The document provides an overview of intravenous (IV) therapy, detailing its purpose, types of IV fluids, and procedures for cannulation, as well as highlighting potential local and systemic complications. It categorizes IV fluids into crystalloid and colloid solutions based on solute concentration and discusses factors influencing site selection for cannulation. Additionally, it emphasizes the importance of measuring and monitoring fluid intake and output to maintain fluid and electrolyte balance in patients.

1. INTRAVENOUS
THERAPY
Babli Shama
M.Sc. MSN
TUTOR
NINS, GUWAHATI

2. INTRAVENOUS THERAPY
Replacement of fluids and electrolytes intravenously is one
of the most commonly used treatment modalities for fluid
and electrolyte imbalances.
IV therapy is a way to give fluid, medicine, nutrition, or
blood directly into the bloodstream through the vein.

3. FACTORS TO CONSIDER IN SELECTION OF
SITE FOR INTRAVENOUS CANNULATION
Non-dominant hand.
Most distal part of vein initially.
Extension and splint if cannulation is to be done near
the joints.
Veins that feel Soft, full, large, and naturally splinted
bones are preferred.
Avoids veins on the extremities. an injured or past
surgical intervention.

4. FACTORS TO CONSIDER IN SELECTION OF
SITE FOR INTRAVENOUS CANNULATION

5. VASCULAR ACCESS DEVICES
Peripheral short catheter: used for administration of IV
therapy that is expected to last only for a week.
TPN and chemotherapy drugs can’t administered through
them.

6. VASCULAR ACCESS DEVICES
Midline peripheral catheters: These catheters can be used
for IV therapies that may extend from 2 weeks to 6 weeks.
Inserted just above or below the antecubital fossa into the
cephalic or proximal basilic veins.

7. VASCULAR ACCESS DEVICES
Central venous devices: the possible sites for insertion of
CVL are the internal jugular, femoral, and subclavian.
A variety of IV fluids, blood products, TPN, and medications
can be administered through the central venous devices.

8. COMMONLY USED VEINS FOR
INTRAVENOUS CANNULATION
• The commonly used
venipuncture sites are
metacarpal, basilic and
cephalic veins
• The antecubital basilic and
median veins are usually used
for blood draws and bolus
injection of medications.

12. TYPES OF IV FLUIDS
IV fluids are classified on the bases of the concentration
of solute in the solvent.
1. Crystalloids
a) Isotonic solutions
b) Hypotonic solutions
c) Hypertonic solutions
2. Colloids

13. CRYSTALLOIDS
Crystalloids contain small molecules that can
cross the semipermeable membrane and enter
in the intercellular space.
They are used to increase fluid volume both in
interstitial and intervascular space.
Crystalloids are distinguished based on their
tonicity into isotonic, hypotonic, and hypertonic
solutions.

14. 1. ISOTONIC SOLUTIONS:
They have same concentration of solutes as blood
plasma.
These solutions expand the vascular volume
initially.They are used to treat hypovolemia, burns,
fluid loss in diarrhoea and mild metabolic acidosis.
Examples
RL (lactated Ringer’s ) balanced electrolyte
solution.

15. 0.9% NaCl (normal saline)
It can be used temporarily to expand the ECF volume,
but not given as a routine maintenance solution as it
conation Na+ and Cl+ in excess.
D5 (Dextrose 5% in water):
Dextrose 5% is avoided in patients who have risk of
developing cerebral edema, because after
metabolization of dextrose free water molecules leads
to the expansion of ICF and ECF volume.

16. 2. HYPOTONIC SOLUTIONS
They have less concentration of solutes then blood plasma.
Hypotonic solutions are used to treat patients with
dehydration or elevated sodium levels.
As the concentration of solutes is low in these fluids, it attracts
water into cell and helps in treating cellular dehydration.
Promote elimination by kidneys.
Not administered to the patients with risk of cerebral edema
and 3rd
space fluid shift.
EXAMPLES:
0.33% NaCl (0ne third normal saline)
0.45%NaCl (half normal saline)

17. 3. HYPERTONIC SOLUTIONS
They have higher concentrations of solutes than blood
plasma.
Hypertonic solutions expand the vascular volume by
pulling out fluids from the intracellular and interstitial
compartments.
Also used for peripheral parenteral nutrition and to
replace nutrients and electrolytes.
Avoided for patients with kidney and heart failure.

