PHARMACOLOGY

INTRAVENOUS THERAPY
OBJECTIVES

• Identify sites for selecting a peripheral IV site.

• Identify common veins.
• Identify characteristics of implantable devices.
• Describe different types of IV fluids.
• Calculate IV drip rates.
DEFINITIONS

• Primary tubing: tubing that is utilized to deliver

intravenous fluids.
• Secondary tubing: shorter tubing that is utilized to
deliver secondary or IV piggyback fluids.
• Piggyback ( IVPB): smaller amounts of fluids and/or
medications. Ususally 500 cc’s and less (typically 50 -
250 cc’s). Connected to an existing line or attached to
a heparin lock.
DEFINITIONS

• Heparin Lock: device that is used to give intravenous

access without the use of an existing IV line.
• IV Pump: controlled apparatus that delivers a set amount
of fluids per minute/hr. Device used for continuos infusion
at a set rate.
• IV Push: directly injecting medication into an IV line
manually.
INTRODUCTION

• IV administration of
medication places the
drug directly into the
bloodstream (bypasses all
barriers to drug
absorption).
IV THERAPY

• Large volumes of
medication and
intravenous fluids can be
administered into the
vein. The onset of action
is the most rapid of all
parenteral routes.
IV THERAPY

• Drugs may be given by:

• direct injection with a needle and a syringe (IV push),
• via intermittently via a piggyback, or continuos infusion through an
established peripheral line
• central venous line
• via an implantable venous access device
IV THERAPY

• Use of the IV route

requires time and skill to
establish and maintain an
IV site.
• Patient is less mobile.
• Increased possibility of
infection and severe
adverse reaction.
INTRAVENOUS THERAPY

• Mediations for IV
administration are
available in:
• ampoules
• vials
• pre-filled syringes
• piggyback containers
INTRAVENOUS THERAPY
IV SOLUTIONS
• Various types of IV
solutions are also made
available for infusion via
the IV route.
• Examples:
• NS (Normal Saline)
• LR (Lactated Ringers)
• D5W (Dextrose)
INTRAVENOUS THERAPY
PURPOSES
• To Supply fluid when the client is unable take orally.
• To provide glucose (main fuel for metabolism).
• To provide water soluble vitamins, electrolytes, and
medications.
• To establish a lifeline for rapidly needed medications.
• To administer blood.
GENERAL PRINCIPLES

• Use Standard Precautions

• Never recap needles
• Use needle protector systems
• Verify the drug is dissolved
• Inspect IV site for signs of infiltration
GENERAL PRINCIPLES

• DO NOT administer a drug if it is hazy, cloudy, has foreign

particles or precipitate.
• DO NOT mix with blood or blood by products.
• DO NOT give in an IV solution if incompatibility is
unknown.
• Flush entirely through the IV line before adding a second
medication to the line.
SASH GUIDELINES

• Saline flush first

• Administer the drug
• Saline flush to follow
• Heparin flush
• May/may not dilute medication
• Know rate of administration
MORE…GENERAL PRINCIPLES

• Know the length of time an agent is stable after being mixed.

• IV bags should be changed every 24 hours.
• Label IV’s
• Change IV sets/tubing every 72 hours.
• Lipid & TPN tubing changes every 24 hours.
• Never speed up an IV rate to “catch up”.
TYPES OF IV FLUIDS

• Isotonic fluids

• Hypotonic fluids

• Hypertonic fluids
ISOTONIC FLUIDS

• Same osmolarity as serum/body fluids.

• Expands intravascular compartment without affecting the
intracelluar and interstitial compartment.
• Used in hypovolemia.
• Examples: LR (Lactated Ringers), NS (Normal Saline 0.9%)
HYPOTONIC FLUIDS

• Shifts fluids out of the intravascular compartment, thus

hydrating the intracelluar and interstitial compartments.
• Lower serum osmolarity
• Example: Normal Saline 0.45%
• Used in clients with cellular dehydration.
HYPERTONIC FLUIDS

• Draw fluids/electrolytes into the intravascular

compartment, dehydrating the intracelluar and interstitial
compartments.
• Increase serum osmolarity.
• Examples: D5NS, D51/2NS, D5LR.
• May be used postoperatively.
GENERAL PRINCIPLES

• D5W is isotonic in the container only.

