This document provides information on IV therapy, including definitions, objectives, anatomy and physiology related to IV therapy, indications for IV infusions, types of infused substances, IV equipment, cannulation procedure, site maintenance, and potential complications. The objectives are to define key terms, demonstrate procedures, and describe how to assess for and manage issues like infiltration or infection at the IV site. Maintaining aseptic technique and changing equipment regularly is emphasized.

1. IV THERAPY
Continuing Nursing Education

2. INTRODUCTION
Can You Imagine life without water?
Of course not, because water is essential to sustain life. Likewise, body fluids are vital to
maintain normal body functioning
Total body fluid (TBW), accounts for approximately 60% of total body weight (this can be
80% or higher in a newborn down to 50–55% in a mature woman).
Total Body Fluid can be divided into Intracellular and Extracellular

3. Do You Know ?

4. OBJECTIVES
• Upon completion of this program the employees will be able to:
 Define the difference between arteries and veins.
 List the common intravenous sites
 List the purposes of intravenous therapy.
 Identify and demonstrate the use of the different types of intravenous
equipment, solutions, administration sets and heparin or saline locks.

5. OBJECTIVES
 Describe the importance of aseptic technique when using I.V. equipment.
 Explain and demonstrate how to calculate the rate of flow ordered and to regulate
the flow using the various administration sets.
 Describe the signs of infiltration and/or irritation at an I.V. insertion site.
 Describe the action(s) to be followed for infiltration at an I.V. insertion site and
removal of I.V. line if indicated.
 Describe what should be checked when problems in adjusting the flow rate are
encountered.
 Demonstrate the technique for affixing the needle/cannula using adhesive tape.

6. INTRODUCTION
Iv therapy are the fastest methods available to administer medicine or hydrate a
patient. Usually performed in a healthcare setting, intravenous therapy may be as
quick as a single injection or require a port for long-term therapy.
Intravenous fluids are administered for the purpose of providing nutrition,
restoring lost fluids, electrolytes, vitamins and minerals, maintaining fluid balance
during surgical and comatose conditions, and for administering medications
directly into the circulatory system.

7. INDICATIONS OF IV INFUSIONS
Fluid and electrolyte replacement.
Administration of medicines.
Administration of blood/blood products.
Administration of Total Parenteral Nutrition.
Hemodynamic monitoring.
Blood sampling.

8. ANATOMY AND PHYSIOLOGY

10. DIFFERENCE BETWEEN
ARTERIES AND VEINS
 Thick wall
 Pulsate
 Bright red blood
 No valves
 Deep
 Thin wall
 Non pulsating
 Dark red blood
 Have valves
 Superficial

12.  VEINS OF THE UPPER
EXTREMITIES
Digital Vessels
-Along lateral aspects fingers, infiltrate easily, painful, difficult to immobilize
and should be your LAST RESORT.
Metacarpal Vessels
-Located between joints and metacarpal bones (act as natural splint)
-Formed by union of digital veins
-Geriatric patients often lack enough connective / adipose tissue and skin
turgor to use this area successfully.

13. • Cephalic (Intern’s Vein)
-Starts at radial aspect of wrist
-Access anywhere along entire length
(BEWARE of radial artery/nerve)
• Medial Cephalic (“On ramp” to Cephalic Vein)
-Joins the Cephalic below the elbow bend
-Accepts larger gauge catheters, but may be a difficult angle to hit and maintain
Medial cephalic Vein
 Veins of the Upper Extremities

14.  Veins of the Upper Extremities
• Basilic
- Originates from the ulnar side of the metacarpal veins and
runs along the medial aspect of the arm. It is often overlooked
because of its location on the “back” of the arm, but flexing the
elbow/bending the arm brings this vein into view
• Medial Basilic
- Empties into the Basilic vein running parallel to tendons, so it
is not always well defined. Accepts larger gauge catheters.
- BEWARE of Brachial Artery/Nerve

15. Veins of Lower Extremity

16. VENIPUNCTURE SITE FOR INFANTS

17. ADVANTAGES OF IV INFUSION
Immediate / Therapeutic effect
Control over the rate of administration / dilute infusions / prolonged action
Patient cannot tolerate drugs / fluids orally
Some drugs cannot be absorbed by any other route
Pain and irritation is avoided compared to some substances when given SC/IM

18. DISADVANTAGES:
 Cannot recall drug/Reverse action of drug/may lead to toxicity
 Phlebitis: Mechanical/chemical irritation
 Thrombophlebitis
 Infiltration and Extravasation
 Microbial contamination/Infection
 Circulatory overload -
Insufficient control of administration may lead to speed shock / Decrease blood pres
sure, tachycardia, cyanosis n Anaphylaxis/ Allergic reactions -
Itching, rash, shortness of breath.

