This document discusses various aspects of IV therapy, including how to set up a primary IV line using sterile technique in 6 steps, how to use secondary lines and ADD-Vantage bags to administer small volume medications, how volumetric pumps and PCA devices work to control fluid administration, the different types of IV fluids indicated by abbreviations of their contents and strengths, and how parenteral nutrition is administered through a central line to provide complete nutrition intravenously.

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Chapter 15
Introduction to IV Therapy

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Primary Line
• Typically connected to maintenance IV
fluids
• Includes spike, drip chamber, and roller
clamps for adjusting drip rate and ports for
IV medications

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Primary Line Set-Up: Step 1
• Assumes IV fluid bag is ready
• Open package containing tubing
• Close all roller clamps on IV tubing to
prevent air bubbles

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Primary Line Set-Up: Step 2
• Use sterile technique
• Pull cover off port on bag
• Pull cover off IV tubing spike
• Spike IV bag

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Primary Line Set-Up: Step 3
• Squeeze drip chamber
• Fill approximately half full with IV fluids
– Or to mark provided by tubing manufacturer

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Primary Line Set-Up: Step 4
• Prime tubing with IV fluids to remove air
• Open roller clamp closest to drip chamber
• Air must be displaced to prevent client from
experiencing air embolism

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Primary Line Set-Up: Step 5
• Close roller clamp

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Primary Line Set-Up: Step 6
• Label tubing with the following
information:
– Date
– Time
– Initials

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Remember
• With gravity drip IV lines, pressure in line
is created when fluid drop falls in drip
chamber
• With electronic volumetric IV pump, pump
maintains constant pressure in line to
maintain patency of IV access

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Secondary Line
• Shorter tubing used to infuse small-volume
medications
• Also referred to as IV piggybacks (IVPB) or
minibags (IVMB)

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ADD-Vantage® Bags
• Have powdered medication in vial in top of
small-volume bag with IV fluid in it
• Vial opened within IV bag
• Medication mixes with fluid for infusion
• Used to package medications with short
shelf life in solution

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Volume-Controlled Burettes
• For greater accuracy in measurement of
small-volume IV medications or fluids, use
calibrated burette chamber
• Used most often in intensive care unit (ICU)
for frequent small-volume fluid replacement

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Indwelling Infusion Ports
• Used for intermittent IV medication
administration, either IVMB or IV bolus
• Most often referred to as:
– Saline locks
– Heparin locks
– Medlocks

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IV Bolus/IV Push
• Medications administered directly through
lock or into IV tubing port if IV fluids
infusing

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Flush with IV Bolus
• When administering IV bolus medications,
must flush before and after medication with
5 to 10 mL of compatible flush fluid

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Volumetric Pumps
• Electronic devices
• Force fluids into vein under pressure
• Maintain patency of IV
• Control infusion rates

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Volumetric Pumps
• Hospital or clinical in-service education
required for use of all infusion pumps
• Programming of pumps must be double-
checked
• IVs still should be checked every hour

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Syringe Pump
• Variations on electronic volumetric pumps
• Used to infuse drugs that cannot be mixed
with other solutions or medications
• Used with very small volumes
– e.g., infants, ICU clients

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Patient-Controlled Analgesia
(PCA) Devices
• Allow client to self-administer medication
to control pain
• Pre-filled syringe or medication bag
containing analgesics (opioids) inserted into
device

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PCA Pumps
• Items programmed into device include the
following:
– Dosage
– Frequency
– Lock-out time
– Amount

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Introduction to IV Fluids
• Manufactured and packaged under sterile
conditions
• Most prepared in plastic bags
• Volumes range from 25 to 1000 mL

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IV Fluids
• Abbreviations
– Dextrose (D)
– Water (W)
– Saline (S)
– Normal saline (NS)
• Numbers identify percentage strengths

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Fluid Strengths
• Percentages mean grams of drug per 100
mL of fluid
– e.g., 5% dextrose, 0.9% normal saline, 0.45% normal
saline, 3% saline

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Parenteral Nutrition
• Administer nutrition solution via central
vein through central venous access device
(CVAD)
• Usually infused slowly
• Solutions usually changed every 24 hours to
prevent spoilage and bacterial growth

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Types of Parenteral Nutrition
• Total parenteral nutrition (TPN)
• Partial parenteral nutrition (PPN)
• Hyperalimentation