary infusion stops
 Open the lower clamp of the volume-control set, and start
the infusion at the desired rate
 When the chamber is empty, allow about 10 ml of IV
solution to flow into it and through the tubing to flush the
system, unless contraindicated
 Discard the used items according to standard precautions
Patient Teaching
 Tell the patient the name of the drug why
you’re giving it, and any adverse effects he
may experience or should report
 Advise him to report pain, redness, swelling,
or other problems with the insertion site
Piggy Back
Equipment:
 prescribed drug (usually premixed in a minibag)
 continuous secondary tubing or piggy back extension tubing
 extension hook
 20G or smaller 1” needle or needleless system
 medication label (if you aren’t using a premixed solution)
 alcohol pads
 1” adhesive tape
 gloves
Preparation:
 If the drug is incompatible with the primary IV
solution, also get two 3-ml syringes with 22G 1”
needles; fill them with normal saline solution
 Check your facility’s policy to see if you need
another 3-ml syringe with heparin flush solution
 You may also need infusion pump or a time tape
 Verify the order on the patient’s chart
 Identify the patient by checking his armband
wash your hands
Procedure:
 If you need to add a drug to a secondary IV
solution, remove any seal from the secondary
container. Most solution bags have a sealed outlet
and unsealed injection ports, whereas most bottled
solutions have a seal covering their dual-outlet port
 Clean the injection port with an alcohol pad
 Inject the prescribed drug into the solution and
gently agitate the container to thoroughly mix the
solution
Patient Teaching:
 Tell the patient the name of the drug, why
you’re giving it, and any adverse effects he
may experience or should report
 Tell him to report pain, redness, swelling, or
other problems with the insertion site
COMPLICATIONS
Infiltration

 occurs when IV fluids enters the

subcutaneous space & around the
venipuncture site
Cause:
 Dislodgement of the IV cannula from the vein
results in infusion of fluid into the
surrounding tissues
Preventions:
 Ensure that IV and distal tubing are secured
sufficiently with tape to prevent movement
 Splint arm or hand as necessary
 Check IV site frequently for complications
 Proper venipuncture technique

Interventions:
 Stop infusion immediately and remove IV needle or
catheter
 Restart IV in the other arm
 If infiltration is moderate to severe, apply warm,
moist compresses and elevate limb
 Document interventions and assessment
Thrombophlebitis/Phlebitis

 inflammation of vein often accompanied by

clot formation
Causes:
 Injury to vein during venipuncture, large-bore
needle/catheter use
 Irritation to vein due to rapid infusions or
irritating solutions
 Slow infusion rate due to clot formation at
the end of the needle/ catheter
Preventions:
 Anchor needle or catheter securely at insertion
site
 Change insertion site at least every 72 hours or
according to hospital policy
 Use large vein for irritating fluid because of
higher blood flow, which rapidly dilutes irritant
 Sufficient dilute irritating agents before infusion
Interventions:
 Apply cold compress immediately to relieve
pain and inflammation
 Discontinue IVF and remove catheter/needle
immediately
 Follow the moist, warm compresses to
stimulate circulation and promote
absorption.
 Document interventions and assessment
Bacteremia/Septicemia

 contamination of IV site and solution which

results to fever, chills and general malaise.
Causes:
 Incorrect insertion of catheter
 Contaminated equipment or infused solution
 The critically ill or immunosupressed patient
is at greatest risk of bacteremia
Prevention:
 Practice good handwashing
 Use strict asepsis when inserting IV or changing
IV dressing
 Observe IV site routinely
 Provide routine care along with proper dressing
 Maintain integrity of infusion system
Intervention:
 Discontinue IV line and restart it in another vein
as ordered
 Notify physician
Circulatory Overload

 a condition which results when a client

receives IV fluid faster than the body can
distribute and excrete.
Causes
 Delivery of excessive amount of IV fluids
Preventions:
 Always monitor intake and output when
patient has an IV line
 Know patient cardiovascular history
 Splint arm or hand if IV flow rate fluctuates
too widely with movement
Interventions:
 Decrease IV to KVO rate- 10gtts/min
 Raise patient’s head to facilitate breathing
 Keep patient warm to promote peripheral
circulation
Air Embolism
 an abnormal circulatory condition in which air
gas travels through the bloodstream and
becomes lodged in a blood vessel.
Causes:
 Air enters the catheter during tubing changes
 Air in tubing delivered by IV push or infused
by infusion pump
Prevention:
 Clear all air from tubing before infusion
 Change solution containers before they run dry
 Ensure that all connections are secured
Intervention:
 Immediately, turn patient on his/her left side
and lower head of the bed
 Notify the physician immediately
 Administer oxygen PRN
 Stay with the patient
 Document interventions and assessment
Hemorrhage/Bleeding

Causes:
 Loose connection of tubing or connection
port
 Inadvertent or accidental removal or
peripheral or central catheter
 Anticoagulant therapy
Preventions:
 Tape all catheters securely- use transparent
dressing when possible for peripheral or
central catheters. Tape the remaining catheter
lumens in a loop so tension is not directly on
the catheter.
 Keep pressure on site at least 10 minutes after
removal of catheter for anticoagulated
patients.
Interventions:
 Pressure dressing may be applied over the site
to control the bleeding
 Notify the physician.
Venous Thrombosis

Causes:
 Infusion of irritating solutions
 Infection along catheter may preclude this
syndrome
 Fibrin sheath formation with eventual clot
formation around catheter. This clot will
eventually occlude vein.
Preventions:
 Ensure proper dilution of irritating substances
 Ensure superior vena cava catheter tip placement
for irritating solutions
Interventions:
 Stop fluid immediately and notify health care
provider
 Reassure patient and institute appropriate therapy:
 Anticoagulants
 Heat
 Elevation of affected extremity
 Antibiotics
IV Computations
Delivery System
 Microset – 60gtts/ml
 Macroset – 15gtts/ml
 Bloodset – 10gtts/ml

Formulas

Rate of Infusion/Flow Rate – drops of fluid to administer per minute

(gtts/min)

FR= (ml of solution prescribed per hour) x (drops delivered per ml)
60min/hr
Example:
 An order has been written for a patient to receive 500ml of 5%
dextrose in water (D5W) over a period of 5 hours in a standard
Microdrip system. Find the rate of infusion.
Hourly Volume

ml/hour = total volume

total time
 OR
HV = Flow Rate x (60min/hr)
Drop Factor
Examples:
 
A patient is to receive 1000ml of 5% dextrose in D5LR
over a period of 5 hrs. How many ml will the patient
receive in an hour?
Length of Time of Infusion

L = total volume
HV
Examples:

A patient is to remove 720ml of 5% dextrose in

LR at 15gtts/min. How long will the IVF be
consumed?
 At 7am, #2 D5LR is at 960ml running at
20gtts/min. How long will the IVF be
consumed and at what time will it be
consumed?