19. 90-95% of patients in the hospital receive some
type of intravenous therapy.

20. R I G H T S O F M E D I C AT I O N
A D M I N I S T R AT I O N

21. THINK !!
Before administering any
medication…

23. • Always check patient’s identification bracelet.
• Ask patient to state their name and birth date.
• Compare medication order to identification bracelet and patient’s
stated name and birth date.
• Verify patient’s allergies with chart and with patient.

25. • Perform a triple check of the medication’s label
1. When retrieving the medication.
2. When preparing the medication.
3. Before administering medication to patient.
• Always check the medication label with the physician’s orders.
• Never administer medication prepared by another person
• Never administer medication that is not labeled.

27. • Check label for medication concentration.
• Compare prepared dose with medication order.
• Triple all medication calculations.
• Check all medication calculations with another nurse.
• Verify that dosage is within appropriate dose range for patient
and medication.

29. • Verify schedule of medication with order.
1. Date
2. Time
3. Specified period of time
• Check last dose of medication given to patient.
• Administer medication within 30 minutes of schedule.

31. • Verify medication route with medication order before
administering.
• Medication may only be administered via route specified in
order.

33. • Inform patient of medication being administered.
• Inform patient of desired effects of medication.
• Inform patient of side effects of medication.
• Ask patient if they have any known allergies to medication.

35. • The legally responsible party (patient, parent, family member, guardian, etc.)
for patient’s care has the right to refuse any medication.
• Inform responsible party of consequences of refusing medication.
• Verify that responsible party understands all of these consequences.
• Notify physician that ordered medication and document notification.
• Document refusal of medication and that responsible party understands
consequences.

37. • Properly assess patient and tests to determine if medication is safe and
appropriate.
• If deemed unsafe or inappropriate, notify ordering physician and
document notification.
• Document that medication was not administered and the reason that
dose was skipped.

38. After medication
has been
administered…

40. • Assess patient for any adverse side effects.
• Assess patient for effectiveness of medication.
• Compare patient’s prior status with post medication status.
• Document patient’s response to medication.

42. • Never document before medication is administered.
• Document
1. Medication
2. Dosage
3. Route
4. Date and Time
5. Signature and credentials
6. When appropriate, signature of other nurse checking medication

43. INFUSED SUBSTANCES
1. Volume expanders
2. Blood-based products
3. Blood substitutes
4. Buffer solutions
5. Other medications
6. Others

44. 1. Volume expanders
Volume expanders may either be isotonic, hypotonic, or hypertonic. Hypertonic fluids are not
are not generally recommended in children due to increased risk of adverse effects.
a) Crystalloids Solutions RLS, DNS, 3mL of isotonic crystalloid solution are needed to replace
1mL of patient blood.
b) Colloids:
i. Large proteins
ii. Remain in vascular space
iii. Blood replacement products
iv. Plasma Substitutes (Hypertonic)-Dextran, Hetastarch.
Infused substances

46. 2. Blood-products
- Blood transfusion
3. Blood-based products
- also called artificial blood or blood surrogates
- the main blood substitutes used today are volume expanders such as crystalloids and
and colloids.
-Also, oxygen-carrying substitutes are emerging
Infused substances

47. 4. Buffer solutions
-used to correct acidosis or alkalosis.
-Lactated Ringer's solution also has some buffering effect.
-Specifically used for buffering purpose is intravenous sodium bicarbonate.
5. Other medications
- Antibiotics, analgesic etc.
6. Others
- Parenteral- nutrition
Infused substances

48.  Butterfly- (winged) or Scalp vein needles (SVN) not recommended for non
compliant patient as it can easily penetrate the vein wall causing
extravasations.
 Catheter over needle.
 Through needle.
PERIPHERAL VENOUS ACCESS DEVICES

49. IV CATHETERS

50. IV ADMINISTRATION SETS
Administration set includes
the bag (in the past it was a glass bottle),
the port,
the tubing - . The tubing has a drip chamber, one or two additional ports for a
piggy-back IV or for IV med administration, and a shut off valve.
 and the end port to attach the needle

51. DO YOU KNOW ?
Macro drip set delivers 10-20 drops/ml.
 Blood transfusion delivers 10drops/ml.
Microdrip set delivers 60 drops/ml.

