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![Select the appropriate administration set and size of
catheter.
✓Consider factors such as:
type of infusion [viscous or non-viscous]
age and condition of patient [children, elderly, cardiac
patient]
rate of administration [KVO vs 6h]
✓Administration set - macro or micro, vented or unvented
✓Size of catheter - the lower the number of the gauge, the
larger the diameter of the catheter lumen](https://image.slidesharecdn.com/ivtherapy-251212075018-59d88339/75/Basic-Intravenous-Therapy-IV-Solutions-pptx-43-2048.jpg)
Basic Intravenous Therapy, IV Solutions.pptx
- 1. Basic Intravenous Therapy Gracia A.Nieves, RN PREPARED BY:
- 2. PURPOSES • To supplyfluid when clients are unable to take in an adequate volume of fluids by mouth • To provide salts and other electrolytes needed to maintain electrolyte balance • To provide glucose (dextrose), the main fuel for metabolism • To provide water-soluble vitamins and medications • To establish a lifeline for rapidly needed medications
- 3.
- 4. 1. Fluid andElectrolyte Replacement • Dehydration (e.g., due to vomiting, diarrhea, or burns) • Hypovolemia or shock • Electrolyte imbalances (e.g., hypokalemia, hyponatremia)
- 5. 2. Nutritional Support •Total Parenteral Nutrition (TPN) for patients unable to eat or absorb nutrients orally • Partial Parenteral Nutrition (PPN) for supplementing inadequate oral intake
- 6. 3. Medication Administration ๏Antibiotics for severe infections ๏ Pain management (e.g., opioids, NSAIDs) ๏ Chemotherapy for cancer treatment ๏ Emergency drugs (e.g., epinephrine, atropine)
- 7. 4. Maintenance ofVenous Access ‣ Preoperative and postoperative care ‣ Continuous medication infusion (e.g., insulin, heparin) ‣ Long-term therapy (e.g., dialysis, chemotherapy)
- 8. Blood and BloodProduct Administration ‣ Treatment of anemia (e.g., packed RBCs) ‣ Coagulation disorders requiring plasma or platelets
- 9. Emergency and CriticalCare ‣ Rapid fluid resuscitation in trauma or shock ‣ Administration of life-saving drugs in cardiac arrest ‣ Immediate access for emergency drugs in critically ill patients
- 10.
- 11. Crystalloid Solutions ✓Small moleculesthat easily pass through blood vessels ✓Used for hydration, electrolyte replacement, and shock ✓Includes both isotonic, hypotonic, and hypertonic solutions
- 12. 1. Isotonic Solutions ‣Equal concentration of solutes to the body’s plasma ‣ Used to replace fluids without causing cell shrinkage or swelling ‣ Commonly used for hydration and fluid loss Examples: Normal Saline (0.9% NaCl) for dehydration, blood transfusions Lactated Ringers (LR) for burns, surgery, and trauma Dextrose 5% in Water (D5W) initially isotonic, becomes hypotonic after metabolism
- 14. 2. Hypotonic Solutions ✓Lowerconcentration of solutes than plasma ✓Causes fluid to move into cells, making them swell ✓Used for cellular dehydration and hypernatremia Examples: 0.45% Normal Saline Dextrose 2.5% in Water (D2.5W) 0.33% Normal Saline
- 15. 3. Hypertonic Solutions ✓Higherconcentration of solutes than plasma ✓Draws fluid out of cells, making them shrink ✓Used for severe hyponatremia, cerebral edema, and shock Examples: Dextrose 10% in Water (D10W) 3% or 5% Normal Saline Dextrose 5% in Normal Saline (D5NS)
- 16. Colloid Solutions ✓Contains largemolecules that stay in the bloodstream ✓Used to expand blood volume in cases of shock or severe bleeding Examples: Albumin Dextran Hetastarch (Hespan)
- 17.
- 18. Peripheral Venous AccessSite Selection • The site chosen for peripheral venous access (venipuncture) varies with the client’s age, length of time an infusion is to run, the type of solution used, and the condition of veins. • For adults, veins in the arm are commonly used; for infants, veins in the scalp and dorsal foot veins are often used. • The larger veins of the adult’s forearm are preferred over the metacarpal veins of the hand for infusions that need to be given rapidly and for solutions that are hypertonic, are highly acidic or alkaline, or contain irritating medications.
- 20. • The metacarpal, basilic, and cephalicveins are common venipuncture sites. • The ulna and radius act as natural splints at these sites, and the client has greater freedom of arm movement for activities such as eating.
- 21. Types of cannula 1.Peripheral IV cannula: Injected in a vein located at the extremities/limbs of the body 2. Central line IV cannula: Injected into major vein stems of the body
- 22.