18. EXAMPLES:
D5NS - 5% dextrose in normal saline
D5 1/2 NS – 5% dextrose in 0.45% NaCl
D5 RL – 5% dextrose in lactated ringer’s

19. COLLOIDS
Also known as plasma expenders or volume
expenders.
Colloids contain large particles that do not cross the
semipermeable membrane and remain in the IV
space.
They draw fluids from extravascular spaces due to
their high oncotic pressure, hence increasing the
intravascular volume.
Examples:
Dextran & albumin.

20. CALCULATION OF INTRAVENOUS FLUID PLAN

21. COMPLICATIONS OF IV FLUID
THERAPY
LOCAL COMPLICATIONS
1. Infiltration: when IV cannula is dislodged from
veins and fluids are infused into surrounding
tissues.

22. LOCAL COMPLICATIONS
2. Extravasation: fluid seeps out from the lumen
of the vessel into surrounding tissues, mainly
leaking of vesicant drugs into surrounding tissues.
3. Thrombosis: formation of local thrombus due
to injury to endothelial cells of the venous wall.
4. Phlebitis: inflammation of the vein at the site of
IV infusion, associated mainly with alkaline and
acidic solutions which are higher in osmolarity.

23. LOCAL COMPLICATIONS
5.Thrombophlebitis: when thrombosis is
accompanied by inflammation.
6.Occlusion: mainly caused by clots due to
inappropriate flushing or very slow flow
rate.
7. Dislodgement: unintentional slipping out
of catheter from situ.

24. SYSTEMIC COMPLICATIONS
1. Air Embolism: large amount of air enters into
patients veins, it is a serious complication that may
lead to respiratory distress, weak pulse, increased
CVP, decreased BP, and loss of consciousness with
dislodgement into various parts of body
2. Hematoma: leakage of blood into surrounding soft
tissues. Minor hematomas May resolve itself within 2
weeks and warm compressions are effective in
resolving them.
3. Systemic infection: local infection or not using
proper aseptic techniques may lead to local and
systemic infection.

25. SYSTEMIC COMPLICATIONS
4. Speed shock & circulatory overload: patient may feel
anxious, respiratory distress, increased BP and CVP and
neck engorgement, circulatory overload and speed shock
may lead to congestive heart failure or even the death of
patient.
5. Allergic reactions: when patient is allergic to catheter
or the medications which are inserted via it.
6.Vasovagal reaction: patient experience vasospasm due
to pain, vein may suddenly collapse during venipuncture
and patient may experience dizziness, diaphoresis, pain,
nausea, hypotension or even faint. Nurse have to check BP
and report immediately while performing necessary

26. MEASURING FLUID INTAKE AND
OUTPUT
Measurement and recording of all fluid intake and
output during a 24–hour period provides important
data about the client's fluid and electrolyte balance.
 The unit of measurement of intake and output is mL
(milliliter).To measure fluid intake, nurses convert
household measures such as glass, cup, or soup
bowl to metric units. Gauge fluid balance and give
valuable information about your patient's condition.

27. MEASUREMENT OF VOLUME
1 tablespoon (tbsp) = 15 millilitres(ml)
3 teaspoons(tsp) = 15 millilitres(ml)
1 cup(C) = 240 millilitres(ml)
8 ounces(oz) = 240 millilitres(ml)
1 teaspoon(tsp) = 5 millilitres(ml)
1 cup(C) = 8 ounces(oz)
16 ounces(oz) = 1 pound(lb)
1 ounce (oz) = 30milliliters(ml)

28. INTAKE
Oral fluids
Ice chips
Food that are tend to become liquid at room temperature
Tube feedings
Parenteral fluids
Intravenous medications
Catheter or tube irritants

29. OUTPUT
Urine
Vomitus and liquid faeces
Tube drainage
Wound
Drainage
Draining fistulas

30. DO’S AND DON'TS
• Those patients have undergone surgery or if he has a
medical condition or take medication that can affect
fluid intake or loss. Measure and record all intake and
output.
• At least every 8 hours, record the type and amount of all
fluids he's received and describe the route as oral,
parenteral, rectal, or by enteric tube.

31. DO’S AND DON'TS
• Ice chips are recorded as fluid at approximately
half their volume.
• Record the type and amount of all fluids the patient
has lost and the route. Describe them as urine,
liquid stool, vomitus, tube drainage, and any fluid
aspirated from a body cavity.

32. DO’S AND DON'TS
• If irrigating a nasogastric or another tube or the
bladder, measure the amount instilled and subtract it
from total output.
• An accurate measurement, keep toilet paper out of
your patient's urine. Measure drainage in a calibrated
container. Evaluate trends over 24 to 48 hours.
• Don't assess output by amount only. Consider color,
color changes, and odor too. Don't use the same
graduated container for more than one patient