Nsg 155, M 4.

3 IV Therapy

1. Indications for IV Therapy

a. Desire a rapid effect of the med
b. Medication is too irritating for tissues
c. Once established less painful for multiple
injections
d. Parenteral Nutrition
e. Dialysis
f. Maintain fluid balance or correct imbalances
g. Correct E-lyte deficiencies or correct acid-base
balance
h. Blood or Blood Products
2. Safety Concerns
a. Once infused, unable to get it back. Effect
immediate.
b. If very potent must know and have access to
antidote
c. Fluid Volume overload especially with elderly
d. Compatibility
3. IV Fluids classified by concentration of fluids & pH,
compare to normal blood plasma
Osmolality (normal 270 300)
a. Isotonic same concentration as blood, water does
not move in or out of cells. GREATEST risk of fluid
overload (especially with geriatrics). Exp. - D5%W,
0.9% NS.
b. Hypotonic water moves into cells to expand them,
too much and can have lysis of cells. NEVER inject
Water. Exp. - 0.25% NS
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Nsg 155, M 4.3 IV Therapy

c. Hypertonic water moves out of cells into the

vascular space. Use to correct fluid, e-lyte, and acidbase balances. Exp. TPN, 3% Sodium Chloride,
10% dextrose, 20% Dextrose.
4. Equipment
a. Catheters
i. Vascular Access Devices peripheral, short,
superficial veins, 72 96 hr
ii. Midline Catheters 6-8 inches (intracath),
insert at ACF, use for 1-4 weeks
iii. Peripherally Inserted Central Catheter (PICC)
1. 40 65 cm, C X R to confirm placement,
long term use, tip in superior vena cava
outside of right atrium
iv. Percutaneous Central Catheter tip sets
outside of right atrium, C X R to confirm
placement before use.
v. Tunneled Central Catheters long term
catheters, part of line is in subcutaneous area
separates point of insertion with entrance into
vein decrease infection
vi. Implanted Ports located below skin, need use
special needles to access Huber needle,
surgically implanted. Long term use,
especially chemo. Port must be flushed after
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Nsg 155, M 4.3 IV Therapy

each use, aspirate to insure proper placement

before instill meds.
vii. Dialysis catheters Larger lumens, dual
never use!!!
b. Tubing infusion sets
i. Primary tubing
ii. Secondary tubing
iii. Containers bags or glass bottles
iv. Needleless connections
c. Pumps/Controllers
i. Controllers count volume infusing, alarms if
infusion disrupted. Infuses per gravity.
ii. Pumps pressurized to infuse specific volumes
per hour.
1. Syringe pumps
2. Ambulatory pumps
3. Smart pumps able to do your drug and
drip calculations.
5. Complications (Iggy, pg 226-9)
a. Infiltration: rate slows, edema at or above site, skin
tightness, blanching or coolness to skin, possibly
fluid leakage from site. Stop & D/C IV catheter.
Sterile drsg, apply cold compress, elevate extremity
b. Extravasation: leakage of a vesicant solution, same
as infiltration, possibly tissue sloughing in 1-4 weeks.
Stop infusion & D/C tubing, try to aspirate fluid
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Nsg 155, M 4.3 IV Therapy

from tissue. Catheter stays put to possibly inject

antidote.
c. Phlebitis inflammation of the vein. C/O of pain at
site, vein may appear red, and inflamed, vein could
become cordlike. D/C IV catheter, warm compress,
d. Thrombosis blood clot in vein. IV infusion may
slow or stop, swollen extremity, tender, red. D/C IV,
apply cold compress, elevate extremity.
e. Thrombophlebitis blood clot in inflamed vein. S/S
same as phlebitis and thrombosis. D/C IV elevate,
cold compress initially then warm.
f. Ecchymosis & hematoma blood infused into tissue,
hematoma is a larger bleed under skin painful
lump. Swelling at first, bruising at site, pain. D/C
IV catheter, apply pressure to stop bleeding, elevate.
g. Site Infection localized tenderness, redness, warm,
possibly purulent drainage, hardness at site caused
by microorganism. Clean site with alcohol,
expressing drainage, D/C catheter under sterile
technique using sterile scissors, clip off the tip of a
catheter into a sterile cup to send for culture. After
cleaning site cover with gauze drsg.
h. Venous Spasm sudden contraction of vein or
artery. Cramping or pain at site, numbness in area,
IV infusion slows, inability to remove PICC or
midline catheters. Slow IV rate, warm compress,
redress.

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Nsg 155, M 4.3 IV Therapy

i. Nerve Damage Accidentally piercing or complete

transection of nerve. C/O tingling, pins & needles,
numbness. Stop insertion of catheter or remove
catheter.
j. Volume overload - monitor cardiac and respiratory
function. C/O of SOB & cough, Bp elevated,
puffiness around eyes, dependent edema, JVD, lungs
sound wet
k. Allergic Reaction reaction to IV catheter or
medications infusing. Local or systemic effect. If
local may have a wheal, redness, or itching at site.
Systemic runny nose, tearing, bronchospasm,
wheezing, rash, could lead to anaphylaxis.
6. Skill
a. Primary line App. M 4.32
b. IVPB App. M 4.33
c. IVP know how fast to push med, IV drug
handbook.
7. Systematic Check App. M 4.31
8. Dressings peripheral & central
a. Peripheral: (pg. 223 Iggy) Usually clean with
b. Central: App. M 4.25.
9. Order for IV fluids
a. Type of fluid
b. Rate of administration
c. Additives
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Nsg 155, M 4.3 IV Therapy

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