• Most IV fluids come in plastic bags which do not require an
air vent in the administration set.
• Glass containers for IV delivery do require an air vent in
the set.
IV SET CONSIDERATIONS

• Will an IV pump be used?

• What is the rate of delivery?
• Use a microdrip set when small amounts of fluid are being
given (delivers 60 gtts/mL).
• Use a macrodrip set when large volumes are being
delivered (delivers 10 - 15 gtts/mL).
 PERIPHERAL ACCESS
• When selecting an IV site, consider the following:
• Length of time IV will be required.
• Condition and location of veins.
• Type of medication/fluid to be administered.
• Patient’s age & preference.

• Best to start in the most distal site and progress upward.

COMMON VEINS IN THE
ARM/FOREARM
• Metacarpal
• Doral network
• Cephalic
• Basilic
** To avoid irritation and leakage from a previous puncture
site, the subsequent sites should be made above the earlier
site.**
 GENERAL PRINCIPLES
REGARDING SITES
• Avoid use of veins over bony
prominences of joints.
• Avoid use of veins in hands of
elderly.
• Veins commonly used in children:
back of hand, dorsum of foot, scalp
veins.
• Do not use veins with
varicosities or an
extremity with poor
blood flow.
• Assess the vein by
inspection & palpation.
• Use non-dominant hand.
• Avoid areas of flexion.
CENTRAL VENOUS ACCESS

• Used in the following situations:

• When large volumes, high concentrations, or some
hypertonic solutions are to be infused.
• Peripheral sites have been exhausted.
• Long term/home therapy is required.
• Central sites commonly used for silastic catheters
(Hickman, Broviac, Groshong) are the jugular, subclavian, or
cephalic veins.
• The distal end is positioned in the superior vena cava to
allow maximum dilution of the fluid with blood.
• X-Ray verifies placement after insertion.
IMPLANTABLE VASCULAR
ACCESS DEVICES
• Known as Infus-A-Port, Port-A-Cath, Mediport.
• Used when long term therapy ie required and
repeated accessing of the vein is required.
• Device or port is implanted into SQ pocket in chest
wall by suture. Distal end of the catheter is threaded
into the superior vena cava.
• Port contains self-sealing rubber septum.
• Only a Huber needle is used to access the port.
 STARTING AN IV INFUSION

• Partially fill the drip chamber.

• Verify the order, type of
solution, amount to be • Prime the tubing.
administered, rate of flow, and • Dilate the vein.
client allergies.
• Place extremity dependently.
• Maintain sterility of the
• Place tourniquet 6 - 8 inches
equipment.
above site.
• Label bag and tubing.
• Client should clench/
• Hang solution three feet unclench fist.
above the client’s head.
STARTING THE INFUSION

• Cleanse the site of entry.

• Hold the needle or cannula at a 15 to 30 degree angle
with bevel up.
• Once in the vein, reduce angle until cannula is almost
parallel to skin.
• Size of cannula will be determined by use & size of the
vein.
• 18 gauge for blood, standard is 20 gauge.
PIGGYBACK MEDICATIONS

• Infused intermittently via secondary tubing that is

inserted into a port in the primary tubing.
• The port is distal to the IV site.
• Elevate IVPB 12 inches above existing primary bag
when pump is not used (allows gravity flow).
• Set the rate for the IVPB.
• Existing bag will resume rate after IVPB is complete.
• Gravity : gtts/min____Pump : mL/hr.
IV CALCULATIONS - ML/HOUR

• Find out how many mL/hr the IV is to infuse.

• Total Volume
• Total Time = mL/hour
• If order is 1000mL of D5W q 8 hrs, then
• 1000 mL
• 8 hrs = 125 mL/hr
IV CALCULATIONS - GTTS/MIN

• Drop factor
• Time in min X hourly volume = gtts/min
• The gtt factor is the number of gtts in 1 mL. The box which
contains the IV tubing will designate the drop factor.
• Example: ___15___
• 60 X 125 =
• 1/4 X 125 = 31.25 or 31 gtts/min
QUESTIONS?
THANK YOU!

Maria Cristina S. Alteran RN MN