Detail description

1. Intravenous therapy
By-
Dr. ASHOK DHAKA BISHNOI
Director, JINC

2.  It is the administration of fluid in to blood stream
by I/V catheter or butterfly needle inserted in to a
peripheral vein replace water, Electrolyte &
Nutrients
Introduction:-

3. 1. Used to clients who are unable to take orally.
2. Replaces water, electrolytes, & nutrients more
rapidly than oral administration
3.Unconcious patient
4.Hypovolumic shock
5.During surgery
uses:-

4.  I/V:- 30-60 second (Give quick effect in all
parental route)
 IV injection (IV push) = 1-60 ml

5. Types of solutions:
1. Hypertonic solutions
2. Hpotonic solution
3. Isotonic solution
Osmolality:- Concentration of a solution expressed as the total
number of solute particles per kilogram.
270-300 Mosm/kg water
Osmolarity :-the concentration of a solution expressed as the
total number of solute particles per litre.
 Measured by Osmometer.
Osmoler Gap :-Deference B/W Osmolality & Osmolarity
normal osmol gap is < 10 mOsm/kg .

6. 1.Hypertonic solutions:-more concentrated than
body fluids.
 Causes movement of H2O from cells into the
extracellular fluid.
Eg.
 3% NS
 5% NS
 10% dextrose in water (D10W)
 5% dextrose in 0.45% sodium chloride (NS) (D5W/½
NS)

7. 2.Hypotonic solution:-Solutions that are more dilute or have a lower
osmolality than body fluids.
 Causes movement of water into cells by osmosis.
 Administer slowly to prevent edema.
Eg.
 0.45% sodium chloride (NS ); (½ NS) Osmolarity of 154 mOsmol/L
 0.225% sodium chloride (NS); (¼ NS)
 0.33% sodium chloride (NS); (⅓ NS)


8. 3.Isotonic solution:-Solution that have the same
osmolality as body fluids.
 It increases extracellular fluid volume.
 These solutions do not enter the cells because no
osmotic force exists to shift the fluids.
 Eg.
 0.9% sodium chloride (NS); (0.9% NS)
 5% dextrose in water (D5W)
 5% dextrose in 0.225% saline (D5W/¼ NS)
 Lactated Ringer’s (LR)/Sodium lactate solution / Hartmann's
solution
.

9. Lactated Ringer’s (LR)/Sodium lactate solution / Hartmann's
solution
Composed of
 sodium chloride 6 g/L,,,,,,sodium lactate 3.1 g/L
 potassium chloride 0.3 g/L……..calcium chloride 0.2 g/L.
Lactated Ringer's contains ions of
 Sodium 130 mEq/L……..Potassium 4 mEq/L
 Calcium 2.7 mEq/L …….Chloride 109 mEq/L
 Lactate 28 mEq/L.
Uses:-
 Low blood volume,Low BP,Burn
Contraindication:-
 RF

10. 0.9% sodium chloride (NS); (0.9% NS)
 Half-NS (0.45% NaCl)
 Quarter-NS (0.22% NaCl) used alone in Neonatal Intensive Care Units.
 pH of NS is 5.5 (4.5 to 7.0)
Composition:-
 9 g/L Sodium Chloride
 Osmolarity of 308 mOsmol/L. It contains 154 mEq/L Sodium &Chloride (GMCH).
Uses:-
 Clean wounds, help remove contact lenses
 Dehydration
 Dilute BCG (AIIMS Bhubaneswar 2018)
 Nebulization .Hemodialysis, Hyponatremia
Contraindication:-
 HT, PE, CHF,Pre-eclampsia

11. Types of volume expanders
1.Crystalloids:-contain electrolyte.
 Used for fluid volume replacement.
 Eg. Ringer's solution & 5% dextrose in water.
2.Colloids/Plasma expanders.
 It pull fluid from the Interstitial compartment into the
vascular compartment
 Used to increase the vascular volume rapidly.
Eg.Hemorrhage or severe hypovolemic.
 Eg. Albumin, Hetastarches (starches), Dextran

12. Size of cannula according to color:-

13. 
16 G needle used if Major Surgery/RTA accident
require massive fluid

18 G needle Used in Blood and lots of fluid

20 G needle is a Universal

22 G needle used in Small and elderly (Appropriate
for fluid maintenance)

15. Containers:-
 1. Container may be glass or plastic.
 2. Squeeze the plastic bag to ensure intactness &
assess the glass bottle for any cracks before
hanging.
 Range in size from 50 mL to 1000 mL
 Note:-Do not write on a plastic IV bag with a marking pen
because the ink may be absorbed through the plastic into the
solution.
 Use a label & a ballpoint pen for marking the bag, placing the label
onto the bag.

16.  Note:- During I/V therapy , hang the bottle on the
I/V pole about 18-24 inch height.

17.  The needle is 0.5 to 1.5 inches in length with 16 to 26 G.
 The smaller the gauge number, the larger the outside
diameter of the cannula.
 For peripheral fat infusion (lipids), a 20 or 21 gauge is
used.
Instruction which follow during administration of I/V
fluid:-

18. The micro drip chamber delivers about 60 drops or
gtt/ml.
 Micro drip chamber are used if the fluid will be infused at a slow rate
(<50ml/Hr)
 Macro drip chamber deliver 15 (10-20) drops or
gtt/ml.

19. Formula:-

20. 1.The physician orders dextrose 5 % in water, 1,000
ml to be infused over 8 hours. The I.V. tubing
delivers 15 drops/ml. Nurse John should run the
I.V. infusion at a rate of:
 a. 30 drops/minute
b. 32 drops/minute
c. 20 drops/minute
d. 18 drops/minute
 b. 32 drops/minute

21.  Change the filter/Drip set every 24 to 72 hours to
prevent bacterial growth.
 Veins in the hand, forearm & antecubital fossa are
suitable sites.

22.  The most frequently used sites are the veins of
the forearm because the bones of the forearm act as a natural support &
splint.
 Veins in the hand (Cephalic vein) , forearm (Basilic vein) &
antecubital fossa are suitable sites in adult.
 Veins in the scalp & feet (Sephanous vein)may be suitable
sites for Infants

23. Site Selection:-
 Short term:- (Peripheral vein (7days)
 Mid term:- (anterior Jugular vein, Subclavian vein (4Week)
 Long term:-( PICC Line)-Peripheral insert Central catheter)
(6Month)
 Incase of 3-5 year (Port Implant –Cancer patient-Superior vena-
cava & Rt Atrium

24.  Before inserting the IV line. Clean the IV site, skin &
an antimicrobial solution, using an Inner to
outer circular motion.

25.  If client with CHF usually not giving a solution
containing saline because it increase water
retention of water.
 If client with DM usually does not receive dexrose
(Glucose) solution.
 RL Solution contain Potasium & should not be
administered to client with renal failure

26. IV Complications:-
 Phalibitis:-An inflammation of the vein.
 Thrombophalibitis:- Development of a clot & infection of vein
 (Thrombophob Ointment used to minimize clot)
 Infiltration:-Seepage of Intravenous fluid out of the vain& in to the
surrounding in to the interstitial space.
 Air embolism
◦ Air enters blood stream
 Infection
◦ Localized or systemic
 Tissue damage
 Hematoma

27.  A client is nauseated, has been vomiting for several
hours, and needs to receive an antiemetic (anti-
nausea) medication. Which of the following is
accurate?
A. An enteric-coated medication should be given.
B. Any medication will not be absorbed as easily
because of the nausea problem.
C. A parenteral route is the route of choice.
D. A rectal suppository must be administered.
 C. A parenteral route is the route of choice.
MCQ