IV THERAPY

1. Dr. Ahmad Aqel
2020

2. • IV solutions contain dextrose or electrolytes
mixed in various proportions with water.
• Purposes:
1) to meet daily requirements of water, electrolytes,
and nutrients
2) To replace water and correct electrolyte deficits
3) To administer medications and blood products
– Pure water (without electrolyte; osmolality = 0) >>>
RBC rupture them (Can’t used by IV)
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3. CRYSTALOIDS:
 Isotonic:310 mOsm/L (250-375)
 Hypotonic: less than 250 mOsm/L
 Hypertonic: greater than 375 mOsm/L
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Classified according to whether their total osmolality is
the same as, less than, or greater than that of blood.
BLOOD OSMOLALITY = 275-295 mOsm/L

4.  Do not cause red blood cells to shrink or swell.
 Isotonic fluids expand the ECF volume.
 3 L of isotonic fluid is needed to replace 1 L of
blood loss.
 Fluid over load (hypertension and heart failure)
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5. 1) D5W:
– it is isotonic before administration become
hypotonic after administration
– Used to supply water and to correct an increased
serum osmolality.
– Not given for pts with increased ICP or head
trauma.
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6. 2) Normal Saline (.9% sodium chloride)
• Used for:
– to correct an extracellular volume deficit and to
replace large sodium losses such as in burns
– used with administration of blood transfusion.
• Not used for:
– heart failure, pulmonary edema, renal impairment, or
sodium retention.
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7. 3) Lactated Ringer’s:
 contains Na, Cl, K, Ca, & HCO3
 Used to correct dehydration and hyponatremia
 Used for fluid resuscitation after blood loss
 Not used for maintenance therapy:
 lactate converts into bicarbonate and causes alkalosis
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8.  Lowers the serum osmolality, causing fluid to shift from
the intravascular to intracellular and interstitial spaces.
 Example: Half saline (. 0.45% NaCl, 2.5% D5W):
 used to treat conditions causing intracellular dehydration,
when fluid needs to be shifted into the cell , such
as:Hypernatremia, DKA, Hyperosmolar hyperglycemic
 Excessive infusions:
 lead to intravascular fluid depletion, decreased BP, cellular
edema, and cell damage.
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9. Example: NS+ D5W; or high concentration saline
 Cause cells to shrink (draw water from ICF to ECF)
 Use slowly with caution:
• cause extracellular volume excess and precipitate
circulatory overload and P. edema and cellular
dehydration.
 Hypertonic solution (50% dextrose) must be
administered by central venous catheter .
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10.  For pts can’t eat by mouth:
 IV route to give high concentration of glucose, fat
and proteins
 For administration of colloids (blood products)
 For IV medications
 caution can cause rapid reaction
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11. Central veins: Subclavian and Internal Jugular Veins.
Avoid using
Leg veins may cause thromboembolism
Veins distal to a previous IV : may cause infiltration or phlebitis
Sclerosed or thrombosed veins
An arm with an AV shunt or fistula
An arm affected by edema, infection, blood clot, deformity,
severe scarring, or skin breakdown
The arm of the side of a mastectomy (impaired lymphatic
flow)
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12. Dr. Ahmad Aqel 12
Recommended vein sites
Cephalic Basillic
Metacarpal Median
Good size & easy access

13. Venipuncture:
 the most distal site of the arm is used first
Vein ch-ch:
 firm, elastic, engorged, and round—not hard, flat, or bumpy.
 For flushing (use twice the volume capacity of the catheter).
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Drops per minute =
total infusion volume x drop factor
total time of infusion per minute
Electronic infusion devices Volumetric pumps

14. Systemic Complications
1) Fluid overload:
 S&S: increased BP& CVP, crackles, cough, dyspnea,
rapid, shallow respirations, edema, and wt gain.
 Causes: rapid infusion, hepatic, cardiac, renal
disease.
 Treatment: decrease IV rate, V/S, assess breath
sounds, and high Fowler’s position.
 Complication: heart failure, and pulmonary edema.
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15. 2) Air embolism:
 S&S:
 palpitations, dyspnea, cyanosis, coughing,
wheezing; hypotension; weak, rapid pulse; CP
 Treatment:
 clamping the cannula, left Trendelenburg position,
assess V/S, breath sounds, and administer oxygen.
 Prevention:
 filling all IV tubing with solution, and using air
detector
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16. 3) Septicemia, other infections:
 S&S:
 fever, increased pulse and RR, N&V,D, chills
 in local infection erythema, edema, and drainage.
 in severe sepsis :septic shock.
 Prevention:
 aseptic technique, examine IV fluid for cloudiness,
leaks, expired date
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17. 4) Infiltration & Extravasation
 Infiltration: Nonvesicant solution/medication into surrounding
tissue
 Extravasation: Vesicant solution/medication into surrounding
tissue
 Ch-ch: redness, pain, edema, leakage of fluid, coolness,
decrease flow In extravasation: pain, redness, Blisters,necrosis
 Treatment: stop infusion, warm compress (with isotonic &normal
pH ) cold compress (with hypertonic &increase pH) , elevate extremity,
antidote.
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18. 5) Phlebitis: inflammation of a vein.
 Chemical causes (irritating agent, rapid infusion, and
medication incompatibilitiy
 Mechanical causes (prolong cannulation, catheter gauges
larger than the vein)
 Bacterial causes (, lack of aseptic technique)
 S&S: red warm area, pain, and swelling.
 Treatment: discontinuing the IV line and warm compress
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19. 6) Thrombophlebitis: a clot plus inflammation in the
vein.
 S&S: localized pain, redness, warmth, and swelling,
sluggish flow rate, fever, malaise, and leukocytosis.
 Treatment: Stop IV infusion; cold compress (to
decrease blood flow & increase platelet aggregation), then
warm compress; elevating the extremity.
 The IV line should not be flushed
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20. 7) Hematoma: blood leaks into tissues
surrounding the IV insertion site.
 Causes: needle slips out of the vein, or less
pressure after removal of the cannula.
 S&S: ecchymosis, swelling, and leakage of blood
 Treatment: light pressure with a sterile, dry
dressing; apply ice; elevate the extremity
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21. 8) Obstruction and clot:
 Causes: kinked tubing, slow rate, empty IV
bag.
 Signs: decreased rate and backflow into the
tube
 Treatment:
 stop fluid, change cannula,
 Don’t do irrigation or milking of the iv tube
 Don’t raise the rate or the container and don’t
aspirate the clot.
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