52. Calculating Drip Rate
 How to calculate the drip rate (drops/minute):
Volume to be infused (mL) x (gtt/mL) = gtt /min
Time (minutes)
Drip Factor = (gtt/mL) Of the TUBING which is found on the manufacturers
packaging

53. EXAMPLE
 Volume = 4 pints
 Time = 24 hours
 Drip factor of tubing = 15 gtt/ml.
4000mL/(24h x 60min/h)] X 15gtt/ml = approx 21 drops/min

54. CANNULATION
“The aim of intravenous management is safe, effective delivery of
treatment without discomfort or tissue damage and without
compromising venous access, especially if long term therapy is
proposed”

55. BEFORE PROCEDURE
Always perform !!
Patient identification.
Hand washing.
Use of PPE.
Following policies of manufacturer & healthcare.

56. What equipment do you need?
 Dressing Tray .
 Non Sterile Gloves / Apron
 Cleaning Wipes
 Gauze swab
 IV cannula (separate slide)
 Tourniquet
 Dressing to secure cannula
 Alcohol wipes
 Saline flush and sterile syringe or fluid to be administered
 Sharps bin

57. Encourage venous filling by:
• Correctly applying a tourniquet
• Opening & closing the fist
• Lowering the limb below the heart

58. SITE CHOICE
• Identify a suitable vein

59. Painful phlebotomy and IV start.
 Use 25-27g insulin syringe to create a wheal similar to a TB skin test on top of or
just to side of vein with 0.1 -0.2 ml normal saline or 1% xylocaine without
epinephrine.
 Topical anesthesia cream may be applied to children>37 weeks gestation 1 hr.
prior to stick.
 Have the patient close their fist prior to stick
 Make sure the skin surface cleansing agent (alcohol/chlorhexidine) is dry prior to
stick.

60. Procedure
• Wash hands, prepare equipment.
• Remove the cannula from the packaging and check all parts are operational.

61. • Remove the protective sleeve from the needle taking care not to touch it
at any time
• Hold the cannula in your dominant hand, stretch the skin over the vein
to anchor the vein with your non-dominant hand
• (Do not re palpate the vein)

62. • Insert the needle (bevel side up) at an angle of 15-35o to the skin (this will
depend on vein depth.)
• Observe for blood in the flashback chamber.

63. • Lower the cannula slightly to ensure it enters the lumen and does not
puncture exterior wall of the vessel.
• Gently advance the cannula over the needle whilst withdrawing the
guide, noting secondary flashback along the cannula.
• Release the tourniquet.

64. • Apply gentle pressure over the vein (beyond the cannula tip) remove the
white cap from the needle.

65. • Remove the needle from the cannula and dispose of it into a sharps
container
• Attach the white lock cap
• Secure the cannula with an appropriate dressing

66. • Flush the cannula with 2-5 mls 0.9% Sodium Chloride or attach an IV giving
set and fluid.
• Video

67. Finally
 Document the procedure including
– Date & time
– Site and size of cannula
– Any problems encountered
– Review date (cannula should be in situ no longer than 72 hours without appropriate risk
risk assessment.)
– Note: some hospitals have pre-printed forms to record cannula events
 Thank the patient.
 Clean up, dispose of rubbish.

68. IV SITE MAINTENANCE
Assessments include
• peripheral IV sites for evidence of cannula-related complications at least every 8
hours.
• whether the catheter type and size is appropriate for the fluid, medication or
blood component to be administered.
• catheter for patency at least every eight hours.
• the patient for systemic signs of infection at least every eight hours.
• If the patient is restrained, the restraint should not interfere with the IV site.
Instruct the patient and/or family to report burning, pain, redness, leaking at the site,
or swelling to the team.