- 23. Commonly available variantsin IV cannula:
- 27. Central line IVcannula:
- 28. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Phlebitis • Mechanical: caused by the cannula rubbing and irritating the vein • Chemical: usually caused by meds or solutions that have high or low pH or with high Localized redness, pain, heat, and swelling which can track up the vein leading to a palpable venous cord (feels like a small rope) Note: Phlebitis may be more difficult to assess with a CVAD because the tip of the catheter (thus delivery of the meds or solutions) occurs in a larger vessel. Prevention: Assess sites frequently. • Peripheral: Choose PVADs with smallest gauge necessary for purpose. Follow agency protocols for use of IV securement of devices or dressings. • Chemical: Follow Parental Drug Therapy Manual guidelines in your agency for medication dilution and administration guidelines. • Treatment: Remove PVAD-short or midline catheters. Apply warm compress. Slow infusion rates. Initiate new PVAD-short if necessary. • Document. Report to agency Complication of IV therapy
- 29. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Infection: at insertion site or systemicall y Poor aseptic technique, prolonged IV use. Insertion site may become red, tender, swollen, or have purulent drainage. Systemic signs and symptoms may include malaise, fever, hypotension, or tachycardia. Strict hand-washing, aseptic technique for all procedures, close monitoring of vital signs, strict protocols for dressing, tubing and cap changes. Monitor blood work and vital signs. Remove IV immediately. Monitor for signs and symptoms of systemic infection Complication of IV therapy
- 30. PROBLEM CAUSES S/SINTERVENTIONS Infiltration • Occurs when a non- vesicant IV solution is inadvertentl y administere d into surroundin g tissue. Pain, swelling, redness, skin surrounding insertion site is cool to touch, change in quality or flow of IV, tight skin around IV site, IV fluid leaking from IV site, frequent occlusion alarms on IV pump. Prevention: Confirm IV patency during IV therapy. Recheck IV patency before medication administration. Use IV securement devices to stabilize IV insertion sites. Avoid areas of flexion and always assess IV sites before, during, and after infusing IV fluids or medications. Treatment: Stop infusion and remove cannula. Complication of IV therapy
- 31. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Extravasation • Occurs when vesicant (irritating, toxic) solution is administered and inadvertently leaks into surrounding tissue causing damage to surrounding tissue. • Like infiltration, this will be more difficult Same as infiltration but also includes burning, stinging redness, blistering, or necrosis of tissue. Stop infusion. Remove PVAD- short or midline catheter. Follow agency policy for extravasation for specific medications. For example, toxic medications have a specific treatment plan.
- 32. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Bleeding / hemorrhag e Bleeding at the insertion site. If this is an arterial bleed, significant edema and pain may present itself. Bleeding (venous) at site sometimes controlled with manufactured hemostatic product (StatSeal). Suspected arterial bleeds must be reported to an appropriate healthcare provider immediately
- 33. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Hematoma Improper IV insertion or removal Vein puncture or fragile veins Insufficient pressure applied after IV removal Swelling and bruising at IV site Pain and tenderness Skin discoloration (reddish or purplish) Remove IV catheter Apply direct pressure to the site Elevate the extremity Apply a warm compress after 24 hours to promote absorption Monitor for worsening swelling or complications
- 34. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Air Embolism Air entry into the IV line, usually from improper priming or IV tubing disconnection Sudden shortness of breath • Chest pain • Cyanosis • Hypotension • Decreased level of consciousness Clamp IV line immediately Place patient in left lateral Trendelenburg position (prevents air from entering the right ventricle) Administer 100% oxygen Notify physician immediately Monitor vital signs closely
- 35. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Fluid Overload Excessive IV fluid administration Rapid IV infusion rate Pre-existing conditions (e.g., heart failure, kidney disease) Hypertension Tachycardia Dyspnea, crackles in lungs Jugular vein distention (JVD) Edema Slow or stop IV infusion Elevate head of bed Administer diuretics if prescribed Monitor intake and output (I&O) Assess lung sounds frequently
- 36. Complication of IVtherapy PROBLEM CAUSES S/S INTERVENTIONS Thrombophlebiti s Irritating IV medications or solutions Poor IV site selection or prolonged catheter placement Lack of aseptic technique Redness, warmth, and swelling along the vein Pain and tenderness at IV site Palpable cord-like vein Stop IV infusion and remove catheter Apply warm compress to reduce inflammation Elevate the affected limb Monitor for signs of infection or clot formation Restart IV in a different site, preferably the opposite extremity
- 39.
- 42. Responsibilities of Nursesin IV Therapy
- 43. Select the appropriateadministration set and size of catheter. ✓Consider factors such as: type of infusion [viscous or non-viscous] age and condition of patient [children, elderly, cardiac patient] rate of administration [KVO vs 6h] ✓Administration set - macro or micro, vented or unvented ✓Size of catheter - the lower the number of the gauge, the larger the diameter of the catheter lumen
- 44. Choose the mostappropriate IV site. ✓consider the patient's preference and other factors such as medical condition, age, vein condition, type of fluid/medication, duration of therapy, and skill of the therapist ✓NEVER start an IV in an artery. ✓Start in the patient's nondominant hand. ✓DO NOT initiate in an extremity with compromised lymphatic or venous flow, with dialysis or shunt inserted ✓Avoid veins over bony prominences, highly mobile, or those of the lower extremities unless absolutely necessary
- 45. ✓Check for thefluid and other equipment for infusion IV containers should be inspected for cloudiness, discoloration, or presence of precipitate. Verify expiration date. Inspect IV stand or pump and IV start kit for possible defects and contamination ✓Use aseptic technique in assembling the infusion & during insertion Universal / Institutional Infection control protocol
- 46. ✓ Regulate IVFinto desired flow rate. Consider factors affecting flow rate: -Human error -Patency of tubing -Height of IV stand -Patient position-Fluid volume in the container ✓ Know when to change or discontinue the infusion. -Doctor's order and hospital policy ✓ Monitor for signs of complications. -Complications of IV therapy ✓ Document the procedure (date and time therapy is initiated, type of infusion, flow rate, insertion site)