69. • Nurses should discontinue the IV fluid if ordered by physician.
• Labeling of IV bags/bottles, tubing sets and IV site must be done .
a. Inpatient units: all IV bags/bottles, tubing sets and IV site labeled with the date
started or changed.
b. Procedural areas / ambulatory units: bags/bottles and tubing sets without
not need to be labeled unless and until the patient should be transferred to an
inpatient location; IV site labeled with date and time started or changed
c. IV bags/bottles containing added medications labeled with date and time
started or changed; discard if not used promptly.

70. WHEN TO CHANGE.
• IV administration sets/tubing must be changed between 72 and 96 hours.(Crystalloids)
• The IV site must be changed between 72 and 96 hours.
• IV catheter inserted during emergency should be replaced no later than 48 hours.
• Dressings must be changed immediately if their integrity is compromised.
• Tape and gauze dressings must be changed every 48 hours.
• Transparent dressings must be changed every 72 hours.
Tubing Change
Crystalloid -Every 72 hours
Medication Line -Every 72 hours
PN -Every 24 hours
Lipids -Every 24 hours
Albumin -Every 24 hours
Blood Products -Every 4 hours

71. COMPLICATIONS
“The intravenous (IV) cannula offers direct access to a patient's vascular system and provides
a potential route for entry of micro organisms into that system. These organisms can cause
serious infection if they are allowed to enter and proliferate in the IV cannula, insertion site, or
IV fluid”

72. • IV-Site Infection: pus or inflammation at the IV site.
• Most common cannula-related infection, may be the most difficult to identify
72

73. • Cellulites: Warm, red and often tender skin surrounding the site of cannula insertion;
pus is rarely detectable.

74. • Infiltration or tissuing occurs when the infusion (fluid) leaks into the surrounding
tissue.
• Important to detect early as tissue necrosis could occur – re-site cannula immediately

75. • Thrombosis / thrombophlebitis occur when a small clot becomes detached from the
sheath of the cannula or the vessel wall.
• Flush cannula regularly and consider re-siting the cannula if in prolonged use.

76. • Air embolism occurs when air enters the infusion line.
• Make sure all lines are well primed prior to use and connections are secure

77. • Extravasation is the accidental administration of IV drugs into the surrounding tissue.
• The leakage of high osmolarity solutions or chemotherapy agents can result in significant
tissue destruction, and significant complications

78. • Bruising commonly results from failed IV placement - particularly in the elderly and those
on anticoagulant therapy.

79. • Hematoma occurs when blood leaks out of the infusion site.
• Apply pressure to the site for approximately 4 minutes and elevate the limb

80. • Phlebitis is inflammation of a vein
• Prevention can be using aseptic insertion techniques,
• Choosing the smallest gauge cannula possible for the prescribed treatment,
• Secure the cannula properly to prevent movement and
• Carry out regular checks of the infusion site.

81. • Fluid overload occurs when fluids are given at a higher rate or in a larger volume than the
system can absorb or excrete.
• Possible consequences include hypertension, heart failure, and pulmonary edema.

82. REFERENCES
“Clinical Pocket Manual, Medications and I.V.s,” Nursing 87 Books, Springhouse
Corporation,Pennsylvania.
“Intravenous Medications, A Guide to Preparation, Administration and Nursing
Management,” J.B.Lippincott Company, Philadelphia – Toronto.
“Intavenous Therapy, A Handbook For Practice,” The C.V. Mosby Company, St. Louis –
Toronto London 1980.
http://www.safeinfusiontherapy.com/cps/rde/xchg/hc-safeinfusion-en-
int/hs.xsl/7854.html
http://nursing.uchc.edu/nursing_standards/docs/IV%20Therapy%20-%20Peripheral.pdf
http://vincesaliba.com/yahoo_site_admin/assets/docs/Peripheral_Intravenous_Cann
ulation_Policy_-_Sep_2011.26351535.pdf

83. http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Peripheral_Intrav
enous_IV_Device_Management/
http://www.nursingtimes.net/the-care-and-maintenance-of-peripheral-
intravenous-catheters/201769.article
http://jmm.sgmjournals.org/content/27/3/161.full.pdf
http://webbertraining.com/files/library/docs/218.pdf
http://legacy.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/ACF2FF9.c
fm&pub_id=8&article_id=131